Managing Body Dysmorphia: The Mental Funhouse Mirror

What is Body Dysmorphia?

Suffering from body dysmorphia is like living in a funhouse mirror - no matter how others perceive you, all you can see is a twisted reflection of yourself in your mind’s eye. A full belly becomes a gut; a light spray of acne becomes a disfiguring welt. You may find yourself constantly looking in the mirror picking at your skin, or obsessively measuring your waistline, or losing sleep as you lie awake comparing your appearance to others. Friends and relatives don’t see your “flaw” the way you do, and it may be frustrating to talk about it with them. No matter what you do to address the issue, nothing seems to affect the part of you that you hate. At its worst, body dysmorphia can make you feel that it’s not worth living if you can’t control the way you look.

In contrast to common insecurity and low self-esteem that may be alleviated by a new look or fun experience, body dysmorphic disorder is a disruptive thought pattern that causes sufferers to focus almost exclusively on a perceived flaw, and to invest disproportionate time and resources in addressing that flaw. Focuses for sufferers can range from temporary superficial imperfections like acne, wrinkles, and body hair, to characteristic traits like nose shape and size, body type, and hair thickness and texture, among others. An average person will still make it to work that day if a pimple pops up on their chin. A person with body dysmorphia may see the same pimple and call out sick, afraid to let others see their imperfection.

Some sufferers turn to plastic surgery, disordered eating, extreme beauty treatments, excessive exercise, and other risky behaviors for the sake of concealing or destroying what makes them feel ugly. Commonly, even if these behaviors seem to have the desired effect on the sufferer’s appearance, the feelings of ugliness and shame persist. If untreated, this negative thought pattern can develop into chronic anxiety, and even depression and suicidal ideation. The sufferer may also experience adverse health effects from pursuing more extreme forms of body modification to achieve an imagined perfection.

What causes Body Dysmorphia?

There are a number of risk factors that increase your chance of developing body dysmorphia. These can include family history of the condition, societal pressure over beauty standards, existing mental illnesses like depression and anxiety, and negative life experiences like neglect, bullying, or abuse. The feelings at the core of this disorder are inadequacy, shame, perfectionism, and fear of ridicule, and those feelings may be completely internal, or instigated by a negative family situation or romantic relationship.

The disorder is common among teenagers whose changing bodies can present a real challenge to them. As they increase their social interaction with the world, they’re encountering acne, changes in weight distribution, and new hair growth. While to others these are just normal if unpleasant aspects of puberty, these changes can feel monstrous and unwelcome to a young person. Add to this a deep engagement with social media, where beauty standards are impossibly high and widely standardized, and you have a perfect recipe for a skewed self-concept. While some grow out of this way of thinking, others can’t shake the sense that they were made wrong, and need to correct or hide the way they look.

How can you treat body dysmorphic disorder?

Research tells us that while cosmetic and surgical interventions can often make body dysmorphic disorder worse, engaging in talk therapy can provide long-term relief from your symptoms without changing your appearance at all. As with many mental health disorders, treatment depends on severity and how long you’ve suffered from the issue. If you find yourself spending multiple hours in the day looking in the mirror, avoiding photos or social situations so that no one can see you, or stuck in depressive thought patterns around your appearance, a therapist can be a good resource to address the way you think about your body.

While you’re waiting for your appointment, explore these exercises to help you build positive thought patterns around your body, and begin to see yourself for who you truly are.

Avoiding “All-or-Nothing” in Self Talk

The things we hear repeatedly on a regular basis change the way we think, especially when those things come from our own heads. If you feel intensely uncomfortable about the way you look, the language you use to talk about yourself is probably also intense, using extreme words like “always,” “never,” and “completely.”
“I always look terrible in photos.”
“I’ll never find love if I don’t lose weight.”
“My skin is completely disgusting.”

The truth is, things rarely fall into these “all-or-nothing” categories, and speaking about ourselves in these terms creates a false reality. A therapist can help you dig deeper into these self-talk patterns, but for now try to catch yourself when you say something about you is “always,” “never,” or “completely.” When you notice yourself making an internal comment like this, pause and try to come up with a more balanced version of the sentence that speaks more truly to real life.
“I think I look terrible in this photo.”
“I may or may not lose this weight, and the right person will love me for who I am.”
“Sometimes I feel like my skin is disgusting.”

Notice that the revised scripts aren’t completely self-affirming, and they don’t have to be. Just focus on building a pattern of reassessing thoughts that use all-or-nothing language. It will take time to change the way your brain works, but this tiny adjustment makes you aware of what information comes from outside, and what comes from within.

I Can’t Read Minds

A lot of the insecurity and shame that comes with body dysmorphia stems from our belief that we can read people’s minds. People can say cruel things that change the way we think about ourselves, and we can start to assume that everyone will think about us in that way. We preemptively criticize and conceal ourselves to feel safe from these assumed attitudes, and we rarely stop to wonder how we know what everyone's thinking.

While our natural empathy may allow us to guess others’ emotions, it can’t tell us for certain how another person feels or thinks about us. If we’re already feeling badly about ourselves, we tend to project that feeling onto others, so it’s difficult to know someone’s opinion of you unless you directly ask them. All that to say, pay attention when you find yourself trying to read minds.
“I know my girlfriend hates my acne.”
“That guy looked at me funny because of my nose.”
“I can’t go to the beach - everyone will judge my body.”

In each case, you’re assuming that you accurately guessed what other people are thinking about you, and that their thoughts about you are negative. You are likely also using their assumed disgust as validation of your own view of your body. It can be hard to untangle these cognitive threads, but a small intervention can be a helpful first step.

Write the words “I cannot read minds” on a post-it, or on your phone so that it stays top of mind. Every time you find yourself assuming others’ thoughts and projecting negativity onto them, refer to your note and remind yourself that the information you think you’re receiving from them is false, or at the very least incomplete. Reword the sentence to allow the possibility of an alternative:
“I think my girlfriend hates my acne, but that may not be true - she’s never said so.”
“That guy looked at me funny - I assume it’s because of my nose, but maybe that’s just how his face looks.”
“People will see my body if I go to the beach, and some may not like it, but most probably won’t even notice.”

Again, we’re not asking you to break from insecurity and revulsion around your body completely - just to start introducing your brain to a new script that may start to take over as you practice this revision. You don’t even have to believe the words you’re saying to yourself at the outset; that will come later. For now, focus on feeding your brain new information to balance the negative information it’s been eating.

Self-Esteem Pie

Our self-esteem is generally based on a number of factors - professional and educational achievements, relationships with family and friends, hobbies and skills, and personality traits. You can arrange these aspects of your life into a “self-esteem pie,” a pie graph that shows each of the things you base your self-esteem on as a slice.

If you suffer from body dysmorphia, your self-esteem pie may look quite different from others. While your personal traits and achievements may be part of it, your appearance probably takes up a disproportionate amount of the pie chart - maybe half to three quarters.

Try drawing your self-esteem pie, and set your appearance to one quarter of the chart to start. Fill the rest of the chart with other things that make you feel good about yourself - your sense of humor, your creativity, your mental and physical strength - anything that you consider a positive aspect of your life and personality. Put the pie somewhere you can see it daily, and refer to it when you find yourself anxious or upset about the way you look - even if one quarter of the chart is out of your control, the other three quarters are filled with things that balance it out. Try to redraw the chart on a regular basis, perhaps once a month to start. Increase the number of sections in the chart each time - from four to six, six to eight, etc. Each time only allow one slice for your external appearance. As the slice grows smaller and the rest of the chart fills with other positive qualities that make up the complex and interesting person you are, you may find it easier to recall these positive things to mind when you feel stuck in your mirror.

Conclusion

Body dysmorphic disorder can be a serious and life-disrupting challenge to our long term happiness and wellbeing, but many sufferers experience some form of recovery after working with a therapist for a period of time. Whether that’s pushing yourself to see friends even though you feel insecure, or going to the beach in a swimsuit even if it scares you, the new things you will try under a therapist’s guidance will make your world bigger and more beautiful, and give you another look at yourself that is more loving, compassionate, and balanced.

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