What is body dysmorphic disorder?
When bodybuilder and fitness coach Lindsey Marie Greeley was just 17 years old, she competed in her first bodybuilding show. She would stare in the mirror in the weeks leading up to competitions, “trapped in her head,” obsessed with having the perfect body. She would be devastated by a third-place ranking and by “constructive criticism” from the judges such as “You still aren’t small enough; you need to lose more weight.”
Before long, she’d developed body dysmorphic disorder (BDD), along with an eating disorder. It’s not just athletes and bodybuilders that are affected by the condition, Swinburne University of Technology estimates that up to 2 per cent of the general population live with BDD.
BDD diagnostic criteria
Some people don’t like part (or all) of their body, but BDD goes beyond dissatisfaction. According to the psychiatric manual DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition), this is the criteria used to indicate a patient has BDD:
- Preoccupation with non-existent or slight defects and flaws in appearance
- Repetitive or compulsive behaviours, such as mirror checking or changing clothes many times
- Clinical significance, meaning the obsession must cause significant distress or must inhibit everyday functioning, such as a person’s social life
- Differentiation from an eating disorder, which ensures that the clinician shouldn’t actually be diagnosing the person with an eating disorder
- There are two additional further distinctions to the diagnosis:
Muscle dysmorphia: a person is particularly worried about their body build (muscles) being too small or insufficient. This specific type has been linked to higher suicide rates and poorer quality of life than other types.
Insight specifier: how accurate or inaccurate a patient’s perception of themselves is.
Beth Rosenbaum is a clinical social worker and therapist with over 30 years working with eating disorders and BDD. She says that there can either be an infatuation with reaching a certain size or weight, or people can have a preoccupation with how a certain body part looks. She typically sees women obsessing over their breasts, stomachs, and thighs, trying to fit the “societal perfection expectations for women.”
For men, often it’s the stomach, chest and muscles, abs, biceps, and a concern they aren’t meeting a standard as well. She’s also careful to differentiate between BDD and body dissatisfaction.
The emotional toll can be severe, with people thinking about the body part(s) they hate many times per hour, disrupting their daily lives and ability to concentrate.
What causes BDD?
There isn’t one cause, but a variety of triggers in conjunction with past or current traumas in the patient’s life. Rosenbaum says it’s often a result of underlying emotional issues that need to be addressed. She also sees most people with eating disorders also suffering from BDD as well.
Societal standards, social media scrolling, and the inaccurate idea that our lives would be better if we were a smaller size, are all to blame, Rosenbaum explains. Mixed messages about society’s expectations don’t help either.
She describes women’s magazines which she says traditionally have told women in particular conflicting messages: “On one side of the cover, it’s the miracle diet next to how to bake the perfect cake. I did a research project on conflicting messages…what do we do with that?”
BDD can also be associated with transgender patients who are transitioning.
“People who were born with a female gender [and now identify as male] may have a hard time with breast development and hips and stomach, and that too can lead to eating disordered behaviour,” Rosenbaum says. She also sees other major bodily transitions, such as pregnancy and postpartum life, being a trigger for BDD. “You could lose all the ‘baby’ weight but your body proportions have changed,” she says.