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Body Image and Body Dysmorphic Disorder

Sherry-Lee Smith

Registered Psychologist
Perth, Western Australia

Body Image

Body image can be defined as the thoughts and feelings a person has as a result of the perception they hold of their physical self. When you have a healthy body image you value who you are as a person and are comfortable and happy with the way you look. If your self-worth is determined by the way you look you may have an unhealthy body image. If you think your body is unattractive or not good enough and you are fixated on trying to change or hide it you probably have a negative body image.

The social environment in which you live can have a significant influence on the development of a negative or unhealthy body image. The people you surround yourself with and the media you are exposed to impact on how you think and feel about your appearance. You have a higher risk of developing a negative body image when you live in an ‘appearance orientated environment’. This means that if you spend most of your time in the company of people who focus on appearance you are more likely to think negatively about the way you look. Receiving negative feedback from those around you about your appearance also puts you at an increased risk of developing an unhealthy body image. Furthermore, exposure to unrealistic and unattainable body images through the media creates the erroneous perception that you will only find love, happiness and success by living up to the ideal body image.

Body image concerns can create a great deal of distress for many people. When these concerns impair a person’s ability to function in everyday life there is a possibility that they have developed a psychological disorder such as an eating disorder or body dysmorphic disorder.

Body Dysmorphic Disorder or Body Dysmorphia

Body Dysmorphic Disorder (BDD) is relatively common, yet often under-recognised or misdiagnosed. People who suffer from body dysmorphia judge their sense of self primarily by their appearance. They often experience shame and embarrassment around the way they look. These individuals may experience low self-esteem and feelings of being unlovable or unworthy as well as a sensitivity to rejection. Feelings of defectiveness related to their appearance are also common.

Individuals with body dysmorphia have a preoccupation with a perceived defect in their appearance. This obsession commonly focuses on one or multiple body parts that the person finds ugly or ‘not right’ in some way. Often these worries centre on facial features, skin or hair, however any body part can be the focus, as well as overall appearance or build. Over time this preoccupation can change from one body part to another. Sometimes a person with body dysmorphia has a general perception of themselves as unattractive or ugly. A person with body dysmorphia will find these obsessions distressing and the thoughts are likely to impair their daily functioning.

BDD is an obsessive-compulsive related disorder. When a person with body dysmorphia experiences these preoccupations they will engage in compulsive behaviour aimed at reducing their anxiety over their physical appearance. This behaviour is directed at disguising, improving and examining the defect and may include;

  • Comparing their appearance to others
  • Mirror checking
  • Excessive grooming (hair cutting, make-up application, shaving, hair styling etc.)
  • Seeking reassurance from others about their appearance or attempting to convince others of the defects ugliness
  • Skin picking
  • Dieting
  • Excessive exercising
  • Steroid use
  • Camouflaging (with a hat, clothes, make-up, sunglasses etc.)
  • Pursuing dermatological treatment or cosmetic surgery

The compulsive behaviour seen in people with body dysmorphia is time-consuming, distressing and difficult to control. Unfortunately the behaviour that is aimed at reducing anxiety inevitably increases anxiety in the long term (even if the anxiety is temporarily reduced).

Age of onset

Body Dysmorphic Disorder usually starts in adolescence, although it can begin as early as childhood. Adolescence is a time when many young people have appearance concerns. However when body dysmorphic symptoms are seen in these age groups it should not automatically be dismissed as a normal adolescent concern. Due to the embarrassment and shame experienced by sufferers, BDD often remains undiagnosed until 10-15 years after onset.

Factors that contribute to the development of body dysmorphia

There are various theories regarding what causes BDD. Some theories focus on individual or social factors, while others focus on biological causes. Factors that contribute the development of body dysmorphic may include;

  • A genetic predisposition or vulnerability in neurobiological functioning
  • Individual and personality factors – such as shyness, a tendency to be self-critical, insecurity, perfectionism or an anxious temperament
  • Negative early life experiences or childhood adversity – for example teasing or bullying (either about appearance or competence), poor peer relationships, social isolation, lack of support in the family or childhood abuse
  • Traumatic experiences – such as physical or sexual assault

How medical treatment or counselling/psychotherapy can help

BDD can be more persistent and therefore more difficult to treat than other psychological disorders. However, those who engage in treatment fare better than those who don’t. When patients are persistent with treatment symptoms can improve.

The use of a group of anti-depressants called serotonin re-uptake inhibitors (SRIs) appear to be helpful in treating body dysmorphia. However, higher doses usually need to be used than those found to be effective with depression. Often patients don’t see improvements for at least 8-16 weeks, which is much longer than responses for depression. Generally it is recommended that patients stay on medication for a minimum of 1 year.

Psychological treatment can also help people with body dysmorphia in the following ways;

  • Developing an understanding of how and why body dysmorphia occurs
  • Developing an understanding of the factors that maintain body dysmorphia
  • Identifying and challenging unhelpful thinking
  • Addressing past trauma/s
  • Addressing compulsive behaviours through behavioural exercises
  • Improving social skills
  • Identifying and addressing the impact of body dysmorphia
  • Developing an alternative view of the self
  • Addressing socio-cultural factors of body dysmorphia
  • Treating co-occurring mental health issues

Tips to help with body image issues or body dysmorphia

  • Set health related goals rather than goals focused on appearance
  • Avoid negative self-talk
  • Avoid comparing yourself to others, especially celebrities and other people in the media
  • Focus on your positive qualities and skills
  • Limit your exposure to relationships and media that focus on appearance (studies show people tend to feel worse about their appearance after reading magazines that focus on appearance)
  • Spend time with people who have a healthy relationship with their body
  • Focus on improving yourself in ways that don’t involve appearance
  • Question your media defined ideas of beauty and try to focus on the beauty you see in people you admire
  • Remember there is no right or wrong in regards to your appearance
  • Give yourself a break from the mirror
  • Define yourself in ways other than your appearance

If you are experiencing any difficulties with body image issues and would like help please contact Sherry-Lee Smith on 042 135 1020 or smith.sherrylee@gmail.com.

Sherry-Lee Smith
Registered Psychologist

Mt Lawley Counselling Centre
13 Alvan St
Mt Lawley WA 6050

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