Can you imagine what is would be like to have your beautiful young son or daughter come to you with such hatred for their appearance that they are begging you to take them to a plastic surgeon?
I think from time to time we all check out our image in the mirror and make an evaluation of it. Some people (young and old) make such critical evaluations of their appearance that they start to believe that they are unable to contribute to any sort of life because of their appearance. When this becomes debilitating, we usually consider a diagnosis of Body Dysmorphic Disorder.
Our body image is different to an image of our body. An image or photo of our body captures how it is at any point in time. Our body image, though, is the representation we have of our own bodies. It is essentially a judgement or series of judgements we make about how we think we appear.
When you ask people to tell you about their bodies, rather than give you facts , for example, on the colour of their hair or their measure height they usually give you judgemental words like plump, skinny, solid, pale….even ugly. For most of us, this is not a problem, but for a few, the way their body image becomes central to their level of happiness.
When we determine our worth or happiness by our judgement of how we look, things can get pretty complex.
Body Dysmorphic Disorder or BDD is a diagnosis used when there is an intense preoccupation with a perceived flaw in physical appearance. (For most BDD it is with people’s own appearance, but BDD by proxy can mean that parents become obsessed about flaws in their children’s appearance). Individuals with BDD often spend lots of time checking and worrying about a particular aspect of their appearance. They may spend a lot of time comparing their appearance with others, and engaging in behaviours designed to try to hide or conceal the area of concern or generally try to avoid being seen by others.
It is thought that BDD affects 1-2 percent of the population and it does not seem to vary with gender.
In the clients I have seen with Body Dysmorphic Disorder, they usually focus on one feature in particular – their teeth or the shape of their lips and sadly, if they do take steps to have these adjusted to their liking (people with BDD are often frequent customers of plastic surgeons), it does not always mean that their happiness improves and they will then go onto to target the next part of their body that they find the most displeasing.
The thinking if ultimately something like “if I can just change the way I look, my life will be wonderful”
BDD is much more than just vanity or being dissatisfied with how they look, it can become obsessive and often co-morbid (or exists together with) with depression, anxiety (especially social anxiety) and I have seen it accompanied by self harm and suicidal ideas, too. It can make it hard for a young person to leave the house, go to school or uni, or meet up with friends…or if they do, there needs to be much time trying to cover or adjust a certain aspect of their appearance.
This means BDD can interfere with living with others. Those with BDD will often continually seek reassurance about their appearance or spend lengthy times in the family bathroom or be frequently late for work or school. There is often quite a deal of secrecy and shame associated with BDD and BDD can quite often be associated with financial difficulties, too, with money being spent on treatments or cover ups.
Oversimplifying it, but in an attempt to explain how BDD starts and is maintained we could consider it going something like this example (although imagine it being much more complex/less staright forward):
- Someone tells me I have a crocked nose
- I believe that I have to look perfect to be liked by others
- I spend hours trying to cover up my crooked nose with makeup, but that all gets too hard and the products I use have cause swelling and redness, so I start avoiding going out whether others will see me crooked nose. I keep checking with the people I love about my nose, but that doesn’t satisfy me for long.
- I stop socialising, friendships drop away and I never get to test the idea that I have to look perfect for others to like me or want to be friends with me.
Where does BDD come from?
It is thought that most BDD starts in adolescence and that much goes untreated for many years. Adolescence is a time of many body changes, and also for some, an increased risk for acne, but other times of life where the body changes can also be triggers – like the emergence of wrinkles or loss of hair with aging or new scarring after an accident or medical issue.
Those at risk of BDD or serious negative body image have often been teased or excluded and are also more likely to associate with peers or even family members who are very focused on appearance. Certain personality types may be more prone but also, social and cultural pressures are thought to contribute including social media. I have also seen BDD that began following a period of childhood and family trauma.
There are so many industries that depend on us being dissatisfied with our body image – Industries worth billions of dollars. They flood the media with direct and indirect messages about happiness being derived from appearance.
How can we prevent it?
Sadly, at this stage, we don’t’ have any strategies that definitely prevent BDD. I like to try to educate children about the powers of advertising and the tricks marketers pay to make us buy things. However, the best the research can suggest is that people seek treatment early.
So, if you are a parent of a teen, it is usual for them to spend more time in the bathroom and in front of the mirror as they approach puberty, but if the checking is accompanied by frequent negative statements about their appearance, constant comparisons of themselves to others, regularly needing reassurance that they look okay, and avoiding socialising or leaving the house, you should increase your level of concern.
The first point of call should be your GP or Mental Health professional. A proper diagnosis is essential.BDD has some similarities to Eating Disorders in that it is also about body image, but the preoccupation is usually different, with eating disorders normally being about weight and shape and usually leads to a change of eating patterns.
Treatment can include medication and psychological intervention. Psychological treatment is focused on tackling negative body image by building body acceptance and using techniques to help reduce the amount of time spent obsessing, checking or seeking reassurance about appearance. Psychologists can also help with uncovering and challenging assumptions and negative predictions that link appearance with ideas of success and happiness. Psychologists can also help a person to tackle their avoidance or behaviours that set up self fulfilling loops around unhelpful assumptions
There is some very useful information at the BDD Foundation website.
If you have young children (preschool and early primary) and you are concerned about them developing a negative self image, perhaps you could share “You are Like You” with them to open up some conversations about their thoughts about themselves.