Many people deal with insecurities related to their body: “I’m too fat,” “I’m too skinny,” “I don’t have enough muscle,” “my face looks weird,” or something else. But at what point do typical body insecurities cross the line into body dysmorphic disorder, which is a clinically diagnosable mental illness? Here’s how to tell if you have body dysmorphia, according to therapists who specialize in treating it.
What is body dysmorphia?
Body dysmorphia is a form of obsessive compulsive disorder wherein a person is preoccupied with a perceived physical “flaw” or several flaws. Jesse Kahn, LCSW-R, CST, sex therapist and director at the Gender & Sexuality Therapy Center tells O.school that often, these “flaws” are not noticeable or appear quite minor to others. This issue is officially known as body dysmorphic disorder (BDD).
“These flaws can be entirely real, entirely imagined, or some imaginary exaggeration of the flaw, resulting in distressing angst often resulting in lower self-esteem,” Brian Ackerman, LMSW, a psychotherapist at G&STC, tells O.school.
What causes body dysmorphia?
There is no specific etiological cause for body dysmorphia, according to James Vining, LCSW, another psychotherapist at the center. It’s thought to be a combination of biological and psychological factors, including potentially a difference in the way the brain of a person with BDD perceives visual cues. A person with BDD may feel self-hatred when they can’t attain often impossible standards of beauty perpetuated by social media, advertisements, and more.
“The most insidious aspect of body dysmorphia is that it is a cultural and systemic disease, not just an individual one. Based on the ever-present myth that we won’t be seen or valued unless we conform to and achieve an aesthetic ideal, we inherit this idea that having a specific kind of body guarantees social acceptance, status, power, desirability,” Vining tells O.school.
This cultural context can, over time, affect how an individual psychologically perceives — and treats — not only their body but themselves.
Signs of body dysmorphia.
The following behaviors in excess may be signs of BDD, according to Ackerman, Kahn, and Vining:
- Ruminating on perceived physical flaws, especially ones that other people don't notice
- Getting feedback from others on your physical appearance that is positive and incongruent with your internal, very negative views of your perceived flaws
- Checking the mirror for the perceived flaws
- Grooming, picking at the skin, or trying to hide the perceived flaws
- Seeking reassurance from others about the perceived flaws
- Comparing your body to others, particularly the parts related to the perceived flaws
- Extreme focus on “fixing” or removing the “flawed” part
- Anxiety, shame, or embarrassment related to the perceived flaws
- Very low self-esteem
Do I have body dysmorphia, or am I just insecure?
“Everyone has body insecurities,” Ackerman explains. “The critical difference with body dysmorphia is that the body insecurities themselves become ‘clinically distressing’ — that is, the bullets listed above become so energy and time consuming in your life, that your ability to function socially, professionally, and in other areas of life is impaired.”
For example, a person with BDD may feel like they can’t meet up with friends somewhere if they don't know if the location will have a suitable mirror for checking themselves, he says.
How bad is my body dysmorphia?
There are different types of body dysmorphia depending on the amount of insight the person has about their disorder. According to the DSM-V, those three types are:
- With good or fair insight: The individual recognizes that the body dysmorphic disorder beliefs are definitely or probably not true or that they may or may not be true.
- With poor insight: The individual thinks that the body dysmorphic beliefs are probably true.
- With absent insight/delusional beliefs: The individual is completely convinced that the body dysmorphic beliefs are true.
That said, just because someone is aware of their body dysmorphia doesn’t mean that it’s less severe in how it distorts self-perception or that it’s less damaging to the person’s well-being.
“Sufferers may even be able to rationally identify that they intellectually ‘know’ that their body is ‘fit’ and aesthetically pleasing to them in their own self-assessment, yet still be fixated on changing that part of the body into an unachievable ideal,” Vining says.
How to heal from body dysmorphia.
Work with a mental health professional. Body dysmorphia is a mental health disorder, so working with a mental health professional is the most effective route for getting treatment. A psychiatrist can prescribe medications that can help manage many of the symptoms of BDD, and a therapist who specializes in body image disorders can help you develop a healthier relationship to your body and cope with distressing thoughts.
Notice your triggers. Get curious about how your dysmorphia emerged, Kahn recommends to O.school. “What was the environment and the cultural narratives that allowed the dysmorphia to thrive?” From there, explore what triggers and activates your dysmorphia, he says. “For example, how does scrolling on social media impact your dysmorphia? Considering images on social media tend to be so edited, manipulated, and unrealistic, social media is a common trigger.”
When you know what triggers and environments allow your dysmorphia to thrive, you can develop ways to deal with the types of thoughts and emotions that come up in those situations — and, where possible, minimize your exposure to them.
Rethink your relationship to your body. While it’s okay to want to strive for a certain aesthetic that you like, it shouldn’t come at the expense of your well-being or self-confidence.
“Remember first that you really are already perfect as you are (no, really, make space for that!),” Ackerman tells O.school. “Second, consider the thing you perceive as a body flaw. Is it something you can change, or is it a feature that will be with you no matter what?”
Pay attention to how your body feels. Vining recommends the use of mindfulness and somatic work to help move away from distracting thoughts about your body’s appearance. Try to shift your attention from focusing on how your body looks to focusing on how it feels, he says. What feelings do you have within your body? How can you make your body feel good?
“Mindfulness and somatic work … allows the person to experience and consciously notice how the body feels, rather than focus exclusively on how it looks or how other people value it,” he says. “This is a shift from perception to mindful embodiment and teaches the person that other types of self-experience are valuable.”
Connect to your true values. “Most people would benefit from identifying how their personal values differ from exclusively achievement-based goals (body),” Vining says.
What do you value? Do appearances and status need to be such powerful drivers in your life? What other things do you care about that matter more for you to invest your energy into? Your personal values do not have to reflect our society’s values, Vining reminds. What gets praised on social media, for example, doesn’t have to be the same things you care about.
The bottom line.
Healing from body dysmorphia involves making a conscious shift in the way you’re thinking about your body, potentially with the support of mental health professionals. As you go about this journey, just remember this simple truth: Your body is not the sole source of your value as a person, and you can lead a happy, healthy, confident life no matter what your body looks like.