You care about how you look.
Whether or not your job depends on it, you like being lean, athletic, and well dressed.
You worry about your appearance more than most people.
It might be the few millimeters of fat over your abs, that small gap between your teeth, or that tiny spot of acne on the back of your neck that no one else can see. Whatever it is, that little “defect” drives you nuts.
You don’t talk about it, because you’re worried that people will think you’re vain or that you’e being a hypochondriac. Maybe you don’t think it’s a problem.
Everyone feels like this sometimes. So how do you draw the line between being reasonably concerned with how you look and having a body image disorder?
Let’s find out.
The Three Clinical Elements of a Body Image Disorder
The Diagnostic and Statistical Manual of Mental Disorders is what most researchers and doctors use to diagnose mental illnesses. To have a body image disorder, the book says you need to have these three symptoms:1
- “… a preoccupation with a defect in appearance. The defect is either imagined, or, if a slight physical anomaly is present, the individual’s concern is markedly excessive.”
- “The preoccupation must cause significant distress or impairment in social, occupational, or other important areas of functioning.”
- “The preoccupation is not better accounted for by another mental disorder (e.g., dissatisfaction with body shape and size in Anorexia Nervosa).”
Here’s what that means in more practical terms.
1. You can’t stop thinking about your appearance.
People with body image disorders generally think about their appearance for more than an hour per day.2
About 40% of people with body image disorders think about their appearance for 3-8 hours per day.3
25% of them think about their appearance more than 8 hours per day.3
These people also feel stressed and depressed during this time.2
Virtually everyone with body dysmorphic disorder, or BDD, performs compulsive behaviors like mirror checking, skin picking, or touching certain body parts.2,4 In most cases, they feel worse afterwords.5
People with body image disorders often think their obsessions are normal, since they’ve never been officially diagnosed with a mental disorder.
They aren’t. If you feel like you can’t escape thoughts about how you look, to the point your anxieties penetrate almost every minute of your day, you probably have a body image disorder.
2. You feel like you can’t be around other people.
“Avoidance” is one of the most common behaviors of people with body image disorders. They will often avoid being around others, since they’re afraid of being judged or appearing “ugly.”
People will lose their jobs or give up their education to avoid being around others. In one study on 200 people with body image disorders, 72 of them had missed at least one week of work in the past month, and 22 had dropped out of school permanently because of their body dysmorphia.6
In two other studies, 27-31% of people with body image disorders had been housebound for at least one week due to their disorder.6
In the short-term, avoiding others can help some people feel better. In the long-term, however, it generally makes people feel worse and makes it harder for them to recover.2
The people with the worst body image concerns also tend to have the worst social lives and overall quality of life.7 If it’s painful for you to be seen by other people, you probably have a body image disorder.
3. You’re constantly trying to change your appearance with cosmetic procedures or products.
71 to 76 percent of people with body image disorders try to get cosmetic treatment like plastic surgery, tooth whitening, or tanning. About 65 percent of these people actually get the treatments.2
The sad thing is that only about 3.6-7% of people with body image disorders feel better about their appearance after getting treatment.8,9
In extreme cases, people with body dysmorphia will take surgery into their own hands. In one case, “a woman who was preoccupied by the ugliness of multiple areas of her body who desired liposuction but could not afford it, used a knife to cut her thighs and attempted to squeeze out the fat.”10
That’s an extreme example, but there are others like it.10
People with body image disorders will also often spend thousands of dollars and hours on activities like hair brushing, showering, applying makeup, shopping for beauty products, and finding new clothes to feel better about their appearance.2
There’s nothing wrong with spending a little time and money to make yourself look better, but if it starts to threaten your health, social life, and financial stability, it’s more likely you have a body image disorder.
4. You compulsively hide certain aspects of your appearance.
People with body image disorders often try to cover up certain physical features, especially when they’re in public. They often wear hats, makeup, sunglasses, large coats, and other pieces of clothing to disguise what they view as “flaws.”
These are called “safety behaviors,” because their point is to “…reduce or avoid painful emotions or prevent something bad from happening, such as being humiliated or embarrassed.”2
5. You can’t stop comparing your body to others, or a previous version of your own body.
People with body image disorders often compare themselves to others, and often ask their friends and family if they look good enough.2
Many people with body image disorders also reminisce about how they used to look. Even over relatively short periods of time, people with body dysmorphia will think they’re getting uglier.
Not everyone with body dysmorphia is overly concerned with what others think, but they often are.
6. You have other mental disorders.
Most people with body image disorders have other psychological problems.
About 75% of people with BDD will also experience, or have experienced, depression.2
30-49% have substance use disorders.2
32-33% have OCD.2
37-39% have social phobia (fear of being around others).2
Most people with eating disorders also have some level of body dysmorphia, and people with body image disorders are also much more likely to develop eating disorders.2,11-13
7. You think about suicide, a lot.
80% of people with body image disorders think about committing suicide, and around 25% of people will actually try to end their own lives.2 It’s one of the most common symptoms.
Do you have a body image disorder?
“Disorders” are really a collection of normal behaviors that are taken to unhealthy or destructive extremes.
Virtually everyone feels a little insecure about some aspects of their appearance. It’s when those insecurities threaten your mental, physical, and social health that you know you have a problem.
You might have several of the symptoms listed above, but that doesn’t necessarily mean you have a body image disorder. You have to fit most of these criteria for an extended period of time before you get too worried.
The best way to know if you have a body image disorder is to talk to a therapist. Most people aren’t honest with themselves or won’t be able to see their behaviors as negative.
Since you’re a self motivated and independent person, however, you might not be ready to go to a therapist. Or maybe you don’t think your concerns are big enough to warrant professional help.
If you’re an [elite member of *Evidence Magazine*](https://evidencemag.com/join-evidence/), you’ll get access to the book *Your Need to Know Guide to Body Image Disorders*. It will help you understand and overcome your insecurities about how you look.
> Did you enjoy this article? [Click here to check out my book, *Flexible Dieting](https://evidencemag.com/flexible-dieting-book)*. Want an even more in-depth education on how to lose weight, build muscle, and get stronger and healthier? [Join Evidence Mag Elite](https://evidencemag.com/elite) and get member’s-only reports and interviews.
1. DSM-IV: DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS. 4 ed. WASHINGTON, DC: AMERICAN PSYCHIATRIC ASSOCIATION; 1994. Available at: https://justines2010blog.files.wordpress.com/2011/03/dsm-iv.pdf.
2. 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/.
3. Phillips KA, McElroy SL, Keck PEJ, Pope HGJ, Hudson JI. Body dysmorphic disorder: 30 cases of imagined ugliness. Am J Psychiatry. 1993;150(2):302–308.
4. Phillips KA, Dufresne RGJ. Body dysmorphic disorder: a guide for primary care physicians. Prim Care. 2002;29(1):99–111– vii. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1785389/.
5. Veale D, Riley S. Mirror, mirror on the wall, who is the ugliest of them all? The psychopathology of mirror gazing in body dysmorphic disorder. Behav Res Ther. 2001;39(12):1381–1393.
6. Didie ER, Menard W, Stern AP, Phillips KA. Occupational functioning and impairment in adults with body dysmorphic disorder. Compr Psychiatry. 2008;49(6):561–569. doi:10.1016/j.comppsych.2008.04.003.
7. Phillips KA, Quinn G, Stout RL. Functional impairment in body dysmorphic disorder: a prospective, follow-up study. J Psychiatr Res. 2008;42(9):701–707. doi:10.1016/j.jpsychires.2007.07.010.
8. Phillips KA, Grant J, Siniscalchi J, Albertini RS. Surgical and nonpsychiatric medical treatment of patients with body dysmorphic disorder. Psychosomatics. 2001;42(6):504–510. doi:10.1176/appi.psy.42.6.504.
9. Crerand CE, Phillips KA, Menard W, Fay C. Nonpsychiatric medical treatment of body dysmorphic disorder. Psychosomatics. 2005;46(6):549–555. doi:10.1176/appi.psy.46.6.549.
10. Veale D. Outcome of cosmetic surgery and “DIY” surgery in patients with body dysmorphic disorder. The Psychiatrist. 2000;24:218–220. Available at: https://pb.rcpsych.org/content/24/6/218.full.
11. 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.
12. 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.
13. 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/.