YOU LOOK DISGUSTING
When You Hate Your Appearance — Living With Body Dysmorphic Disorder
Not liking your nose is one thing — trying to hide it from the world is another. People with body-image issues have anxiety problems that need to be treated.
By Marie Suszynski
Medically Reviewed by Cynthia Haines, MD
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Most people have something about their appearance that they dislike or wish they could change. But imagine worrying so much about an aspect of your body — maybe the shape of your nose or an uneven skin tone — that you literally spend hours thinking about it, until you start canceling lunch dates so others don’t see that perceived flaw.
Some people with body dysmorphic disorder, or BDD, obsess about their body image so much that they can’t think about anything else. On average, people with BDD think about their perceived flaws for three to eight hours a day, which is much more often than the average person, says Katharine Phillips, MD, professor of psychiatry and human behavior at the Warren Alpert Medical School of Brown University in Providence, R.I.
BDD leads to depression, anxiety, shame, and other negative emotions, Dr. Phillips says, and significantly interferes with day-to-day functioning. Some people with BDD become homebound or even suicidal. In fact, a large proportion of people with BDD think about and attempt suicide, Phillips says: “This disorder needs to be taken seriously and appropriately treated.”
Anxiety problems may have something to do with a poor body image or BDD, although doctors also say that genetics and environment play a role.
BDD: About the Disorder
The 1 percent of people who have BDD think they’re ugly, deformed, or abnormal. Some even feel as if they look monstrous. But the truth is far different. “The person with BDD looks normal,” Phillips says. “The flaws they perceive can’t be noticed by other people or are only slight.”
The supposed imperfection could be anything, but experts say it most commonly has to do with the hair, skin, nose, chest, or stomach. People with BDD may spend a lot of time doing their hair or makeup, changing their clothes, or exercising. Some may even get plastic surgery, but are likely to never feel as if the alleged problem has been fixed.
People with BDD also tend to do things compulsively to hide what they hate. They may avoid mirrors or constantly check their appearance in a mirror. They may try to hide the offending trait with hats, makeup, hairstyles, or certain clothes, or by positioning their body for camouflage.
People with BDD also tend to compare their appearance with that of others. BDD can cause people to avoid socializing, and they may even have trouble with work or school.
BDD: Triggered by Anxiety?
Jennifer Greenberg, PsyD, a clinical research fellow at Massachusetts General Hospital and Harvard Medical School in Boston, says that doctors don’t know the exact cause of BDD, but they think it develops from a combination of:
- Brain chemistry
- Psychology — being a perfectionist, for example
- Environment — being teased as a child, your family values, or living in a culture that emphasizes appearance
And the last point is a big one: We live in a time when the message is that beauty is everything, says Susan Walsh, PsyD, a neuropsychologist and assistant professor in the department of psychiatry and behavioral neurosciences at Loyola University Health System in Maywood, Ill.
That puts pressure on the average person to look perfect, but for someone who may have a poor body image or be prone to BDD, it can cause even more problems. “If a person has an addictive type of character with low self-esteem, it’s a perfect combination (for BDD),” Dr. Walsh says, adding that stress or trauma can also put someone at risk for BDD.
People who have anxiety disorders such as obsessive-compulsive disorder (OCD) or social anxiety disorder are also more likely to have BDD, and those with depression and eating disorders, such as anorexia nervosa or bulimia, may also be at higher risk for it.
BDD: Diagnosis and Treatment
If you’re wondering if you have BDD, a starting place could be a self-test developed by Phillips. But keep in mind that the test is not a diagnosis, only a screening for BDD.
If you think you may have the disorder, you should see a therapist who has experience in BDD or OCD to get a diagnosis. Try going to the or the to find a therapist who can help.
For treatment, doctors have found that cognitive-behavioral therapy (CBT) can effectively lower the amount of time people spend preoccupied with body image and practicing compulsive behaviors such as checking their appearance in mirrors. CBT works by changing thoughts and helping people feel more comfortable in situations that usually cause anxiety.
Doctors also treat BDD with selective serotonin reuptake inhibitors, or SSRIs, a class of prescription antidepressants. Studies have found that these medications can have a significant effect on symptoms of BDD for most people.
What doesn’t work: Getting plastic therapy, skin treatments, or dental work to hide your perceived flaws. That’s because the root of BDD isn’t about your appearance, it’s about the way you look at yourself.
You don’t have to live a life obsessively concerned about your body. Most people who seek treatment for BDD see improvement. The amount of time it takes to feel better varies from person to person, but sticking to your treatment should help you better enjoy life.
Video: Why thinking you're ugly is bad for you | Meaghan Ramsey
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