body dysmorphia

Healthy for Men magazine | October 2019

What is body dysmorphia, in simple terms? 

Body dysmorphia is a condition where someone has a pretty constant fear of, and is therefore compulsively preoccupied by minor, even non-existent, ‘flaws’ in their body and how it appears to others. As is the case with anything fear focuses on, it completely distorts the person’s perception of whatever it’s looking at. The fear can focus on any part of the body, often the face and head as these are the parts most visible to others. People with body dysmorphia might be consumed by worries about minor skin blemishes, wrinkles, acne, hair thinning and the size and shape of genitalia. They might also focus on the size and shape of whole body, for example, being too short or not being muscular enough, the latter being known as ‘bigorexia’.

Body dysmorphia is experienced by both men and women and, because anxiety is often more dominant in adolescence, is more common among younger people. 

How does it manifest itself? 

As the body is always there and the worries are intrusive and compulsive, the person’s fear of it results in significant distress and profoundly affects their quality of life. Body dysmorphia will impact on the person’s thoughts, feelings, body and behaviours, often interfering with their daily functioning.

What are some of the causes?  

People haven’t really agreed on one root cause of body dysmorphia. As with most psychological issues, you can look to neurological factors, like over-activity in the amygdala (the part of the brain that orders us to be frightened of something), genetic factors, including some people being born with lower levels of the ‘feel-good’ chemical serotonin than others, environmental factors, such as whether our care-givers experienced anxiety, depression and/or addictions during our childhood and even the evolutionary factor of it making good sense, from a survival and procreation point of view, to be concerned about how we appear physically to others. You might also add to all of these some current cultural factors, particularly the pervasive emphasis on physical ‘perfection’ on social media. 

How does it make sufferers behave? 

There are lots of changes to behaviour that might result from body dysmorphia. When you’re frightened of something, you’ll often be compelled to keep looking out for it. The person will therefore compulsively check the relevant part of the body in the mirror and always be comparing it to other people’s when they’re around them.  

The compulsion to fix the perceived ‘flaw’ can lead the person to preoccupy about grooming and stand in front of the mirror for hours trying to solve or camouflage the ‘problem’. If the body part focused on is the skin, for example, they might make lots of visits to dermatologists looking for a ‘cure’. Many people experiencing this kind of dysmorphia will also obviously be drawn to cosmetic procedures for a ‘fix’. If the root of anxiety isn’t dealt with though, once a particular issue is ‘resolved’ a person’s worry will often settle on another part of their body. This can lead to the kind of serial cosmetic surgery we’ve all got very used to seeing. 

If bigorexia is the issue, a person might over-train and over-exert themselves with weights, even training on injuries, to increase muscle mass. They may also use too many protein supplements and perhaps abuse steroids. They’ll probably think about training most of the time, prioritising it above all else in their life and experiencing real stress if they’re unable to go. Because of the link between diet and muscle mass, the person might also get into disordered eating patterns and go on diets which actually cause them some physical harm. 

Of course if we’re fearful of something, we’re also likely to engage in avoidant behaviour to ‘survive’ psychologically. If a person believes there’s something really wrong with their appearance that can clearly be seen by everybody else, they might isolate and avoid social events. They may also not look in mirrors and refuse to have their picture taken. 

You can see that all of the above will impact on a person’s behaviour and result in significant mood swings. Also, because the dysmorphia means the person is seeing something which is either non-existent, or greatly exaggerated in their mind, if they do speak to others about it, they’ll often be told, probably in a well-intentioned way, that it’s just not an issue and not to worry. They might even be called vain or superficial for preoccupying about appearance. To the person with body dysmorphia though, they believe 100% that this perceived flaw is real and that it threatens their psychological existence. This can leave them ashamed and alone with their fears. 

Unfortunately, the combination of compulsive distressing fears, with a hatred of the body, shame and social isolation, means people with body dysmorphia have a quite a high risk of suicide.  

How can it be overcome, and what are the treatments? 

Because people who experience body dysmorphia are often quite ashamed of preoccupying so much about appearance, many will hide it from others. It’s really important to know, that, as with most forms of psychological distress, it’s not something you have to live with and that it can be worked through over time. 

Current suggested treatments include cognitive behavioural therapy, known as ‘CBT’ and anti-depressants or a combination of the two depending on the intensity of symptoms. CBT focuses both on addressing the distressing thoughts and on changing the behaviours they lead to. For example, a person might be encouraged to go out in public with the perceived flaw uncovered if they’ve been avoiding social contact. Anti-depressants usually work by increasing the levels of feel-good chemicals in the person’s brain, reducing the anxiety and depression that can be both the cause and the result of body dysmorphia.  

In terms of treatment, I think it’s also really important to take a wider look at the person’s life and history. This might include their relationships with themselves and others, how they reward and calm themselves and areas such as meaning and purpose in their life. The person’s fear in the case of body dysmorphia focuses on their body, but the roots of why they feel less safe than they actually are in life can often be found in their past and wider aspects of their present. All of these factors can and should be looked at over time to help the person feel safer in life.  

In terms of medication, where someone’s in really intense distress and engaging in self-destructive behaviours, even having suicidal ideation, anti-depressant medication can be a helpful way of reducing the intensity of this. This allows more of the space they need to look at what happening and to think about changes. 

It’s key to bear in mind though that what’s often going to be needed medium to long term is for the person to really look at how they see themselves, others and life generally and how each of these aspects either fuels or soothes their obsessions and compulsions. The person needs to be helped to live and enjoy their life in the longer-term without the need to be medicated through it. 

What would your advice be for anyone obsessing over their appearance or worrying they may suffer from this. The obvious one is “seek help” but who can they turn to? And are there any practical tips you can offer? 

If someone believes they’re experiencing body dysmorphia, it’s important they learn as much as they can about it and how it might be affecting them. Even doing this can be really de-shaming. They’ll realise they’re not alone and that there are ways through it. If it’s too daunting at first to go to see a therapist, internet forums can be a great way to find out more and get support, empathy and understanding from others. 

At some point though, it’s probably going to be necessary to go see someone who has expertise in treatment of body dysmorphia. As well as this face-to-face help, and in common as with most forms of psychological distress, people also tend to feel better when they’re physically active, regularly practice some form of meditation or mindfulness and try to stay away from alcohol and drugs that can worsen symptoms.