Body Dysmorphia: Bodily Complaints That Never End

Like seen in this gif, all of us have a lot of things to complain about when it comes to our appearance. I wish for a flat stomach every time I want to go out wearing a cute crop top. I wish my thighs wouldn’t get all jelly when I sat down in those shorts. Like Rachel from F.R.I.E.N.D.S., I sometimes have insecurities about my nose too. I wish I wasn’t so tall that I looked like a mother to my BFF when we clicked pictures!

But we can’t have all that we want, can we? And most of us make peace with it (trust me, I try).

However, what happens when slight cribbing about your thinning hair turns into a full blown obsession
with trying out all possible hair treatments in the market? What happens when you start believing in the frantic SMS you type out to your friend—“MY LIFE IS OVER”—when you get a pimple on a date night?

Let me tell you what happens: Body Dysmorphic Disorder (BDD).

Body Dysmorphic Disorder is a diagnosis that is related to Obsessive Compulsive Disorders in which a person becomes unhealthily preoccupied with a real or perceived ‘defect’ in their appearance. An important point to note right away is that even if there is a bodily shortcoming present, it is perceived and reacted to in an out of proportion manner i.e. a small scar, barely noticeable, near your eyebrow may be seen as disfiguring your entire face, thereby inviting that much unnecessary stress in response to it. The perceived flaw may seem invisible and imaginary to people around a BDD suffered but it is a firm reality to that person who unrelentingly believes that there is “something wrong” with how s/he looks. So, no: This disorder is not to be confused with one’s vanity with their appearance. It is a very real and distress- causing mental health condition.

BDD is different from Eating Disorders

Undoubtedly, eating disorders and BDD both circle around body image issues. However, eating disorders are solely concerned with one’s dissatisfaction with their body shape and size. On the other hand, in BDD, dissatisfaction with body weight is just one of the many other body areas that can become a target of constant depreciation. This is to say, BDD sufferers may become preoccupied with scars and hair, facial structure and skin irregularities like moles or even the looks of their genitalia.

A surprising fact? In BDD, people (usually men) can be overcome by the thinness of their body i.e. a lack of muscle and sturdy body build. So, BDD is not all about feeling fat and becoming obsessively
worried about it. Instead, BDD may be concerned with the complete opposite of it too! In fact, the clinical term for this particular type of BDD is Muscle Dysmorphia.

Another differentiating point between BDD and eating disorders is that the latter entail erratic food consumption patterns: you eat too much or too less or purge and exercise till you drop. However, BDD involves fairly normal eating patterns and the individuals may or may not be of the normal weight. Instead, BDD patients may seek cosmetic surgeries as a means of dealing with their insecurities.

Lastly, while eating disorders are more common amongst females, the prevalence of BDD is more or less same for both the sexes. Nevertheless, there may be subtle differences in the body parts that become trouble centers for the two. For instance, females with BDD usually perceive ugliness in their hips and weight while men are more likely to see it in their body build and thinning hair.

Sure, there seems like a considerable overlap between the two disorders and it is even quite possible that an individual may be diagnosed with both at the same time. This may be so when a person shows irregular eating along with distress about a bodily area other than their waist length.

Tell tale signs of BDD

A person with BDD constantly checks himself/ herself in the mirror or their selfie camera for ensuring that they look fine. They groom themselves to an excessive degree as if they are trying to make up for some irreparable short coming. They may also be the ones who constantly elbow you to ask if they look fine. They need a lot of reassurance.

Now you may be thinking, “Hey, I do that too!” But in order to understand what makes these signs a clinical diagnosis try multiplying the intense insecurity with which these actions are undertaken by 10 and estimate the number of times these actions are performed to be almost always. Some say that individuals with BDD spend approximately 1 full hour each day wondering and worrying exclusively about their appearance!

Often, individuals who develop BDD are said to carry a certain amount of biological vulnerability for the same. However, it is only when biology combines with sensitive social experiences of teasing or rejection related to how one looks during adolescence, is when this disorder manifests. Once the idea of having “not up to the mark” appearance takes roots, their thoughts becoming completely biased—almost as if shining an attentional spotlight—on their negative body image. At the same time, they start engaging in checking rituals mentioned above and slowly begin withdrawing from others out of embarrassment. These behaviors at the crux of the moment may seem like “helping” them to reduce their anxiety levels but carry the potential to emerge into full blown Obsessive Compulsive Disorder (OCD), Social Anxiety Disorder or Major Depression. Obviously, this hampers interpersonal relationships of the individual and in 1/3^rd of the cases the BDD patient may become delusional! For example, if they see two people exchanging a laugh while passing by them, they will be ferociously convinced that the topic of amusement was their bodily shortcoming. Social isolation inevitably cuts off their support networks and this when combined with repeated failures on interpersonal, academic and occupational fronts (arising from interference caused by their mental illness) pushes BDD patients towards suicide ideation and attempts 10 to 25% times more than the general population.

Nevertheless, individuals with BDD may have fairly accurate insight about their disordered thinking but may shy away from opening up about their condition to anyone—not even their therapist—for the fear of being misunderstood or absence of knowledge that BDD is treatable. So take out your keen, observant glasses to look out for these signs so that you can help someone who may be in need for professional help to go ahead and seek that help.

BINGE EATING DISORDER: WHAT UNDERLIES ALL THOSE LAYERS OF FAT?

“Let’s binge eat!” my friend squealed.

 “You mean a ‘who-can-eat-pani puri-till-they-drop’ competition? You’re on, buddy!” I replied.

Fill in any favorite food item of yours in the underlined part above—biryani, ice cream, chips, fries—and there you have it, a fun binge eating day with your BFF by your side or a hearty me-time while you catch up on a rerun of your favorite TV show.

I’m sure that all of us are guilty of “binge eating” on some occasion or the other. So much so, that when I introduce Binge Eating as a disorder, many of you will be surprised, maybe worried? However, let’s not jump to conclusions. In order to qualify for a clinical diagnosis of Binge Eating Disorder (BED), one needs to meet the following criteria:

1. When you say that you are going to binge eat, do you mean that you can eat an amount of food so large within such a short period of time (say, 2 hours) that most others may not be able to consume under similar circumstances? If yes, then you’re binge eating.

2. When you are binge eating, do you feel a sense of lack of control—feel as if you can’t stop eating or how much you’re eating? If yes, then you’re binge eating.

3. Binge eating episodes are often associated with eating rapidly as if under the fear of being caught cheating. You hardly taste the food you are so ravenously hogging on! You may eat until you feel uncomfortably full. You may also eat large amounts of food without physically feeling the need to eat. They feel extremely embarrassed about their seemingly uncontrollable eating behavior. And once the sin of overeating is committed, do you feel disgusted with yourself, guilty or depressed about such “rash” eating behavior? If yes, then probably you’re binge eating.

4. Do you feel distress for gobbling down 10 plates of pani puri? Sure, your body might be protesting for an outlet of all that spice. But do you mentally feel troubled for eating and eating and never stopping?

5. How often do you go on binge eating sprees? In order to receive this diagnosis, one must exhibit a compulsive eating episode at least once per week for a span of 3 months.

6. A person has BED if they don’t repeatedly purge all the food that they eat as in bulimia nervosa and only if they are NOT currently suffering from anorexia during which it is possible to have a few episodes of binge eating while still being significantly underweight and meeting all the other requirements for anorexia nervosa.

It may seem somewhat obvious that individuals with binge eating disorder are often overweight. We don’t binge eat fruits and vegetables. We binge eat fats-laced, carbohydrates-rich guilty pleasures. However, making a reverse assumption that all overweight/ obese people are suffering from BED may not be appropriate. Nevertheless, research has repeatedly shown that BED sufferers are over represented in populations that are obese and seeking help for reducing their body weight.

Binge eating disorder is different from anorexia and bulimia wherein the person starts looking abnormally thin and hence receives a lot of attention and sympathy. Instead, BED simply hides under the layers of fat which somewhat seem normal in our trending move towards widening waistlines but at the same time is despised by most. So if a person is fat, you’re fast to assume that he is lazy and undeserving of your help while if a person looks like a moving skeleton, you may raise your brows to form a crease of worry. Although the process of destigmatizing larger body sizes is a long way to go, would it hurt to ask someone you think is struggling and suffering if they need some love and support?  

How to detect if someone is battling against BED?

Since these individuals are very well aware that there is something wrong with them and that acceptance for their enlarged body shape is scarce, they engage in secretive eating. They may eat in normal quantities at the dinner table but if you were to peep into their room or car, you may discover a secret stash of fatty foods or left over wrappers and tins of such foods. They may eat between their meals to be able to eat “normally” in front of others. There have been cases where binge eaters have reported that they have gone “restaurant-hopping” and feasted on foods while driving their way from one restaurant to the other!

A more extreme step would be to actively isolate themselves while eating their daily meals as far as possible because they fear the judgmental looks that will be directed their way if they eat the way they eat.

Mostly though not always, BED is a response that is triggered by depression or anxiety. So if you find a loved one eating erratically and showing simultaneous unruly mood fluctuations then you may want to talk and find out if everything is okay. All of us find comfort in food. When its exam time, I personally find myself eating more amount and eating at more number of times then I do on a normal basis. That’s basically a response to stress. In our brains, when we eat delicious food, it releases the feel-good hormone of dopamine. Dopamine is the same hormone that is also released when we engage in pleasurable activities or even in addictions like smoking. Thus, speaking of the concept of reinforcement again, we can say that binge eating is somewhat maintained as a disordered habit because the release of dopamine in the brain rewards us to continue this behavior.

Low self esteem and exhibition of a “What-The-Hell” logic can also be considered as indicators of BED. These individuals do not believe in their own ability to regulate eating. Thus, even though they may decide to enter a weight loss regime, the moment they slip (which all of us do, with or without the disorder), they may think, “Of course, I am not capable of doing this healthy eating and exercising stuff. Now that I have already broken a diet rule, what the hell, I might as well break all the other rules!”

We all are foodies in our own right. But when are we pushed across the fine line between normality and abnormality because of a threatened body image is something to ponder on. Keep pondering, keep reading, keep following this series on body image!