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Actor Megan Fox, a longtime 2023 Sports Illustrated Swimsuit issue cover star considered a sex symbolhave he said he was with her The 5 million to 10 million people in the United States affected by body dysmorphia.
“I don’t see myself as other people see me. There’s never a point in my life where I loved my body, never ever,” said Fox in a video Sports Illustrated interview. “When I was little, that was an obsession like, ‘But I have to look this way.’ And why I became so aware of my body at such a young age, I’m not sure.
A discrepancy between how a person sees themselves and how others see them is a telltale symptom of body dysmorphia. Also known as body dysmorphic disorder, it is “characterized by excessive preoccupation with a perceived defect in physical appearance or marked preoccupation with a slight physical anomaly,” according to American Psychological Association.
What people actually look like — or how attractive they are — often has nothing to do with it.
“If this person has, like, a visible scar or other physically noticeable deformity, that’s not what we’re talking about,” says Ramani Durvasula, a clinical psychologist and author based in California.
“The individual becomes preoccupied, almost obsessive, with a small physical feature. There may be a slight blemish, a small bump on the nose, a tooth slightly out of line, the shape of something, but it is not noticeable to others. man,” she added. “It’s not good enough. … And it will basically take their life.”
Microgen Images/Science Photo Library RF/Getty Images
People with body dysmorphia often spend a lot of time looking in the mirror to analyze visible defects.
Around 2% of the global population has body dysmorphia, and the disorder affects men and women almost equally, according to Anxiety and Depression Association of America. Symptoms usually begin to appear in puberty when bodies begin to change dramatically.
There is a subform of body dysmorphia: muscle dysmorphia, which mainly affects men, is marked by a preoccupation with the perception that one’s body is not lean or muscular enough — often no matter how big one is.
Here’s what it’s like to live with body dysmorphia, and how people can find help.
What is not body dysmorphia
Body dysmorphia is commonly mistaken for an eating disorder, but that’s not the case because of some differences, according to Durvasula and Ann Kearney-Cooke, a Cincinnati-based psychologist who specializes in eating and body image disorders.
People with eating disorders are preoccupied with a distortion in how they perceive their shape or weight, Durvasula said. “The person engages in (disordered eating) behaviors as well as what we call compensatory behaviors, which can be things like not eating for certain periods of time, exercising too much, using of diuretics or laxatives, things like that.”
Body dysmorphia, however, generally centers around an imagined or real feature, experts said.
What causes body dysmorphia?
There is no single cause of body dysmorphia, but there are several contributing factors.
“Body dysmorphia is in the same family of disorders as obsessive-compulsive disorder,” says Durvasula. “The only genetic evidence we see is that if someone has a first-degree relative (a parent or sibling) with OCD, they may be more likely to develop body dysmorphia.”
Researchers have suggested that the brains of some people with body dysmorphia may have “abnormalities in processing visual input when it comes to evaluating their own face,” according to a 2010 study.
Sometimes body dysmorphia occurs in conjunction with anxiety. If a person is preoccupied with certain things due to anxiety, a bodily feature may be another issue to focus on, Durvasula added.
“Social media certainly didn’t help with this. There are many more social comparisons to what other people look like. A lot of people put the wrong images out there,” says Durvasula. “In adolescence, that form of evaluation — physical appearance, fit and all that — becomes clearer.”
Having family members who evaluate, validate or love themselves or others based on appearance can also play a role, she added.
“It makes people hypersensitive to (perceiving) flaws in their appearance,” Kearney-Cooke added. “And what often happens, somewhere deep inside, whether it’s because of difficult childhoods or whatever, they feel, ‘I’m not good enough. I’m not attractive.’ And then they project it into their body.
A perfectionist mindset exacerbates this perception, he adds.
Living with body dysmorphia
The effects of body dysmorphia can reach all aspects of life – social, work and financial – especially if the disorder worsens over time without treatment.
“Because they’re so obsessed with this kind of feeling that there’s this physical problem, they’ll spend huge amounts of time and money either getting cosmetic medical treatments or cosmetic dental treatments, dermatologic treatments, even surgical treatment,” says Durvasula.
People with body dysmorphia also have “examining” behaviors, which can look like spending hours looking in the mirror and taking countless selfies and evaluating them, Durvasula added.
Compulsively looking in the mirror can reduce fears about what people think of their appearance or help them see if a perceived flaw is still present or has gotten worse, according to National Association of Anorexia Nervosa and Related Disorders. They think the feature is abnormal or ugly. Body dysmorphia was originally described as “the imagined ugliness syndrome,” says Kearney-Cooke.
A person with the disorder may also seek reassurance from others by asking if they can see the defect, if a feature looks OK, or if something is wrong or different about the feature.
People with body dysmorphia may isolate themselves out of shame or from spending too much time worrying about their appearance, experts say. They can also burn out their social support by constantly seeking reassurance, Durvasula adds.
Spending too much time scrutinizing their appearance can result in them often being late for work or not doing schoolwork, she said. Some people put themselves at financial risk by purchasing cosmetic products or procedures — incurring debt for themselves or their families, and sometimes doing so secretly because of concerns about what can happen if people know.
Kearney-Cooke had a patient who was so obsessed with a visible defect in her nose that she was constantly looking in the mirror, even while driving, the psychologist said. Crashing the car into a tree while doing so was a wakeup call for the patient, he says, leading to treatment and eventually some improvement.
Getting treatment for body dysmorphia
Body dysmorphia can’t be cured, and it’s a “difficult clinical condition” to manage because “it’s a pattern that’s very resistant to change,” Durvasula says. But some effective treatments are available.
One that many experts prefer is cognitive behavioral therapy. A person’s distortions or thoughts are believed to drive this behavior, so therapists work on the person’s distortions and go from there, Durvasula said. Because body dysmorphia falls into the same category as obsessive-compulsive disorder, treatments for OCD, such as “exposure and response avoidance,” can also help manage body dysmorphia. In a safe environment, this therapy reveals people in situations that arouse their obsessions or triggers and require them to choose not to respond with compulsive behavior.
When undergoing such treatment, a person with body dysmorphia doesn’t look in the mirror or take selfies as much, Durvasula said. “They really have to endure the discomfort of not engaging in the evaluation behavior. But that has to be supplemented with cognitive behavioral work.”
A history of trauma will also require trauma-informed therapy, which will involve a mental health professional who recognizes how human trauma can be a root cause of body dysmorphia.
“Some of the therapy can also be very educational – in the kind of images we see in the world and how unrealistic they are,” says Durvasula.
Researchers are looking at chemicals in the brain, such as serotonin, that are also a cause of body dysmorphia, Kearney-Cooke said – so antidepressants known as selective serotonin reuptake inhibitors or SSRIs may also be helpful in treatment.
If you can’t find a mental health professional who specializes in body dysmorphia, try working with someone who specializes in OCD or eating disorders, says Durvasula.