April 27, 2022

I am a family systems theory psychologist specializing in the treatment of eating disorders. Systems theory tells us that in order to solve a problem we have to use the right set of assumptions. Further, it tells us that if we use the wrong assumptions, the problem will continue to get worse. Suffice it to say, the underlying assumptions of those suffering from eating disorders are incorrect. One good example is the role that body dysmorphia plays in driving disordered eating. The more the patient gives in to the incorrect underlying assumptions the more severe the condition, the more severe the condition the more the patient gives into the incorrect underlying assumptions. 

Body dysmorphia is a symptom of an eating disorder. Most practitioners and even the lay public, know this. But body dysmorphia is also a condition in its own right. Most people, including practitioners, are not aware of Body Dysmorphic Disorder (BDD) or its baby brother Muscle Dysmorphia (MD). 

Let’s begin with BDD. The underlying assumptions of those suffering from Body Dysmorphic Disorder include:

  • Imagined defects in appearance. 

    • “My thighs are fat.” 

    • “My belly sticks out too much.” (In an individual weighing 70 pounds) 

    • “My skin is gross.” 

    • “I hate my toes/hair/ears/etc.” 

  • Preoccupation with weight (very common among anorexics) 

    • “I weigh too much.”

    • “I would be more attractive if I lost weight.”

    • “No one can respect me if my weight goes over 100 pounds.”

  • Obsessive-compulsive behavioral patterns 

    • “I must try on every pair of jeans to make sure that they still fit.”

    • “I have to eliminate zits from my face.” 

    • “I can’t stop biting my cuticles.” 

  • Social Isolation 

    • “I know when they look at me, they think I’m fat. It’s better if I just avoid them.”

    • “I have to hide my face/toes/nails/hair, so I can’t go…” 

Another common symptom found in BDD is obsessive-compulsive behavior, which can become full-blown Obsessive-Compulsive Disorder (OCD). If you have had a patient or a family member with OCD, then you probably know how useless it is to try and convince the sufferer that their assumptions are wrong. They will assume that you are trying to fool them or trick them. I find that it works better to focus on their strengths in treatment, as it reduces anxiety, making the OCD behavior less necessary. Family support, instead of judgment, works the same way.

Chances are that even if you have heard about Body Dysmorphic Disorder. You may not fully understand it. This obsession with a flaw, which can be extreme, is often partnered with the compulsion of going to extremes to hide or fix the “flaw.” If there is a real flaw, its importance is severely exaggerated. A person suffering from BDD spends much of their day thinking, obsessing, and compulsing over this real or perceived flaw. I have had patients spend up to 8 hours in front of a mirror, missing work/school, or passing on social activities in order to focus on how to fix the “flaw”. So it can be quite intrusive and dysfunctional. 

The other version of BDD that most people have not even heard of is called Muscle Dysmorphia (MD). It primarily affects males, often athletes, and presents as an obsessive preoccupation with a delusional or exaggerated belief that one’s own body is too small, too skinny, or insufficiently muscular. In most cases, the individual’s actual build is normal or even muscular already.

Men suffering from MD are obsessed about being inadquetly muscular and lean, when in fact, they are not. Their compulsive behavior may include spending many hours in the gym, spending inordinate amounts of money on supplements, having strange eating patterns, and even substance abuse. The behavioral patterns become obsessive in a way that is similar to BDD. Indeed there is a definite OCD component in MD as well.

What drives these obsessions? Are we just talking about anxious people that are just too self-focused? Or has our society run amok? Probably both. Social media may not be the cause, but it isn’t helping and, in my opinion, plays a major role. 

If you are an Instagram user, a Facebook user- really any social media- you see #fitspo every day. Generally, there is a photo of an extremely defined body part like abs, arms, or chest, along with this #fitspro caption. Sometimes faces are included and sometimes they aren’t.

So what does #fitspo stand for? “Fitsporation.” In theory, #fitspo images are supposed to inspire “healthy” bodies. And maybe some of them do. But if you just google #fitspo, you will find image after image of an exceptionally “fit” person’s body part. Image after image after image. Seriously. Of course, most of them have received many likes! My question is, does this inspire us or terrify us?

What does it mean that we are collectively acknowledging well-developed near-perfect body parts by giving them likes? What about the people that lost 20 pounds by eating healthy food and engaging in a fitness routine that brought down their cholesterol but didn’t happen to end up with a six-pack? Shouldn’t they receive just as much attention and adulation?

#fitspo seems to focus directly on the appearance of body parts, i.e. the size, and visual perfection of the part. Call me cynical but that just seems dangerous to me. But then I think most social media is dangerous. Maybe the photo should say #8hoursadayinthegym or #Mywifeleftmebecauseofmyobsession or #Ispendallmytimeandmoneyonthis. 

It’s easy to see how a person’s own expectations about what is realistic could become distorted, especially when one is bombarded with these images over and over again, and they are so glorified. They set the standard of perfection so high that the would-be health seeker just gives up. Again, I am speaking directly about the images, as opposed to someone posting something like, “Just broke my personal record for deadlifting,” or #myfirsttriathalon. Both of those are based on personal fitness goals achieved, which deserves respect. It is important to note the difference.

Bottom line, BDD and its baby brother MD are serious disorders that require treatment. If you need help click here to schedule an appointment with Dr. Norton or call for your free 15-minute consultation at (513) 205-6543.