What to know about body dysmorphia, the condition affecting Megan Fox

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Megan Fox is a cover model for the 2023 Sports Illustrated Swimsuit Issue. She has been considered a sex icon and has admitted that she is one of the 5 to 10 million Americans who suffer from body dysmorphia.

I don't see myself as other people do. In a video with Sports Illustrated, Fox stated that she has never loved her body. When I was a child, I had an obsession with looking a certain way. Why I was so aware of my body at such a young age, I don't know.

Body dysmorphia is marked by a discrepancy in how someone sees themselves compared to how others perceive them. According to the American Psychological Association, body dysmorphia is characterized by an excessive preoccupation with a perceived defect in appearance, or disproportionate concern about a minor physical anomaly.

The way people look or how attractive they appear has little to no relation to their actual appearance.

Ramani Durvasula is a clinical psychologist based in California.

The individual becomes preoccupied and even obsessed with a minor physical feature. She added that it could be something as small as a blemish on their nose, or a slightly out-of-place tooth, or a blemish on the skin. It's never enough. It will basically take over the lives of these people.

According to the Anxiety & Depression Association of America, around 2% of global population suffers from body dysmorphia. The disorder affects both men and women in almost equal proportions. The symptoms usually appear during adolescence, when the body starts to change dramatically.

A subtype of body dysmorphia is muscle dysmorphia. This affects primarily men and is characterized by a preoccupation with the belief that a person's body doesn't look lean enough or muscular.

Find out what it's like to live with body dysmorphia and how you can get help.

What body dysmorphia really is

According to Durvasula, and Ann Kearney Cooke, a Cincinnati psychologist who specializes in eating and body-image disorders, body dysmorphia can be mistaken for an eating disorder.

Durvasula explained that people with eating disorders have distorted perceptions of their weight or shape. The person will engage in both (disordered) eating behaviors and what we call compensatory behavior, such as not eating for a certain period of time, excessive exercise, or the use of laxatives or diuretics.

Experts said that body dysmorphia is usually centered around an imagined or actual feature.

What causes body dysmorphia?

Body dysmorphia is not a single cause, but it can be attributed to a number of factors.

Durvasula explained that body dysmorphia belongs to the same disorder family as obsessive compulsive disorders. The only genetic evidence that we can see is if someone has a first degree relative with OCD (a parent or a sibling), they may be more likely to have body dysmorphia.

According to a study from 2010, researchers have suggested that some people with body dismorphia may have abnormalities in their brains when they examine their own faces.

Sometimes anxiety and body dysmorphia occur together. Durvasula added that if someone is preoccupied by certain things due to anxiety, a body feature could be something else they focus on.

Social media definitely hasn't helped. Social media has made it easier to compare how other people look. Durvasula stated that many people create false images. In adolescence this form of evaluation, physical appearance, fitting-in and all that, will be more prominent.

She added that having family members who love, value or evaluate themselves or others on the basis of appearance can play a part.

Kearney Cooke said that this makes people overly sensitive (to) flaws. "And often, deep down, people feel that they are not enough, whether because of a difficult childhood or for other reasons. I'm not beautiful. They then project this onto their bodies.

She added that a perfectionist mentality intensifies her view.

Living with Body Dysmorphia

Body dysmorphia has a wide range of effects on all aspects of your life, including social, occupational, and financial. This is especially true if it worsens without treatment.

Durvasula explained that because they are so obsessed by this sense of physical problems, they spend a lot of money on cosmetic medical treatments, cosmetic dental treatments and dermatologic treatments.

Durvasula said that people with body dysmorphia can also engage in 'checking behaviors', such as spending a lot of time staring at themselves and taking selfies, and then evaluating them.

According to the National Association of Anorexia Nervosa & Associated Disorders, compulsively checking the mirror can help ease fear about how they think they look. It also helps them determine if a perceived flaw still exists or has gotten worse. They believe the feature to be abnormal or ugly. Kearney Cooke explained that body dysmorphia used to be called 'the imagined ugly syndrome'.

A person with a disorder may also ask others for reassurance by asking them if they can see the flaw or if the feature appears to be normal. They might even inquire if there is anything wrong or different with the feature.

Experts said that people with body dysmorphia may isolate themselves because of shame, or they might spend too much time worrying about their appearance. Durvasula said that they can also exhaust their social support by continually seeking reassurance.

She said that spending so much time on their appearance could lead to them being late for work or ignoring schoolwork. Some people are in serious financial trouble by purchasing cosmetics or procedures. They may incur debts for themselves or their family, and do so secretly out of fear of what others might think.

Kearney Cooke's patient was obsessed with her perceived nose flaw. She would look in the mirror constantly, even when driving. She noted that the patient's crash into a tree was a wakeup for her, and led to treatment.

Treatment for Body Dysmorphia

Durvasula explained that body dysmorphia is not curable and can be difficult to manage, as it is a "pattern that's resistant to change". There are some treatments that work.

Many experts prefer cognitive behavioral therapy. Durvasula explained that therapists will work with the distortions of a person and then move on from there. Body dysmorphia falls under the same category of obsessive compulsive disorder. Treatments for OCD such as "exposure and reaction prevention" could be useful for managing body dysmorphia. This therapy involves exposing people to triggers or situations that cause their obsessions in a safe setting. They are then required to refrain from compulsive behavior.

Durvasula explained that a person suffering from body dysmorphia is not allowed to take selfies or look at themselves in the mirror. They have to tolerate the discomfort that comes with not checking themselves. But this has to be combined with cognitive behavioral work.

Trauma-informed treatment is also required if the patient has a history of trauma. This would include a mental health specialist acknowledging that trauma can be a cause of body dysmorphia.

Durvasula stated that some of the therapy could also be educational, focusing on the sort of images we see in the world.

Kearney Cooke explained that researchers have also been studying brain chemicals such as serotonin as a possible cause of body dysmorphia. Antidepressants, known as selective Serotonin Reuptake Inhibitors or SSRIs, can be used to treat this condition.

Durvasula suggested that if you are unable to find a mental healthcare professional who specializes in body dysmorphia then try someone with expertise in OCD and eating disorders.