When you look in the mirror do you fixate on a part of yourself that you despise? This can be problematic for people of all ages and cultures around the world.
Body Dysmorphic Disorder or “imagined ugliness” (Phillips, 2004) leaves people believing “they look ugly or deformed (thinking, for example, that they have a large and ‘repulsive’ nose, or severely scarred skin).” When in reality, these “perceived defects” are not observable or appear slight to others.
As a result of these perceived “deformities”, some individuals to stop socializing, working, or become home bound and hide in shame. For some who cannot find relief or help, Body Dysmorphic Disorder may impair them so deeply, they may attempt to take their own lives.
The full diagnostic criteria for the disorder is met when an individual is preoccupied with the defect(s) or flaw(s), and at some point they perform repetitive behaviors like checking the mirror frequently, grooming excessively, skin picking, reassurance seeking or mental acts such as comparison to others due to their own preoccupation (American Psychiatric Association, 2013). In addition, these beliefs would have to cause “clinically significant distress or impairment in social, occupational, or other important areas of functioning, and this preoccupation is not better explained by someone with concerns of weight or body fat in someone who meets the diagnostic criteria for an eating disorder.”
Concerns of individuals with Body Dysmorphic Disorder tend to focus on the face or head; but can include any body area, or the entire body. Typically, the individual has multiple areas of concern. Another commonality is the impairment causes at least 3-8 hours a day of preoccupations which are “associated with fears of rejection and feelings of low self-esteem, shame, embarrassment, unworthiness, and being unloveable” (Phillips, 2004).
This disorder is “typically seen first in teens and pre-teens, around the age of 12, and it affects both men and women equally, occurring in about 2.5% of men, and 2.2% of women (Lyons, 2020). Learning how to manage distress is a helpful tool for all of us, but also “one way to help keep adverse behaviors at bay” (Lyons).
Medication for depression, and Cognitive Behavioral Therapy can be very helpful to identify maladaptive beliefs, according to International OCD Foundation (Hartmann, Greenberg, & Wilhelm, 2020). Just like other unhealthy thinking styles, common errors of thinking can be found in people with Body Dysmorphic Disorder. Some examples include:
Personalization - “I know others are staring at my acne scars and think I’m hideous”
All or nothing thinking – “My nose makes me look repulsive”
Mindreading – “I know my girlfriend wished I had a six pack instead of a roll over my jeans”
In working with people in counseling, we help clients overcome these common unhealthy narratives. We also help identify any underlying core belief that the individual feels they are unlovable or not worthy of love, or another harmful belief. These deep beliefs usually begin in childhood and can cause much agony, resulting in internalized depression as well as skewed thinking that can lead to years of pain, suffering, and impairment.
Other therapy modalities include mindfulness, acceptance, and value-based living (Anxiety and Depression Association of America, 2020). These modalities can lead to living life in the present moment, non-judgmentally, accepting oneself for all that they are, as well as the the truth of all they are not.
Should you know someone suffering from these types of beliefs, please encourage they seek help to prevent them from many years of silent suffering. Should you catch yourself belittling your own reflection, remember you are uniquely you and you are so much more than your perception. Also remember that your beautiful children may be listening and could mirror the thinking style you model about their own bodies.
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Teresa Jacobson is a Doctor of Behavioral Health and Licensed Professional Clinical Counselor Supervisor counseling men and women adults in Ohio. You can reach her for a free consultation for confidential telehealth sessions at (513) 234-9184, email, firstname.lastname@example.org, or feel free to visit her website at www.jacobsoncounseling.org
American Psychiatric Association (2013). Desk Reference to the Diagnostic Criteria from DSM-5
Anxiety and Depression Association of America. ACT with CBT for BDD: More than alphabet soup.
Hartmann, A., Greenberg, J., and Wilhelm, S. (2013) A therapist's guide for the treatment of body
dysmorphic disorder. International OCD Foundation. https://bdd.iocdf.org/professionals/therapists-guide-to-bdd-tx/
Lyons, L. (2017). Body dysmorphic disorder. https://www.eatingdisorderhope.com/blod/dd-mirror-lies
Phillips, K.A. (2004). Body dysmorphic disorder: recognizing and treating imagined ugliness.
World Psychiatry 3(1):12-17. https://www.ncbi.nlm.nig.gov/pmc/articles/PMC1414653/