The dissatisfaction with one's body image is, at times, part of a mor complex clinical scenario, such as BDD (also known as Dysmorphia).
In the most recent version of the Diagnostic Statistical Manual of Mental Disorders, BDD has been placed within the Obsessive-Compulsive Disorder spectrum
The DSM-V criteria for diagnosing Body BDD focus on :
excessive preoccupation with one or more defects/imperfections in physical appearance
enactment of repetitive behaviour or mental actions in response to the preoccupation
severe impairment of daily functioning
You might find the full description and differential diagnosis here.
In recent decades, the prevalence of BDD has reached an incidence of 2.5% in the general population and 7-15% of people using cosmetic medicine ( i.e. fillers, Botox, RF, laser) as well as cosmetic and plastic surgery treatments.
Nevertheless, the true prevalence may be much higher. This is due to a general tendency to underdiagnose this disorder and, above all, the failure of those affected to seek psychological help.
aetiology
Usually, dysmorphic feelings about one’s body emerge during adolescence.
It is around the age of 13 that a series of control strategies may appear. Such strategies may include looking at oneself obsessively in the mirror, changing clothes in an attempt to hide something perceived as a flaw, or applying exaggerated makeup to hide the defect.
Although the aetiology of body dysmorphism is unclear, it is thought that certain biological and environmental agents may represent important risk factors.
These factors also affect the psychological sphere and become a working target during psychotherapy, including possible genetic factors linked to a family history of BDD ( although this could be explained by a parental style marked by an excessive emphasis on physical appearance/physical characteristics).
Certain life experiences that coincide with the typical age of onset of the disorder may also contribute to its development; these include episodes of bullying or ill-treatment by peers.
In addition, structural factors closely linked to the person, such as character traits oriented towards perfectionism, low self-esteem, fear of being alone and fear of social judgement, may also contribute.
Interpreted by Kraepelin as a compulsive neurosis, Janet defined dysmorphia as "an obsession with body shame", emphasising the intrusive nature of thoughts.
Symptoms of body dysmorphism
As mentioned, in BDD one or more details of their physical appearance become the source of overwhelming anxiety.
As with obsessive-compulsive disorder, the main symptoms are intrusive thoughts (obsessions) about one's physical appearance, intense emotions judged as intolerable, and compulsive behaviour implemented to resolve the situation.
The main concerns include:
Genitals
Nose
Nose
Hair
Teeth
Abdomen
Mass
Those who suffer from BDD are often inclined to avoid social situations And often perform rigid rituals, such as changing clothes, exercising excessively, styling their hair in a certain way, etc., in order to conceal the problem.
Usually, protective behaviours concern:
Repeatedly looking at oneself in the mirror or avoiding them at all costs
Spending hours on social networking sites comparing one's appearance with that of others
Excessive self-care
Excessive exercise
Seeking for reassurance in others
Compulsively buying body care products
Excessive wearing of make-up to hide alleged imperfections
Excessive request for cosmetic corrective procedures (including surgery)
Avoiding public exposure
Body dysmorphic disorder, in severe cases or if left untreated, can lead to depression, self-harm and suicidal thoughts.
The preoccupation with body image remains one of the core roots of BBD. But what do we mean by Body Image?
Body image
The body image is the subjective and conscious representation of one's body, generated at the reflexive level with the input of information from sensory channels.
It is influenced by various factors, such as the environment during formative years, the peer group and the media, which has grown exponentially with the arrival of social media, making access to various sharing platforms via smartphones always accessible.
Dissatisfaction with one's body image often surfaces in adolescence. Social comparison, combined with the internalisation of ideals, is one of the main mechanisms involved in the perception of one’s body image. These two mechanisms are instrumental in the development of body dissatisfaction.
Scientific studies
Several studies have shown that individuals who compare their physical appearance with that of others considered more attractive than themselves are more likely to be dissatisfied with their body image.
In one study, it was found that higher overall Instagram usage was associated with greater self-objectification (i.e. perceiving oneself as solely a function of one's physical appearance). This relationship was mediated by both internalisation and comparison of one's own appearance with the aesthetic canons present massively on social media.
Pandemic and the use of social networks
Over the past year, the pandemic provoked a sharp increase in the use of social networks, which have also played a very positive role in dealing with isolation.
However, as we have already pointed out, various studies confirm that increased exposure to images of 'others' deemed more attractive corresponds to a growing dissatisfaction with one's own image.
For those who had to attend meetings or attend lectures from the computer, the use of video calls meant constant exposure to their own image on the screen.
The so-called “Zoom Dysmorphia” has been affecting many people in the past two years. By being able to look at themselves during calls, as if they were constantly in front of a mirror, many people are distorting their self-image.
A German study by Quittkat and colleagues analysed the impact of the Covid-19 pandemic on mental health. A considerable increase was found in certain classes of symptom disorders: Generalised Anxiety Disorder, Depression, Health Anxiety, and BDD.
BDD and online dysmorphia
As explained, the core of BDD is the excessive and persistent preoccupation with physical defects. Whether present or not, the preoccupation that arises talkingsignificantly impairs the individual's quality of life and functioning, causing great distress.
For some time now, there has been talk of new forms of body dissatisfaction arising online: if linked mainly to videos and photos, one speaks of 'Snapchat dysmorphia' or 'Instagram dysmorphia' or more generally 'selfie dysmorphia' or 'filter dysmorphia'.
Instead, we refer to "Zoom dysmorphia" when the discomfort is related to one's image in video calls” (Ramphul and Mejias, 2018) since those became the main form of communication for work, school and socialising during the pandemic.
Video call services also offer filters to retouch one's appearance, reinforcing this trend (Pfund et al, 2020).
Beyond the specific term, what is crucial is that we are dealing with digital lens images that can be edited and filtered; images and videos that we have an eye on all the time. It is precisely this continuous observation of oneself that can lead to noticing, and exacerbating, aspects that we do not like.
their
The search for help
As pointed out, seeking psychological help, despite great suffering, for people with dysmorphic feelings is not a matter of course.
Learning emotional regulation strategies, gradually exposing oneself to feared situations and promoting a compassionate attitude towards oneself (with Compassion Focused Therapy) facilitates the resumption of a more functional and satisfying everyday life for those suffering from this disabling and often little-known disorder.
BDD tends to be chronic. However, in several cases, cognitive-behavioural psychotherapy and psychodynamic psychotherapy have proven effective.
Cognitive-behavioural psychotherapy can be helpful in eliminating cognitive distortions and erroneous beliefs about alleged body imperfections and also in reducing anxiety, often associated with the disorder, through deconditioning and relaxation techniques.
Psychodynamic psychotherapy can help detect certain psychic dynamics that may underlie the disorder and that may have been triggered by experiences in childhood or early adolescence.