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Actor Megan Fox, a 2023 Sports Illustrated Swimsuit issue cover star who has long been regarded as a sex symbol, has said she’s among the 5 million to 10 million people in the United States affected by body dysmorphia.
“I don’t ever see myself the way other people see me. There’s never a point in my life where I loved my body, never ever,” Fox said in a video interview with Sports Illustrated. “When I was little, that was an obsession I had of like, ‘But I should look this way.’ And why I had an awareness of my body that young, I’m not sure.”
A discrepancy between how someone perceives themselves and how others see them is a hallmark symptom of body dysmorphia. Also known as body dysmorphic disorder, it’s “characterized by excessive preoccupation with an imagined defect in physical appearance or markedly excessive concern with a slight physical anomaly,” according to the American Psychological Association.
What people actually look like — or how attractive they are — often has little to do with it.
“If this person had, like, a very visible scar or other physically noticeable deformity, that’s not what we’re talking about,” said Ramani Durvasula, a clinical psychologist and author based in California.
“The individual gets preoccupied, almost even obsessive, over a small physical feature. It could be a little blemish, a little bump in their nose, a tooth that’s a little bit out of line, the shape of something, but it would not be noticeable to other people,” she added. “It’s never good enough. … And it will kind of basically take over their lives.”
Around 2% of the global population has body dysmorphia, and the disorder affects men and women almost equally, according to the Anxiety & Depression Association of America. Symptoms usually begin to appear in adolescence when bodies start drastically changing.
There is a subform of body dysmorphia: Muscle dysmorphia, which primarily affects men, is marked by preoccupation with the perception that one’s body isn’t lean or muscular enough — often regardless of how muscular a person may be.
Here’s what living with body dysmorphia is like, and how people can find help.
What body dysmorphia isn’t
Body dysmorphia is commonly mistaken as an eating disorder, but that’s not the case due to some distinctions, according to Durvasula and Ann Kearney-Cooke, a Cincinnati-based psychologist specializing in eating and body image disorders.
People with eating disorders are preoccupied with a distortion in how they perceive their shape or weight, Durvasula said. “The person engages in (disordered eating) behaviors as well as what we call compensatory behaviors, which could be things like not eating for certain periods of time, hyper exercise, the use of diuretics or laxatives, that kind of thing.”
Body dysmorphia, however, generally centers around an imagined or real feature, experts said.
What causes body dysmorphia
There isn’t a sole cause of body dysmorphia, but there are some contributing factors.
“Body dysmorphia is in the same family of disorders as obsessive-compulsive disorder,” Durvasula said. “The only genetic evidence we see is that if a person has a first-degree relative (a parent or sibling) with OCD, they might be more likely to develop body dysmorphia.”
Researchers have suggested that the brains of some people with body dysmorphia might have “abnormalities in processing visual input when it comes to examining their own face,” according to a 2010 study.
Body dysmorphia sometimes occurs at the same time as anxiety. If someone’s preoccupied with certain things because of anxiety, a bodily feature might just be another issue to focus on, Durvasula added.
“Social media has definitely not helped this. There’s a lot more social comparison to what other people look like. Many people put false images out there,” Durvasula said. “In adolescence, that form of evaluation — physical appearance, fitting in and all that — is going to be much more pronounced.”
Having family members who evaluate, validate or love themselves or others based on appearance can also play a role, she added.
“That makes the person overly sensitive to (perceiving) flaws in their appearance,” Kearney-Cooke added. “And what often happens is, somewhere deep inside, whether it’s because of difficult childhoods or whatever, they feel like, ‘I’m not enough. I’m not attractive.’ And then they project it onto their body.”
A perfectionist mindset intensifies this view, she added.
Living with body dysmorphia
The effects of body dysmorphia can extend to all aspects of life — social, occupational and financial — especially if the disorder worsens over time without treatment.
“Because they’re so obsessed with this sort of sense that there is this physical problem, they will spend significant amounts of time and money either getting cosmetic medical treatments or cosmetic dental treatments, dermatologic treatments, even surgical treatments,” Durvasula said.
People with body dysmorphia also have “checking” behaviors, which can look like spending lots of time looking in the mirror and taking countless selfies and assessing those, Durvasula added.
Compulsively looking in the mirror can ease fears about how people think they look or help them see if a perceived flaw is still there or has worsened, according to the National Association of Anorexia Nervosa and Associated Disorders. They think the feature is abnormal or ugly. Body dysmorphia was originally described as “the imagined ugliness syndrome,” Kearney-Cooke said.
Someone with the disorder might also seek reassurance from others by asking if they see the flaw, if a feature looks OK, or if something’s wrong with or different about the feature.
People with body dysmorphia might isolate themselves out of shame or from spending too much time worrying over their appearance, experts said. They can also burn out their social support by constantly seeking reassurance, Durvasula added.
Spending so much time analyzing their appearance can result in often being late to work or not doing schoolwork, she said. Some people put themselves in financial peril by buying cosmetic products or procedures — incurring debt for themselves or their families, and sometimes doing so in secret because of concerns of what might happen if people knew.
Kearney-Cooke had a patient who was so obsessed with a perceived flaw on her nose that she was always looking in the mirror, even while driving, the psychologist said. Crashing a car into a tree while doing so was a wakeup call for the patient, she noted, leading to treatment and eventually some improvement.
Getting treatment for body dysmorphia
Body dysmorphia can’t be cured, and it’s a “difficult clinical condition” to manage because “it’s a pattern that’s very resistant to change,” Durvasula said. But some effective treatments are available.
One preferred by many experts is cognitive behavioral therapy. A person’s distortions or thoughts are believed to drive this behavior, so therapists work on the person’s distortions and go from there, Durvasula said. Since body dysmorphia is in the same category as obsessive-compulsive disorder, treatments for OCD, such as “exposure and response prevention,” could also be helpful for managing body dysmorphia. In a safe environment, this therapy exposes people to situations provoking their obsessions or triggers and requires them to choose to not respond with compulsive behaviors.
When undergoing such treatment, a person with body dysmorphia doesn’t get to look in the mirror much or take selfies, Durvasula said. “They’re having to actually tolerate the discomfort of not engaging in the checking behavior. But that has to be complemented with the cognitive behavioral work.”
A history of trauma would require trauma-informed therapy as well, which would involve a mental health professional acknowledging how the person’s trauma could be a root cause of body dysmorphia.
“Some of the therapy may also be very educational — on sort of the images that we see out in the world and how unrealistic they are,” Durvasula said.
Researchers have been looking into brain chemicals, such as serotonin, being a cause of body dysmorphia as well, Kearney-Cooke said — so antidepressants known as selective serotonin reuptake inhibitors or SSRIs can also be helpful in treatment.
If you can’t find a mental health professional specializing in body dysmorphia, try working with someone who has expertise in OCD or eating disorders, Durvasula said.
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