Body dysmorphic disorder: What happens when our brains lie to us
“When you’re in the mirror, do you like what you see?” —Charli XCX
Many of us have complicated relationships with mirrors. On one end of the spectrum, you may be hesitant to walk by the mirrors in your house because you’d rather not see how you look. On the other end, maybe you try to catch your reflection in every possible mirrored surface to evaluate your body shape at any given moment.
Mirrors have become storytellers. In simple terms, they tell us about our appearance. They show us what other people might see when they look at us. Maybe our hair is tangled. Maybe our shirt doesn’t match our pants. Maybe a piece of clothing is too loose or too tight.
What we do with these stories is up to us, but it’s not always within our control.
That’s where body dysmorphic disorder and body dysmorphia come in.
In this post, I’ll reveal:
the origins and causes of body dysmorphic disorder
the thoughts and behaviors of someone with body dysmorphia
the subtypes of body dysmorphic disorder
how to support someone (including yourself) who may struggle with body dysmorphia
What is body dysmorphic disorder?
Body dysmorphia is a symptom of a larger condition called body dysmorphic disorder (BDD). People with body dysmorphia or BDD might engage in one or more of the following behaviors:
Excessive focus on one or more parts of the body that they perceive to be flawed
Fear and anxiety about how others perceive their appearance
Frequently comparing their appearance with others’ appearances
Spending a great deal of time looking at their appearance in a mirror or other reflective surface OR intentionally avoiding mirrors to refrain from seeing their appearance
Frequently taking photos of themselves to check their appearance; using apps or filters to alter their appearance
Avoiding situations where people might notice aspects of their appearance that they don’t like and that they don’t want others to see
Undergoing medical procedures like cosmetic surgery to alter what they don’t like about their appearance
As you can see from this list, many symptoms of BDD extend beyond what we see in the mirror. And a lot of these behaviors have become normalized with the rise of social media and image-altering technology. Because of this, BDD may be more pervasive than ever.
A literature review from January 2024 reports the global prevalence of BDD in males and females to be between 2% and 3%. The review goes on to say that BDD affects all ages, with the onset usually occurring in adolescence.
What causes body dysmorphic disorder?
The attitudes and perceptions we have about our bodies don’t show up overnight. Although body dysmorphia can be a result of some hereditary factors, it’s largely caused by what we learn and understand about how our bodies should look. And what we see in the mirror doesn’t reflect our ideal body type.
Body dysmorphic disorder can arise as a result of the following factors.
Biological
Twin studies have revealed a 43% genetic link to body dysmorphic disorder. Other research has shown that a family history of BDD, obsessive-compulsive disorder (OCD), or depression may put people at risk of developing BDD. These individuals tend to have abnormal levels of certain neurotransmitters, like serotonin and dopamine, which can affect mood regulation and how we perceive ourselves and the world around us.
Psychological
Individuals with certain personality traits may be more likely to develop BDD. Such traits include perfectionism, high self-criticism, and low self-esteem.
Environmental and social
Regardless of whether someone has a genetic or psychological predisposition to BDD, their environment can play a huge role in how they perceive their appearance. Those who’ve experienced childhood trauma, emotional or physical abuse, and/or bullying, especially about their appearance, are likely to develop negative feelings about themselves and their bodies.
On top of this, social pressures and cultural beauty standards that value physical appearance can precipitate a preoccupation with body image.
What happens in the brains of people with body dysmorphic disorder?
Researchers have conducted studies to examine the brains of people with body dysmorphic disorder. Their findings have shown the following:
Hyperactive amygdala. In people with BDD, the amygdala can be hyperactive, which can result in heightened emotional responses to negative stimuli, like perceived physical flaws.
Difficulty processing visuals. Those with BDD may have difficulty processing visual information like facial and emotional expressions. This can cause them to more intensely fixate on physical details, like specific body parts.
Frontostriatal dysfunction. As seen in individuals with OCD, dysfunction in this part of the brain can lead to obsessive thought patterns and urges to perform compulsive behaviors (i.e., body checking, checking your appearance in a mirror).
Is there more than one type of body dysmorphic disorder?
Body dysmorphic disorder has two subtypes.
1. Muscle dysmorphia: Muscle dysmorphia develops from beliefs that one’s body is not muscular enough. This overvaluation of appearance can cause a person to negatively obsess about their body and fixate on how to gain more muscle.
A person with muscle dysmorphia may engage in excessive physical activity, like lifting weights for hours a day, or start taking substances like anabolic steroids in an effort to build muscle.
2. Body dysmorphic disorder by proxy. People with BDDBP are fixated not on their own appearance, but on someone else’s appearance. In BDDBP, the person is preoccupied with another person’s (i.e., the person of concern [POC]) perceived physical defects and may seek to improve or hide the defect. They may openly comment on the defect by pointing out how it’s different from others, and/or avoid situations where the POC’s defect might be on display and subject to ridicule.
What are the treatment options for someone with body dysmorphic disorder?
If you’re struggling with how you perceive your (or someone else’s) body and are concerned about how much attention and energy you’re putting into it, there are options to help you unlearn this obsession and develop a more neutral stance about your body.
Support groups
Eating disorders are isolating. They want to close you off from people in your life who might help you, because that would be a threat to their existence. This is why finding others who are experiencing the same thoughts and feelings as you can be transformative.
Click below or click here to browse support options around the world.
Cognitive behavioral therapy (CBT)
CBT helps patients focus on how thoughts, emotional reactions, and behaviors affect their daily life. It teaches you tools to challenge negative thoughts and develop self-talk practices that can help reframe these thoughts when they arise.
Medications
Although there aren’t any medications that specifically treat BDD, meds that help ease symptoms of BDD (like depression and OCD) can be helpful for some. Talk to your primary doctor and/or a psychiatrist to learn more about your medication options.
Personal story
If only I got to my thinnest, then all my problems would be solved. But even when I got to my thinnest, I still found parts of my body that I wasn’t satisfied with, that I wanted to change.
It wasn’t until I learned how to notice, label, and reframe the self-hate I was spewing did I realize the problem wasn’t my body—the problem was my mind. The eating disorder had hijacked my thoughts, pushing me to always want more, to never be satisfied.
Our minds can play tricks on us, and when an eating disorder is in control, there’s no winning.
How can I support someone who has body dysmorphic disorder?
If you notice a loved one engaging in any of the behaviors or using language mentioned above, they may be struggling with their body image. Even though you may not know exactly what they’re dealing with, you can offer support in a few ways.
Learn more about BDD
One of the best ways to support someone with an eating disorder is to learn as much as you can about it. You may never quite understand why they’re feeling certain feelings or having certain thoughts, but doing your own research can help you build empathy for what they’re going through.
Validate their feelings
Create a safe space in which they can share what they’re going through. Listen intently. Even if what they’re saying does not make sense to you, try not to make assumptions or judgments. Instead, validate that their feelings are real.
Encourage them to seek professional help
People with BDD are often unaware that they have a problem, so it’s important not to push them in any one direction. Ask them if they’ve thought about sharing with a professional or if they want your help in finding someone to talk to. They may decline and defend, and that’s OK. Remind them of your support regardless of their decisions.
Pause & Prompt
In this moment, how do you feel about your body image?
What thoughts and physical sensations come up for you when you think about your body image?
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