Key Takeaways
Body dysmorphia is an invasive and intense worry about how one looks
Biology, environment, and experiences all impact the risk of developing body dysmorphia
Holistic approaches including therapy, medication, and coaching increase the likelihood of success in managing conditions like body dysmorphia
What is body dysmorphia?
By definition, body dysmorphia disorder is an obsession focused on one’s physical appearance. Body dysmorphia typically starts out with a specific perceived flaw and can easily become generalized to the point that an individual obsesses over many parts of the body. Individuals with body dysmorphia spend a significant amount of time trying to fix, obsessing, or worrying their perceived flaw or flaws. This behavior includes a lot of time in front of a mirror, comparing one’s appearance to that of others, an overwhelming nervousness when around others, and avoidance of photos unless highly curated.
Okay, that was kind of a text book explanation. The reality is body dysmorphia is hard to pinpoint because individuals, and society, have great ways of masking it. I have come up with my own simplified definition based on working with patients and my own experiences.
Body dysmorphia is an invasive and intense worry about how one looks.
The key here is that this behavior is invasive and intense. We aren’t talking about having a hard time picking out an outfit once in a while or feeling uncomfortable in a social setting from time to time. Body dysmorphia is pretty much a constant feeling that consumes daily thoughts, overtakes their ability to function, and hinders their happiness in all or most aspects of life.
What are the symptoms body dysmorphia?
It’s hard to attribute exact symptoms because of the overlap between body dysmorphia and other disorders, including depression, anxiety, obsessive compulsive disorder, and eating disorders. Those wrestling with body dysmorphia usually do so behind closed doors, much like other mental health struggles.
Some individual expressions of symptoms are paradoxical, meaning their symptoms are in opposition to what would be expected. A paradoxical effect for coffee or caffeine would be to cause drowsiness. As it relates to body dysmorphia, you may know someone who is constantly poking fun at others based on appearance while projecting a sense of superiority about their own looks. This sort of behavior serves two purposes: to bring others down in an attempt to elevate oneself, and to test the waters about what opinions others have about certain people and appearance characteristics. Neither of these goals validates the individual long enough to overcome their feelings of constant worry about their appearance.
Here are some of the symptoms of body dysmorphia:
Feeling down: presented as a lack of confidence or insecurity
Fatigue & Lack of motivation: difficulty finding energy for work or important parts of life because of the effort put into controlling one’s appearance
Apathy: indifference toward otherwise exciting activities
Overwhelming anxiety: nervousness, especially in social situations
Sensitivity to criticism: unable to accept critique, even unrelated to appearance
Excessive worry about appearance: exorbitant time in front of the mirror
Spending an excessive amount of time on grooming or dressing: heavily applied makeup, unable to select clothing choices, or using clothing to hide parts of the body
Extreme dieting or exercise: going through diets or working out to gain or lose weight
Obsessive focus on appearance in pictures: taking repeated pictures, filtering, or editing beyond reality
Need for external validation: seeking reassurance from others including solicitation of compliments and engaging in risky behavior as a means of validation through sex, drugs, or dangerous behavior
Body modification: obsession with cosmetics, procedures, drugs, or medications like steroids or diet pills in order to achieve a desired look
Narcissistic tendencies: overcompensation of insecurity through harsh criticism of others, selfish behaviors, or inability to respect other’s boundaries
Constant comparison of self: ranking one as better or worse in terms of appearance, intelligence, material goods, or social status
Let’s get real… where does body dysmorphia come from?
Like most mental health disorders, we don’t know for certain, but we have theories. Yes, body dysmorphia has a biological component, in that those with certain chemical imbalances may have an increased risk of the developing condition. Body dysmorphia tends to manifest as a result of environmental experiences, often traumatic ones. This could be as seemingly trivial (but certainly not trivial) as being made fun of even just once as a kid. Maybe someone says to a kid at school “why are your eyes so big” or “why do you have man-boobs?”
Boom.
Here is something that kid never heard before. But in the context of adolescence and perhaps other mini-traumas at home, school, or elsewhere, this comment has turned an entire concept of self upside down. Or, maybe a parent makes comments about physical appearances to a child, or maybe makes comments about their own physical appearance in front of a child. Or maybe an abusive partner says or does something about appearance. How about things said on TV or through social media about what is sexy and what looks good? You bet these settings manufacture damaged thought processes about body image. The point I am trying to make here is that where body dysmorphia can stem from really depends on the individual and their experiences.
A holistic approach to body dysmorphia
News flash! Holistic and integrative psychiatry provides a great platform for addressing things like body dysmorphia. Remember, a holistic and integrative approach includes things like medication, where appropriate. But we dig deeper here. We look for potential root causes in the physical or biological sense that might predispose certain symptoms so that we can address those symptoms from a whole-body perspective. For body dysmorphia, talk therapy is absolutely critical. We have to change the way we think about our bodies in order to change the relationship we have with our bodies. Other things like the development of healthy routines, nutrition and exercise plans, and mindfulness practices will significantly improve the way in which we carry ourselves, relate to others, and respect our bodies.
So a good holistic game plan for body dysmorphia may include combination of the following:
Medication: Remember I view medication in most cases like “training wheels” – if we aren’t learning new skills, pills won’t solve the problem.
Therapy: Changing the way we think about our bodies to overcome disruptive thoughts
Coaching: The development of healthy routines that optimize our daily lives and encourages a healthy lifestyle helps us to reduce stressors that can compound struggles with body dysmorphia
Nutrition & Exercise Planning: Our physical health impacts our mental health. By approaching our physical health as the foundation to mental health we are more likely to be successful
Supplementation: Nutraceuticals can be viable options instead of medication in some cases, can help fill gaps in nutrition, and address potential biological imbalances
Mindfulness & Meditation: Learning to be live in the present helps reduce symptoms of depression and anxiety, which are often synonymous with body dysmorphia
Genetic Testing: This helps us identify how to use medication and if there are certain biological markers that might predispose us to certain disorders or behaviors
As always, not every plan will include medication or any other intervention (although all likely include therapy). Each holistic plan should be tailor to the needs of the individual by a provider who understands the complexity and nuanced presentation of a disorder like body dysmorphia.
Conclusion
Body dysmorphia is an invasive and intense worry about how one looks, remember the key here is that this behavior is invasive and intense. Symptoms often mimic other mental health disorders like depression or anxiety. Usually individuals struggle with body dysmorphia in the dark, but you may see signs of insecurity, difficulty in social settings, worry about appearance, and sensitivity to criticism. Paradoxical symptoms are not uncommon and include selfish or risky behaviors, overly critical of others, and a constant comparison of self to others. These thought patterns are multifactorial in origin and include biological, environmental, and experiential components. A comprehensive holistic approach is the best way to address body dysmorphia. Holistic approaches include therapy, coaching, lifestyle optimization, and medication where appropriate.
If you have questions about integrative psychiatry, are interested in seeking care, or are interested in learning about how to practice integrative psychiatry, please reach out to me via email at ryan@proactivepsychiatry.com. I am working to spread the word about integrative psychiatry, so feel free to repost this blog, just be sure to cite my post!