If you’ve ever made it a goal to change your appearance, you’re not alone. Around 43% of UK adults have the goal of losing weightFor many, these goals can extend to more extreme methods of altering their appearance, such as cosmetic or plastic surgery.
But when does this common and widespread desire for self-improvement and betterment become something more sinister? 3 percent of the general populationThis can lead to a constant desire to modify or change one’s physical appearance, a condition known as body dysmorphic disorder (BDD).
People with BDD believe that they have significant physical flaws or defects that, to other people, may be minor or even non-existent.
Rebecca*, a 36-year-old woman, strongly believes she looks like she has a “moon face” because she can’t help but look in the mirror at the acne scars that cover her skin.
Or Tyson*, the 17-year-old who spends hours every day in the gym trying to build muscle mass because he feels he looks like a “toothpick.”
Tyson and Rebecca have been told time and time again by family, friends, and medical professionals that what they see is different from what others see, but they don’t believe it. Seeing is believing, right? But what if your eyes can deceive you?
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Long Attachment
BDD isn’t a new condition: It was first described by Italian psychiatrist Enrico Morselli in 1891, long before we became obsessed with our TikTok feeds.
He described people with “body dysmorphic disorder” (the former name for BDD) as people who are “suddenly overcome by the fear that their body may be deformed in the midst of everyday life, while talking, while reading, while sitting at a table – in fact anywhere and at any time throughout the day.”
BDD is thought to be caused by a complex interplay of biopsychosocial factors, including genetic factors, differences in brain structure and function, and a history of adverse childhood experiences such as bullying, abuse or neglect, which can lead individuals to feel ashamed about themselves and their bodies.
This tendency is often manifested or exacerbated by societal pressures around appearance — in fact, research supports the idea that attractive people often enjoy social advantages, such as being perceived as more trustworthy, healthy, confident, and intelligent.
This increases your chances of finding love, getting a job, or even earning a higher salary.
This often has a negative impact on the minds of people with BDD, making them feel like they have less chance of succeeding in life.While we cannot ignore that these benefits of beauty exist in our society, the pursuit of beauty at all costs can be harmful to both our physical and mental health.
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Unrealistic perfection
Although BDD existed before the development of social media, social media has certainly played a role in increasing the prevalence and severity of BDD.
The emphasis on sharing the “perfect” selfie, the use of filters, the various ways to augment or enhance an image, and powerful algorithms that ensure you (or your disability) are served up with the content that interests you most are the perfect combination to increase the focus on appearance.
Heavy social media use and photo editing have been linked to an increased risk of developing BDD, comparing appearances, and interest in undergoing surgical and non-surgical cosmetic procedures.
This relationship arises in a variety of ways. First, our perception of attractiveness and beauty is often influenced by our “visual diet.” After an extended period of consuming curated content showcasing the best angles, lighting, makeup and outfit choices, and artificial enhancements through the addition of filters, our perception of beauty can start to become biased towards highly idealized and edited images.
As a result, viewers may feel pressured to fit into this newly formed ideal of beauty and may attempt to conform by applying filters to themselves or seeking cosmetic procedures to better meet this standard.
Unfortunately, the positive effect a filter has on your self-image only lasts while it’s applied; once the filter is removed or you see yourself in the mirror in the real world, you may find yourself feeling unattractive or unacceptable.
There is also an increased pressure to build a “personal brand” online, which can extend beyond just posting the “perfect” photos to achieving the most beautiful feed, the right captions, hashtags and themes. This can lead to a lack of authenticity and cause a widening disconnect between your “online self” and your “real self.”
Some people say their use of social media has increased social anxiety in their daily lives. They fear they will unintentionally “catfish” others who have become accustomed to looking a certain way in the online world. Thus, a personal brand or polished online persona can lead to feelings of embarrassment and shame about their true appearance and personality.
Once BDD has developed, the disorder is often maintained by harmful patterns of thinking and behavior.
For example, engaging in excessive behavior to check, camouflage, or change one’s appearance, including prolonged observation of oneself in the mirror or taking photographs from different angles, hiding oneself with loose clothing, hats, scarves, or glasses, beauty treatments, new hairstyles, or cosmetic procedures.
Many of these are common everyday behaviors that people undertake for self-expression and self-improvement. However, when taken to an extreme, these behaviors can lead to an excessive focus on appearance.
One study compared the mirror-gazing patterns of people with and without BDD and found that even healthy people who stared at themselves in the mirror for more than 10 minutes experienced heightened awareness of their “flaws” and increased levels of distress.
People with BDD experienced this intense distress even after only looking at themselves briefly, for around 25 seconds. These findings support the idea that people with BDD have different patterns of visual processing when looking at faces, often focusing on small details and individual features rather than the overall picture.
Similarly, if someone without BDD looks at themselves long enough, they too will begin to see themselves in parts rather than as a whole, which is one reason why the “Zoom effect” and the proliferation of video calls during the COVID-19 pandemic has increased self-image distress for many people.
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Extreme Measures
People with BDD seek out beauty and cosmetic treatments at a much higher rate than the general population to help them feel better about themselves.
Approximately 70% of people with BDD have previously undergone cosmetic surgeryThey account for up to 15% of all cosmetic surgery patients.
These high rates make sense: For Rebecca, who is concerned about the scars on her face, dermatological treatments like chemical peels and anti-wrinkle injections seem like the obvious solution.
Unfortunately, while most people who seek cosmetic surgery are satisfied with the results, studies have shown that this is not the case for people with BDD. In up to 91 percent of casesBecause your symptoms don’t change, you continue to focus on the areas that were treated and continue to work on ways to hide, check up, or cover up your “flaws.”
After undergoing cosmetic surgery, your concerns may change. People who were concerned about having a “hooked” nose before surgery may develop new concerns after rhinoplasty (nose surgery) about their nose appearing larger as a result of the surgery and about others criticizing them for having the surgery.
In other cases, BDD symptoms may actually worsen after treatment, making someone who is already self-conscious and vulnerable even more so.
It is an ethical and professional obligation for cosmetic surgeons to identify BDD in their patients before performing procedures, as patients with BDD may sue, complain, or demand compensation for procedures that do not meet their expectations.
It may be disheartening to learn that cosmetic surgery may not be the answer to your intense and painful obsession with appearance, but the good news is that effective, evidence-based treatments exist.
The National Institute for Health and Technology Assessment First-line treatment for BDD should include cognitive behavioral therapy with exposure and response prevention (CBT-ERP) and the addition of psychiatric medication for moderate to severe cases.
CBT for BDD involves identifying unhelpful stereotypes and expectations you have about yourself and your appearance (such as “I have to always be well-dressed when I leave the house” or “No one will love me with a nose this size”) and learning new ways to move away from these thoughts or develop more flexible, helpful thought processes (such as “I want to find a partner who is attracted to my values, interests, and passions, not the look of my nose”)
Adding ERP involves gradually exposing the patient to situations, environments, or people that they would normally avoid, while at the same time trying not to engage in the compulsive behavior.
For example, Rebecca might work on gradually eliminating cosmetics from her daily routine so she can go out without wearing heavy makeup to hide her skin, while Tyson might work on reducing his training schedule or going to the beach with his friends without having to cover up with a t-shirt.
These exposure exercises are designed to help individuals learn that what they fear most (being judged or ridiculed for their appearance) may not happen. Through exposure rather than avoidance, they can begin to live more productive, fulfilling, and joyful lives.
Current estimates suggest that CBT-ERP: Up to 70% of people with BDD experience significant relief from their symptoms.When combined with drug therapy, this rises to 80 percent.
If you’re reading this and you feel like you’re worrying a little too much about the way you look, here are some things you can try…
How to Worry Less About Your Appearance
Mirror hygiene
Set a limit on the amount of time you spend looking at yourself. Unless you’re doing it for a specific purpose like putting on makeup or shaving, staring at yourself for more than 10 minutes can cause stress. Don’t avoid mirrors, but only look at them when necessary.
Engage in hobbies that have nothing to do with appearance
BDD is often associated with an excessive focus on appearance at the expense of other activities. Spending time with friends and family and doing the activities you love can boost your self-esteem and help you realize that your strengths go beyond just your appearance.
Social Media Detox
Look at your social media and notice how much of the content you’re consuming is highly edited images or content promoting fitness, beauty or cosmetic procedures. Unfollow or hide any content that makes you feel self-conscious, or set limits on the time and amount of time you spend on social media.
Stop looking for reassurance
Try not to talk to others about your appearance. Asking for feedback on your appearance can make you feel bad, whether the answer is positive or negative. Focus the conversation on more interesting topics.
Rather than chasing the perfect body, maybe it’s time to discover a broader sense of self-worth that can withstand the inevitable challenges of aging and growing up that we all experience, whether we like it or not.
*Names and descriptions do not reflect actual clients.
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Source: www.sciencefocus.com
