You have a friend.
You’re close, you have a lot in common, and you think they’re awesome. Maybe you’re workout buddies, you’re their personal trainer, or you just like hanging out.
They’re fit, healthy, and seem to be happy.
Then there’s the part that others don’t see, but you do, because you’re their friend.
- They constantly criticize how they look.
- They ask you for reassurance—“I feel like I’ve gotten leaner, but can’t really tell, what do you think?” (Editor’s note: If your significant other ever asks you this question, the answer is always “Yes.”)
- They’re never happy with their appearance, even if everyone else thinks they look stunning.
- They workout five times more than usual after eating something they think they shouldn’t have.
You think they might have a body image disorder, known technically as body dysmorphic disorder (BDD), but you’re not sure what you should do. You have a lot of questions.
- Is this normal?
- Are they just being vain?
- Why are they like this?
- Should I be worried?
Here are six things your friend wants you to know.
1. Body image disorders are more common than you think.
The latest research indicates that about 0.7-2.4% of the world population has a body image disorder.1 That’s about 50-171 million people around the world.
About 2.25%, or just over 7 million people in the United States, have a body image disorder. That’s about one out of every 50 people.1
Researchers think that the actual number of people with body image disorders might be much higher than that. Most of the people with BDD don’t talk about their problems, don’t get help, and aren’t diagnosed when they do seek help.1-5
People who are interested in health, fitness, and appearances also tend to have a higher rate of body image disorders. Bodybuilders generally have much higher rates of body dysmorphia than average people,6-10 though not all studies have found that to be the case.11
Beauticians also tend to have higher rates of body dissatisfaction and eating disorder symptoms.12,13
Body dysmorphia is not rare. It’s a common problem that your friend shouldn’t be ashamed of, whether they’re a man or a woman.
2. Men and women have almost the same risk of developing a body image disorder.
The latest data on the United States population found that 2.5% of women, and 2.2% of men, had body image disorders.14 Another study found similar rates in Germany, with 1.9% of women and 1.4% of men having BDD.15
About 30-50% of the people who are clinically treated for body image disorders are also men.16,17
Basically, it’s about a 45/55 spit between men and women. If your friend is a dude, they’re not alone.
3. Body image disorders are not just in your head.
People often assume that those with body image disorders are weak, vain hypochondriacs. In fact, body dysmorphia was once described as “beauty hypochondria” by some researchers.2,3
The reason your friend has a body image disorder is largely due to their genetics.18,19
There’s also some evidence that the brains of people who have body image disorders are more prone to detail oriented thinking, and it’s a trait they can’t necessarily control.20-22
You can’t expect your friend to just “get better.” It’s not their fault, and acting like it is will just make them feel worse.
4. People with body image disorders are usually suffering from other mental illnesses.
If your friend has a body image disorder, that’s probably not their only psychological problem.
People with body image disorders usually have depression, anxiety disorder, social phobia, OCD, or a combination of these issues.1,23
Around 33% of people with body image disorders also have an eating disorder.24 People who tend to have the most restrictive eating behaviors also have the most severe body image concerns.4,7,25
About 58% of people with body dysmorphia are severely depressed, and 76% of people with body image disorders will be severely depressed in their lifetimes.3
One study found that 50% of people with body image disorders were, or had been, addicted to drugs or alcohol.26
Body image disorders are about much more than looks. Your friend is probably dealing with a lot more than anxiety over their acne, so don’t underestimate how much they’re suffering.
That could be a dangerous mistake.
5. People with body image disorders are more likely to kill themselves than almost anyone else.
Your friend is more likely to think about killing themselves, attempt killing themselves, or actually end their own life, than almost anyone else.
About 80% of people with body image disorders think about killing themselves frequently, a behavior called suicide ideation. 25% will actually try to end their own lives. 2-3% actually kill themselves.1
The only other mental disorder that has a higher suicide rate is probably anorexia.27-29
As you learned a second ago, however, many people with body image disorders are also anorexic or bulimic. As you might guess, people with body image disorders who have the most eating disorder symptoms also have the highest risk of suicide.4
You might think your friend is the kind of person who could never kill themselves. Maybe that’s true, or maybe they’re just good at hiding their feelings.
You feel like you should say something to them, but they might have no idea what you’re talking about.
6. People with body image disorders usually don’t know they have a problem.
You want to know the reason I wrote this article from the perspective of helping a “friend?” Because it’s a lot easier to imagine helping someone else than it is to help yourself.
I really wrote this article under the assumption that you have a body image disorder, and that I’m your concerned friend. I also assumed that you have some level of “Anosognosia.”
Pronounced “A-noz-ug-nose-ia,” this is a condition in which the person who’s sick has a very poor grasp of their situation. Sometimes they’re completely delusional, and other times they just don’t fully understand they’re ill. This is also occasionally called “lack of insight.”
Anosognosia is extremely common among people with body image and eating disorders.1-4,30-33 It’s also one of the reasons it’s so hard to get better.
I should know, since I’ve been dealing with an eating disorder and body image problems since I was 12. I have it under control at this point, but I went for a long time without accepting that I had an eating disorder. It took me even longer to acknowledge, and deal with, my body image issues.
Your “friend” needs your help.
Whether you have a body image disorder or know someone who does, you probably have a lot of questions.
“How do I know if I have a body image disorder, or am I just more concerned than others about my appearance?”
“What kind of treatment options are available?”
“What do I say to a friend I suspect is struggling?”
Or, if you’re like me, “How can I deal with this on my own?”
Let’s talk about it in the comments.
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1. Bjornsson AS, Didie ER, Phillips KA. Body dysmorphic disorder. Dialogues Clin Neurosci. 2010;12(2):221–232. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/20623926/.
2. Gupta R, Huynh M, Ginsburg IH. Body dysmorphic disorder. Semin Cutan Med Surg. 2013;32(2):78–82.
3. Phillips KA. Body dysmorphic disorder: recognizing and treating imagined ugliness. World Psychiatry. 2004;3(1):12–17. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1414653/.
4. Phillips KA, Wilhelm S, Koran LM, et al. Body dysmorphic disorder: some key issues for DSM-V. Depress Anxiety. 2010;27(6):573–591. doi:10.1002/da.20709.
5. Prazeres AM, Nascimento AL, Fontenelle LF. Cognitive-behavioral therapy for body dysmorphic disorder: a review of its efficacy. Neuropsychiatr Dis Treat. 2013;9:307–316. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/23467711/.
6. Santarnecchi E, Dettore D. Muscle dysmorphia in different degrees of bodybuilding activities: validation of the Italian version of Muscle Dysmorphia Disorder Inventory and Bodybuilder Image Grid. Body Image. 2012;9(3):396–403. doi:10.1016/j.bodyim.2012.03.006.
7. Babusa B, Tury F. Muscle dysmorphia in Hungarian non-competitive male bodybuilders. Eat Weight Disord. 2012;17(1):e49–53.
8. Mosley PE. Bigorexia: bodybuilding and muscle dysmorphia. Eur Eat Disord Rev. 2009;17(3):191–198. doi:10.1002/erv.897.
9. Behar R, Molinari D. [Muscle dysmorphia, body image and eating behaviors in two male populations]. Rev Med Chil. 2010;138(11):1386–1394.
10. Hildebrandt T, Schlundt D, Langenbucher J, Chung T. Presence of muscle dysmorphia symptomology among male weightlifters. Compr Psychiatry. 2006;47(2):127–135. doi:10.1016/j.comppsych.2005.06.001.
11. Pickett TC, Lewis RJ, Cash TF. Men, muscles, and body image: comparisons of competitive bodybuilders, weight trainers, and athletically active controls. Br J Sports Med. 2005;39(4):217–22– discussion 217–22. doi:10.1136/bjsm.2004.012013.
12. Lukacs-Marton R, Szabo P. [State of health, eating and body image disorders among employees in the beauty industry]. Orv Hetil. 2013;154(17):665–670. doi:10.1556/OH.2013.29591.
13. Lukacs-Marton R, Szabo P. [Beauticians’ eating attitudes and body attitudes]. Psychiatr Hung. 2013;28(1):70–76.
14. Koran LM, Abujaoude E, Large MD, Serpe RT. The prevalence of body dysmorphic disorder in the United States adult population. CNS Spectr. 2008;13(4):316–322.
15. Rief W, Buhlmann U, Wilhelm S, Borkenhagen A, Brahler E. The prevalence of body dysmorphic disorder: a population-based survey. Psychol Med. 2006;36(6):877–885. doi:10.1017/S0033291706007264.
16. Phillips KA, Diaz SF. Gender differences in body dysmorphic disorder. J Nerv Ment Dis. 1997;185(9):570–577.
17. Phillips KA, Menard W, Fay C. Gender similarities and differences in 200 individuals with body dysmorphic disorder. Compr Psychiatry. 2006;47(2):77–87. doi:10.1016/j.comppsych.2005.07.002.
18. Monzani B, Rijsdijk F, Iervolino AC, Anson M, Cherkas L, Mataix-Cols D. Evidence for a genetic overlap between body dysmorphic concerns and obsessive-compulsive symptoms in an adult female community twin sample. Am J Med Genet B Neuropsychiatr Genet. 2012;159B(4):376–382. doi:10.1002/ajmg.b.32040.
19. Monzani B, Rijsdijk F, Anson M, et al. A twin study of body dysmorphic concerns. Psychol Med. 2012;42(9):1949–1955. doi:10.1017/S0033291711002741.
20. JD F, J T, A B, S B. Visual information processing of faces in body dysmorphic disorder. Arch Gen Psychiatry. 2007;64(12):1417–1425. doi:doi: 10.1001/archpsyc.64.12.1417.
21. JD F, T M, E H, al E. Abnormalities of visual processing and frontostriatal systems in body dysmorphic disorder. Arch Gen Psychiatry. 2010;67(2):197–205. doi:doi: 10.1001/archgenpsychiatry.2009.190.
22. Feusner JD, Hembacher E, Moller H, Moody TD. Abnormalities of object visual processing in body dysmorphic disorder. Psychol Med. 2011;41(11):2385–2397. doi:10.1017/S0033291711000572.
23. Fang A, Hofmann SG. Relationship between social anxiety disorder and body dysmorphic disorder. Clin Psychol Rev. 2010;30(8):1040–1048. doi:10.1016/j.cpr.2010.08.001.
24. Ruffolo JS, Phillips KA, Menard W, Fay C, Weisberg RB. Comorbidity of body dysmorphic disorder and eating disorders: severity of psychopathology and body image disturbance. Int J Eat Disord. 2006;39(1):11–19. doi:10.1002/eat.20219.
25. Murray SB, Rieger E, Hildebrandt T, et al. A comparison of eating, exercise, shape, and weight related symptomatology in males with muscle dysmorphia and anorexia nervosa. Body Image. 2012;9(2):193–200. doi:10.1016/j.bodyim.2012.01.008.
26. Grant JE, Menard W, Pagano ME, Fay C, Phillips KA. Substance use disorders in individuals with body dysmorphic disorder. J Clin Psychiatry. 2005;66(3):309–16– quiz 404–5. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2504687/.
27. Guillaume S, Jaussent I, Olié E, et al. Characteristics of Suicide Attempts in Anorexia and Bulimia Nervosa: A Case–Control Study. PLoS One. 6(8):e23578 EP –. doi:doi:10.1371/journal.pone.0023578.
28. Pompili M, Mancinelli I, Girardi P, Ruberto A, Tatarelli R. Suicide in anorexia nervosa: a meta-analysis. Int J Eat Disord. 2004;36(1):99–103. doi:10.1002/eat.20011.
29. Pompili M, Mancinelli I, Girardi P, Accorra D, Ruberto A, Tatarelli R. [Suicide and attempted suicide in anorexia nervosa and bulimia nervosa]. Ann Ist Super Sanita. 2003;39(2):275–281.
30. Uher R, Treasure J, Campbell IC. Biological Psychiatry. John Wiley & Sons, Ltd; 2003.
31. Phillips KA, Pinto A, Hart AS, et al. A comparison of insight in body dysmorphic disorder and obsessive-compulsive disorder. J Psychiatr Res. 2012;46(10):1293–1299. doi:10.1016/j.jpsychires.2012.05.016.
32. Marazziti D, Giannotti D, Catena MC, et al. Insight in body dysmorphic disorder with and without comorbid obsessive-compulsive disorder. CNS Spectr. 2006;11(7):494–498.
33. Eisen JL, Phillips KA, Coles ME, Rasmussen SA. Insight in Obsessive Compulsive Disorder and Body Dysmorphic Disorder. Compr Psychiatry. 2006;45(1):10–15. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1613795/.