A voice in Katherine’s head tells her she is ‘ugly’, but help for her common condition may be on the way

As early as grade 2, Katherine Kalaitzidis began to see parts of herself as different, or inferior, to other girls. Things only she could see.

“I suddenly felt a little bit less feminine than the other girls who had long hair, or long eyelashes,” says the 24-year-old.

Katherine Kalaitzidis lives with body dysmorphia disorder and feels her own appearance is sub-par.Credit: Wayne Taylor

“In high school, it got to the point where I was so scared of walking through corridors and people looking at me that I refused to go to school, or hid in the toilets – all because I had this voice saying, ‘They don’t like you, you’re less likely to be hired, have friends, to find romantic love all because you’re less attractive than other people’.”

Even after she began receiving therapy for what was later diagnosed as the relatively common condition, body dysmorphic disorder, “there’s still this strong instinct that I am ugly”.

“I have issues with my face, in particular, thinking my nose is slightly too round, my forehead is massive, my hair grows back too far, my jaw is far too wide,” says the emerging singer-songwriter, who hopes to demystify what can be an extremely debilitating condition.

The condition drives many to seek multiple cosmetic surgeries, or to develop eating disorders, but no comprehensive treatment exists. New Australian research promises to help with the continued development of a treatment.

‘Body dysmorphic disorder is not narcissism or vanity, it’s a serious mental health disorder.’

Professor Susan Rossell, cognitive neuropsychologist

A team led by Professor Susan Rossell, a cognitive neuropsychologist, has released findings showing that people with body dysmorphia process visual information differently.

The anomalies convince them they have serious faults and also lead sufferers to misinterpret the facial expressions of other people, and to the belief people are also seeing them as flawed.

“They are seeing [themselves] differently,” says Rossell, of Swinburne University of Technology. “This research has shown it isn’t their thinking style that’s problematic, it’s the information they get through their eyes, and how it is interpreted in their brain.”

Where the brains of people without the condition compile composite images, those with dysmorphia “get stuck” on processing individual features, rather than switching to “configural processing”, creating a cohesive whole.

“As soon as they look in the mirror, an area will become obvious to them, or they’ll start to focus on it – like their nose – and they won’t be able to stand back and look at it configurally,” says Rossell, whose team’s new paper is published in the journal, Psychiatry Research.

Rossell has seen patients with wide-ranging, negative beliefs about certain body parts that have had serious impacts on their self-esteem and quality of life.

“When I first started researching body dysmorphia 15 years ago, I read about people who don’t like their noses, but now I know it’s everything from people’s teeth to their jaw lines, to hair, to breast shape, to symmetry,” she says.

Men and women experience body dysmorphia at equal rates, Rossell says, and where prevalence has been recorded at 2.5 per cent of the population, she and others including psychiatrist Professor David Castle, from the University of Tasmania, believe that because people often do not seek treatment, the true incidence could be about 5 per cent.

Singer and songwriter Billie Eilish has helped to destigmatise body dysmorphia by discussing it widely.Credit: Richard Shotwell

“Body dysmorphia disorder is surprisingly common, and to many people, it can be distressing and disabling,” Castle says. “We know there is a big treatment gap, and we’ve been looking at trying to help [through this research].

“There are various psychological and pharmacological approaches, but this takes it another step, to look at how people view themselves in terms of visual processing.”

When patients are helped to understand that what they see is not an accurate reflection of their appearance, “the penny drops; they realise other people don’t see them in that way and if they understand, it helps turn that around”.

This can help reduce “terrible fear that people will see you in a certain way; see you as a monster or the Elephant Man, when it’s not accurate … this is really profound”, Castle says.

Singer and songwriter Billie Eilish has helped to destigmatise body dysmorphia by discussing it widely. She has told of her difficulties with her self-perception and being overly preoccupied with her appearance.

Katherine Kalaitzidis is using her experience with body dysmorphia as material in her songwriting.Credit: Wayne Taylor

Jim Hungerford, chief executive for the body image support organisation the Butterfly Foundation, describes the research as “incredibly important to destigmatise both people who have BDD, as well as people with eating disorders, because there is a very strong overlap”.

“We are seeing an increased prevalence [of eating disorders], and also seeing that people affected are becoming younger and younger,” he says, as seen in data the foundation commissioned by consultancy Deloitte this year.

Hungerford hopes the new research can help reduce the shame many sufferers of the disorder feel, that prevents them from speaking about it or seeking treatment. “I can imagine the effect of feeling you’re not worthy enough to get help,” he says.

Like Kalaitzidis, Hungerford says social media is a big driver of young people developing disordered perceptions about their bodies.

“What I would really like people to understand is that when I make negative comments about my own appearance, I am not doing that as an attention-getting device or some form of compliment fishing,” Kalaitzidis says.

“I really do feel inferior to others, even if they don’t see my flaws. It’s a mental health illness which is not even known about by the majority of society.”

If you or someone you know needs support with body image issues, the Butterfly Foundation helpline is 1800 334673. Lifeline is on 131144, or Beyond Blue 1300 224636.