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Hello everybody and welcome back to the psychology of your 20s.
The podcast where we talk through some of the big life changes and transitions of our
20s and what they mean for our psychology.
Hello everybody, welcome back to the show, welcome back to the podcast, new listeners,
old listeners, wherever you are in the world.
It is so great to have you here back for another episode as we of course break down the
psychology of our 20s of your 20s.
Before we begin a brief trigger warning that this episode does deal with some fairly
in-depth discussions around weight loss, weight gain, appearance and eating disorders.
So please do just take a second to consider whether you are in a healthy mental space, a
healthy mindset to be listening to this right now.
This episode will still be here in a few days, in a week, in a few months.
So you can always return to it when the time is right, when the time is better.
Let's get into it.
Today we are going to be talking about a pretty vulnerable topic, one that has I think
especially serious implications for our mental health, both in our 20s and beyond and even
before.
And it can also just be such a present and overwhelming shadow in our lives, our thoughts, our feelings,
our opinions about our body, do have this incredible capacity to really influence every other
area of our daily life, of our existence, about values, of our relationships.
And yet we really do tend to kind of keep it out of the light of day.
We really avoid discussing this openly because I think of, you know, well shame and how hard
it is to come out and say, you know what, the moment I really dislike my body, I really
hate some part of me or I'm fixated on my appearance and I don't know how to stop it.
I think it's also what it comes down to is embarrassment as well as shame.
The sense that caring this much about your looks is somehow, you know, vapid or vein.
When actually it goes so much deeper than what other people might want to label it, it
is and can be very disordered, a very disordered pattern of thinking and beyond that, something
that is hugely and largely beyond our control.
I've come to realize the more I also choose to speak more openly about this experience,
how many of us are struggling with some form of negative and harsh thinking about our bodies,
about our weight, about our appearance, but you wouldn't think that given how much
we have trained ourselves in society has trained us to be silent about it.
From that, it hasn't just trained us to be silent, it's also trained us to view and
treat our body like it is a constant work in progress rather than something that we
can just be satisfied with as it is.
So consider this your say space, we're going to discuss everything to do with this today,
specifically the topic of body dysmorphia and what that actually means.
I think we hear a lot of people talk about how, you know, they are just satisfied with
their appearance with their weight.
Is that always body dysmorphia or can we just have symptoms without a diagnosable condition?
The other point that people mention is how it's really difficult to even be able to tell
what we look like, how a lot of us are really struggling with just a genuine acknowledgement
of our appearance and how other people see us, is that body dysmorphia or is that something
else? What is the actual, I would say pathology and criteria behind BDD, body dysmorphic disorder?
So we're going to discuss all of that including the origins of this condition, what makes
us more susceptible, including the impact of toxic gym and diet culture, how it manifests,
the impact, but also some stories from you guys, the listeners who were really vulnerable
and open about their personal experiences.
And I also just want to talk more generally about what it means to really dislike your
body without having BDD and why that is becoming increasingly more common and what we can
actually do about it, what are ways of interrupting this really negative belief system that our
appearance is really at the core of our worth or matters more than it does.
So we have so much to talk about, so much research, so much science and of course, so much
psychology, so without further ado, let us get into it.
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Body dysmorphia is one of those conditions that I think we've all heard about which is
definitely and largely misunderstood.
To start off with, I just want to get our basics down pat.
What actually is BDD.
BDD, body dysmorphic disorder is a mental health condition.
It's a lot more than feeling occasionally negative about your body.
It is an entire pattern roundabout cycle maze, inescapable maze of negative emotions, negative
perceptions and negative feelings that are all directed towards your appearance.
What it really involves is an obsessive focus and shame and anxiety around some perceived
flaw in our appearance.
This often very small feature of us, it could be some feature of our face, our physique,
muscle mass, our skin, combination of all those things, our weight, our height.
This small feature becomes a preoccupation, regardless of whether it is real or imagined,
no matter how small it is.
When I say real or imagined, I mean that this thing that we really dislike about ourselves
could be so tiny and obscure that no one else would ever notice it.
But for us, it feels like a huge part of who we are.
It feels like we exist in the world and as we are existing this huge spotlight is highlighting
to ourselves and everybody around us this feature that we really don't like.
Even when others say that we look amazing, they compliment us, they say we look lovely,
they reassure us that no one is noticing this flaw that we are focused on, we can't
believe them.
Whereas a part of us that is quite honestly delusional and constantly tells us that all
these other people must be lying.
They just can't see it, they must be blind in some way.
We continue to have this hyper focus on this flaw and we normally resort to repetitive
behaviors in order to kind of self-sooth or regain some control over this aspect of our
appearance that is causing mental tension.
These behaviors are things like always checking ourselves in the mirror, constant mirror checking,
constant grooming and touching or skin picking, only choosing clothes that will hide this
feature or part of yourself.
These are actually called BDD safety behaviors and they are one step above avoidance whereby
they make us feel like we have control over what part of us is being made visible to others
and therefore we can control the judgments that we assume people are making about us based
on this feature.
So it's not just that we have a fixation on this flaw, it's not just that we have this
personal spotlight, it's also that in order to be meeting the criteria of BDD you have
to become obsessed with how you can fix it.
In our minds if the flaw was to disappear or suddenly go away so would all of our mental
distress.
And so we are always searching or coming up with a plan to erase this part of us whether
that is through excessive exercise, intense skin care routines or cosmetic surgery.
So cosmetic surgery has a really important kind of place in this discussion now that I've
kind of brought it up.
What I found was really interesting when I was really digging into this research is that
whilst only about I would say 3 to 5% of the general population has BDD and that's even
like quite a generous statistic, it's probably sitting at around 3.5 amongst people who pursue
cosmetic interventions, not just surgery but fillers, injections, non-invasive procedures.
That prevalence of BDD in that population rises to almost 25%.
So depending on how you feel about cosmetic surgery, you may think that this could provide
some relief to people with BDD, it's almost like a treatment.
You know, if they're experiencing so much shame associated with their appearance here
is this fix.
But on the other hand, this is a multi-billion dollar industry that makes its money on exacerbating
and praying on these insecurities and the purported ability to kind of fix them.
We have to remember BDD is a mental disorder, not a physical disorder.
The problem is with cosmetic intervention is that it actually often makes people with
body dysmorphic disorder feel worse or actually just the same after the procedure.
They may even become more preoccupied with the perceived floor because it has just changed.
It hasn't gone away and they can seek further cosmetic procedures leading to a times in
addiction.
So something that really fascinated me about this kind of interaction between body dysmorphic
disorder and cosmetic surgery is the study that said that yes, a lot of people who pursue
cosmetic surgery would actually make the criteria for this mental condition.
But more so, they are actually also the people that are most likely to take legal action
against surgeons because even when the surgeon in their mind has fixed this floor, you know,
it hasn't gone away just because it's, you know, physical form has changed.
This feature of us is once again a preoccupation that it's coming from something that is kind
of mentally disturbed or mentally, I don't like to say broken, mentally different is probably
a better way.
Mentally disordered, right?
It's just not an accurate reflection of what we actually look like.
It's not an accurate reflection of our physical form so it doesn't actually matter if that
feature of us changes.
So obviously not everybody with BDD is going to seek out cosmetic surgery, but I think
it does really reveal to us how hard it is to control such a loud and persistent thoughts
about our body and why it does seem that drastic measures will be the only solution to silence
them.
This is often why as well BDD is compared to parallel disorders like OCD and eating disorders.
I feel like that one might have come to mind for you almost immediately.
And these disorders in particular have a high chromobility with BDD.
That means that often, not often, but you know, it's not uncommon for people to have
a dual diagnosis.
So for these two things to be appearing at the same time for somebody to have BDD and
an eating disorder or OCD and BDD.
So the comparison to OCD really emerges because of the excessive situation which results in
compulsive behaviors, which really kind of follows a similar format to how OCD manifests.
However with, you know, body dysmorphia, it's really solely based on an obsession and
a compulsion to do with appearance.
So the link to eating disorders is also quite a common one.
If someone is that disgusted, I would say almost tormented by their appearance.
Sometimes this can really manifest in disordered eating habits, you know, wanting to control
this aspect of yourself through whatever behavior or means necessary.
But it's also important to remember that a lot of people with BDD do actually just have
quite normal eating patterns.
Like you can have BDD without abnormal eating.
It's also interesting because people who are experiencing anorexia or binge eating disorder
or bulimia, yes, they may find that this has resulted from initial feelings of like extreme
dissatisfaction and fixation with some perceived flaw.
But also another component of this is that sometimes there is, you know, behaviors like restricting
food or excessive exercising or purging can also emerge simply from a place of control,
not just bodily modification, which is why I think BDD is really deserving of its own
separate diagnosis.
All right, so let's talk about risk factors here.
There are obviously some people who are a lot more susceptible to this than others like
most mental health conditions.
And when we talk about mental health conditions and we talk about who's at risk, the biggest
thing it mostly comes down to or always comes back to in some sense is family history.
If someone in your close or your immediate family has endured BDD, your chances go up
quite a bit.
This, you know, it comes down to genetic predisposition, but also exposure and life experiences.
You know, if that individual with BDD was a parent, their own experience with this
condition is going to influence how they raise you and how they parent you as much as
they may try for it not to, you know, if this kind of condition goes untreated, it does
have the impact of bleeding into all these other aspects of our lives, including our relationship.
So for example, I heard from someone who spoke about how their mother was obsessed with
slimmeness for all her life, she would enjoy these like drastic diets, she got multiple
surgeries in the pursuit of this small body, this small physique.
She would always comment on her weight to others.
She really never seemed happy regardless of the results.
So definitely meaning the criteria for BDD here.
And as a child, this person spoke about how her mother really implanted a lot of those
beliefs in her through the way that she, you know, controlled her as a parent.
She would, you know, control her food, for example, she would choose flattering clothes
and colors for her and tell her, these are the colors that you should wear or you can't
wear those things.
They make you look fat.
She was constantly, you know, commenting on her skin, especially as she hit puberty and
developed acne in this person said to me, you know, two years ago, I got the same diagnosis
that my mom had gotten.
And sometimes I think how much of it was genetic and how much of it was environmental and was
my, you know, the environment of my upbringing.
Because in those situations, how are you meant to develop a healthy sense of self-esteem?
How are you meant to detach your appearance from yourself worth?
When that kind of preoccupation is being passed down to you by the person in your life that
matters the most to you as a child, which is your caregiver.
This kind of example, and I don't like to say example, this person's experience here,
this, they're very much personal experience really demonstrates to me as well how negative
life experiences also play a really crucial role, especially experiences like childhood
bullying, like neglect, like teasing, like abuse.
So I actually have a story about this that is from my own life that I've never really
shared before on this show, you know, it never really came up.
But it is one of my earliest and most lucid memories from childhood.
It's also one of those moments that really goes to show how, you know, passing words
can really leave quite a lifelong mark.
So when I was around seven, six or seven years old, I used to always go out of, you know,
to school hourscare, like, I don't know if that's a thing everywhere in the world, but,
you know, both my parents were working and so I like stayed at the school a little bit
longer with like other kids whose parents were also working or also had things to do.
And we were watching this movie with a bunch of other kids called The Little Princess.
And this boy turns to me and he goes, you know, you look, you would look just like her
if you weren't so fat.
I have never been able to shake those words even till the day they have left such an imprint
on me.
It was like the first time that I ever felt shame about my body.
And I think when I was a teenager, now as an adult, my whole life, my weight has been
a point of fixation for me.
There has never been a period of my life where I've been satisfied with how I look or how
I weigh, how I feel in my body.
And I often wonder whether that would have been different if that hadn't happened because
it was almost like this new, you know, it was almost like that was the beginning.
Like I became conscious of everything that I could change that I didn't like about myself
and the fact that people could observe these things that I didn't like about myself and
could make judgments or mean comments to me about my appearance and it mattered.
It's also really interesting to me how that continues to come up as a problem for me in
my life.
I posted like this random video on my Instagram a few weeks ago, if you follow me over there,
I think you'll know which one it is.
And it reached an audience that I basically like didn't intend it to.
Like it went semi viral and the audience was, you know, men in their like 30s and 40s
who didn't, you didn't agree with what I was saying.
And as always goes with those situations, if like a middle aged man doesn't agree with
what you're saying, the first thing they're going to resort to doing is making a comment
about your weight or your appearance.
And oh my gosh, did I not get hundreds of them and they were awful.
And the only thing I could think of was, oh my god, this is just like this all over again.
It brought me right back to that version of me who was first really made aware that her
body wasn't just that acclimed and to run and to play and to giggle and to eat yummy foods.
Like it was there to be judged.
Those early life experiences might seem very far in the past, but they definitely linger,
especially since BDD typically starts, you know, in our early teen years when everything
is so formative, but also when those childhood experiences and memories are a lot more fresh
and we are a lot more impressionable.
So there are some other risk factors, including personality traits like perfectionism.
If we are of course preoccupied with being flawless in every other area of our life, of
course our appearance is going to come into that, you know, the existence of even a tiny
perceived floor, a bad skin day, stretch marks, a facial feature that can really disrupt
our whole identity and be quite distressing.
I will say something that is not a factor here is gender.
So with eating disorders, for example, there is, you know, typically a much higher prevalence
amongst women.
It's normally around three times the rates that we would see in men for things like anorexia
and bulimia.
But for BDD, men and women people of all genders are influenced the same.
It just expresses itself quite differently.
One area that this is really evident to me is when it comes to weight.
Women typically want to be thinner, whereas men want more muscle.
They're preoccupied with gaining weight.
Obviously this isn't always the case, but I do think that it's a distinction that we
can really see when we just look around ourselves, when we just compare what our male friends
versus our female friends complain about when it comes to their size.
So in the DSM, there is even a specifier around this particular kind of BDD that results
from muscle dysmorphia, whereby somebody is really engrossed with the idea that their
body build is too small.
They are not muscular enough to be seen as, I don't know, manly or to be seen as big
enough or worthy enough or like strong enough, whatever it is.
This in my mind can also be really attributed to, I would say, a rise in toxic gym culture
and this idea of bigorexia.
Now this is a term that I learned from a recent article by the Guardian and they talk about
how we all know what anorexia is.
This is a play on words.
And anorexia is typically associated with the pursuit of smallness and thinness, whereas
bigorexia is this pursuit of being as huge as possible.
And in this article, they spoke to some guys and some women as well, but mainly men about
the lengths that they are willing to go to to achieve this.
And no matter how many people say, wow, you are so huge, you are massive.
Every time they look at the mirror, they do not see that.
They see themselves as tiny.
And this one man in this article was talking about how he would eat the only thing he would
eat would be chicken breasts and protein sources.
And he was like, I looked amazing, like in my mind, it looked so huge, but I was so unhealthy.
And like his kidneys started failing and his liver started failing.
And I think that that really comes down to this crucial point, which is that this obsession
with a muscular body is largely ignored because it's seen as healthy or a worthwhile
bodily pursuit because what's unhealthy about strength?
And what's unhealthy about spending time in the gym?
What's unhealthy with fueling your body in this optimal way?
What's unhealthy about protein?
And I think a lot of people experiencing this, witnessing this would be quick to highlight
how easy it is for this to tip into very unhealthy and maladaptive terrain.
How this is just another version of an unrealistic or an extreme expectation for our body image
that is promoted by certain in groups and certain cultures and certain aspects of society?
So this distinction, this general distinction is, I think, between weight loss and weight gain
for different genders is essentially a reflection of what society expects from men and women.
You know, the beauty ideals that each gender is very much forced to endure.
And we can't ignore that component, the influence of our social conditioning and how we have
been taught to hate our bodies not instinctually but through external influence.
So BDD, I think it's what I would call a modern day disorder because it really has a risen
mainly in the last 100 years, probably even 20 to 50 years specifically.
And it's really emerged as some researchers would say from the fact that we now have more
comparison points than ever to judge ourselves based on.
And we are increasingly being exposed to this messaging around what we should look like
and what is not desirable.
This is because things like TV, advertising, social media, they have made us more aware
of the social norms around attraction and what society sees as beautiful or not.
Secondly, they have exposed us to what other people look like, meaning of course more
opportunities to come up short and compare.
And finally, you know, the media uses looks and appearance as something through which they
can influence and sell us things.
And so let's be honest, they benefit from us not feeling great.
They benefit from us seeing a beautiful person on TV and wanting whatever skincare product
that they're using or seeing, you know, a huge, huge guy on some superhero movie and
admiring not just this plot line and this narrative around him being a hero, but the fact
that he looks so great and the fact that we could copy his workout routine and the fact
that he is like this really jacked cool guy.
And the socio cultural theory of self-esteem would tell you that the messages given to us
by the media about the importance of appearance and what is hot and what is attractive and
what looks good.
They are so easily internalized by us as individuals and they also so easily influence how we
treat ourselves, our standards, our habits and our behaviors.
I think as we feel more pressure to conform with that, we become more aware once again of
the aspects of ourselves that we feel will be judged based on prevailing norms of attraction.
If I am not thin, does that mean I will be unhappy?
If I am not bigger, if I don't fix my nose, if I don't fix my skin, does that mean that
I will never find love?
Will they consider me for this job if my hair is thinning, if I'm too frail, if whatever
my teeth aren't straight?
And all of it comes back to this idea, this irrational belief that the secret to happiness
is our appearance.
I want to share another person's experience here because I think they articulate a bit
so well in a much better way than I ever could.
I've struggled with body dysmorphia and eating disorders since I was 12, I'm 20 to now.
Last year I started recovery and treatment after being at my lowest with my symptoms, so
I had the urge of seeking help.
It's been a tough journey and very difficult to accept the diagnosis.
The mind-blowing thing is that almost my entire adolescence and early adult years I thought
life was about my weight, appearance and body composition.
And I made it till now, just like that, fitting so perfectly into society and no one noticed
that something was going on.
What I'd like to emphasize is that just because weight loss and obsession with appearance
is culturally normalized in our society doesn't mean that it is healthy or even pleasure
able at all.
I've been in this mental prison for years, losing time, missing experiences, people that
I will never regain.
I really hope that we could move towards a more inclusive society in terms of body norms
to not feel like the only way to fit in is to a stereotype of beauty that is unachievable.
Unachievable.
I love that this individual firstly thank you so much for sharing and that was like kind
of emotional when I first read that.
Secondly, I like that you finished on that because so many of the examples that fuel
our body dysmorphia are the 1% due to crazy amazing genetics, are due to something that
we could never change and at times or even due to somebody who themselves has body dysmorphia
and who is undergoing crazy surgeries and crazy efforts to fix the part of themselves
that we are sitting back and admiring.
So I really think that it is such a weird mess around where if everybody is experiencing
this, the person that we are probably comparing ourselves to is probably looking at us or
looking at somebody else and wanting what they have as well.
So you know the norm is constantly evolving and yet we're constantly chasing the sense
of again that appearance equals happiness.
Alright, we're going to take a short break but when we come back I want to discuss whether
body dysmorphia is more prevalent than we think but also how we can kind of move through
some of the stress, dissatisfaction, worry, anxiety around our appearance.
Stay with us.
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For example, you may try a new food for the first time, realize you don't like it and
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We wanted to get rid of some hair on our legs.
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There is an important distinction here between BDD and having the occasional negative
perception about our body and it is an important one because I would go so far as to say that
nearly every single one of us has something that they want to change about how we look
but we aren't really going to drastic measures to do that.
You know maybe that doesn't qualify us as having a mental health condition however I think
just because it's not as intense as it is for people with body dysmorphia doesn't make
hating your body easy.
It is so difficult to wake up in a body that you increasingly do not like or find problem
with because that is your home you know as the incredible Emma Thompson says that is
your vessel there is no escaping that you will exist in this body and no one else is
until the day that you die.
So hating how you look and how you feel quickly evolves into hating yourself almost instantly
because the two things you know yourself or your soul and your appearance your body the
very hard to separate.
So I wanted to hear from you guys the listeners around the world around just how many of us
are experiencing this kind of daily dislike how endemic it is because whilst I think we
can all recognize the you know the universality of warry and dissatisfaction towards our appearance
I don't think we talk about it enough and I think that having a general and a more like
kind of bird's eye view of just how many of us are going through this is quite comforting.
So I kind of wanted to just siphon it down to the area of like weight loss because I feel
like a weight change more like weight loss or weight change because I think that weight
is something that most of us have a general insecurity about compared to more unique things
about ourselves that are probably different between each of us you know it's kind of hard
to talk about like oh would you want to change that unique scar or would you want to change
that you want to know as job like when people you know that's yeah big insecurity but not
as prominent as weight is for all of us.
So you know it's kind of sad to say it but weight dissatisfaction is a bit of a human equalizer
that's why I chose it.
So out of almost 2000 of you 70% of you said that in the past year you had thought about
losing weight nearly every month and for those of you who said every month shockingly it
was like 47% of that faction who said that you thought about it every day.
So nearly 50% of you said every day that weight loss is on your mind clouding your thoughts
and your judgment.
I want you to like genuinely think about this for a second is there any other warrior insecurity
that we all share as much as that one.
You know as we are all going about our daily lives we each have our own unique set of problems
we each have you know work deadlines we each have relationship issues we each have small
anxieties small to do lists and the one thing that seems to you know bind us all together
is that in this small reality that is our own reality all of us are sharing this collective
thought that we don't like how we look and that we want to lose weight.
Like I was thinking about this the other day when I was on the train and I was looking
around it was like a park train and I was like how many people here right now have thought
about dieting today.
How many people on this train have you know put on their jeans in the morning and been
like oh gosh I really probably should lose a few.
And that's just crazy to me because you would look at all these people and you know if
the statistics that I got from you guys are saying it that's like 50% of those people
on that train have thought about it that day and yeah I wouldn't have been able to tell
you that that's what they were thinking and yet I would have thought that I would be
the only one because our own lives just feel so unique and so isolated.
And that's the other interesting.
