Body Image and Body Dysmorphia Disorder

Heaven, a 16-year old female high school sophomore, came to see me because she had been dealing with a lot of abuse and trauma. Her depression and anxiety caused here to reach out for counseling. It was at the height of the COVID pandemic, and during one particularly difficult session she admitted to me that she had always felt that her thighs were too fat.

When COVID hit, Heaven’s mother immediately withdrew her from public school. She had been failing anyway, and she was failing school– not because she was being bullied, or because there was some sort of other external problem impeding her ability to function at school.

“I couldn’t stop bullying myself about how big and ugly my thighs were compared to everyone else’s,” Heaven said. “I mean, all day long, from the moment that I woke up to the time that I went to bed, all I could think about was how ugly my thighs were, and how I just knew that everyone was staring at me and judging me!”

After she shared that information with me I referred her to an eating disorders specialist and she was, correctly diagnosed with body dysmorphic disorder (BDD). Her therapist strongly encouraged Heaven and her mother to immediately remove Heaven from all social media and to be more aware and selective of the movies and TV she was watching and the music that she was listening to.

Both she and her mother spent several weeks basically detoxing her a lot of popular culture. Heaven admitted that “[detoxing from popular culture] initially was hard, and I was afraid that I was going to miss a lot of stuff—and the reality is that I did, …but what I ultimately ended up missing was my anxiety and my depression. They both got better—a lot better!”

Heaven immediately began to notice that her anxiety became significantly less severe and her depression became more manageable. After several weeks she didn’t even miss all the movies or TV, and her mother reported that Heaven “is a lot like her old self again. She’s happier than I’ve ever seen her.”

She is now seeing her therapist weekly now and is happier than she’s ever been. However, at the height of the pandemic, when the world had basically come to a screeching halt, Heaven’s grades had shot straight up.

When I asked her why she thought she had been doing so much better at school, she instantly sat up straight as an arrow and blurted out, all my school is online and the only thing that we can all see on Zoom is our faces. It’s like the pressure’s totally off and I can focus on being myself and being good at what I do, which is school!”

But I don’t want you to think that BDD affects only females. Unfortunately, it doesn’t discriminate, and hits males pretty hard, too.

Trayvon’s Story

Trayvon is a 17-year old male high school Junior. He came to see me because he recently was placed into foster care and was mandated by child protective services to see me in order to help him to better manage his transition into foster care and into being adopted.

Trayvon is involved in high school football. In fact he’s on the varsity team and in his Sophomore high school year he was one of only several hundred high school football players from across the country who was invited to a prestigious college summer football camp. This football camp is attended by high schoolers from across the country as well as college football scouts from across the country. This was a big deal. Did I mention that he was able to go as a Sophomore? Trayvon is planning to play football at a university on a full athletic scholarship, and he can do it.

The second semester of his Sophomore year Trayvon began having a problem with working out a lot and hyperfixating on eating right and getting his physique exactly like he felt that it needed to be. His workout regime became so severe that he began failing several classes. Instead of paying attention in class and completing his homework at home, he was planning and researching his work outs, or working out.

In all his over focus on his appearance, his muscles and physique, all in order to play football more effectively, Trayvon was actually disqualifying himself from being able to play because he started failing most of his core classes. When I learned of his hyperfixation I referred to a specialist, who shortly thereafter diagnosed him with BDD (specifically muscle dysmorphia).

Since then, Trayvon sees a therapist (who banned him from doing his own “research”), his doctor, and coordinated a nutritional assessment with a clinical dietician, physical therapist, and an athletic trainer, in order to more realistically address his concerns for a healthier daily nutritional diet and work out regime.

Trayvon stopped doing his own research, which basically amounted to reading men’s fitness magazines and websites and watching a lot of ESPN.

“It was like before, when I was trying to figure it all out by myself, it’s like I knew that I wasn’t right…that I wasn’t enough…but I couldn’t stop myself and I was embarrassed to admit to anyone that as cut and as swole as I was, it wasn’t enough for me. It was like I needed to be perfect. I mean, have the perfect body so I could perform at my peak all the time. But now I understand that I’m not a machine and it’s okay for me to work hard and play hard and plan good, but at the end of the day, when I leave it all on the field, I got to be okay with whatever. I’m happy now.”

What Does God Say About You & Your Body?

The Bible has a lot to say about our physical bodies. In fact, in Genesis 1 and 2 the Bible describes the unique ways in which God designed the first man and woman. The physical bodies of the man and woman were created to contain the spirit—the spark of life–that God then breathed into them. They were designed specifically by the Creator Himself to reflect His own image. So Scripture is clear that God cares a great deal about our physical bodies and how we treat them (Romans 12:1).

Because we value the bodies that God gave us, we strive to keep our bodies healthy and functioning well. However, when we place too much focus upon the appearance of our bodies, it can leave us anxious or depressed. Our body image is a direct result of the attention we pay to our particular culture’s ideas of what is desirable or beautiful.

But when we focus too much on our beauty or physique we can tend to become prideful, and pride leads to destruction (Proverbs 16:18; James 4:6). In fact, Psalm 139:13,14 sets the standard for a healthy outlook on body image: “For you created my inmost being; you knit me together in my mother’s womb. I praise you because I am fearfully and wonderfully made.”

If we are fearfully and wonderfully made, then that leaves no room for disagreement with our Creator’s design. Having a clear understanding of who God is and who we are makes it easier for each of us to understand that we were each created for His glory and His pleasure (Colossians 1:16).

When we become followers of Jesus, our bodies become the temple of the Holy Spirit (1 Corinthians 3:16, 6:19, 20). As Jesus’ followers, we treat our bodies with reverence and respect, because they ultimately belong to Him (Romans 6:12, 13). We recognize that they belong to Him because He first created them and then bought them back from sin and death through His own death, for each of us, on the cross of Calvary.

So, our body image should be based on one simple factor: does the way I present my body indicate that my life is dedicated to the glory of God? When God’s glory is our goal, we can have confidence and pleasure in our physical appearance, regardless of society’s standards, knowing that we are pleasing the only One whose opinion matters (Psalm 37:18).

BDD is all about What You See

Body dysmorphic disorder (BDD) is a mental health condition in which you can’t stop thinking about one or more perceived defects or flaws in your appearance — a flaw that appears minor or can’t be seen by others. You may feel so embarrassed, ashamed and anxious that you may avoid many social situations.

When you have body dysmorphic disorder, you intensely focus on your appearance and body image, repeatedly checking the mirror, grooming or seeking reassurance, sometimes for many hours each day. Your perceived flaw and the repetitive behaviors cause you significant distress and impact your ability to function in your daily life.

You may seek out numerous cosmetic procedures to try to “fix” your perceived flaw. Afterward, you may feel temporary satisfaction or a reduction in your distress, but often the anxiety returns and you may resume searching for other ways to fix your perceived flaw.

Symptoms

Signs and symptoms of body dysmorphic disorder include:

• Being extremely preoccupied with a perceived flaw in appearance that to others can’t be seen or appears minor
• Strong belief that you have a defect in your appearance that makes you ugly or deformed
• Belief that others take special notice of your appearance in a negative way or mock you
• Engaging in behaviors aimed at fixing or hiding the perceived flaw that are difficult to resist or control, such as frequently checking the mirror, grooming or skin picking
• Attempting to hide perceived flaws with styling, makeup or clothes
• Constantly comparing your appearance with others
• Frequently seeking reassurance about your appearance from others
• Having perfectionist tendencies
• Seeking cosmetic procedures with little satisfaction
• Avoiding social situations

Preoccupation with your appearance and excessive thoughts and repetitive behaviors can be unwanted, difficult to control and so time-consuming that they can cause major distress or problems in your social life, work, school or other areas of functioning.
You may excessively focus over one or more parts of your body. The bodily feature that you focus on may change over time. The most common features people tend to fixate about include:
• Face, such as nose, complexion, wrinkles, acne and other blemishes
• Hair, such as appearance, thinning and baldness
• Skin and vein appearance
• Breast size
• Muscle size and tone
• Genitalia

A preoccupation with your body build being too small, or not muscular enough (muscle dysmorphia) occurs almost exclusively in males.
Insight about body dysmorphic disorder varies. You may recognize that your beliefs about your perceived flaws may be excessive or not be true, or think that they probably are true, or be absolutely convinced that they’re true. The more convinced you are of your beliefs, the more distress and disruption you may experience in your life.

When to See a Doctor

Shame and embarrassment about your appearance may keep you from seeking treatment for body dysmorphic disorder. But if you have any signs or symptoms, see your health care provider or a mental health professional. Body dysmorphic disorder usually doesn’t get better on its own. If left untreated, it may get worse over time, leading to anxiety, extensive medical bills, severe depression, and even suicidal thoughts and behavior.

If you have suicidal thoughts

Suicidal thoughts and behavior are common with body dysmorphic disorder. If you think you may hurt yourself or attempt suicide, get help right away:
• In the U.S, call 911 or your local emergency number immediately.
• Call a suicide hotline number. In the U.S., call the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255) or use its webchat at suicidepreventionlifeline.org/chat.
• Call your mental health professional.
• Seek help from your primary care provider.
• Reach out to a close friend or loved one.
• Contact a minister, spiritual leader or someone else in your faith community.

Causes
It’s not known specifically what causes body dysmorphic disorder. Like many other mental health conditions, body dysmorphic disorder may result from a combination of issues, such as a family history of the disorder, negative evaluations or experiences about your body or self-image, social media, and abnormal brain function or abnormal levels of the brain chemical called serotonin.

Risk factors

Body dysmorphic disorder typically starts in the early teenage years and it affects both males and females.
Certain factors seem to increase the risk of developing or triggering body dysmorphic disorder, including:
• Having blood relatives with body dysmorphic disorder or obsessive-compulsive disorder
• Negative life experiences, such as childhood teasing, neglect or abuse
• Certain personality traits, such as perfectionism
• Societal pressure or expectations of beauty
• Having another mental health condition, such as anxiety or depression

Complications

Complications that may be caused by or associated with body dysmorphic disorder include, for example:
• Low self-esteem
• Social isolation
• Major depression or other mood disorders
• Suicidal thoughts or behavior
• Anxiety disorders, including social anxiety disorder (social phobia)
• Obsessive-compulsive disorder
• Eating disorders
• Substance misuse
• Health problems from behaviors such as skin picking
• Physical pain or risk of disfigurement due to repeated surgical interventions