Body image disturbance is a component central to several eating disorders. For this reason, people are commonly confused about whether body dysmorphia is synonymous with an eating disorder. It is not.
What is body dysmorphia?
Body dysmorphia is the experience of extreme criticism of some aspect of one’s appearance. This phenomenon occurs in eating disorders and in body dysmorphic disorder. In less severe forms, it can also be experienced by people without any psychiatric illness.
What is body dysmorphic disorder?
This is a condition in which someone is preoccupied with specific perceived flaws in their appearance that are minor or completely unnoticeable to the casual observer.
Examples of imagined flaws include:
- asymmetry or unevenness with part(s) of the body
- nose shape or size, or other facial features
- acne, scars, birthmarks, or wrinkles
- hair thinning, or frizziness
- muscles being too small or ill-defined.
Persistent and intrusive thoughts about the specific body part or overall appearance become highly distressing. In response to these thoughts, an individual may engage in maladaptive behaviors, including repeatedly checking or avoiding mirrors, seeking reassurance from others, pursuing cosmetic procedures to “fix” the issue, or spending a lot of time on grooming (or in some cases, skin picking).
These concerns and behaviors rise to the level of a diagnoseable problem when they interfere with daily life. Many people are insecure about their appearance, or occasionally wish they looked different. In cases of body dysmorphic disorder, there is more intensity, persistence, and interference of these thoughts, as well as the associated, concerning behaviors.
Body dysmorphic disorder is treatable. A form of cognitive behavioral therapy tailored for the diagnosis is the first-line psychotherapy treatment. Medications, such as SSRIs (one type of antidepressant), are also sometimes prescribed.
What distinguishes body dysmorphic disorder from an eating problem?
Though these two problems often involve some type of body image distress, they are distinct in important ways:
- the focus of the concern with appearance,
- core fear and associated beliefs, and
- types of behavioral disturbances.
Concern with Appearance
People with eating disorders such as anorexia nervosa and bulimia nervosa are concerned about their weight and/or overall body shape. Eventually, it becomes an overly important part of how they evaluate themselves. While this is not a diagnostic criterion for binge eating disorder, individuals with this kind of eating problem will also sometimes express preoccupation with body size.
Across eating disorders, there is – as the name implies – an overfocus on eating as well. This may be connected to fears of weight gain, an intense drive for thinness or muscularity, or a reliance on eating to “exert control” or cope with difficult emotions.
Individuals with some eating disorders may be concerned about focused areas of their body, such as their arms, stomach, or legs, but this is usually part of a larger picture of dissatisfaction with overall body size.
Core Fears and Problematic Thoughts
People with eating disorders experience many problematic thoughts about how they look, what they weigh, their exercise patterns, and what they eat (including types of food and portion size). They may believe that gaining weight is entirely unacceptable, or that if they start to gain weight, they will never stop. Individuals sometimes believe their self-worth is tied predominantly to appearance: “No one will like me unless I am thin.” Or beliefs that too rigidly connect eating with other behaviors: “If I eat a slice of cake, then I must exercise extra.”
With body dysmorphic disorder, the central fear is something like, “This part of me is deformed (or ugly, or wrong).” There is typically an associated belief that people will notice, and judge harshly, based on the perceived flaw. While weight gain may be a concern, it is more likely to be framed as a specific defect in appearance, rather than fear of fatness or weight gain: “My thighs look deformed.”
Behavioral Disturbances
In contrast to the problematic behaviors typical of body dysmorphic disorder, hallmark behavioral features of eating disorders include:
- restricting food based on food rules,
- calorie counting,
- fasting,
- binge eating,
- eating in response to emotion or in secret,
- purging, and
- compulsive exercising for the purpose of weight control.
There are many behaviors that become most prominent at mealtime.
What are the similarities?
In both disorders, self-consciousness about appearance is linked to social isolation, avoidance, and low self-esteem. Behavioral disturbances can have a repetitive and compulsive quality. And, individuals with both types of disorders in some cases lack awareness about the extent to which their body image perception is distorted.
Can someone have an eating disorder and body dysmorphic disorder?
Yes, these problems can co-occur. Eating disorders (as a group) are more common than body dysmorphic disorder. The rates of their overlap vary by study and clinical setting. Body dysmorphic disorder is more common in people with eating disorders than in the general population, and vice versa. In one study, approximately 30% of those with body dysmorphic disorder also had an eating disorder. There is also some research suggesting that in individuals with both disorders, body dysmorphic disorder tends to precede the eating disorder.
When these disorders co-occur, symptoms of each disorder tend to be more severe and impairing. Additional diagnostic complexity – including higher rates of depression, suicidality, anxiety, and OCD – is then also common.
The International OCD Foundation can provide additional information and treatment resources for help with body dysmorphic disorder. Contact us (646-774-8066; edru@nyspi.columbia.edu) or the National Eating Disorders Association to find help for an eating disorder.
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