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Actor Megan Fox, a 2023 Sports Illustrated Swimsuit cover star who has long been considered a sex symbol, has said she is one of 5 million to 10 million people in the United States affected by body dysmorphia.
“I never see myself the way other people see me. There was never a point in my life where I loved my body, never, ever,” Fox said in a video interview with Sports Illustrated. “When I was little it was an obsession I had of, ‘But I should look like this.’ And why I was so aware of my body so young I’m not sure.
A discrepancy between how someone perceives themselves and how others see them is a hallmark symptom of body dysmorphia. Also known as body dysmorphic disorder, it is “characterized by excessive preoccupation with an imagined defect in physical appearance or markedly excessive concern with some minor physical abnormality,” according to the American Psychological Association.
What people actually look like – or how attractive they are – often has little to do with it.
“If this person had a very visible scar or other physically noticeable deformity, then we’re not talking about it,” says Ramani Durvasula, a clinical psychologist and author based in California.
“The individual becomes preoccupied, even obsessively, with some minor physical feature. It could be a little blemish, a little bump in their nose, a tooth that’s a little out of place, the shape of something, but it wouldn’t be noticeable to other people,” she added. “It’s never good enough. … And it will basically take over their lives.
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People with body dysmorphia tend to spend a lot of time looking in the mirror analyzing perceived flaws.
According to the Anxiety & Depression Association of America, about 2% of the world’s population has body dysmorphia, and the condition affects men and women almost equally. Symptoms usually begin to appear in adolescence when bodies begin to change dramatically.
There is a sub-form of body dysmorphia: Muscular dysmorphism, which mainly affects men, is characterized by a preoccupation with the perception that one’s body is not slim or muscular enough – often regardless of how muscular one is.
Here’s what living with body dysmorphia is like and how people can find help.
What body dysmorphia is not
Body dysmorphia is often mistaken for an eating disorder, but it’s not because of a number of 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 engaged in a disruption in how they perceive their shape or weight, Durvasula said. “The person is engaging in (disordered eating) behaviors, as well as what we call compensatory behaviors, which could be things like not eating for periods of time, hyper-exercising, using diuretics or laxatives, things like that.”
However, body dysmorphia 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 some contributing factors.
“Body dysmorphia belongs to the same family of disorders as obsessive-compulsive disorder,” Durvasula said. “The only genetic evidence we see is that if a person has a first-degree relative (a parent or sibling) with OCD, they are more likely to develop body dysmorphia.”
Researchers have suggested that the brains of some people with body dysmorphia may show “abnormalities in processing visual input when it comes to examining their own faces,” according to a 2010 study, according to a 2010 study.
Body dysmorphia sometimes co-occurs with anxiety. If someone is preoccupied with certain things due to anxiety, a body feature may be another problem to focus on, Durvasula added.
“Social media certainly did not contribute to this. There’s a lot more social comparison to what other people look like. A lot of people are posting false images,” Durvasula said. “In adolescence, that form of evaluation — appearance, belonging and all that — will be much more pronounced.”
Having relatives who judge, validate or love themselves or others based on appearance may also play a role, she added.
“That makes the person overly sensitive to (perceiving) flaws in their appearance,” Kearney-Cooke added. “And what often happens is that somewhere deep down, whether it’s because of a troubled childhood or whatever, they feel like, ‘I’m not enough. I’m not attractive.’ And then they project it onto their body.”
A perfectionist mindset reinforces this view, she added.
Living with body dysmorphia
The effects of body dysmorphia can extend to all aspects of life – social, occupational and financial – especially if the condition worsens over time without treatment.
“Because they’re so obsessed with this kind of feeling that there’s a physical problem, they’re going to spend a lot of time and money on cosmetic medical treatments or cosmetic dental treatments, dermatological treatments and even surgical treatments,” Durvasula said.
People with body dysmorphia also have “controlling” behaviors, which can look like they spend a lot of time looking in the mirror and taking countless selfies and judging them, Durvasula added.
According to the National Association of Anorexia Nervosa and Associated Disorders, compulsive looking in the mirror can reduce anxiety about how people think they look or help them see if a perceived flaw is still there or has worsened. They think the feature is abnormal or ugly. Body dysmorphia was originally described as “the imagined ugliness syndrome,” Kearney-Cooke said.
Someone with the disorder may also seek reassurance from others by asking if they see the flaw, if a feature looks right, or if there is something wrong or different about the feature.
People with body dysmorphia may isolate themselves out of embarrassment or because they worry too much about their appearance, experts say. They can also burn out their social support by constantly seeking reassurance, Durvasula added.
Spending so much time analyzing their appearance can lead to them often being late for work or failing to do their schoolwork, she said. Some people put themselves in financial danger by purchasing cosmetic products or procedures – putting themselves into debt for themselves or their families, and sometimes they do so in secret out of concern about what might happen if people knew.
Kearney-Cooke had a patient so obsessed with a perceived flaw in her nose that she always looked in the mirror, even while driving, the psychologist said. Crashing a car into a tree in the process was a wake-up call for the patient, she noted, leading to treatment and eventually some improvement.
Getting treatment for body dysmorphia
There’s no cure for body dysmorphia, and it’s a “difficult clinical condition” to treat because “it’s a pattern that’s very resistant to change,” Durvasula said. But some effective treatments are available.
A preference of many experts is cognitive behavioral therapy. A person’s distortions or thoughts are believed to drive these behaviors, so therapists work on the person’s distortions and go from there, Durvasula said. Since body dysmorphia falls into the same category as obsessive-compulsive disorder, treatments for OCD, such as “exposure and response prevention,” can also be helpful for managing body dysmorphia. In a safe environment, this therapy exposes people to situations that provoke their obsessions or triggers and requires them to choose not to respond with compulsive behaviors.
When undergoing such treatment, a person with body dysmorphia can’t look in the mirror or take selfies much, Durvasula said. “They actually have to tolerate the discomfort of the non-controlling behavior. But that needs to be complemented by the cognitive-behavioral work.”
A history of trauma would also require trauma-informed therapy, where a mental health professional would recognize how the person’s trauma could be a root cause of body dysmorphia.
“Part of the therapy can also be very educational — about the images we see in the world and how unrealistic they are,” Durvasula said.
Researchers have looked at brain chemicals, 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 has expertise in OCD or eating disorders, Durvasula said.