Dubai, United Arab Emirates (CNN) — American actress Megan Fox, the cover star of the 2023 Sports Illustrated Swimsuit magazine, who has long been considered a symbol of seduction, said she is between 5 to 10 million people in the United States affected by body dysmorphic disorder.
“I never see myself the way other people see me,” Fox said in a video interview with Sports Illustrated. “There’s never been a point in my life where I loved my body, ever.”
She continued, “When I was young, I had a visual obsession with looking a certain way. I’m not sure why I was so self-conscious at such a young age.”
A difference between how a person sees themselves and how others see them is a symptom of body dysmorphic disorder, which is defined as “an excessive focus on an imagined defect in physical appearance or an extremely excessive concern for a minor physical defect,” according to the American Psychological Association.
And what people actually look like — or how attractive they are — often has little to do with it.
“If this person has, say, a very visible scar or a noticeable physical deformity, that’s not what we’re talking about,” explained Ramani Darvasula, a California-based clinical psychologist and writer.
She explained that a person with BDD becomes preoccupied, even almost manic, because of a minor physical defect, such as a slight bulge in the nose, or a slightly misaligned tooth, that is not noticeable or visible to others.
She added that the patient will never feel satisfied, and the thought of this defect will dominate his life.
Credit: Microgen Images/Science Photo Library RF/Getty Images
About 2% of the world’s population suffers from body dysmorphic disorder, and the disorder affects men and women almost equally, according to the Anxiety and Depression Association of America. Symptoms usually begin in adolescence, when bodies begin to change drastically.
A subtype of body dysmorphic disorder, muscle dysmorphic disorder that primarily affects men, is defined as an excessive preoccupation with being thin or not muscular enough, regardless of how muscular the person is.
Here’s how people with body dysmorphic disorder live, and when they should seek help.
What is not considered a body dysmorphic disorder?
Body dysmorphic disorder is often confused with an eating disorder, but that’s not the case due to some differences, according to Dravasola and Ann Kearney-Cook, a psychologist who specializes in eating and body image disorders based in Cincinnati, Ohio.
Drvasola explained that people with eating disorders preoccupy themselves with distorted thoughts about their body shape or weight.
“A person (with an eating disorder) engages in behaviors that we call compensatory behaviours, which could be for example not eating for certain periods of time, doing intense exercise, or using laxatives,” she said.
However, body dysmorphic disorder generally centers around an imagined or real trait, experts say.
What causes body dysmorphic disorder?
There is no single cause of body dysmorphic disorder, but there are some contributing factors.
Drvasula mentioned that body dysmorphic disorder falls within the same family of disorders, especially obsessive-compulsive disorder.
“The only genetic evidence we see is that if a person has a first-degree relative (father or sibling) with obsessive-compulsive disorder, the first may be more likely to have body dysmorphic disorder,” she said.
The researchers noted that the brains of some people with body dysmorphic disorder may experience “abnormalities in the processing of visual input when their face is examined,” according to a 2010 study.
Sometimes body dysmorphic disorder occurs at the same time as anxiety.
And if a person is preoccupied with certain things because of anxiety, physical trait may be just another issue to focus on, according to Drvasola.
“Social media definitely doesn’t help with that, there’s more social comparison of what other people look like. False images abound on these platforms,” Drvasola said.
And in adolescence, this kind of evaluation, i.e. physical appearance, comparison with others, etc., is more evident, according to Drvasola.
Family members who rate themselves or others based on appearance can also play a role, Kearney-Cook notes, “This is what makes someone so sensitive to any imperfections[in their appearance].”
And she continued, “What often happens is that he feels that he is not good or attractive, whether because of a difficult childhood or because of some other experience, and then he transfers this thought to his body.”
She added that an idealistic mindset reinforces this vision
Living with body dysmorphic disorder
The effects of body dysmorphic disorder can spill over into all aspects of life — social, professional and financial — especially if the disorder worsens over time without treatment.
“Since they are obsessed with this kind of sensation of having this physical problem, they will spend a great deal of time and money either getting medical-cosmetic treatments, cosmetic dental treatments, dermatological treatments, or even surgical treatments,” Drvasola said.
Drvasola added that people with BDD also have “checking” behaviors, which can be spending a lot of time looking in the mirror and taking countless selfies and evaluating them.
Pathologically looking in a mirror can ease concerns about how people perceive their appearance or help them see if a perceived flaw is still present or has become worse, according to the National Association of Anorexia Nervosa and Related Disorders.
Experts pointed out that people with body dysmorphic disorder may isolate themselves because of shyness, or from spending too much time worrying about their appearance.
Some people expose themselves to financial risk by purchasing cosmetics or cosmetic procedures, thereby burdening themselves and their families with debt, sometimes doing so secretly for fear of what might happen if people found out.
Body dysmorphic disorder treatment
Body dysmorphic disorder cannot be cured, Drvasula said, and is a “clinical condition” that is difficult to deal with because it is “a pattern that is very resistant to change.” However, there are some effective treatments available.
Many experts favor cognitive behavioral therapy.
Drvasola believes that a person’s thoughts drive this behavior, so professionals work to address those thoughts and go from there.
Because body dysmorphic disorder falls into the same category as obsessive-compulsive disorder, OCD therapies, such as exposure and response prevention, can also be helpful in managing body dysmorphic disorder.
In a safe environment, this therapy exposes people to situations that trigger their obsessions or triggers and requires them to choose not to respond with compulsive behaviors.
When undergoing such treatment, a person with body dysmorphic disorder can’t look in the mirror as much or take selfies, but actually has to endure the discomfort of not engaging in checking behavior, according to Dravasola.
However, this must be supplemented with cognitive behavioral therapy.
A history of trauma will also require therapy, which may include sessions with a mental health professional who can explain how a person’s trauma could be a root cause of body dysmorphic disorder.
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