() — Actress Megan Fox, star of the cover of Sports Illustrated Swimsuit issue 2023, long considered a sex symboldeclared that he is part of the 5 and 10 million of people affected by body dysmorphia in the United States.
“I never see myself the way others see me. There was never a time in my life where I loved my body, never ever,” Fox said in a video interview with Sports Illustrated. “When I was little, it was an obsession that was sort of: ‘But I should look like this.’ And why I became aware of my body so young, I’m not sure.”
Megan Fox attends the Sports Illustrated Swimsuit Issue 2023 Launch Party in Hollywood, Florida on May 19. (Credit: Alberto Tamargo/Getty Images for Sports Illustrated Swimsuit)
The discrepancy between how a person perceives himself and how others see him is a characteristic symptom of body dysmorphia. Also known as body dysmorphic disorder, it is “characterized by excessive preoccupation with an imagined flaw in physical appearance or markedly excessive preoccupation with a minor physical abnormality,” according to the American Psychological Association.
How people actually look — or how attractive they are — usually doesn’t have much to do with it.
“If this person had, for example, a highly visible scar or other physically noticeable deformity, we wouldn’t be talking about that,” says Ramani Durvasula, a California-based clinical psychologist and author.
“The individual worries, almost even obsesses, about a small physical feature. It could be a small blemish, a small bump on the nose, a slightly misaligned tooth, the shape of something, but it would not be noticeable to other people.” added. “He’s never good enough. … And he basically takes over their lives.”
People with body dysmorphia tend to spend a lot of time looking in the mirror to analyze perceived flaws. (Credit: Microgen Images/Science Photo Library RF/Getty Images)
Around the 2% of the world population suffers from body dysmorphia, and the disorder affects men and women almost equally, according to the Anxiety & Depression Association of America. Symptoms usually begin to appear in adolescence, when bodies begin to change drastically.
There is a subform of body dysmorphia: the muscle dysmorphiawhich mainly affects men, is characterized by preoccupation with the perception that one’s body is not thin or muscular enough, often regardless of how muscular the person is.
Here’s what it’s like to live with body dysmorphia and how you can find help.
What is not body dysmorphia?
Body dysmorphia is often mistaken for an eating disorder, but it’s not because of some differences, according to Durvasula and Ann Kearney-Cooke, a Cincinnati-based psychologist who specializes in eating and body image disorders.
People with eating disorders are concerned about a distortion in the way they perceive their shape or weight, Durvasula said. “The person engages in (disordered eating) behaviors, as well as what we call compensatory behaviors, which could be things like not eating for certain periods of time, hyper-exercise, use of diuretics or laxatives, those kinds of things.”
However, body dysmorphia often centers on a real or imagined trait, according to experts.
Causes of body dysmorphia
There is no single cause of body dysmorphia, but there are some factors that contribute to it.
“Body dysmorphia is in the same family of disorders as obsessive-compulsive disorder,” Durvasula says. “The only genetic evidence we see is that if a person has a first-degree relative (parent or sibling) with OCD, they may be more prone to developing body dysmorphia.”
Researchers suggest that the brains of some people with body dysmorphia may have “abnormalities in the processing of visual information when examining their own face,” according to a 2010 study.
Body dysmorphia sometimes occurs at the same time as anxiety. If someone is worried about certain things because of anxiety, a body trait may just be another topic to focus on, Durvasula added.
“Social media hasn’t helped at all. There’s a lot more social comparison of how other people look. A lot of people are spreading fake images,” Durvasula explains. “In adolescence, that form of evaluation — physical appearance, fitting in and all that — is going to be much more pronounced.”
Having family members who evaluate, validate or love themselves or others based on appearance can also play a role, he added.
“That makes the person overly sensitive to (perceiving) flaws in their appearance,” Kearney-Cooke added. “And what often happens is that somewhere inside, whether it’s a difficult childhood or whatever, they feel like ‘I’m not good enough. I’m not attractive.’ And then they project that onto their body.”
A perfectionist mindset intensifies this vision, he adds.
living with body dysmorphia
The effects of body dysmorphia can spill over into all aspects of life — social, work, and financial — especially if the disorder worsens over time without treatment.
“Because they are so obsessed with the feeling that they have a physical problem, they invest a lot of time and money in aesthetic medical treatments, aesthetic dental treatments, dermatological treatments and even surgical treatments,” explains Durvasula.
People with body dysmorphia also engage in “checking” behaviors, which can include spending a lot of time looking in the mirror and taking countless selfies and evaluating them, Durvasula added.
Compulsive looking in the mirror can alleviate fears about how you look or help you see if a perceived flaw is still there or has gotten worse, according to the National Association of Anorexia Nervosa and Associated Disorders. They believe the trait is abnormal or ugly. Body dysmorphia was originally described as “imagined ugliness syndrome,” Kearney-Cooke said.
People with this disorder may also seek comfort from others by asking if they see the flaw, if a trait looks good, or if there is something wrong or different about that trait.
According to experts, people with body dysmorphia may isolate themselves out of shame or spending too much time worrying about how they look. They may also deplete their social support by constantly seeking security, adds Durvasula.
Spending so much time analyzing their appearance can cause them to be late for work or not do their schoolwork. Some people put themselves in financial jeopardy by purchasing cosmetic products or procedures, putting themselves or their families into debt, and sometimes do so in secret for fear of what might happen if people found out.
Kearney-Cooke had a patient who was so obsessed with a defect in her nose that she would always look in the mirror, even while driving. Hitting the car into a tree while she was doing it was a wake-up call for the patient, she pointed out to her, which led to treatment and eventually some improvement.
Treatment of body dysmorphia
Body dysmorphia has no cure and is a “difficult clinical disorder” to treat because “it’s a very resistant pattern to change,” Durvasula explains. But there are some effective treatments.
One of the favorites by many experts is cognitive-behavioral therapy. A person’s distortions or thoughts are believed to drive this behavior, so therapists work on the person’s distortions and go from there, Durvasula said. Since body dysmorphia is in the same category as obsessive-compulsive disorder, OCD treatments such as “exposure and response prevention” might also be helpful in managing body dysmorphia. In a safe environment, this therapy exposes people to situations that provoke their obsessions or triggers and requires them to choose not to respond with compulsive behaviors.
When undergoing such a treatment, a person with body dysmorphia is unable to look in the mirror much or take selfies, Durvasula explains. “They have to really tolerate the discomfort of not engaging in the control behavior. But that has to be supplemented by cognitive-behavioral work.”
A history of trauma would require trauma-informed therapy as well, which would involve a mental health professional recognizing how the person’s trauma might be a root cause of body dysmorphia.
“Some of the therapy can also be very educational, about the images we see in the world and how unrealistic they are,” Durvasula explains.
According to Kearney-Cooke, researchers have also studied brain chemicals, such as serotonin, that cause body dysmorphia, so antidepressants known as selective serotonin reuptake inhibitors, or SSRIs, may also be helpful in treatment.
If you can’t find a mental health professional who specializes in body dysmorphia, try to work with someone who has experience with OCD or eating disorders, Durvasula said.
