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Marie Osmond is opening up about her experiences with body shaming and body dysmorphia, starting from when she was a teenager. The actress and singer, 63, says a producer from her talk show Donny & Marie (which ran from 1976 to 1979) would constantly make incredibly cruel comments about her weight. “It was on that lot that I was taken out to the back by some head of the studio — and I’m like 5′ 5″ and about 103 lbs. — and he basically said, ‘You’re an embarrassment to your family. You’re fat,'” Osmond says, adding that another producer told her that “250 people were going to lose their jobs because you can’t keep food out of your fat face.”
Osmond says the pressure led to her trying unhealthy diets which got her weight down to 92 lbs.—but she realized she had a serious problem. “I was in the dressing room, bending over putting on my pantyhose, and there was a girl in there changing who was just an emaciated skeleton with skin on her,” she says. “And I just thought, ‘Oh my gosh, that’s so sick,’ and I stood up and realized that girl was me. And it was just one of those big ‘AHA’ [moments], that ‘Oh, body dysmorphia is a real thing.'”
“Concern about appearance is usually normal, and a sign of healthy self-esteem,” says Michael Craig Miller, MD. “But being overly self-conscious about looks may be a problem, and it’s extremely distressing when it takes the form of body dysmorphic disorder (BDD). People who have this condition are preoccupied with what they regard as physical defects. In many cases, this concern reaches delusional proportions: they see bodily flaws that aren’t there and have little to no awareness that their worries are irrational. Some with the disorder know that they’re unreasonably hung up on some aspect of their appearance, but this only makes them feel ashamed and causes them to keep their painful symptoms a secret.” Here are five symptoms of BDD to be aware of, according to experts.
Obsessive focus on perceived flaws is one of the most common signs of BDD. “Often people with BDD become preoccupied with checking their appearance in the mirror or they spend an inordinate amount of time grooming,” says Dr. Miller. “The shame they feel may cause them to avoid socializing. They may focus on their appearance to the exclusion of everything else, including work or personal relationships. BDD increases the risk for suicide and half of those with the disorder develop alcohol or drug problems.”
“In BDD, people are tormented by obsessive thoughts associated with a part or parts of their physical appearance being flawed in some way, yet these flaws tend not to be noticeable to anyone but themselves,” says Scott Granet, LCSW. “Typically, the focus is on features associated with the head and face, such as hair thinning, skin tone and the nose. However, any part of the body can become the focus, especially those associated with physical appearance such as the stomach, legs, teeth and too many other parts to mention here. As part of the diagnosis, the preoccupation also includes compulsive behaviors such as mirror checking, comparing the body part to that of others, and pursuing needless dermatologic treatments and plastic surgery.”
Compulsive behavior could be a sign of body dysmorphia. “Similar numbers of men and women have BDD, despite the stereotype that women are more concerned with their appearance,” says Dr. Miller. “Men often have a variation called muscle dysmorphia. Someone with this problem believes his body is too small or not muscular enough — he may get compulsive about working out, be prone to eating disorders, and abuse anabolic steroids.”
Skin picking is another sign of BDD-related compulsive behavior. “Because of its similarities to obsessive-compulsive disorder (OCD), BDD is often considered to be on the obsessive-compulsive spectrum,” says Susan McQuillan, MS, RDN. “With obsessive-compulsive disorder, you may suffer from recurrent thoughts, fears, or images that you cannot control. Any anxiety you feel leads to the performance of rituals or routines (known as compulsions) that help release the tension. When you have BDD, your obsession with perceived flaws leads to ritualistic skin picking, excessive grooming, or other behaviors. That obsession can also have a negative affect on your social, professional, and family relationships as well.”
People with body dysmorphia may have severe social anxiety and fear of being around others. “The focus of fear is humiliation and embarrassment in social situations,” say Eric Hollander, MD, and Bonnie R. Aronowitz, PhD. “Exposure to social situations often is associated with extreme anxiety, including panic symptomatology. Although the patient acknowledges that the fear is unreasonable or disproportionate to the situation, feared social situations are typically avoided. This avoidance or endurance with marked distress results in impairment in occupational, marital, and social functioning. In social anxiety disorder, the most frequently reported feared social situations are public speaking, approaching strangers, and eating in public.”
People with body dysmorphia may struggle with work, doctors say. “Having BDD can negatively affect your work performance, your relationships and interactions with your coworkers and supervisors, as well as your ability to perform your everyday job duties,” says Jennifer Greenberg, PsyD. “In fact, a substantial proportion of people with BDD are unable to hold a job or go to work because of BDD symptoms. If you do have a job, BDD symptoms can dominate your life while at work, making it difficult for you to focus on anything else. This can lead to showing up late to work (or missing work altogether), performing job duties poorly, and having trouble concentrating. Many individuals with BDD shy away from jobs they are qualified for and might really enjoy, and you might instead be drawn to a job that keeps you out of the spotlight, like working from home or at night. Promotions that would increase responsibility and interactions with others are often passed up.”
“People with BDD often get cosmetic surgery or dermatology treatments in pursuit of fixes for perceived flaws,” says Dr. Miller. “Sadly, their unrealistic expectations can lead them to feel worse, not better, and the disappointment can be devastating. A group from the University of Pennsylvania reviewed studies linking cosmetic breast augmentation and suicide. The authors noted that among patients with BDD who receive this surgery, more than 90% had similar or worse symptoms of BDD after the procedure.”
Studies suggest body dysmorphia may be under-diagnosed in patients who want cosmetic surgery. “Body image problems should become a standard topic during cosmetic consultations,” say researchers from University of Groningen. “Most of the cosmetic professionals in our sample reported to have a considerable degree of awareness of BDD and to use this knowledge in their decision whether or not to perform a cosmetic procedure.”
Low self-esteem and self-loathing are common signs of BDD. “Perhaps the most damaging part of living with the disorder is the toll it takes on someone’s self-worth,” Granet says. “Anyone who treats BDD has heard people describe themselves as disgusting, a monster, a freak, along with other comments such as ‘I don’t deserve to live looking like this.’ It’s no wonder that BDD has such a high suicide attempt rate. People with the disorder believe that their life satisfaction hinges on their looking better, hence desperate attempts to pursue ways to achieve that. Two teenagers told me recently that they’re looking for part-time jobs so they can afford to pay for plastic surgery and another told me that he spent some of the money that had been set aside for college to pay for a procedure he later felt made him look worse.”
Low self-esteem can impact many aspects of someone’s life, Granet says. “In discussing self-esteem, let’s not forget about other important aspects of life such as work, school, relationships, and hobbies. “Nope, too ugly to have any of that,” a BDD sufferer might say. Too often people with BDD think that their appearance has to improve before they can sufficiently engage in these types of pursuits. Think again. If you wait for that the BDD will win every time. You must put those and other meaningful activities into to your life first, and begin to improve your self-esteem that way. No one is just their hair, their eyes, their chin, etc… Everyone defines themselves based on other parts of life, and that shouldn’t be any less true for people with BDD. While building one’s self-esteem in other areas is important, it does not take the place of CBT, which of course needs to happen. It just gives the BDD less of an opportunity to flourish.