Do you hate the way you look?

0:00This BBC podcast is supported by ads outside the UK.

0:30Check out their deviled eggs, cold-pressed juices, and more. Spring is in bloom now at Whole Foods Market. This podcast is sponsored by Pocket Hose. I gotta tell you, being a homeowner, there's so many things you have to think about all the time. For example, I have to replace my hoses every single year. Because they're weak, they get tangled, and there's kinks. Then I found the Pocket Hose Ballistic. This is the upgrade I've been looking for for a long time, man. It's reinforced with a liquid crystal polymer used in bulletproof vests. You know what that means? No kinks. It's not going to get tangled.

1:02It also comes with this pocket pivot, which gives you total freedom of movement. And the spigot has like a 360 degree rotation, which is pretty cool. There's also this upgraded UV coating. They add it for free. So your hose basically looks brand new all the time. Right now, when you get the new Pocket Hose Ballistic, you'll get a free 360 degree rotating pocket pivot and a free thumb drive nozzle. Go to Pocket Hose dot com slash podcast. That's pockethose.com slash podcast for your two free gifts with purchase. Pockethose.com slash P-O-D-C-A-S-T. Hello and welcome. I'm Kimberly Wilson. I'm a counseling psychologist and this is Complex.

1:46The psychology podcast that helps you navigate your way through all the information that's out there about our mental health. And let's face it, there's a lot of it. In this episode, I'm looking at body image and its more serious counterpart, body dysmorphic disorder.

2:07Now it's January and the time of year when we're supposed to be pounding the pavements, pumping weights, detoxing, creating new, improved versions of our bodies. Well, not on this podcast. Because, I mean, let's be honest, aren't we all a little bit tired of that by now? I certainly know that I am.

2:32There is so much, too much pressure on us to have the perfect body. But frankly, that whole idea is doomed to fail. And this pressure causes me and my colleagues a great deal of concern because dissatisfaction with our bodies is on the relentless rise. In fact, in a recent study, 61 % of adults and 66 % of children reported feeling negative about their body image most of the time. How is that okay? Today I want to dig down into body dissatisfaction and body dysmorphia, which is when we can't stop obsessing over a part of our body that we dislike or think is flawed. So how can you tell the difference between the two?

3:20and what can you do to improve your relationship with your own body? So let me be your guide through the dark and dingy cave of misinformation to the beautiful green open space of understanding.

3:38Now I'm sure you, like me, have seen body dysmorphia posts trending on social media. It seems to be everywhere and it's a term that can be used too easily. So perhaps this is a good moment to clarify where the line is between the condition and say something like disliking what you see in the fitting room mirror. As usual, I've asked an expert guest to help me unpick it and we'll be hearing a story from someone who grapples with the image she has of herself.

4:11Okay, here's my expert guest, Professor Viran Swamy. He's from Anglia Ruskin University and he researches the psychology of body image, among many other things. Hi Viren. Hello Kimberly. So can you please tell me a little bit about yourself and your expertise in this area? So I'm a social psychologist and I study body image, which is basically how we think about our physical selves, how we experience our bodies. And one of the things I try and do is find ways of helping people experience the body in more positive ways. Okay, thank you. and I'm seeing a lot of references to body dysmorphia online but you're here to talk about body dysmorphic disorder so what's the difference please?

4:55So body dysmorphia is essentially an older term for the same thing it was initially discovered or described by Enrico Morselli who was an Italian psychiatrist and he called it body dysmorphophobia which simply means a perception that your body is ugly or some aspect of your body is ugly today we call it body dysmorphic disorder because it's part of a psychiatric continuum which places it on the same continuum as other obsessive disorders like obsessive compulsive disorder. And as a researcher, have you noticed any trends in, I suppose, the conscious awareness or people talking about body dysmorphic disorder or kind of related concerns?

5:32I think that the language has entered popular culture. I think you see celebrities talking about body dysmorphia a lot more, but I think people sometimes bandy that term when they in fact mean something other than body dysmorphic disorder or not a clinical condition. And I say this because I think a lot of people will experience forms of anxiety around their appearance. They might experience body dissatisfaction. But if it doesn't interfere with your everyday functioning, then typically we wouldn't consider that to be body dysmorphic disorder. Okay, thank you very much. I'm so delighted that you're here.

6:05I think you're the perfect person to talk about this subject with. So let's get into the complexity.

6:14All right. So as I said, we've heard from one listener whose concerns seem to sum up the issues that we are wanting to talk about. I'm going to call her Rachel, but that's not her real name. So Rachel says, everyone tells me I'm pretty. My mum and my dad, my boyfriend, my friends, but I definitely don't feel pretty. What spoils my face is my lips. They're really wonky. I can't stop thinking about how wonky they are. I've tried using makeup and lipstick to change their shape, but it doesn't work. When I tell my partner about it, he tells me I'm just being stupid, but I'm getting more and more unhappy with them.

6:51I'm now thinking of having plastic surgery. Rachel, we're going to do our very best to break this down and explain what might be going on. Viren, could you give me a definition of body dysmorphic disorder, please? At the most basic level, body dysmorphic disorder is a preoccupation or an obsession with some aspect of the body or the appearance, which to other people seems normal, but to you as the person experiencing it feels completely or absolutely flawed. Yes. As you describe it, it's as if they have tunnel vision. Their entire world narrows down around this aspect of their body, their physicality, and everything else kind of fades away.

7:32Absolutely. It consumes their entire identity. I can give you an example. There was a famous case of a Russian aristocrat in the early 1900s. His name was Sergei Pankachev. He was a patient of Freud, as it happens. Freud called him the wolf man. The story is that Pankachev kept having repeated dreams about a wolf staring at him from a branch of a tree. Freud never worked out what the significance of that dream was for his condition. But one of the things that happened later in his life was that he had minor surgery on his nose. And he came to believe that his nose was horribly flawed in some way.

8:07And according to one of the psychiatrists who was treating him later on, what Pankajef would do was essentially carry on a pocket mirror. And he would look at this pocket mirror every few minutes. And sometimes he would dust his nose, believing the pores were too big. And sometimes he would remove the dust because he thought the pores were becoming too small. Apparently, when he would come home, the first thing he would do is run in to his house and look in the mirror. So every behavior and every waking second was consumed by looking at his nose, thinking about his nose, working out how he could camouflage the nose.

8:38And that is essentially body dysmorphic disorder where your entire identity, your emotional well-being is consumed by one or several parts of your body. It's really interesting to hear Sergei as the example because I think generally when we think about body dissatisfaction, typically a woman comes to mind. What is your sense of how this splits across the sexes in terms of either body dissatisfaction or body dysmorphic disorder? So there is a clear gender divide. When we talk about body dissatisfaction, it is much more common for women to experience negative body image. With body dysmorphic disorder, though, we don't see a clear gender divide.

9:12It's typically more or less the same in both women and men. What people might be concerned about might differ across gender. So, for example, men typically are much more likely to be concerned or are preoccupied with their muscles. And there is a specific form of body dysmorphic disorder called muscle dysmorphia, which is simply an experience where typically men, but not necessarily just men, will experience their bodies as being too small and their muscles not well developed enough. Men are also much more likely than women to experience preoccupations with their genitals. Women are much more likely to show preoccupations with their skin, their nose and their face compared to men.

9:49this makes me think of the meaning of those aspects of our bodies in the social world so muscles and genitalia for men being about virility and i suppose skin and figure and facial features again for women being about attractiveness and their value as a partner that i think wider culture probably exacerbates an underlying condition if you're living in a society constantly tells you that the most important aspect of your being is your appearance the the difference though here i think a lot of the time with people who experience body dysmorphic disorder there is a shame involved because they believe that other people will think they're vain that to obsess about the a particular body part means that you are exhibiting symptoms of vanity when in reality what a lot of people who experience body dysmorphic disorder want is just for that aspect of the body to be normal not to be beautiful just to experience it as being normal so we've got all of the different kind of contributing factors to the amount of distress someone might be experiencing and you can see why body dysmorphic disorder in particular might be underdiagnosed if a person feels like they can't talk to other close individuals in their life because they don't see the same things they see or if they believe that a health practitioner might think well you're just being vain you're not really experiencing anything debilitating you can see why people might be hesitant to seek professional help so it's underdiagnosed we think absolutely so the general population about between about one to two percent of the people of people will experience symptoms of body dysmorphic disorder but we think that's probably an underdiagnosis i'm wondering though where it starts where it begins you know it's for someone like Rachel, it wouldn't start overnight, would it?

11:36There isn't a common pathway that will be the same for everyone. What we do know is that symptoms typically begin in adolescence. That's not always going to be the case. It can begin later in life as well. We don't really know why it begins. One of the explanations is that there is a biological component, so you inherit the genes that might trigger body dysmorphic disorder within particular environments. The The most common explanation though is that it's often related to childhood trauma. So several studies have shown that adults who experience body dysmorphic disorder have experienced some form of trauma as a child, typically emotional or sexual abuse.

12:12So it may be that as a child, if you've experienced some form of trauma or some form of abuse, you locate the form of abuse in a specific body part and you begin to try and manage your trauma by focusing or hyper-focusing on some aspect of the body. That's really interesting because there's an idea in psychoanalytic theory about containing and we think of the mind as a container. So if you can say things, you can convert your troubles into words. If I can use emotion words, I can express them and get them out. But if you don't have that because maybe you haven't developed the language yet, because no one's actually asked you, because you are not at that developmental stage, then your body becomes the container for your distress.

12:53And it kind of makes me think of that, that idea that we have to put the distress somewhere and if we can't think about it or talk about it, it gets potentially located somewhere in ideas around our bodies. Yeah, absolutely. I think for a lot of theorists, what seems to be happening is that for young people in particular, if you haven't got the language to articulate distress, often what happens, it becomes easier to locate that distress on the body, to say actually something's wrong with my physical self rather than go through and wade through more difficult trauma. And I suppose maybe on an unconscious level, there's an idea that this is fixable, you know, that I could get in there and I could make this better.

13:34Yeah. So you might be camouflaging it, you might be hiding it, you might be changing your clothes every few hours, because that's one way of control. So you're controlling what you feel to be uncontrollable. You explain that so clearly and exquisitely and helpfully, and in a way that I think is really easy to understand. And it's becoming clear, including to me, that there's a real distinction between dissatisfaction, being a bit unhappy with an aspect of my body, you know, passing by a shop window and thinking, but getting on with my day versus body dysmorphic disorder and how this preoccupation can take over someone's life.

14:15If we were to think about the key characteristics of body dysmorphic disorder, what would you say they were? So I think there are three key characteristics. One is the emotional distress and they might spend a lot of time ruminating and feel like they can't control their thoughts about that aspect of their appearance. The other is the behavioral element. So the behavioral element might be repetitive behaviors or rituals that you develop to try and manage your perceived flaws like constantly checking in the mirror or repeatedly touching the part of the body that feels flawed or picking at your skin is a common ritualistic behavior where you constantly do something to that body part.

14:55And probably the most important thing is whether it's having an impact on your ability to function in everyday life. That is the key characteristic here. You're no longer able to do the things that you'd like to be able to. Okay, so for example, I am turning down invites to go out with my friends because I'm so worried about how I'll look or what they might think of me, or just because I feel so distressed that I don't think I can gather up the energy to go out with my friends. Yeah, that sounds like body dysmorphic disorder. Okay, so we have our three criteria of body dysmorphic disorder and how that differs from everyday normal dissatisfaction, we might call it.

15:32Although it feels really difficult calling it normal dissatisfaction. I feel really sad thinking that so many of us just walk around unhappy with ourselves. You know, psychologists have a term for this. We call it normative discontent. And what that simply means that it is a normal part of our experience to feel dissatisfied with our appearance now. Most people experience it. So studies suggest between 60 and 70 percent of men in the UK and about 90 percent of women will experience some form of body dissatisfaction or body anxiety. Well so let's put that on a scale then. If so many people are experiencing this, if we were putting body dissatisfaction on a scale with this normative discontent at one end and body dysmorphic disorder at the other.

16:12Let's see what it would look like. For example, for someone like Rachel. So someone who's experiencing body dissatisfaction might experience, for example, a perception that they're not thin enough or that they don't like the body. For example, they may not like going dress shopping because it feels difficult. But it's not debilitating. It's not stopping them from having a life. And do we have somewhere in the middle, somewhere where it's slightly more than this normative discontent but not quite the acute end of disorder. So that's where it becomes much more difficult to diagnose because we don't tend to think of body dissatisfaction in that kind of scale or continuum form where we place body dysmorphic disorder at the other end.

16:55Body dysmorphic disorder is essentially a clinical disorder and what that simply means is that your cognitions or your thoughts are not working the way we would necessarily want them to be. You're seeing the world in a way that doesn't necessarily reflect reality. So we might have a scale of body dissatisfaction, but actually body dysmorphic disorder doesn't sit on a scale. It is a discrete condition that kind of sits within the world of obsessive compulsive disorders. Absolutely. If someone is at home and they recognize, maybe I have something more than normative discontent, what would be the clue that their behaviors might be indicative of a problem?

17:37I think one indication is the amount of time you spend thinking about the perceived flaw in your body so if you're spending one or two hours a day worried and fixated on that body part then that might be a sign that something is not quite working as it should be the other tipping point might be the experience of the distress if you feel like this body part is causing you distress to the point where you feel like it's not manageable anymore, that you might want to self-harm, or that you might be thinking about suicide because of this body part, then that's a clear indication that you're now having, you're experiencing something debilitating.

18:18If you are listening and you recognize yourself in these examples, then I want to urge you to seek expert support either from your GP or from credible organisations that are set up to help. You can find details of some of these in the show notes. But if this is someone that you care about, maybe a child or a partner or a sibling, Viren, what would you suggest? I think these conversations can be really difficult sometimes because it might be really frustrating to have to deal with someone who is constantly seeking reassurance, whether it's a reassurance about whether you can actually see what they can see or whether it's a reassurance over the experience itself, whether the emotions that they're experiencing are normal and okay.

19:00Am I being silly? Am I being ridiculous? Exactly. And those conversations are often quite typical with someone who's experiencing body dysmorphic disorder. And I think just exercising some compassion and patience can be really important. Rather than shutting down these conversations and getting angry or frustrated about it, to recognize that body dysmorphic disorder is a mental health condition that doesn't just go away on its own. And that without professional help, it often gets worse. Okay, thank you. But it sounds like that for most people who might think they have BDD, body dysmorphic disorder, actually it's much more likely that they fall into the category of normal or normative discontent body dissatisfaction.

19:39If this is you, then there are some things that you can do that can help you to manage it. What would you suggest, Viren? Get yourself off social media is probably the most immediate answer to your question. there's a lot of evidence to suggest that social media exacerbates body dissatisfactions associated with more negative body image in general if you want to promote what we call embodiment which is a positive situating in your body living your body in the way it was meant to be lived in there are simple steps you could take spending time in nature is probably the most effective one and cost effective as well it's free so there's a lot of evidence now to suggest that people who spend a lot of time in nature in natural environments tend to have more positive body image they show greater care for the body they're more respectful of the body they typically focus more on the functions of the body what the body is able to do then rather than what it looks like and can that just be my local park or do i have to kind of find myself in some kind of beautiful landscape any kind of form of nature is beneficial

20:43okay thank you it's been so so good to talk to you and to gain that clarity and for everyone listening i hope you now have a better understanding of what body dysmorphic disorder is what body image dissatisfaction is and the difference between the two and this is exactly what i love to do on complex which is to find evidence-based information to help clarify understanding and misunderstandings. Now, have you ever been ghosted or have you ghosted someone? Perhaps repeatedly. Have you ever wondered why? In our next episode, I'll be looking at attachment, the term used to describe how we form relationships with other people.

21:31How can you recognise it in yourself or maybe in your partner. And we want to hear from you. I'd love to know what you'd like me to talk about and why. You can email your questions to the show, but please note I can't answer them personally. So if you have a concern about a medical or mental health issue, then I'd strongly urge you to seek expert support. And if you want details or further support with some of the issues raised in this podcast, you can find them at bbc.co.uk forward slash action line. The link is in the show notes on BBC Sounds. Don't forget, you can subscribe to Complex. Just make sure your push notifications are turned on so you don't miss out on a single episode.

22:16There is lots of really lovely content in the feed. For example, you can find out what perfectionism does for you or to you and discover how to manage if you're a people pleaser. And that's it. My thanks again to Professor Viran Swamy and also to the lovely team at Loftus Media who produced this episode.

23:00I am Kimberly Wilson. Thank you so much for listening. Take care and go gently.

23:14From BBC Radio 4, I'm Canny. I looked and at the top of the stairs was an old man. Hello, I'm Danny Robbins. So many of you have contacted me since our last series went out with stories of seemingly impossible encounters with the potentially paranormal. Now, this new series of ten episodes features the strangest, the scariest, the most compelling of these experiences. And she started screaming. So, are you feeling team believer or team skeptic? Join the investigation and listen to Uncanny on BBC Sounds, if you dare.

24:07And if you're like me, you're trying to figure out how artificial intelligence is changing the business world and our lives. So each week on Big Technology, I bring on key actors from companies building AI tech and outsiders trying to influence it. Asking where this is all going. They come from places like NVIDIA, Microsoft, Amazon, and plenty more. So if you want to be smart with your wallet, your career choices, in meetings with your colleagues, and at dinner parties, listen to Big Technology Podcast wherever you get your podcasts. Do you love rom-coms? do you wish you could talk about Christmas movies year round?

24:39Then we have the perfect podcast for you, Hallmarkies Podcast. Throughout the year, we cover all things romance, holiday, and Hallmark, including recaps of every Hallmark show, like When Calls the Heart and The Way Home. You can also get loads of bonus content covering shows like Bridgerton, Sweet Magnolias, and just like that. We are an all-female group of friends who are passionate for these shows and movies and give our honest opinions as well as gush over what we love so much. But that's not all. Every Monday, there are interviews with all your favorite actors, writers, directors, and more.

25:15Check out Homeworkies Podcast on all your podcast providers and on YouTube. That's Homeworkies Podcast wherever you listen to podcasts.