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Understanding the Difference Between Body Dysmorphia, Self-Esteem, and Negative Body Image

Body dysmorphic disorder (BDD), unlike body image disturbance, is when an individual is struggling with an over-emphasis on a specific body part as opposed to someone who is unhappy with his or her body size or shape. Body image refers to how people see themselves. Distorted body image (also called negative body image) refers to an unrealistic view of how someone sees his or her body while BDD is an obsessive pathological disorder. Individuals with BDD fixate on a body part repeatedly to the point where it interferes with their social, emotional, educational, and occupational welfare. BDD is an anxiety disorder; more specifically is a type of obsessive-compulsive disorder. Uncontrollable, obsessive thoughts characterize it. BDD is more common than other disorders such as anorexia nervosa and schizophrenia. It is not considered an eating disorder as individuals do not exhibit behaviors such as binging, purging or restricting however it does share some underlying triggers with eating disorders and a result many people often associate BDD with anorexia nervosa, bulimia nervosa and/or binge eating. Like many other mental health disorders, body dysmorphic disorder cannot be cured. It can only be treated.

“I have a horse face,” is a common phrase an individual may use when they are struggling with body dysmorphia. Body dysmorphia is much more than having low self-esteem; it is a debilitating disorder that is characterized by being “overly preoccupied” with imagined flaws or true minor flaws in their appearance to the extent that individuals spend hours each day obsessively thinking about this flaw. What makes BDD particularly dangerous is that people who suffer from this disorder develop dependencies on obsessive behaviors; they believe these behaviors will provide relief. One such example is “mirror checking,” the ritual of checking a mirror hundreds of times a day to either catch a glimpse of looking good or, as is usually the case, reinforce feelings of negativity surrounding body image. This severe mental health disorder can have extreme consequences and is strongly associated with suicide. According to a study exploring the suicide rates associated with BDD, 45 to 70 percent of individuals with BDD have reported suffering from suicidal ideation, and 22 to 24 percent of individuals with BDD have attempted suicide.

Treatment consists of cognitive behavioral therapy in addition to SSRIs, a class of antidepressants that are also used to treat obsessive-compulsive disorder. One of the most critical components of cognitive behavioral therapy for BDD is exposure therapy. Exposure therapy involves exposing an individual to their biggest fears. For example, someone with BDD who thinks his or her face is hideous might try leaving the house without wearing makeup. Exposure therapy is complicated because nobody wants to put themselves into situations that are going to make them feel uncomfortable. The overall goal of cognitive behavioral therapy is to work with clients to replace the stigmatizing language with more factual language. So, these individuals can comment on the shape of their face based on fact, instead of judgment. The more often his patients practice this process, the less anxious they become.

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