The Warped Perspective of Body Dysmorphia
story by Anastasia Rothlisberger and Maria Mann, photos by Gracen Bayer, design by Ileana Rea Martinez
Sitting in class, your mind drifts away from the topic at hand. Your peers lean forward to take in the lecture, but you lean back in your chair, your eyes on the floor. Nothing can take your mind off of the feeling of your thighs pressed into the seat. While your surrounding classmates are absorbed in the PowerPoint presentation, you can’t help but think that they are all secretly staring at your legs. Not even the professor at the front of the room, who is droning on and on like the teacher from Charlie Brown, can snap you back into reality.
This is what a moment in the life of someone with body dysmorphic disorder can look like. The world continues to move around them while their mind becomes trapped in an endless spiral.
What is it?
Body Dysmorphic Disorder (BDD) is a rather taboo topic. It can be sensitive to address, especially for those who have experienced it. Such a matter is important to consider because some people who have it are not even aware of what it is, let alone how it manifests or how it can affect their lives. It is especially common among young people. According to the National Institutes of Health, university students in particular experience BDD at a higher level than the rest of the population.
Emily Shaw, a nutritionist and dietitian counselor at CWU has worked with students in the Medical Center for about eight years. In that time, Shaw has pursued specialized education within the realm of eating disorders, body image and body dysmorphia. “Body dysmorphic disorder…[is] a true mental health disorder,” Shaw says. “It's a mental health condition where someone focuses…on a specific body part.”
BDD is a hyperfixation of perceived flaws that may not even be noticeable to others. Shariden Holland is a sophomore at CWU majoring in clinical physiology who suffers from BDD. According to Holland, her perception of herself through the lens of BDD affects the way she lives her day-to-day life. “It makes me so uncomfortable because I can feel it whenever I am sitting down or when I have to crouch down to pick something up,” Holland says.
Jacob Bass, a junior and woodwind performance major, also suffers from BDD. “When it’s pretty bad… just the act of sitting in a room with another person makes me vehemently aware of how my thighs [and] stomach look,” Bass says. “It can be… all-consuming. I’d be sitting in a class and I couldn’t even pay attention to what was going on because it would be just so consuming.”
A warped, unhealthy obsession with one’s physical traits is the main symptom of BDD, usually causing those with dysmorphic thoughts to lose their sense of self. According to John Hopkins Medicine, BDD can cause such a downward spiral that it may even result in a person experiencing suicidal ideation.
Are eating disorders and BDD the same?
A common misconception about BDD and eating disorders is that they are directly linked. Although disordered eating is a common result of BDD, one can have BDD without developing an eating disorder.
“Whenever I’m explaining [it] to someone, I’m always like, ‘Okay, we have our thoughts, we have our feelings, we have our emotions and then we have our food intake,’” Shaw says. “And when they become really intertwined and start affecting each other, that’s what we get when we get eating disorders.”
Shaw goes on to explain that while BDD and eating disorders are interconnected, they are not mutually exclusive. “The connection that we have…is more disordered body image,” Shaw says. “So when we talk about disordered body image, that is someone's desire or dissatisfaction with their body shape [and] their body size, that is typically connected to an eating disorder because that's how people change what their body looks like.”
Holland’s own experience with the intricacies of these disorders is unique. “I think that body dysmorphia came first, I feel like the eating disorder…was more so a byproduct of it,” Holland says. “I was always comparing myself to everyone else and kind of pointing out all of my flaws, especially in regards to maybe having more fat in one place on my body than other girls did. And then after having all of those observations, when I got into high school, that's when all of the disordered eating behavior really started.”
Root Causes
When working with students who have these conditions, Shaw’s main concern isn’t diagnosis. “For me, I care more about the origin,” Shaw says. “So, where is this coming from?”
BDD has many causes that are difficult to pinpoint. “Body dysmorphic disorder develops from psychological, social, and biological factors,” according to the National Institute of Health. The symptoms of body dysmorphia typically begin during teenage years, and can be affected by a variety of factors including social and familial influence.
Bass’ experience with this disorder started “around the age of 14 [or] 15…” he says. “I was more of a chunky kid and I know, for my father, at least, when I was young, he was very athletic… I remember as a kid, he would constantly be trying to get me to work out because he thought I was gaining too much weight… that kind of put that seed in my head…”
Bass feels that one of the reasons his body dysmorphia persists to this day is due to stigma associated with his identity. The stereotype perpetuated as attractive for LGBTQ+ men in the media is often that of a “twink,” a traditionally thin, somewhat feminine man.
Holland’s body dysmorphia also started around the time she was a freshman in high school. It stemmed from “my upbringing with my family,” Holland says. “Like my parents having struggles with their own weight, and I always got told that I was identical to my mom [and]. . .my mom didn’t like the way she looked.”
BDD in athletes
Body dysmorphia is also quite prevalent in the sports world. It can be triggered by the act of comparing oneself to one’s teammates and competition.
In the case of Kelsea Nunes, a CWU nutrition grad student, it started when she was a gymnast. “I was kind of towards the end of my gymnastics career towards puberty… all of the other gymnasts were kind of petite little girls,” Nunes says. “And then I was just super tall. I just felt bigger than everybody else, even though I was told that I wasn’t.” To this day, contrasting internal and external perceptions of her own body still affect Nunes.
According to Kelly Pritchett, a professor of nutrition and exercise science at CWU, it’s common for athletes to be dissatisfied with their bodies and think that losing weight will improve their performance, regardless of their current body size. However, this is usually not the case.
“[Disordered eating habits] have a negative impact, and that’s described in this new concept known as RED-S,” Pritchett says. “It was introduced in 2014 [and stands for] Relative Energy Deficiency in Sport and as part of that model, it talks about low energy availability or lack of energy to meet the demands of training. And as a result of that low energy availability, we see all these physiological ramifications. So bone health could be impacted negatively [and] iron, we may see a lack of menstruation in female athletes.”
The amount of time that a person has been in this chronic state of low energy availability will predict the severity of the outcome, according to Pritchett. RED-S can cause decreased muscle glycogen (energy stored in muscles), impaired coordination and decreased muscle protein synthesis (building muscles from protein). These are all highly detrimental not only to one's abilities as an athlete, but also the way that they can function in everyday life.
BDD can also be experienced by bodybuilders and other athletes who do strength training. It can manifest as having an insatiable desire for bigger muscles, no matter the existing muscle mass. According to Pritchett, this is a phenomenon known as bigorexia or muscle dysmorphia. BDD in athletes can result in over-exercising which increases the risk for injury.
Body Image
In those with BDD, there is usually a stark contrast in how they perceive their own body and how others perceive their body.
This is the case for Holland. “It’s like night and day,” Holland says. “When I go into the bathroom at night or when I take a shower I feel like I have to turn off all the lights so I don’t have to look at my body in the mirror…But you know, my ex-boyfriend always told me that he found me beautiful and that he would love me if I were 60 pounds heavier or 30 pounds lighter. My friends always tell me that I’m beautiful. My parents think… I’m the prettiest thing on the planet, but I don’t see it and I don’t get it.”
BDD can also affect the way that people dress and how they perceive clothing to fit them. Bass prefers baggy styles of clothing, like sweatshirts, because they feel safer and less revealing. Holland also favors looser clothing for similar reasons, and was victim to the idea that she needed to fit into her clothing rather than her clothing fitting her.
A good first step to promoting a healthier body image in society would be “having people talk about their experience with food, you know, building healthy relationships, the idea that food is value neutral,” Bass says. “There is no such thing as a guilty food…because there is no such thing as guilt as an ingredient. We need to have a serious discussion as a society as to how food…interacts with our lives and how we perceive the consumption of it; both positive and negative.”
Shaw expresses similar feelings. “My hope is that generations are starting to change how we talk about not just food, but talk about what bodies look like in conjunction with food, because really we all know at this point [is] that what we look like is not a great example of what someone's doing,” Shaw says. “So trying to reimagine the way that we talk about food, and knowing that that 100% is not always connected to what our body looks like. And I think that, to me, is probably the biggest thing that we could do to help prevent it in future generations.”
According to Holland, the idea that a person being thin automatically means that they are healthy is something that needs to change. Social media has only contributed to these stigmas.
“The only things that you see on your Instagram explorer page are the things that are really popular on TikTok…” Holland says. “It's always these really really hot people with really impossible body proportions that can only really be achieved by really specific genetics or with a lot of plastic surgery. But like, my brain can't comprehend, like, ‘oh, that's not real.’”
Social media should be a space that promotes normal bodies and healthy eating. In reality, it can encourage disordered eating and comparison to unrealistic bodies, according to Nunes.
Some people will use cosmetic surgery as a way of addressing their body dysmorphia. However, Nunes suggests that this is ineffective because “if you don’t fix the mental health part of body dysmorphia, you’ll just find something else that you don’t like about yourself and then want to fix it.”
Resources
If you or someone you know may be suffering from BDD or eating disorders, please seek professional help.
CWU Student Counseling Services in Black Hall 225 provides care to students in-person or online through one-on-one therapy, workshops and support groups. They can be contacted for appointments at (509) 963-1391 or by stopping by in person.
An app called TimelyCare which provides free medical care and virtual counseling is also accessible to CWU students through their MyCWU account. The “Talk Now” feature can be used 24/7 to reach a provider within five minutes of calling.
Licensed dietitian Emily Shaw can be contacted for nutritional counseling through Student Health Services.
