When Beauty Is a Beast | Body Dysmorphic Disorder Awareness Campaign

Since people affected by BDD are often attractive objectively, it is not surprising that they may be misperceived as being vain and frequently are not properly diagnosed in a timely manner, or ever, in part because their plight is easy to minimize or mock. In fact, feelings of shame and embarrassment relating to worries about being thought to be vain or superficial frequently create barriers to those with BDD being open about the problems they are experiencing, or seeking help even if they want it. This is the difference: vanity is associated with conceit and arrogance about one’s looks while those with BDD worry that due to their “flaws,” they simply don’t measure up in the appearance department – and in a flight of illogic, as persons. Vain people, if anything, drastically overemphasize their beauty; individuals with BDD, if anything, overemphasize their perceived appearance-related defects. However, it is also true that if questioned thoroughly, most of those with BDD do not actually rate their overall appearance as truly deficient but hold strong beliefs that, for them, anything less than extreme attractiveness is unacceptable. Interestingly, typically they are not too concerned about the appearance or flaws of others- to the contrary, they may be quite accepting. It would be disingenuous to say physical attractiveness is irrelevant; however, those with BDD exaggerate this “germ of truth” to the extent that preoccupations with correcting their perceived “flaws” comes to dominate their lives to the point of EVERTHING revolving around this one aspect of life. In fact, while they are engaged in pursuing this goal, often nothing else really matters to them. Consequently, they often experience impairments in their relationships and education as well as their ability to perform in the workplace and carry out the basics of everyday existence. Moreover, they engage in self-defeating behaviors such as excessive exercising, and seeking external “solutions” like spending inordinately on beauty products or seeking unwarranted cosmetic surgery. However, they are rarely, if ever, satisfied by the results for very long and ultimately develop poor self-image, appearance-related perfectionism, and obsessive-compulsive behaviors (e.g. repeatedly examining – or avoiding examining – their reflection, trying to disguise the body part(s) they are worried about with exaggerated make-up, hats, baggy clothes, bottomless-pit reassurance seeking, or, in some of the most severe cases, masks). BDD is often accompanied by other psychological problems or diagnoses. Since those with BDD often also seek solutions through modifying their weight via unhealthy dietary or exercise practices, there is considerable overlap between this condition and eating disorders. Mood and identity instability are often prevalent in this population as well. Over time, BDD-related levels of anxiety, frustration, self-disparagement, and depression may escalate in a vicious cycle. If a person with BDD comes to believe that there is no hope for them to see what they want to see in the mirror, they may become particularly high risk for suicidal behaviors. Typically, providing feedback to those with BDD that they appear to be suffering more from psychological issues than physical ones does not really help – nor does getting angry with them, guilt tripping, or “using logic.” In this respect, BDD is functionally very similar to a delusion. In other words, attempting to talk someone with BDD out of his or her worries is typically fruitless. Sadly, this is often also the case with attempts to get them the psychological interventions that they truly need. Similarly, although those with BDD often compulsively seek reassurance about how they look from their friends or family members, complimenting the person with BDD, or telling them they have nothing to worry about often makes them feel invalidated and may result in these good intentions somehow backfiring into accusations of “just not getting it.” This is just one reason why, to the consternation and confusion of others in their lives, people with BDD often will increasingly become isolative and guarded as their concerns escalate. Dr. Jonathan Hoffman