‘It took a toll’: Body dysmorphia hurts more than self-esteem

People with severe body image distress also struggle with decision-making, planning and short-term memory, new research has shown, in revelations expected to shake up how the disorder will come to be treated.

Researchers at Swinburne University’s Centre for Mental Health recently sought to establish the depth of processing difficulties experienced by people living with body dysmorphia. To do so, they analysed 54 previous studies that referenced neurocognitive vulnerabilities.

Eman Allouche battled severe body image issues as a teenager and similar thoughts returned after she had a baby.Credit: Justin McManus

Body dysmorphic disorder, or BDD, occurs when a person becomes preoccupied with and distressed by perceived flaws in their physical appearance that are either not visible or appear slight to others. Individuals will frequently engage in repetitive mirror checking or avoidance, excessive grooming and constantly compare themselves with others.

About 80 per cent of people with BDD will have suicidal thoughts, and it’s estimated that one in four have tried to take their own lives.

Previous research has demonstrated that BDD, which affects an estimated 1-2 per cent of the population, compels people to focus on minutiae and not the bigger picture. This new, comparative study found differences across all levels of cognition – from basic visual perception to complex executive functions.

“What we have done is show cognitive problems are essential to the symptoms of BDD,” lead researcher Katrina Holmes à Court told this masthead.

‘We have people with PhDs in literature, but in social situations they can’t string a sentence together.’

Researcher Katrina Homes à Court

“It really goes to explaining why [people with BDD] are so socially avoidant. It’s very impactful in terms of their quality of life. I’ve had people tell me, yes they can work, but they’ll never put their hand up for a promotion – especially if it involves standing up in front of people.

“We have people with PhDs in literature, but in social situations they can’t string a sentence together.”

Holmes à Court hopes the findings, which show the symptoms of BDD exist beyond the stereotype of someone who thinks they are “too monstrous” to leave the house, will have wide-reaching implications among GPs, psychologists and even the public.

“The people who don’t understand BDD will sometimes think of it as excessive vanity. But the research shows it’s not a vanity problem, it’s a cognitive problem,” she said.

Eman Allouche said her dysmorphia started when she was about 16.

“I would go home and look at my body and feel disgust and shame around not feeling feminine enough,” Allouche said. “It definitely took its toll.”

The Melbourne-based nutritionist said the study findings resonated with her because, with the benefit of hindsight, she found the classroom a challenging environment.

“I was thinking about my body when I was with other students,” she said. “That probably did take away from the time I should have spent engaging in my academic work. Even just being a kid and doing fun things. So I definitely struggled, academically, at the time.”

Allouche with her daughter IIyana.Credit: Justin McManus

Allouche said her symptoms started easing when she saw a doctor and did some work with a therapist. However, they returned shortly after giving birth, something she attributes – in part – to the prevalence of social media.

“So much of what we see online isn’t realistic. It’s so easy to compare ourselves,” she said.

She has a message to other mothers experiencing severe body image distress: “You’re in a different season, and you can love yourself in that season. Appreciate what your body has done for you and where you are now.”

Clinical psychologist Sarah Cox, who also manages the Butterfly Foundation’s national helpline, said anyone – regardless of age, gender, race and sexuality – can be affected by BDD.

“The difference between BDD and body image issues is that BDD is a distinct, obsessive-compulsive disorder that causes an individual to be overly preoccupied with a particular part of their appearance to the point that it causes significant disruption to daily life and wellbeing,” Cox said.

“In comparison, body image refers to our thoughts, feelings, perceptions and behaviours we have in relation to our bodies and how we look.”

Cox said more long-term studies were needed to assess the impacts of living with body dysmorphia, the concurrence rates of BDD with other conditions and how these illnesses develop.

The team at Swinburne is already looking at the next steps to their research, such as trying to set “something like an IQ test” that can be used to identify which parts of the brain someone with BDD could train. The findings could also inform which treatments will be most effective for certain individuals, and put more emphasis on medical professionals giving people the tools to adapt at school or work.

“A lot of people feel very hopeless and feel very misunderstood,” Holmes à Court said. “There are treatments already. And there will be more coming.”

For support with eating disorders or body dissatisfaction, call the Butterfly National Helpline on 1800 ED HOPE (1800 33 4673) or visit www.butterfly.org.au to chat online or by email seven days a week, 8am-midnight AEST and AEDT.

If you or anyone you know needs mental health support, call Lifeline on 131 114 or Beyond Blue on 1300 224 636.

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