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What Is Body Dysmorphic Disorder (BDD)?

Flipping through magazines as a teen, it was impossible not to compare myself to the airbrushed faces and bodies on the pages. Today, these images have gone digital. And it's not just models in magazines anymore, because anyone can alter their appearance online. Want bigger lips? Smaller waist? Bigger biceps? A six-pack? You got it. You can completely change your online image from the one staring back at you in the mirror. But that disconnect, the gap between real flesh and blood human to modified, idealized online persona, is starting to have an effect on how we see ourselves. And researchers are asking more questions about what these digital manipulations are doing to our perceptions of our bodies and self-image IRL.

A growing number of studies show that social media can have a measurable negative impact on body image and self-esteem. Some research even suggests that scrolling through altered or filtered photos and videos on social media feeds may be a trigger for more serious mental health conditions like anorexia, bulimia, and body dysmorphic disorder.

Body dysmorphic disorder is a condition in which people think there's something very wrong with their physical appearance. People with BDD obsess about these perceived imperfections. It's not just a fleeting thought, or a few minutes a day. They think about it and worry about it a lot, typically between three and eight hours a day. It's probably a little bit more common in women than in men. That's what we find in the general population studies.
What Is Body Dysmorphic Disorder (BDD)?
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BDD is only diagnosed when the perceived flaw in appearance is actually nonexistent or only slight. But most people with BDD don’t realize that the flaws they perceive are actually minimal or not even there. They believe the flaw is clearly noticeable and seems unattractive or ugly to others. And like Dr. Phillips said, BDD can be found in people of all gender identities. Unfortunately, there’ve only been a handful of nationwide studies into how common BDD really is in the general population. But these early studies have revealed startling numbers. It’s estimated that BDD affects close to 2 to 3 percent of the population, and that’s somewhere between 5 to 10 million people in the U.S. alone. So that makes it more common than obsessive-compulsive disorder, anorexia nervosa, or schizophrenia, so it's very under-recognized and under-diagnosed.

Every case of BDD is different and they can range in severity. In some cases, it can be incredibly debilitating, to the point where a person withdraws completely from school, work, and social life, like Kitty. I was spending hours in front of the mirror obsessively picking at my skin, putting makeup on, taking it off, because it wasn't right, and putting it back on again. And what I saw in the mirror was a monster. I just thought everyone would be horrified if they saw me, so it was just safer to stay at home. This mental health disorder most often begins in early adolescence, and those with BDD often focus on multiple body parts.

Some people who suffer from it have likened their experience to staring into a permanent funhouse mirror, where your self-image is wildly distorted by your own brain. Basically, people with BDD perceive themselves differently. In one of the first studies looking into this, researchers compared the fMRI brain scans of a small group of people with BDD to those without the disorder, and they found a clear difference.

When viewing a batch of highly detailed photos of strangers and a batch of blurred images of those same strangers, individuals with BDD used the left side of their brains much more than the control group. And the left side is the part that processes detail. Those without BDD, or the control group, used the right side of their brain more, taking in a more holistic image, and they only switched to using their left side when processing the highly detailed images.

The researchers concluded that those with BDD focus more on the details than on the bigger picture, basically, as one researcher put it, they were “losing the forest for the trees.” I focus on different areas of my face, my body, or whatever. And then in my mind, that creates a picture of what I look like. But of course, that creates a distorted image of how I look, because certain features are distorted to be bigger or worse. I think a major misconception is that BDD is just vanity. That trivializes it and it trivializes the suffering of people with BDD. For an illness that was first described over a century ago, it’s only been in the past few decades that a continued research effort has gone into better understanding this disorder. And there are still some key questions that researchers are trying to figure out. What exactly causes BDD, and what are its triggers once someone has it?

Now, the cause of BDD is very complex. And it's not anyone thing that causes BDD. It's probably about 40 to 50% genetically based. The rest of BDD is due to, you know, we think broadly in terms of environmental factors, that's a very big bucket. These risk factors may include a lot of things like being teased when you’re young, societal messages dictating what you should look like, or as we mentioned earlier, research now looking into whether the hyper-edited images on social media have become a trigger as well. And this is something Dr. Phillips has seen change over her 30 years of studying BDD. I think for some people it is and we don't have good research studies on this issue.

Studies in non-BDD groups have shown that certain forms of social media can worsen body image concerns, which in turn can worsen depression. In my own patients, my sense is that certain forms of social media can make BDD worse.

Social media platforms like Instagram, Tiktok, and Snapchat, where it’s easy to compare your own appearance to that of others, might be more likely to worsen body image than platforms that don’t focus on appearance or don't allow editing of one’s face or body. And in all of these apps, there are built-in features that can alter your looks like thinning your face, smoothing out your skin, or applying makeup.

We just need studies of social media in people with BDD specifically. And now I think increasingly, we see that certain forms of social media can be so distressing for people with BDD. Kitty, for example, used her own experience in her work with the Body Dysmorphic Disorder Foundation. I would always say it's important to be mindful of how you're using anything. Because when you've got BDD, almost anything could be triggering.

So it's about learning to cope with these challenges and find new ways of managing them. But platforms like Instagram, Snapchat, and Tiktok aren’t all bad, either. They can provide a space to raise awareness about things like BDD and create a stronger sense of community. And talking more openly about disorders like this, and the role social media may play in perpetuating them helps tackle the stigma around these issues too. And the good news is that BDD is treatable.

One of the most effective ways to treat it is with a medication called SSRIs. These can limit compulsive behaviors, lessen obsessions, depression, and anxiety over the perceived flaw and also make it easier to be around other people and to function well in daily life. Another treatment is a specialized form of cognitive-behavioral therapy that focuses on identifying the patient’s appearance-related thoughts and behaviors and then applying cognitive restructuring, ritual prevention, and exposure techniques. And good treatment can be transformational for folks like Carly, who has dealt with BDD for over a decade. I often think of my journey, as, it's been a little friend that's come with me.

So from that 11-year-old little girl who had a demon, and she sort of latched on to me, and she obviously wanted to pick me apart. She was a bully. I like to think that from then, to where we're at now, she's sort of becoming my friend. So I keep her at a distance. But when she does come, and she will hurt me, I just have to remind her that she's only allowed a few hours, maybe a day max, and then she's got to go back.

Some who suffer from BDD may think the solution is undergoing cosmetic procedures to alter the flaw they're fixated on, but this usually doesn't improve their issue and can actually even make the fixation worse. And the reason is that BDD is a body image problem. It's not a problem with actual appearance. It’s not really a body problem, it’s a perception problem. Ultimately, we need more research.

Body Dysmorphic Disorder is its own separate issue, but those who struggle with it may also struggle with an eating disorder, obsessive-compulsive symptoms, a great deal of anxiety, substance abuse, and even suicidal ideation. So the more we know about what’s going on in the brains of those with it, the better equipped we’ll be to help those who are dealing with BDD.

If you think someone may have BDD, it's important to take it seriously and encourage the person to get help. Filters can be fun. Social media can be fun, and it's a great place to be creative. But I hope you don’t see the way other people look, or the way a filter makes you look, and think that’s how you should look. I know it's easier said than done, but this is the only body we get, so better to spend our time making friends with it than being at war with it, right? You are enough, just as you are.

If you or someone you know is struggling with BDD or something similar, we’ve included resources in our description below for more information on where to find help. Thanks so much for watching Seeker’s new series, Body Language. I hope you’ve enjoyed this video. And if there’s another health topic you want us to cover, leave us a comment down below, and I'll see you next time!