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Eating Disorders;
Body Dysmorphia

Do you find yourself constantly 'check in' with your mirror, only to find that some bits of your body is not 'perfect' enough? Are you overly obsessed with calculating calories, forcing yourself to do extra exercise just to feel 'less guilty'? Let's fact it: you are most likely to have body dysmorphia, and, more or less, an eating disorder.

Body dysmorphia, also known as body dysmorphic disorder (BDD), is a mental health disorder in which you can't stop thinking about one or more perceived defects or flaws in your appearance — a flaw that appears minor or can't be seen by others. As a result, you may feel "embarrassed", "ashamed" and "anxious" and often avoid social exposure or turn to plastic surgery to "fix" your perceived flaw (temporary satisfaction).

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BDD​ goes beyond just looking in the mirror and not liking your nose or being annoyed by the size of your thighs. Instead, it’s a fixation that interferes with your daily life.

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BDD is a chronic disorder that affects girls and boys equally. The most common area of concerns include:

  • Skin imperfections: wrinkles, scars, acne, and blemishes

  • Hair: head hair, body hair or the absence of hair

  • Facial features: Very often this involves the nose, but it also might involve the shape and size of any feature.

  • Body image: obsess about weight or muscle tone

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It is likely to co-exist in patients with other mental illnesses such as anxiety or depression.

Signs & Signals

  • Engaging in repetitive and time-consuming behaviours, such as looking in a mirror, picking at the skin, and trying to hide or cover up the perceived defect

  • Constantly asking for reassurance from others that the defect is not visible or too obvious

  • Repeatedly measuring or touching the perceived defect

  • Experiencing problems at school or in relationships due to the inability to stop focusing about the perceived defect

  • Feeling self-conscious and not wanting to go out in public, or feeling anxious when around other people

  • Constantly comparing their appearance to others

  • Strong belief that he/she has a defect in his/her appearance that makes he/she ugly or deformed

  • Repeatedly consulting with medical specialists, such as plastic surgeons or dermatologists, to find ways to improve the appearance

Possible Causes of BDD

The exact cause of BDD is not yet found. 

 

One theory suggests the disorder involves a problem with the size or functioning of certain brain areas that process information about body appearance.

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Other factors that may trigger BDD include:

  • Experience of traumatic events or emotional conflict during childhood

  • Low self-esteem

  • Parents and others who were critical of the person's appearance

  • Carefree care providers

  • Peer pressure

  • Wired beauty standards promoted through social media platforms and beauty project propagandas (teenagers, especially girls, may view certain celebrities as their "ultimate goal" to be called "pretty")

Treatment for Body Dysmorphic Disorder

Due to the "shame" and secrecy that often accompany BDD, People with the disorder often are embarrassed and reluctant to tell their doctors about their concerns, making it hard for the disorder to be diagnosed. It is, therefore, extremely important for the patients to accept their illness and be open to seek for help!

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The treatment will likely to be a combination of the following therapies:

  • Psychotherapy: This is a type of individual counselling that focuses on changing the thinking (cognitive therapy) and behaviour (behavioural therapy) of a person with body dysmorphic disorder. The goal is to correct the false belief about the defect and to minimise the compulsive behaviour.
     

  • Medication: Certain antidepressant medications called selective serotonin reuptake inhibitors (SSRIs) are showing promise in treating body dysmorphic disorder, as are antipsychotic medicines such as aripiprazole (Abilify) ,olanzapine (Zyprexa), or pimozide (Orap) (either alone or in combination with an SSRI). No drug is formally FDA-approved for the treatment of BDD.
     

  • Group and/or family therapy: Family support is very important to treatment success. It is important that family members understand body dysmorphic disorder and learn to recognise its signs and symptoms.

Body Dysmorphia v.s. Gender Dysphoria

Gender Dysphoria and Body Dysmorphia are psychological conditions and terms that are often placed in conjunction. While both are important and hard conditions to deal with, they are very different. And you can have both.

In gender dysphoria, a person experiences conflict between the biological gender and the gender they identify with. This may cause distress. As a result the patient may view their body as a flaw – symptoms of body dysmorphia. (a mental disorder involves the believe that an aspect of one's appearance is defective and has to be fixed.)

Body Dysmorphia = Eating Disorders?

BDD and eating disorders are similar in that both involve a concern with body image. However, a person with an eating disorder worries about weight and the shape of the entire body, while a person with BDD is concerned about a specific body part. 

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Researchers have estimated that as many as 12% of people with body dysmorphic disorder also have anorexia nervosa or bulimia nervosa. Yet, not everyone with body dysmorphic disorder has an eating disorder.

Eating disorders (ED) are a group of mental health conditions marked by an unhealthy relationship with food, negatively impacting one's emotions and functional abilities.

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This could lead to:

  • over-focus on your weight, body and food

  • impact your body's ability to get appropriate nutrition

  • harmful effects in organ systems, such as digestive system and circulatory system

  • impair bone/teeth/mouth growth

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Symptoms vary with different ED – anorexia nervosa, bulimia nervosa and binge-eating disorder. The good news is, one can return to healthy eating habits after proper medication. Treatment do help.

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Possible Causes of Eating Disorders

(similar to that of body dysmorphia)

  • Genetics and biology: brain chemicals, hormones, etc

  • Psychological and emotional health: low self-esteem, perfectionism, impulsive behaviour and troubled relationships.

Types of Eating Disorders & Signs and Symptoms
Anorexia (nervosa)
(anorexia: an-o-REK-see-uh) The patients see themselves as overweight even though they are dangerously underweight. They would:

  • abnormally low body weight

  • intense fear of gaining weight

  • a distorted perception of weight or shape

  • extreme efforts or attempts – such as excessive limit calorie intake, exercise, using laxatives or diet aids, or vomiting after eating – to control weight gain​

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With treatment, most people with anorexia will gain back the weight and the confidence they lost.

This could lead to:

  • Thinning of the bones (osteopenia or osteoporosis)

  • Mild anemia and muscle wasting and weakness

  • Brittle hair and nails

  • Dry and yellowish skin

  • Growth of fine hair all over the body (lanugo)

  • Severe constipation

  • Low blood pressure slowed breathing and pulse

  • Damage to the structure and function of the heart

  • Brain damage

  • Multiorgan failure

  • Drop in internal body temperature, causing a person to feel cold all the time

  • Lethargy, sluggishness, or feeling tired all the time

  • Infertility

  • Self-awareness

Signs & Signals

  • Dramatic weight loss

  • Wearing loose, bulky clothes to hide weight loss

  • Preoccupation with food, dieting, counting calories, 

  • Refusal to eat certain foods, such as carbs or fats

  • Avoiding mealtimes or eating in front of others

  • Preparing elaborate meals for others but refusing to eat them

  • Exercising excessively

  • Making comments about being “fat”

  • Stopping menstruating

  • Complaining about constipation or stomach pain

  • Denying that extreme thinness is a problem

Bulimia (nervosa)

This could lead to:

  • Chronically inflamed and sore throat

  • Swollen salivary glands in the neck and jaw area

  • Worn tooth enamel and increasingly sensitive and decaying teeth as a result of exposure to stomach acid

  • Acid reflux disorder and other gastrointestinal problems

  • Intestinal distress and irritation from laxative abuse

  • Severe dehydration from purging of fluids

  • Electrolyte imbalance (too low or too high levels of sodium, calcium, potassium, and other minerals) which can lead to stroke or heart attack

(bulimia: boo-LEE-me-uh) The patients, range from different body type, have episodes of bingeing and purging that involve feeling a lack of control over your eating. Because of guilt, shame and an intense fear of weight gain from overeating, they:

  • restrict their eating during the day

  • binge eating and purging

  • eat a large amount of food in a short time, and then try to rid of the extra calories in an unhealthy way (e.g., force vomiting or excess exercise)

  • preoccupied with weight and body shape

  • judge themselves severely and harshly for the self-perceived flaws

Signs & Signals

  • Evidence of binge eating: disappearance of large amounts of food in a short time, or finding lots of empty food wrappers or containers

  • Evidence of purging: trips to the bathroom after meals, sounds, smells of vomiting, or packages of laxatives or diuretics

  • Skipping meals or avoiding eating in front of others, or eating very small portions

  • Exercising excessively

  • Wearing baggy clothes to hide the body

  • Complaining about being “fat”

  • Constant dieting

  • Using gum, mouthwash, or mints excessively

  • Scarred knuckles from repeatedly inducing vomiting

Binge-eating disorder (BED)
= disordered eating
The patients, either overweight or obese, regularly eat too much food (binge) and feel a lack of control over your eating. They may:

  • eat quickly (within 2 hr) or eat more food than intended, even when not hungry

  • continue eating despite being uncomfortably full

  • feel guilty, disgusted or ashamed by your behaviour and the amount of food eaten after a binge

  • eat alone to hide binging

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However, unlike someone with bulimia or anorexia, the patients don't try to compensate for this behaviour with excessive exercise or purging.

A new round of bingeing usually occurs at least 3~4 times a week (extremely frequent). BED is most common among women. 

Signs & Signals

  • Evidence of binge eating, including disappearance of large amounts of food in a short time, or finding lots of empty food wrappers or containers

  • Hoarding food, or hiding large quantities of food in strange places

  • Wearing baggy clothes to hide the body

  • Skipping meals or avoiding eating in front of others

  • Constantly dieting, but rarely losing weight

Treatment for BED

  • Behavioural weight reduction programs: help with weight loss and with controlling the urge to binge eat

  • Stimulant drug Vyvanse (FDA-approved drug to treat binge-eating disorder) 

  • Antidepressant

  • Psychotherapy 

Dealing with Eating Disorder & Body Dysmorphia
​Self-help tips

  • Externalise and Defuse your thoughts; Challenge it, disobeying what your mind tells you!
    Before accepting your thought as a command to follow, externalise it. For example, when you have the thought, “I can’t eat a bagel,” label it as “an eating disorder thought” and rephrase it as “My eating disorder is telling me not to have a bagel.” This makes it easier for you to disobey your brain.
     

  • Make mealtimes FUN! Eat with friends and family
    Encourage yourself to join others at the table to enjoy each other’s company, rather than talking about problems.
     

  • Run a behavioural experiment
    Make a prediction, “If I allow myself dessert four nights this week, I will gain one kilo,” and run an experiment to test it out. Weigh yourself at the beginning and the end of the week. Have dessert four nights this week. Check to see if your prediction came true

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Treatments

  • Individual therapy. One of the most commonly used is cognitive behavioural therapy (CBT). This identifies dysfunctional thoughts and replace them with facts to help reduce distress.
     

  • Family therapy. Support from family is crucial for one's recovery!
     

  • Group therapy. Join a supportive group to share thoughts and improve together!

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