tag:theconversation.com,2011:/au/topics/body-dysmorphic-disorder-5858/articlesBody dysmorphic disorder – The Conversation2024-02-02T12:54:32Ztag:theconversation.com,2011:article/2223322024-02-02T12:54:32Z2024-02-02T12:54:32ZBody appreciation has been linked to better sexual and life satisfaction – here’s how to cultivate it<figure><img src="https://images.theconversation.com/files/572479/original/file-20240131-29-2mjf8n.jpg?ixlib=rb-1.1.0&rect=7%2C0%2C4683%2C3122&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/studio-shot-gorgeous-charming-young-afro-1155721477">shurkin_son/Shutterstock</a></span></figcaption></figure><p>These days it’s hard to miss the body positivity movement. But love and respect for the body isn’t new and wasn’t invented by the west. Indeed, <a href="https://www.sciencedirect.com/science/article/pii/S1740144523001079">global research</a> I’ve collaborated on has found that body appreciation is understood and experienced the same way all over the world – even if we did find large differences in levels of body appreciation between different countries.</p>
<p>But first, it’s important to understand what body image and body appreciation mean in psychology. </p>
<p>Body image is the <a href="https://www.sciencedirect.com/science/article/abs/pii/S1740144503000111?casa_token=Rcq1wAg3bqcAAAAA:f6JSlomsBkh7fYCH6Yag5hLvYnafoWebugkvXRK85GZlULveHK0gBJzWsf2y8CwW9PGkwubb">“inside view”</a> that you have of yourself. Historically, body image research was focused on <a href="https://books.google.co.uk/books/about/Body_Image.html?id=qZN7w2kXxtoC&redir_esc=y">negative aspects</a>, such as appearance anxiety or clinical conditions including <a href="https://theconversation.com/body-dysmorphic-disorder-what-to-know-about-this-mental-health-condition-206243">body dysmorphic disorder</a>. Over the past two decades, however, the study of <a href="https://books.google.co.uk/books?uid=106235092810786544912&hl=en">positive body image</a> has gained momentum. </p>
<p>There are <a href="https://www.sciencedirect.com/science/article/abs/pii/S1740144515000340?casa_token=HiHQiavOgksAAAAA:NXZa-jEUfgzgmx-5mjDWC5HNKi8-gBprj9gf9i3cTH1xVTJKo7p2MIe__QPaHj6VwpEY8PT6">different forms</a> of positive body image, but perhaps the <a href="https://sciencedirect.com/science/article/abs/pii/S1740144520300474?casa_token=ygYRkOBgPKcAAAAA:pxkPRRghn1PAtCBA4Ow0hPA3p2FqWMNSTXHbUFD4xERixIJ2uMBbuX8uz7lgF3C52jOXvl62">most important</a> and most widely studied is <a href="https://www.sciencedirect.com/science/article/abs/pii/S1740144505000549?casa_token=smBg8epwDQkAAAAA:FIZ1Jm46W_9a4QLtd2J4F25svCWato7fWqc6Yl6hZ61KtzUcTj8RxTjlXgKvxuOLA8WAEH6-">body appreciation</a>.</p>
<p>People who have high <a href="https://www.sciencedirect.com/science/article/abs/pii/S1740144514001314?casa_token=WZfrvT-P7iAAAAAA:8TrD7-T-Y_bEq_DHadfOShff9flnsuJoylbPpo4bb_yKkG1odjUKiOefja52JB5b4XMASkq4">body appreciation</a> are more likely to appreciate the unique characteristics of, and be attentive to the needs of, their bodies. These people also tend to reject narrow appearance ideals as the only form of human beauty.</p>
<p>Body positivity is a movement that promotes positive views of all bodies, whereas body appreciation is an inner relationship to your own body. </p>
<h2>Body appreciation in diverse populations</h2>
<p>Body appreciation is usually measured by researchers using the <a href="https://sciencedirect.com/science/article/abs/pii/S1740144514001314?casa_token=ekHCya4IqJgAAAAA:IuoczNLUI1esS6dY_hsgvjM12uM42XGdffWQ_g9D-xL0ry_ODe-OVeIVMx10FXnHz4kU4m0X">Body Appreciation Scale-2</a> (BAS-2), which includes statements such as “I respect my body” and “I feel love for my body”. An important question for scientists is whether the BAS-2 measures body appreciation in the same way for different groups of people.</p>
<p>To answer this question, my colleagues and I in the <a href="https://www.sciencedirect.com/science/article/abs/pii/S1740144521001479?casa_token=4eSxw6YJpYwAAAAA:Ce9M7-G-7MvvDeGWbLFhBRCE_bUAzoSGvsDGbseUMfIlo7mlXBmAqvDAFIv0SxZsYpMCpIxB">Body Image in Nature Survey</a> – a consortium of 253 international scientists – asked participants from 65 countries speaking 40 different languages to complete the BAS-2. In one of the largest studies ever conducted on body image, <a href="https://www.sciencedirect.com/science/article/pii/S1740144523001079">we found that</a> the BAS-2 was understood in the same way across all communities. </p>
<p>Other studies have found that the BAS-2 is understood in much the same way across <a href="https://www.sciencedirect.com/science/article/abs/pii/S1740144519300051?casa_token=FoDuRk7F0HsAAAAA:zPIZV3WvXM5QIw-WTNvZiaRJpCy7xHSHuKFWecip6v4XqD-j0lPrp1HdhmU0wxL0NN434Z-b">sexual orientations</a> and <a href="https://www.sciencedirect.com/science/article/abs/pii/S1740144522001619?casa_token=xDM7c7twgL4AAAAA:zySjQRSspG591XMxdENskl2Zi7htGIPH1mZGeFfGwZ5Pf7MzPzDLJHD1U8qjdH0foQG8NAzQ">gender identities</a>. This means that body appreciation can be considered a good example of a <a href="https://www.sciencedirect.com/science/article/pii/S1740144523001079">positive phenomenon</a>, much like feelings of happiness and life satisfaction. </p>
<p>It also means scientists can compare levels of body appreciation across diverse communities. In our cross-national study, we found large differences in body appreciation across countries – with Malta, Taiwan and Bangladesh having the highest overall scores, and Australia, India and the UK having the lowest. One possibility, supported by our findings, is that greater <a href="https://econtent.hogrefe.com/doi/full/10.1027/1016-9040/a000150">cultural distance</a> from westernised contexts allows people to disentangle their self-worth from their physical appearance. </p>
<figure class="align-center ">
<img alt="Man hugging himself" src="https://images.theconversation.com/files/572482/original/file-20240131-23-uux6bh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/572482/original/file-20240131-23-uux6bh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/572482/original/file-20240131-23-uux6bh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/572482/original/file-20240131-23-uux6bh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/572482/original/file-20240131-23-uux6bh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/572482/original/file-20240131-23-uux6bh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/572482/original/file-20240131-23-uux6bh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Men seem to have greater body appreciation.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/closeup-portrait-confident-smiling-man-holding-1185172897">Koldunov/Shutterstock</a></span>
</figcaption>
</figure>
<p>Other work has shown that <a href="https://www.sciencedirect.com/science/article/abs/pii/S1740144519302682?casa_token=t8JgoBGb3VcAAAAA:H01FPO4TIFt_r049R5V6OM369cHQrQuagSvHB1Id3UBh09m6sydbf1KXwSq6BTg3YLD_ihj0">men tend to</a> have higher body appreciation than women, and that body appreciation <a href="https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2019.00864/full">increases with age</a>. It may be that men and older people tend to experience less pressure to attain prescriptive appearance ideals. </p>
<h2>When does it start?</h2>
<p>Experiences of body appreciation often develop early in life. For example, <a href="https://www.sciencedirect.com/science/article/abs/pii/S1740144510000392?via%3Dihub">interviews with</a> Swedish adolescents who were satisfied with their appearance found that they accepted their physical imperfections. These adolescents seemed to appreciate what the body is able to do, rather than what it looks like.</p>
<p>Social contexts in which people can feel <a href="https://www.sciencedirect.com/science/article/pii/S1740144510000392?casa_token=-miXs9MkqoMAAAAA:ZKJPa1RyQnACaXiGeTELhgYUHeoj39zcWM3rcoo15MvwAZbd-vtdxPmmu6nIQr04OE7z_zVt">acceptance</a> and belonging – such as supportive friends and encouraging romantic partners – are crucial for the early development of body appreciation.</p>
<p>In these and <a href="https://www.tandfonline.com/doi/full/10.1080/08870446.2020.1820008">other interviews</a>, participants typically say that excelling in physical or other activities, such as singing or exploring one’s sexuality, helped them develop feelings of agency and body appreciation.</p>
<h2>Why is body appreciation important?</h2>
<p>There are many reasons why developing body appreciation is beneficial. For example, greater body appreciation is reliably associated with heathier eating styles. It also <a href="https://onlinelibrary.wiley.com/doi/10.1002/eat.23623">reduces the likelihood</a> of experiencing symptoms of eating disorders, including binge eating and restrictive eating.</p>
<p>Body appreciation is also associated with more positive mental health. <a href="https://www.sciencedirect.com/science/article/abs/pii/S1740144522001188?casa_token=2bjXatdH_HYAAAAA:31bo00_Y40681Sc9PG_00GtizDH8IwsBydqU4iyi7jgqLjiVYCULtVMaYKW9oGa3KySu7QMR">A 2022 review</a> of 240 papers found that higher levels of body appreciation were associated with greater self-compassion and life satisfaction, as well as fewer symptoms of anxiety and depression. </p>
<p>Greater body appreciation is also associated with healthier lifestyle choices. <a href="https://academic.oup.com/hsw/article-abstract/47/2/113/6545786?login=false">Another 2022 review</a> of nine studies with mostly western participants found that body appreciation was associated with less health-compromising behaviour, including risky sexual activity and alcohol abuse. </p>
<p>Other research has found that greater body appreciation provides a strong foundation for developing <a href="https://link.springer.com/article/10.1007/s10508-016-0924-y">more liberal</a>, sex-positive attitudes, as well as more <a href="https://www.sciencedirect.com/science/article/abs/pii/S1740144511001392?casa_token=OCvTjI85jyAAAAAA:mnkqaPRcSMtDm_PmS8n_U-iriCtR4NHkvZun5f4tunrqKtoinVkF0ewQaGk-gvB3rLrAxhc8">positive sexual experiences</a> including sexual satisfaction. Additionally, greater body appreciation is associated with more positive <a href="https://www.sciencedirect.com/science/article/abs/pii/S1740144521000590?casa_token=61aKNFuGM7QAAAAA:RemC29eWnv6CzVNoeLntgHGX1O85zpyNm6ht427yzumo7ZFhDo-uNtwYPZvjJ1eJXbuCyEF1">attitudes toward breastfeeding</a> and <a href="https://www.sciencedirect.com/science/article/abs/pii/S1740144518303826?casa_token=I_d4xJ4iOBMAAAAA:Uvx7zgJw5Fd_L7n92KLQR2wi7pxfWq4CZJLQp1FzIN3sxfgE4s58i4EFmeiHcybeuyx4fQUM">stronger motivation</a> to engage in physical activity. </p>
<h2>Promoting body appreciation</h2>
<p>What all of these studies suggest is that greater body appreciation can provide a strong platform for all manner of positive behaviour and attitudes. When people appreciate their bodies, they are more likely to be attentive to their bodily needs and feel more connected to their bodies. This, in turn, motivates a desire to maintain good mental and physical health.</p>
<p>For children and adolescents, <a href="https://www.sciencedirect.com/science/article/abs/pii/S1740144518302304?casa_token=aVbNDtU_ZCkAAAAA:pmzMu2Ndjz4uOHm4YSIMzUC92aZDY_n4nEmODtlcdOqbUNp6GhEq0aKMBKTKDeBq7NJKmx_R">yoga</a> and physical activity are beneficial, and there are also <a href="https://link.springer.com/article/10.1007/s10643-023-01543-2">picture books</a> that can help children understand what body appreciation looks and feels like. </p>
<p>For adults, many embodying activities – things that promote a sense of inhabiting our bodies – can promote body appreciation. Examples include <a href="https://link.springer.com/article/10.1007/s10465-012-9129-7">dance</a> and other forms of <a href="https://www.sciencedirect.com/science/article/abs/pii/S1740144518303097?casa_token=TZGsMBmiNy4AAAAA:IBw6pRH0J-yO6bcs0V_EMA-cWbtCXKoPM6kWjedOLopU1TNU7jxLxzR7CDY890VNvi3kc-7l">physical activity</a>, <a href="https://www.sciencedirect.com/science/article/abs/pii/S1740144516303941?casa_token=R52dpn3A2zkAAAAA:qsMZ14_ZfpqvbPH851KmZXJE-I9mJJu5l-yzZXgkqCSfH3dol0XnRHbTO7AYuoEilIIcI5JP">life drawing</a>, and even just going for a <a href="https://www.sciencedirect.com/science/article/abs/pii/S1740144517304321?casa_token=huFR7mgR7iUAAAAA:u81n-oTXJzPpB92fGuKVXG0P6SaLmhT3nMXy5l1WtVV7q-qh1v0ID_dFP4OivqrA0qzb1d4A">walk in nature</a>.</p><img src="https://counter.theconversation.com/content/222332/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Viren Swami does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Greater body appreciation is also closely tied to other aspects of wellbeing, such as fewer symptoms of depression.Viren Swami, Professor of Social Psychology, Anglia Ruskin UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2199012023-12-15T05:45:15Z2023-12-15T05:45:15ZThinking about cosmetic surgery? New standards will force providers to tell you the risks and consider if you’re actually suitable<figure><img src="https://images.theconversation.com/files/565962/original/file-20231215-23-9ky8oh.jpg?ixlib=rb-1.1.0&rect=0%2C1%2C1000%2C664&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/surgeon-hand-drawing-marks-on-female-531165886">Africa Studio/Shutterstock</a></span></figcaption></figure><p>People considering cosmetic surgery – such as a breast augmentation, liposuction or face lift – should have <a href="https://www.abc.net.au/news/2023-12-14/new-cosmetic-surgery-standards-introduced/103218180">extra protection</a> following the release this week of new safety and quality standards for providers, from small day-clinics through to larger medical organisations.</p>
<p>The <a href="https://www.safetyandquality.gov.au/sites/default/files/2023-12/national_safety_and_quality_cosmetic_surgery_standards.pdf">new standards</a> cover issues including how these surgeries are advertised, psychological assessments before surgery, the need for people to be informed of risks associated with the procedure, and the type of care people can expect during and afterwards. The idea is for uniform standards across Australia.</p>
<p><div data-react-class="Tweet" data-react-props="{"tweetId":"1735224191073575038"}"></div></p>
<p>The move is part of sweeping reforms of the cosmetic surgery industry and the <a href="https://www.medicalboard.gov.au/codes-guidelines-policies/cosmetic-medical-and-surgical-procedures-guidelines.aspx#:%7E:text=Cosmetic%20procedures%20must%20only%20be,care%20and%20any%20likely%20complications">regulation of medical practitioners</a>, including who is allowed to <a href="https://theconversation.com/doctors-may-soon-get-official-endorsements-to-practise-cosmetic-surgery-but-will-that-protect-patients-202136">call themselves a surgeon</a>.</p>
<p>It is heartening to see these reforms, but some may say they should have come much sooner for what’s considered a <a href="https://journals.sagepub.com/doi/10.1177/07488068221105360">highly unregulated</a> area of medicine.</p>
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Read more:
<a href="https://theconversation.com/thinking-about-cosmetic-surgery-at-last-some-clarity-on-who-can-call-themselves-a-surgeon-196947">Thinking about cosmetic surgery? At last, some clarity on who can call themselves a surgeon</a>
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<h2>Why do people want cosmetic surgery?</h2>
<p>Australians spent an <a href="https://www.safetyandquality.gov.au/sites/default/files/2023-12/media_infographic_cosmetic_surgery_standards.PDF">estimated A$473 million</a> on cosmetic surgery procedures in 2023.</p>
<p>The <a href="https://www.sciencedirect.com/science/article/abs/pii/S1740144518305552">major reason</a> people want cosmetic surgery relates to concerns about their body image. <a href="https://academic.oup.com/asj/article/43/9/994/7125043">Comments</a> from their partners, friends or family about their appearance is another reason. </p>
<p>The way cosmetic surgery is portrayed on <a href="https://www.sciencedirect.com/science/article/pii/S1740144522001784">social media</a> is also a factor. It’s often portrayed as an “easy” and “accessible” fix for concerns about someone’s appearance. So such aesthetic procedures have become far more normalised. </p>
<p>The use of “before” and “after” images online is also a powerful influence. Some people may think their appearance is worse than the “before” photo and so they think cosmetic intervention is <a href="https://academic.oup.com/asj/article/36/8/920/2613944?login=false">even more necessary</a>.</p>
<figure class="align-center ">
<img alt="Young woman sits cross-legged on chair" src="https://images.theconversation.com/files/565696/original/file-20231214-23-j2jz8x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/565696/original/file-20231214-23-j2jz8x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/565696/original/file-20231214-23-j2jz8x.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/565696/original/file-20231214-23-j2jz8x.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/565696/original/file-20231214-23-j2jz8x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/565696/original/file-20231214-23-j2jz8x.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/565696/original/file-20231214-23-j2jz8x.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Body image is a major concern. But other factors motivate people to choose cosmetic surgery.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/woman-home-massaging-tired-painful-spider-2155356421">alinabuphoto/Shutterstock</a></span>
</figcaption>
</figure>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/what-do-normal-labia-look-like-sometimes-doctors-are-the-wrong-people-to-ask-112513">What do normal labia look like? Sometimes doctors are the wrong people to ask</a>
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<h2>People don’t always get the results they expect</h2>
<p><a href="https://journals.lww.com/annalsplasticsurgery/abstract/2009/02000/a_prospective,_multi_center_study_of_psychosocial.5.aspx">Most people</a> are <a href="https://academic.oup.com/asj/article/40/10/1143/5722403?login=false">satisfied</a> with their surgical outcomes and feel better about the body part that was previously concerning them.</p>
<p>However, people have often paid a sizeable sum of money for these surgeries and sometimes experienced considerable pain as they recover. So a <a href="https://www.tandfonline.com/doi/full/10.1080/13548500903112374">positive evaluation</a> may be needed to justify these experiences. </p>
<p>People who are likely to be unhappy with their results are those with <a href="https://journals.lww.com/plasreconsurg/abstract/2014/10000/why_some_patients_are_unhappy__part_2_.46.aspx">unrealistic expectations</a> for the outcomes, including the recovery period. This can occur if people are not provided with sufficient information throughout the surgical process, but particularly before making their final decision to proceed.</p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/thinking-of-getting-a-minor-cosmetic-procedure-like-botox-or-fillers-heres-what-to-consider-first-161271">Thinking of getting a minor cosmetic procedure like botox or fillers? Here's what to consider first</a>
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<h2>What’s changing?</h2>
<p>According to the <a href="https://www.safetyandquality.gov.au/sites/default/files/2023-12/national_safety_and_quality_cosmetic_surgery_standards.pdf">new standards</a>, services need to ensure their own advertising is not misleading, does not create unreasonable expectations of benefits, does not use patient testimonials, and doesn’t offer any gifts or inducements.</p>
<p>For some clinics, this will mean very little change as they were not using these approaches anyway, but for others this may mean quite a shift in their advertising strategy. </p>
<p>It will likely be a major challenge for clinics to monitor all of their patient communication to ensure they adhere to the standards. </p>
<p>It is also not quite clear how the advertising standards will be monitored, given the expanse of the internet.</p>
<figure class="align-center ">
<img alt="Surgeons operate on a patient" src="https://images.theconversation.com/files/565698/original/file-20231214-25-91vwt9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/565698/original/file-20231214-25-91vwt9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/565698/original/file-20231214-25-91vwt9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/565698/original/file-20231214-25-91vwt9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/565698/original/file-20231214-25-91vwt9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/565698/original/file-20231214-25-91vwt9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/565698/original/file-20231214-25-91vwt9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The new standards will govern how cosmetic surgery is advertised and promoted.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/surgical-team-performing-surgery-patient-operating-750079588">Tong Nawarit/Shutterstock</a></span>
</figcaption>
</figure>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/googling-for-a-new-dentist-or-therapist-heres-how-to-look-past-the-glowing-testimonials-84584">Googling for a new dentist or therapist? Here's how to look past the glowing testimonials</a>
</strong>
</em>
</p>
<hr>
<h2>What about the mental health assessment?</h2>
<p>The new standards say clinics must have processes to ensure the assessment of a patient’s general health, including psychological health, and that information from a patient’s referring doctor be used “where available”. </p>
<p>According to the <a href="https://www.medicalboard.gov.au/codes-guidelines-policies/cosmetic-medical-and-surgical-procedures-guidelines.aspx#:%7E:text=Cosmetic%20procedures%20must%20only%20be,care%20and%20any%20likely%20complications">guidelines</a> from the Medical Board of Australia, which the standards are said to complement, all patients must have a referral, “preferably from their usual general practitioner or if that is not possible, from another general practitioner or other specialist medical practitioner”.</p>
<p>While this is a step in the right direction, we may be relying on medical professionals who may not specialise in assessing body image concerns and related mental health conditions. They may also have had very little prior contact with the patient to make their clinical impressions. </p>
<p>So these doctors need further training to ensure they can perform assessments efficiently and effectively. People considering surgery may also not be forthcoming with these practitioners, and may view them as “gatekeepers” to surgery they really want to have. </p>
<figure class="align-center ">
<img alt="Surgeons discuss a patient's case" src="https://images.theconversation.com/files/565701/original/file-20231214-21-lz7rps.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/565701/original/file-20231214-21-lz7rps.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/565701/original/file-20231214-21-lz7rps.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/565701/original/file-20231214-21-lz7rps.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/565701/original/file-20231214-21-lz7rps.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/565701/original/file-20231214-21-lz7rps.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/565701/original/file-20231214-21-lz7rps.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Ideally, mental health assessments should be done by health professionals with experience and training in body image concerns.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/plastic-cosmetic-surgeon-consults-woman-about-2147151401">Roman Fenton/Shutterstock</a></span>
</figcaption>
</figure>
<p>Ideally, mental health assessments should be performed by health professionals who are extensively trained in the area. They also know what other areas should be explored with the patient, such as the potential impact of trauma on body image concerns.</p>
<p>Of course, there are <a href="https://theconversation.com/we-cant-solve-australias-mental-health-emergency-if-we-dont-train-enough-psychologists-here-are-5-fixes-190135">not enough</a> mental health professionals, particularly psychologists, to conduct these assessments so there is no easy solution. </p>
<p>Ultimately, this area of health would likely benefit from a standard multidisciplinary approach where all health professionals involved (such as the cosmetic surgeon, general practitioner, dermatologist, psychologist) work together with the patient to come up with a plan to best address their bodily concerns. </p>
<p>In this way, patients would likely not view any of the health professionals as “gatekeepers” but rather members of their treating team.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/whats-the-connection-between-cosmetic-procedures-and-mental-health-190841">What's the connection between cosmetic procedures and mental health?</a>
</strong>
</em>
</p>
<hr>
<h2>If you’re considering cosmetic surgery</h2>
<p>The Australian Commission on Safety and Quality in Health Care, which developed the new standards, recommended taking these <a href="https://www.safetyandquality.gov.au/sites/default/files/2023-12/media_backgrounder_-_cosmetic_surgery_reforms_will_help_protect_patients_-_14_dec_2023.pdf">four steps</a> if you’re considering cosmetic surgery:</p>
<ol>
<li><p>have an independent physical and mental health assessment before you commit to cosmetic surgery</p></li>
<li><p>make an informed decision knowing the risks</p></li>
<li><p>choose your practitioner, knowing their training and qualifications</p></li>
<li><p>discuss your care after your operation and where you can go for support.</p></li>
</ol>
<p>My ultimate hope is people safely receive the care to help them best overcome their bodily concerns whether it be medical, psychological or a combination.</p><img src="https://counter.theconversation.com/content/219901/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Gemma Sharp receives funding from NHMRC Investigator Grant (Emerging Leadership 2).</span></em></p>If you’re thinking of a breast augmentation, liposuction, or a face lift, this latest move is designed to provide extra protection. Here’s what you need to know ahead of surgery.Gemma Sharp, Associate Professor, NHMRC Emerging Leadership Fellow & Senior Clinical Psychologist, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2097982023-10-05T12:34:44Z2023-10-05T12:34:44ZThe ‘Zoom effect’ and the possible link between videochatting and appearance dissatisfaction<figure><img src="https://images.theconversation.com/files/551566/original/file-20231002-28-4ctl1.jpg?ixlib=rb-1.1.0&rect=47%2C11%2C7951%2C5288&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Unhappiness with your online appearance can lead to negative thinking and poor body image.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/woman-planning-strategy-with-colleagues-in-meeting-royalty-free-image/1428694074?phrase=videoconferencing&adppopup=true">Morsa Images/Digital Vision via Getty Images</a></span></figcaption></figure><p>The COVID-19 pandemic ushered in a new era of digital connection: In the absence of in-person gatherings, many people instead found themselves face-to-face with their co-workers and loved ones on a screen.</p>
<p>Videoconferencing has provided many benefits and conveniences. However, it isn’t surprising that constantly seeing ourselves on screens might come with some downsides as well.</p>
<p>Prior to the pandemic, studies showed that surgeons were seeing increasing numbers of patients <a href="https://doi.org/10.1001/jamafacial.2018.0486">requesting alterations of their image</a> to match filtered or doctored photos from social media apps. Now, several years into the pandemic, surgeons are seeing a new boom of cosmetic surgical requests related to videoconferencing. In one study of cosmetic procedures during the pandemic, 86% of cosmetic surgeons reported videoconferencing as the <a href="https://doi.org/10.1016/j.ijwd.2021.01.012">most common reason for cosmetic concerns</a> among their patients. </p>
<p>Despite the fact that many aspects of life have returned to some version of pre-pandemic normal, it’s clear that videoconferencing and social media will be with us for the foreseeable future. So what does that mean when it comes to appearance satisfaction and making peace with the image that’s reflected back at us?</p>
<p>For the past 10 years, I have worked as a specialist in <a href="https://som.cuanschutz.edu/Profiles/Faculty/Profile/29092">obsessive-compulsive disorders, eating disorders and anxiety</a>. Since the pandemic, I, too, have seen increasing numbers of therapy clients reporting that they struggle with appearance concerns related to videochatting and <a href="https://theconversation.com/mounting-research-documents-the-harmful-effects-of-social-media-use-on-mental-health-including-body-image-and-development-of-eating-disorders-206170">social media</a>.</p>
<h2>Zooming in on image and appearance dissatisfaction</h2>
<p>Every person has perceptions and thoughts about their appearance. These can be neutral, negative or positive. We all look at <a href="https://www.discovermagazine.com/mind/how-the-mirror-changed-humanity-forever">ourselves in the mirror</a> and may have even experienced distress while looking at our reflection. </p>
<p>There are a number of factors that may lead to appearance dissatisfaction.
A preoccupation with thoughts, feelings or images of one’s own appearance is linked to the action of <a href="https://doi.org/10.1016/j.brat.2011.05.003">“mirror gazing,”</a> or staring at one’s reflection. Researchers suggest that this type of selective self-focused attention and mirror gazing <a href="https://doi.org/10.1097/PRS.0000000000008031">can lead to negative fixations</a> on specific attributes or minor flaws, which in turn intensify the preoccupation with these attributes. </p>
<p>Other factors that can contribute to appearance dissatisfaction include <a href="https://doi.org/10.1186/s12888-021-03185-3">low self-esteem</a>, <a href="https://doi.org/10.1002/eat.22151">societal beliefs</a> around appearance, <a href="https://doi.org/10.1007/s10964-009-9500-2">peer</a> and <a href="https://doi.org/10.1016/j.bodyim.2009.04.004">parental influences</a>, <a href="https://doi.org/10.1016/j.eatbeh.2017.11.001">temperament</a> and genetic predispositions to <a href="https://doi.org/10.3389/fpsyt.2019.00864">mental health conditions</a>.</p>
<p>Appearance dissatisfaction and negative evaluations of self are associated with <a href="https://doi.org/10.1186/s12888-021-03185-3">depression, lower self-esteem</a>, <a href="https://doi.org/10.1080/08870441003763246">habitual negative thinking</a> and <a href="https://doi.org/10.1177/2056305120912488">increased social anxiety</a>. What’s more, research suggests that these preoccupations can contribute to the <a href="https://doi.org/10.1016/S0005-7894(02)80007-7">development of eating disorders</a> and disordered eating behaviors, such as frequently restricting food intake or exercising without refueling.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/Cp8rAkR_mrs?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Some people who are unhappy with their Zoom appearance are turning to anti-anxiety medication and even cosmetic surgery.</span></figcaption>
</figure>
<h2>The ‘Zoom’ effect</h2>
<p>With the ubiquity of Zoom meetings, FaceTime calls, selfies and the constancy of documenting our lives on social media, access to our own image can often feel inescapable. And for some people, this can magnify feelings of appearance dissatisfaction that may have been more fleeting before the Zoom era.</p>
<p>Since the pandemic, screen time has increased <a href="https://doi.org/10.1016/j.eclinm.2022.101452">for both adults</a> <a href="https://doi.org/10.1001/jamanetworkopen.2022.56157">and children</a>. What’s worse, recent research suggests that the video and <a href="https://www.liebertpub.com/full/doi/10.1001/jamafacial.2018.0009?ref=dorenato.blog">photo reflections</a> we see of ourselves <a href="https://doi.org/10.1001/jamafacial.2018.0009">are distorted</a>.</p>
<p>Videoconferencing, taking selfies and posting on social media are visually based activities where <a href="https://doi.org/10.1093/asj/sjab257">appearance is often the primary focus</a>. All of them have in common the fact that a person’s image is either live or shared in an immediate manner. Perhaps not surprisingly, these image-based platforms have been significantly associated with <a href="https://doi.org/10.1371/journal.pgph.0001091">appearance dissatisfaction, anxiety, depression and eating disorders</a>. </p>
<p>One study found that those who engaged in more videochatting appearance comparisons, meaning those who looked at others’ appearance during a video call and sized up their own appearance in comparison, <a href="https://doi.org/10.1002/eat.23393">experienced lower appearance satisfaction</a>. This study also found that people who used more photo-editing features on videochat platforms were more likely to compare themselves with others and spend more time <a href="https://doi.org/10.1002/eat.23722">looking at themselves on video calls</a>.</p>
<p>One thing that is unique to videoconferencing is that it allows people to easily <a href="https://doi.org/10.1016/j.paid.2020.110537">compare themselves with others</a> and watch themselves sharing and speaking in real time. A 2023 study found that discomfort with one’s appearance during videoconferencing led to an increased fixation on appearance, which in turn <a href="https://doi.org/10.1016/j.bodyim.2022.12.007">led to impaired work performance</a>. </p>
<p>Researchers also suggest that appearance dissatisfaction is <a href="https://doi.org/10.1089/cyber.2021.0112">associated with virtual-meeting fatigue</a>. The research reports that this could be due to <a href="http://dx.doi.org/10.2139/ssrn.3820035">negative self-focused attention, cognitive overload</a> and anxiety around being stared at or being <a href="https://doi.org/10.1016/j.bodyim.2022.12.007">negatively evaluated based on appearance</a>.</p>
<p>This last point is notable because of the difficulty videochatters have determining where other users are looking. Using the concept of <a href="https://doi.org/10.1111/1467-8721.00039">the “spotlight effect</a>” − our tendency as humans to overestimate how much others are judging our appearance − this difficulty may lead to more anxiety and individuals believing that others are evaluating their appearance during a video call.</p>
<h2>How to combat appearance dissatisfaction in the digital age</h2>
<p>If you find yourself criticizing your appearance every time you hop onto a videoconference call, it may be time to evaluate your relationship with your appearance and seek out help from a qualified therapist. </p>
<p>Here are some questions to consider to help determine whether your thought patterns or <a href="https://theconversation.com/body-dysmorphic-disorder-is-more-common-than-eating-disorders-like-anorexia-and-bulimia-yet-few-people-are-aware-of-its-dangers-195538">behaviors are problematic</a>: </p>
<ul>
<li><p>How much of my day is spent thinking about my appearance?</p></li>
<li><p>What sort of behaviors am I doing around my appearance?</p></li>
<li><p>Do I feel distressed if I do not perform these behaviors?</p></li>
<li><p>Does this behavior align with my values and how I want to be spending my time?</p></li>
</ul>
<p>Another strategy is to be intentional about focusing on what other people are saying in a videoconference instead of peering at your own face. </p>
<p>When it comes to helping others who might be struggling with appearance dissatisfaction, it is important to focus on the person’s innate qualities beyond appearance. People should be conscious of their comments, no matter how well intentioned. Negative comments about appearance have been linked to <a href="https://doi.org/10.1186/s40337-022-00561-6">worsened self-esteem and mental health</a>. When viewing yourself or your peers on video and social media, try focusing on the person as a whole and not as parts of a body. </p>
<p>Reducing screen time can make a difference as well. Research shows that <a href="https://doi.org/10.1037/ppm0000460">reducing social media use by 50%</a> can improve appearance satisfaction in both teens and adults. </p>
<p>When used in moderation, videoconferencing and social media are tools to connect us with others, which ultimately is a key piece in satisfaction and well-being.</p><img src="https://counter.theconversation.com/content/209798/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Emily Hemendinger does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>With our faces seemingly everywhere − from Zoom meetings to selfies − more people are developing anxieties about how they appear online.Emily Hemendinger, Assistant Professor of Psychiatry, University of Colorado Anschutz Medical CampusLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1955382023-03-09T13:39:49Z2023-03-09T13:39:49ZBody dysmorphic disorder is more common than eating disorders like anorexia and bulimia, yet few people are aware of its dangers<figure><img src="https://images.theconversation.com/files/513001/original/file-20230301-20-5yrxjp.jpg?ixlib=rb-1.1.0&rect=12%2C0%2C8231%2C4644&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Those with body dysmorphic disorder often check themselves – and their perceived defects.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/woman-with-bdd-body-dysmorphic-disorder-royalty-free-image/1360144717">Stevica Mrdja/EyeEm via Getty Images</a></span></figcaption></figure><p><em><a href="https://theconversation.com/el-trastorno-dismorfico-corporal-es-mas-frecuente-que-los-trastornos-alimentarios-como-la-anorexia-y-la-bulimia-pero-pocas-personas-son-conscientes-de-sus-peligros-202290">Leer en español.</a></em> </p>
<p>While eating disorders have been <a href="https://doi.org/10.1177/01454455870114005">widely publicized for decades</a>, far less attention has been given to a related condition called <a href="https://bdd.iocdf.org/about-bdd/">body dysmorphic disorder, or BDD</a>. </p>
<p>Body dysmorphic disorder is often hidden from public view due to the shame people feel about one or more parts of their body, yet it is a devastating, debilitating psychological condition. People with the disorder suffer from obsessive thoughts and repetitive behaviors related to their appearance.</p>
<p>Whereas people with eating disorders might view their underweight body as too fat, those with body dysmorphic disorder see themselves as ugly or disfigured even though they appear normal or attractive to others.</p>
<p>Body dysmorphic disorder is more common in both men and women than bulimia or anorexia. About <a href="https://doi.org/10.1017/s1092852900016436">2.5% of women and 2.2% of men</a> in the U.S. meet the criteria for body dysmorphic disorder – that’s higher than the prevalence of generalized anxiety disorder, schizophrenia or bipolar disorder in the general population.</p>
<p>For comparison, at any point in time, bulimia is seen in <a href="https://www.nationaleatingdisorders.org/statistics-research-eating-disorders">roughly 1.5% of women and 0.5% of men</a> in the U.S., and anorexia in <a href="https://www.nationaleatingdisorders.org/statistics-research-eating-disorders">0.35% of women and 0.1% of men</a>.</p>
<p>We are a team of communication and mental health researchers and clinicians from <a href="https://feartocourage.com/about-dr-eva-fisher/">Colorado State University Global</a>, <a href="https://faculty.medicine.hofstra.edu/2313-fugen-neziroglu">Hofstra Medical School</a> and the <a href="https://psychiatry.utoronto.ca/faculty/jamie-feusner">University of Toronto</a>. One of us, Eva Fisher, lived with the disorder for almost 15 years before getting help and recovering. My book, titled “The BDD Family,” provides insights into my <a href="https://feartocourage.com/thebddfamily-book/">daily struggles with body dysmorphic disorder</a> along with information about diagnosis and treatment. </p>
<p>In our view, body dysmorphic disorder needs to be better understood and publicized so that more people suffering from the condition can be properly diagnosed and treated. </p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/MpLWQVv9k84?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Body dysmorphic disorder often involves a fixation on a single feature, like the shape or size of one’s nose, a mole or the shape or curvature of a certain part of the body.</span></figcaption>
</figure>
<h2>Comparison between BDD and eating disorders</h2>
<p>People with body dysmorphic disorder and those with eating disorders share similar negative emotions such as shame, disgust and anger about their appearance. They also engage in some similar behaviors, such as mirror checking, taking photos to check themselves, seeking reassurance from others about their appearance, and using clothing to camouflage or conceal perceived defects.</p>
<p>People who suffer from these disorders commonly avoid places and activities due to self-consciousness about their appearance. In addition, those with eating disorders and body dysmorphic disorder may lack the knowledge that <a href="https://doi.org/10.1016/j.psychres.2012.03.023">their body image beliefs are distorted</a>.</p>
<p>Depression is common in people with body dysmorphic disorder, and they have a <a href="https://doi.org/10.1017/S0033291720002998">higher rate of suicidality</a> than those with eating disorders, including thoughts about committing suicide and suicide attempts. Although both eating disorders and body dysmorphic disorder can be severe and life-threatening, people with body dysmorphic disorder on average <a href="https://doi.org/10.1016/j.bodyim.2009.03.001">experience more impairment in daily functioning</a> than those with eating disorders.</p>
<h2>A personal view</h2>
<p>My (Eva’s) body dysmorphic disorder symptoms started at age 16. Some causes could have been childhood bullying and perfectionism about my appearance. I would obsess about the shape and size of my nose for more than eight hours a day and constantly <a href="https://www.youtube.com/watch?v=UUkZGSIYcEw&t=23s">compare my appearance</a> to models in fashion magazines. </p>
<p>I was convinced that others were judging me negatively because of my nose, which I perceived to be fat and ugly. I hated my nose so much that I didn’t want to get married or have children because I feared they would inherit it.</p>
<p>Even after getting plastic surgery at age 18 to make my nose thinner, I still hated it. This is a very common outcome for people with the disorder who undergo cosmetic surgery procedures. </p>
<p>Research indicates that 66% of people with body dysmorphic disorder have <a href="https://doi.org/10.1016/S1740-1445(03)00003-2">received cosmetic or dermatological treatment</a>. However, even when people feel better about one part of their body after surgery, the <a href="https://doi.org/10.1093/med/9780190254131.003.0030">image obsession often moves</a> to <a href="https://global.oup.com/academic/product/body-dysmorphic-disorder-9780190254131?cc=ca&lang=en&">one or more other body parts</a>. </p>
<p>Some patients will have multiple procedures on the same body part. Other people are so disappointed by the results of their surgery that <a href="https://doi.org/10.1093/med/9780190254131.003.0013">they want to commit suicide</a>. </p>
<p>Tragically, many people with body dysmorphic disorder think about killing themselves, and others attempt to take their own lives. Approximately 80% of people with body dysmorphic disorder <a href="https://doi.org/10.1093/med/9780190254131.003.0013">experience lifetime suicidal ideation</a>, and 24% to 28% have attempted suicide. Often, they are young men and women who feel so hopeless about their perceived appearance defects that suicide seems like the only way to end their suffering.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/iYwfIhJY8TY?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Body dysmorphic disorder carries a high risk of suicide, and sometimes pursuing dermatological solutions can make the issues worse if the person isn’t satisfied with them.</span></figcaption>
</figure>
<h2>When appearance concerns become problematic</h2>
<p>So how is body dysmorphic disorder different from normal appearance concerns? Researchers have found evidence that while <a href="https://doi.org/10.1177/1073191119879241">appearance dissatisfaction can range in severity</a>, there is a distinct group of people with much higher appearance concerns, many of whom likely have the disorder. They feel much worse about their appearance than those with normal appearance concerns and experience greater anxiety, depression, shame and self-disgust about some aspects of their appearance.</p>
<p>About one-third of people with the disorder <a href="https://doi.org/10.1093/med/9780190254131.003.0006">obsess about their perceived flaws</a> for one to three hours a day, nearly 40% for three to eight hours a day and about a quarter for more than eight hours a day. Most people with body dysmorphic disorder know they spend <a href="https://global.oup.com/academic/product/body-dysmorphic-disorder-9780190254131?cc=ca&lang=en&">too much time thinking about their appearance</a>, but others with the condition mistakenly believe that it’s entirely normal to worry about their appearance for hours every day. </p>
<p><a href="https://doi.org/10.1093/med/9780190254131.003.0006">Common body dysmorphic disorder behaviors</a> include, from most to least common:</p>
<ul>
<li><p>camouflaging the perceived defects with clothing and makeup</p></li>
<li><p>comparing one’s appearance to others </p></li>
<li><p>checking one’s appearance in mirrors and other reflective surfaces</p></li>
<li><p>seeking cosmetic treatments such as surgery and dermatology</p></li>
<li><p>repeatedly taking photos to check one’s appearance</p></li>
<li><p>seeking reassurance from others about the perceived flaw or convincing others that it is unattractive </p></li>
<li><p>touching the perceived flaw</p></li>
<li><p>excessively changing clothes</p></li>
<li><p>dieting and skin picking to improve appearance</p></li>
<li><p>engaging in excessive exercise, including excessive weightlifting</p></li>
</ul>
<h2>Discovering the causes of body dysmorphic disorder</h2>
<p>The exact causes of body dysmorphic disorder are unknown. Possible developmental causes include <a href="https://doi.org/10.1017/s0033291711002741">genetic factors</a>, <a href="https://doi.org/10.1016/j.psychsport.2007.10.002">childhood bullying</a> and childhood teasing about appearance and competency, as well as <a href="https://doi.org/10.1016/j.comppsych.2021.152256">childhood maltreatment and trauma</a>. Other factors that could play a role include growing up in a family with an <a href="https://www.scientificamerican.com/article/imagined-ugliness/">emphasis on appearance</a>, perfectionist standards concerning appearance and exposure to <a href="https://doi.org/10.1176/appi.ajp.159.10.1788">high ideals of attractiveness</a> and beauty in the mass media. </p>
<p>Common personality traits among people with body dysmorphic disorder include perfectionism along with shyness, social anxiety, low self-esteem and <a href="https://doi.org/10.1016/j.cpr.2005.04.012">sensitivity to rejection and criticism</a>. </p>
<p>Researchers have found that people with the disorder may have abnormalities in brain functioning. For instance, one study found that people with body dysmorphic disorder, as well as those with anorexia, have an <a href="https://doi.org/10.1017/S0033291715000045">information processing bias</a> toward more detailed visual information rather than viewing images globally – in other words, seeing the trees rather than the forest. This suggests that abnormalities in the brain’s visual system could contribute to the distortions that those with body dysmorphic disorder and anorexia experience.</p>
<h2>Effective treatments</h2>
<p>Fortunately, there are effective treatments for people with body dysmorphic disorder. Cognitive behavioral therapy and medication <a href="https://doi.org/10.4103/psychiatry.IndianJPsychiatry_528_18">are both used to treat the disorder</a>. </p>
<p>During cognitive behavioral therapy, therapists work with patients to help them modify intrusive thoughts and beliefs about physical appearance and to eliminate problematic behaviors associated with body image, such as mirror checking and reassurance seeking. </p>
<p>Medications called selective serotonin reuptake inhibitors, or SSRIs, such as Prozac and Zoloft can <a href="https://doi.org/10.3928%2F00485713-20100701-05">reduce or eliminate cognitive distortions</a>, depression, anxiety, negative beliefs and compulsive behaviors. They can also increase levels of insight and improve daily functioning. </p>
<p>I (Eva) worked with a psychologist and psychiatrist to combat the depression and anxiety caused by my appearance concerns. Fortunately, both the <a href="https://bddfoundation.org/beating-bdd-podcast-27">medication and therapy</a> were effective in reducing my negative feelings and compulsive behaviors. </p>
<p>Two years after I started treatment, my symptoms lessened and became manageable. Today I facilitate <a href="https://feartocourage.com/bdd-resources/bdd-support-group/">two online support groups</a> and encourage people to learn more about the disorder. Group members provide support and comfort to others who understand their daily struggles. They also share advice about getting help for this common but little known body image disorder. </p>
<p>More information about diagnosis and treatment for body dysmorphic disorder is available on the <a href="https://bdd.iocdf.org/">International OCD Foundation BDD</a> site.</p><img src="https://counter.theconversation.com/content/195538/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Eva Fisher works for Colorado State University Global. She is affiliated with the International OCD Foundation.</span></em></p><p class="fine-print"><em><span>Fugen Neziroglu is affiliated with OCDNY, IOCD, ADAA. She has receved funding from Bio Haven Pharmaceutical Company. </span></em></p><p class="fine-print"><em><span>Jamie Feusner receives funding from the National Institutes of Health and the Klarman Family Foundation. He is affiliated with NOCD, Inc. </span></em></p>About a quarter of those with body dysmorphic disorder attempt suicide or struggle with ideas of suicide. Fortunately, medication and therapy have proved highly effective at treating the disorder.Eva Fisher, Communication Faculty Member, Colorado State University GlobalFugen Neziroglu, Clinical Assistant Professor of Psychiatry, School of Medicine, Hofstra UniversityJamie Feusner, Professor of Psychiatry and Clinician Scientist at the Centre for Addiction and Mental Health, University of TorontoLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1908412022-11-14T19:00:32Z2022-11-14T19:00:32ZWhat’s the connection between cosmetic procedures and mental health?<figure><img src="https://images.theconversation.com/files/493402/original/file-20221103-18-8tucph.jpg?ixlib=rb-1.1.0&rect=8%2C0%2C5955%2C3970&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">sam moghadam khamseh/unsplash</span>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>Although we cannot be sure of the exact numbers of Australians undergoing cosmetic procedures, as there is no requirement for health professionals to report their statistics, there is a consensus demand is on the rise. </p>
<p>In 2015, the <a href="https://cpca.net.au/wp-content/uploads/2016/05/31-05-2016_AUSTRALIAS_SPEND_ON_COSMETIC_TREATMENTS_TOPS_1_BILLION.pdf">Cosmetic Physicians College of Australasia</a> found Australians were spending more than $1 billion a year on non-invasive cosmetic procedures like Botox and fillers. This is more than 40% higher, per capita, than in the United States.</p>
<p>In the US, where procedure <a href="https://cdn.theaestheticsociety.org/media/statistics/2021-TheAestheticSocietyStatistics.pdf">statistics are reported</a>, there was a 42% increase in the number of filler procedures and a 40% increase in Botox procedures performed in the last year alone. </p>
<p>Rates of mental health issues in this group may be higher than the general population, but seemingly not enough is being done to ensure the psychological safety of people requesting cosmetic procedures.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/thinking-of-getting-a-minor-cosmetic-procedure-like-botox-or-fillers-heres-what-to-consider-first-161271">Thinking of getting a minor cosmetic procedure like botox or fillers? Here's what to consider first</a>
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</em>
</p>
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<h2>Body dysmorphic disorder</h2>
<p>Body image concerns are generally the main motivator for seeking cosmetic procedures of all kinds. These concerns are <a href="https://www.sciencedirect.com/science/article/pii/S1740144518305552">usually focused on the body part</a> where the cosmetic intervention is sought, such as the nose for a rhinoplasty. </p>
<p>Severe body image concerns are a key feature of several mental health conditions. The most prevalent in people seeking cosmetic procedures is body dysmorphic disorder. In the general community, around 1-3% of people will experience body dysmorphic disorder, but in populations seeking cosmetic surgery, this <a href="https://pubmed.ncbi.nlm.nih.gov/35715310/">rises to 16-23%</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/493403/original/file-20221103-17-v845fh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="Surgeon holding a breast implant" src="https://images.theconversation.com/files/493403/original/file-20221103-17-v845fh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/493403/original/file-20221103-17-v845fh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=401&fit=crop&dpr=1 600w, https://images.theconversation.com/files/493403/original/file-20221103-17-v845fh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=401&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/493403/original/file-20221103-17-v845fh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=401&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/493403/original/file-20221103-17-v845fh.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=504&fit=crop&dpr=1 754w, https://images.theconversation.com/files/493403/original/file-20221103-17-v845fh.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=504&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/493403/original/file-20221103-17-v845fh.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=504&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Rates of body dysmorphic disorder are much higher in populations seeking cosmetic surgery.</span>
<span class="attribution"><span class="source">philippe spitalier/unsplash</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p><a href="https://bdd.iocdf.org/professionals/diagnosis/">Body dysmorphic disorder</a> involves a preoccupation or obsession with one or more perceived flaws in physical appearance which are not visible or seem minor to other people. In response to the distress regarding the flaw, the person with body dysmorphic disorder will perform repetitive behaviours (such as excessively checking body parts in the mirror) and mental acts (such as comparing their appearance with other people). </p>
<p>These concerns can have a significant negative impact on the person’s daily life, with some people too distressed to leave their home or even eat dinner with family members out of fear of being seen by others. </p>
<p>With the distress associated with body dysmorphic disorder seemingly stemming from physical appearance issues, it makes sense someone with body dysmorphic disorder is far more likely to turn up at a cosmetic clinic for treatment than a mental health clinic.</p>
<p>The problem is, cosmetic intervention usually makes the person with body dysmorphic disorder feel the <a href="https://link.springer.com/article/10.1007/s00266-017-0819-x">same or worse</a> after the procedure. They may become even more preoccupied with the perceived flaw and seek further cosmetic procedures. </p>
<p>Patients with body dysmorphic disorder are also <a href="https://academic.oup.com/asj/article/22/6/531/204131">more likely</a> to take legal action against their treating cosmetic practitioner after believing they have not received the result they wanted.</p>
<p>For these reasons, body dysmorphic disorder is generally considered by health professionals to be a “red flag” or contraindication (a reason not to undergo a medical procedure) for cosmetic procedures.</p>
<p>However, this is not entirely clear-cut. <a href="https://academic.oup.com/asj/advance-article/doi/10.1093/asj/sjac243/6678852?searchresult=1">Some studies</a> have shown people with body dysmorphic disorder can improve their symptoms after cosmetic intervention, but the obsession may just move to another body part and the body dysmorphic disorder diagnosis remain.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/new-year-new-you-why-we-think-a-better-body-will-be-a-better-self-127269">New year, new you? Why we think a better body will be a better self</a>
</strong>
</em>
</p>
<hr>
<h2>What about other mental health conditions?</h2>
<p>Body dysmorphic disorder is by far the most well-studied disorder in this area, but is not the only mental health condition that may be associated with poorer outcomes from cosmetic procedures. </p>
<figure class="align-right ">
<img alt="Surgeon performing liposuction with cannula in woman's thigh" src="https://images.theconversation.com/files/493405/original/file-20221103-15-rap4yg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/493405/original/file-20221103-15-rap4yg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=742&fit=crop&dpr=1 600w, https://images.theconversation.com/files/493405/original/file-20221103-15-rap4yg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=742&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/493405/original/file-20221103-15-rap4yg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=742&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/493405/original/file-20221103-15-rap4yg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=932&fit=crop&dpr=1 754w, https://images.theconversation.com/files/493405/original/file-20221103-15-rap4yg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=932&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/493405/original/file-20221103-15-rap4yg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=932&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Recent studies have found rates of mental illness are higher among cosmetic patients.</span>
<span class="attribution"><span class="source">philippe spitalier/unsplash</span>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>According to a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8034989/">recent systematic review</a>, the rates of depression (5-26%), anxiety (11-22%) and personality disorders (0-53%) in people seeking cosmetic surgery may be higher than the general population (which are estimated to be 10%, 16% and 12% respectively).</p>
<p>However, these rates should be interpreted with some caution as they depend greatly on how the mental health diagnosis was made – clinician-led interview (higher rates) versus mental health questionnaire (lower rates). Some interview approaches can suggest higher rates of mental health issues as they may be quite unstructured and thus have questionable validity compared with highly structured questionnaires. </p>
<p>Besides body dysmorphic disorder, the research investigating other mental health conditions is limited. This may just be due to the fact body image focus is at the core of body dysmorphic disorder, which makes it a logical focus for cosmetic surgery research compared with other types of psychiatric disorders. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/body-dysmorphia-sufferers-have-abnormal-visual-processes-1527">Body dysmorphia sufferers have abnormal visual processes</a>
</strong>
</em>
</p>
<hr>
<h2>So what should happen?</h2>
<p>Ideally, all cosmetic surgeons and practitioners should receive sufficient training to enable them to conduct a brief routine assessment of all prospective patients. Those with signs indicating they are unlikely to derive psychological benefit from the procedure should undergo a further assessment by a mental health professional before undergoing the procedure. </p>
<p>This could include an in-depth clinical interview about motivations for the procedure, and completing a range of standard mental health questionnaires. </p>
<p>If a person was found to have a mental health issue in the assessment process, it does not necessarily mean the mental health professional would recommend against pursuing the procedure. They may suggest a course of psychological therapy to address the issue of concern and then undergo the cosmetic procedure. </p>
<p>At the moment, assessments are only recommended rather than mandated for cosmetic surgery (and not at all for injectables like Botox and fillers). The <a href="https://plasticsurgery.org.au/wp-content/uploads/2020/08/2.5-AHPRA-MBA-Guidelines-for-Registered-Medical-Practitioners-Who-Perform-Cosmetic-Medical-and-Surgical-Procedures-2016.pdf">guidelines</a> say evaluation should be undertaken if there are signs the patient has “significant underlying psychological problems”.</p>
<p>This means we are relying on the cosmetic medical practitioner being capable of detecting such issues when they may have received only basic psychological training at medical school, and when their business may possibly benefit from not attending to such diagnoses.</p>
<p>An August 2022 <a href="https://www.ahpra.gov.au/Resources/Cosmetic-surgery-hub/Cosmetic-surgery-review.aspx">independent review</a> by the Australian Health Practitioner Regulation Agency and the Medical Board of Australia recommended the guidelines around mental health assessment should be “strengthened” and emphasised the importance of medical practitioners receiving more training in the detection of psychiatric disorders. </p>
<p>Ultimately, as cosmetic practitioners are treating patients who are seeking treatment for psychological rather than medical reasons, they must have the wellbeing of the patient front-of-mind, both out of professional integrity and to protect themselves from legal action. Mandatory evaluation of all patients seeking any kind of cosmetic procedure would likely improve patient satisfaction overall.</p>
<hr>
<p><em>If this article has raised issues for you, or if you’re concerned about someone you know, visit the <a href="https://butterfly.org.au/">Butterfly Foundation</a> or call the national helpline on 1800 33 4673.</em></p><img src="https://counter.theconversation.com/content/190841/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Gemma Sharp receives funding from an NHMRC Early Career Research Fellowship (Health Professional Category). </span></em></p><p class="fine-print"><em><span>Nichola Rumsey consults with The Australasian Foundation for Plastic Surgery. </span></em></p>Research has confirmed higher rates of body dysmorphic disorder among people seeking cosmetic procedures, but we don’t know as much about other mental health issues.Gemma Sharp, NHMRC Early Career Senior Research Fellow, Monash UniversityNichola Rumsey, Emeritus Professor of Psychology, University of the West of EnglandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1686342021-11-02T12:25:45Z2021-11-02T12:25:45ZThe COVID-19 pandemic increased eating disorders among young people – but the signs aren’t what parents might expect<figure><img src="https://images.theconversation.com/files/429371/original/file-20211029-17-189kn2p.jpg?ixlib=rb-1.1.0&rect=0%2C0%2C6720%2C6709&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">More time spent on social media can leave young adults feeling worse about their bodies.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/diverse-group-of-people-portraits-with-surgical-royalty-free-image/1278426537">Leo Patrizi/E+ Collection via Getty Images</a></span></figcaption></figure><p>Eating disorders <a href="https://doi.org/10.1016/j.jadohealth.2021.05.019">began to spike</a> among young people shortly after the onset of the COVID-19 pandemic.</p>
<p>Experts believe the increase occurred due to disruptions in daily living, emotional distress and more time spent on <a href="https://doi.org/10.1016/j.childyouth.2020.105659">social media</a> – which research has shown can lead to <a href="https://theconversation.com/facebook-has-known-for-a-year-and-a-half-that-instagram-is-bad-for-teens-despite-claiming-otherwise-here-are-the-harms-researchers-have-been-documenting-for-years-168043">lower self-esteem and negative body image</a>.</p>
<p>One peer-reviewed study indicates that eating disorder diagnoses <a href="http://www.doi.org/10.1192/bjp.2021.105">increased 15% in 2020</a> among people under 30 compared to previous years. Other studies have suggested that patients who already had an eating disorder diagnosis <a href="https://doi.org/10.1002/erv.2771">got worse during the pandemic</a>. The researchers reported an increase in eating disorder symptoms along with anxiety and depression.</p>
<p>Eating disorders include <a href="https://www.ncbi.nlm.nih.gov/books/NBK519712/table/ch3.t15/">anorexia nervosa</a>, <a href="https://www.ncbi.nlm.nih.gov/books/NBK519712/table/ch3.t16/">bulimia nervosa</a>, <a href="https://www.ncbi.nlm.nih.gov/books/NBK338301/table/introduction.t1/">binge eating disorder</a> and other specified feeding and eating disorders such as <a href="https://doi.org/10.1016/j.cppeds.2017.02.003">atypical anorexia</a>. The peak age of onset is <a href="https://doi.org/10.1016/S2215-0366(16)00081-X">15-25 years old</a>, but individuals can develop eating disorders <a href="https://doi.org/10.1007/s11920-019-1057-5">at any age</a>. </p>
<p>We are a <a href="https://uvahealth.com/findadoctor/profile/julia-f-taylor">physician</a> and a <a href="https://uvahealth.com/findadoctor/profile/sara-groff-stephens">psychotherapist</a> who <a href="https://www.researchgate.net/profile/Sara-Stephens">specialize in treating eating disorders</a> in teens and young adults. We’ve seen the increased demand for eating disorder services in our own clinic.</p>
<p>While eating disorders have historically been <a href="https://doi.org/10.1002/eat.22846">underdiagnosed in certain groups</a> – specifically males, racial/ethnic minorities, and people who are higher-weight, LGBTQ or from poorer backgrounds – the recent COVID-related increase in patients presenting for care has reinforced that no group is immune from them. </p>
<p>Here are three groups of young people who are often overlooked when it comes to eating disorders. </p>
<h2>1. Adolescent boys and young men</h2>
<p>Historical research on diagnosing eating disorders has focused on females. This has <a href="http://www.doi.org/10.1097/YCO.0b013e328365a34b">made it harder</a> for doctors, families and patients to recognize eating disorders in males. For example, adolescent boys may be more prone to focus on muscle strength and steroid use – indicators that are not captured in traditional, female-focused screening tools and diagnostic criteria. </p>
<p>However, newer research suggests that <a href="https://doi.org/10.1002/eat.22350">males may account for up to half</a> of all cases of eating disorders. While males have likely been underdiagnosed in all categories of eating disorders, male adolescents seem to be <a href="http://www.doi.org/10.1186/s40337-019-0261-3">more prone to avoidant restrictive food intake disorder</a>. This is a relatively new eating disorder that involves inadequate food intake but not distress about body shape or size. </p>
<p>Disordered eating – a pattern of problematic eating behaviors that include dieting, skipping meals and feelings of shame but does not meet formal criteria for an eating disorder diagnosis – is increasingly being self-reported by <a href="https://www.doi.org/10.2147/AHMT.S147480">male athletes</a>. This means high school coaches and athletic trainers are a potential source for increased awareness and recognition of problematic relationships with food or exercise in young males. </p>
<figure class="align-center ">
<img alt="Three teenage boys lift weights together in a gym in a garage" src="https://images.theconversation.com/files/429372/original/file-20211029-13-1rcqhp1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/429372/original/file-20211029-13-1rcqhp1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/429372/original/file-20211029-13-1rcqhp1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/429372/original/file-20211029-13-1rcqhp1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/429372/original/file-20211029-13-1rcqhp1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/429372/original/file-20211029-13-1rcqhp1.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/429372/original/file-20211029-13-1rcqhp1.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Overexercising and avoiding rest days can be signs of an eating disorder.</span>
<span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/diverse-group-of-people-portraits-with-surgical-royalty-free-image/1278426537">Thomas Barwick/DigitalVision via Getty Images</a></span>
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</figure>
<h2>2. Sexual and gender minorities</h2>
<p>Recent studies have also uncovered that disordered eating and eating disorders are <a href="http://www.doi.org/10.1007/s00787-018-1145-9">more common</a> among sexual and gender minority youth than among cisgendered heterosexual youth. This is thought to be related to higher rates of body dissatisfaction, stigma and victimization in those groups. </p>
<p>Psychologists believe the bias and discrimination that gay, bisexual and transgender youth face <a href="http://www.doi.org/10.1016/j.pcl.2016.07.003">increases their stress, negative thoughts and isolation</a>. This may lead to body dissatisfaction and eating disorders. </p>
<p>For <a href="http://www.doi.org/10.1007/s11920-019-1097-x">transgender youth in particular</a>, disordered eating and a focus on body shape and size may also be related to dissatisfaction with physical changes during puberty that are inconsistent with their gender identity. </p>
<h2>3. “Normal”-weighted youth</h2>
<p>Many eating disorders are not associated with being thin. This means that youth can develop serious medical complications related to their eating disorders regardless of their body size. </p>
<p>For example, adolescents with <a href="http://www.doi.org/10.1542/peds.2019-2339">atypical anorexia nervosa</a> meet the criteria for <a href="https://www.ncbi.nlm.nih.gov/books/NBK519712/">anorexia nervosa</a> – such as intense fear of gaining weight or becoming fat, and persistent behavior that prevents weight gain – but they are not underweight. However, they <a href="http://www.doi.org/10.1016/j.eatbeh.2021.101573">may require hospitalization</a> due to severe malnutrition and dangerous vital signs such as abnormally slow heartbeat or low blood pressure. </p>
<p>Similarly, individuals with <a href="https://www.ncbi.nlm.nih.gov/books/NBK519712/table/ch3.t16/">bulimia nervosa</a> – who binge eat and then use forced vomiting, laxatives or other unhealthy behaviors to avoid weight gain – can also have normal body mass index, or BMI. Yet they may develop <a href="https://www.doi.org/10.1542/peds.2020-040279">electrolyte abnormalities and severe gastrointestinal issues</a>.</p>
<h2>Noticing the signs</h2>
<p>Caregivers, coaches, health professionals and all those who interact with young people should remain aware of the increased rates of eating disorders brought on during the pandemic. </p>
<p>The signs that a youth may be developing disordered behaviors or a full eating disorder are not always obvious. For example, indications may include: an inability to take a rest day, or working out more than advised by a coach or athletic trainer; an intense focus on muscle building; avoiding eating in public; a sudden desire to eat “clean” or cut out certain food groups like dairy, meat or desserts; and use of steroids, diet pills or laxatives.</p>
<p>Eating disorders are devastating <a href="https://www.ncbi.nlm.nih.gov/books/NBK519712/">mental illnesses</a> that have massive <a href="https://www.hsph.harvard.edu/striped/report-economic-costs-of-eating-disorders/">social and economic costs</a>. They also carry among the highest <a href="https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/abs/excess-mortality-associated-with-eating-disorders-populationbased-cohort-study/6B3247F26A38BD5C72A592A7513FBE02">mortality rates</a> of all of the psychiatric diagnoses and wreak havoc on the lives of individuals and their loved ones. </p>
<p>Early intervention is important to reduce long-term illness and the emotional and physical devastation that can occur with eating disorders. Breaking down barriers for identification and treatment for all individuals – including boys, sexual and gender minority youth and kids across the weight spectrum – will improve outcomes for those who struggle with these significant illnesses.</p>
<p>[<em>Get our best science, health and technology stories.</em> <a href="https://theconversation.com/us/newsletters/science-editors-picks-71/?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=science-best">Sign up for The Conversation’s science newsletter</a>.]</p><img src="https://counter.theconversation.com/content/168634/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Boys, LGBTQ youth and people with normal body mass index are often overlooked when it comes to recognizing eating disorders, a physician and psychotherapist explain.Julia F. Taylor, Assistant Professor of Pediatrics, University of VirginiaSara Groff Stephens, Assistant Professor of Pediatrics, University of VirginiaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1477062020-10-09T13:34:02Z2020-10-09T13:34:02ZMuscle dysmorphia: why are so many young men suffering this serious mental health condition?<figure><img src="https://images.theconversation.com/files/362640/original/file-20201009-19-172af9o.jpg?ixlib=rb-1.1.0&rect=7%2C7%2C4985%2C3315&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Muscle dysmorphia can lead to other mental health conditions, such as anxiety or depression.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/attractive-muscular-man-admiring-his-muscles-689811460">F8 studio</a></span></figcaption></figure><p><a href="https://www.mentalhealth.org.uk/news/millions-men-uk-affected-body-image-issues-mental-health-foundation-survey">Body image concerns</a> among men are increasingly common and can have a serious impact on mental health. And for an estimated <a href="http://www.bbc.co.uk/newsbeat/article/34307044/muscle-dysmorphia-one-in-10-men-in-gyms-believed-to-have-bigorexia">one in ten young men</a> who go the gym in the UK, these body image concerns can result in a mental health condition known as muscle dysmorphia.</p>
<p>Though researchers are only just beginning to understand the complexities of the condition, it appears young men are currently being affected by it at a higher rate compared to other populations. It’s believed there are many reasons driving this, but researchers have found that media and social media pressure, alongside changing ideas of masculinity may both be major causes.</p>
<p>Sometimes referred to as “<a href="https://www.sciencedirect.com/science/article/abs/pii/S1740144505000744">bigorexia</a>” or “reverse anorexia”, people with muscle dysmorphia believe their body is too small, skinny, or insufficiently muscular – even though the opposite may be true. This distorted view causes a <a href="https://www.sciencedirect.com/science/article/abs/pii/S0033318297714002?via%3Dihub">preoccupation</a> with becoming <a href="https://www.sciencedirect.com/science/article/abs/pii/S1740144512000125">overly muscular and lean</a>, often leading to the development of dangerous habits, such as excessive weight training, restrictive dieting and the use of substances such as anabolic steroids. It can also lead to anxiety, depression and may affect their daily life.</p>
<p>But currently diagnosing muscle dysmorphia is still difficult. Though several <a href="https://www.sciencedirect.com/science/article/abs/pii/S1740144504000269">self-report surveys</a> exist to help physicians diagnose patients, these surveys only <a href="https://www.dovepress.com/muscle-dysmorphia-current-insights-peer-reviewed-article-PRBM">assess related symptoms</a> (such as a desire for bigger muscle, or body image issues) rather than offering a robust diagnosis. </p>
<p>Diagnosis also relies on patients meeting a specific <a href="https://www.sciencedirect.com/science/article/abs/pii/S0033318297714002?via%3Dihub">set of criteria</a>, such as having a preoccupation with being lean and muscular, weight lifting excessively and dieting. But since so many different methods are used to diagnose muscle dysmorphia, this can make fully understanding the condition difficult. </p>
<p>However, in general, most experts agree people with muscle dysmorphia tend to engage in <a href="https://www.tandfonline.com/doi/full/10.1080/10640260902848477?needAccess=true">steroid use</a>, have <a href="https://www.sciencedirect.com/science/article/pii/S1740144517300529">symptoms of eating disorders</a> (such as compulsive exercise and eating habits) and higher body dissatisfaction, usually with their <a href="https://www.tandfonline.com/doi/pdf/10.1080/23311908.2016.1243194">general appearance, weight and muscularity</a>.</p>
<p>People with muscle dysmorphia also tend to have lower self-esteem, higher anxiety levels when their physique is exposed, <a href="https://www.cogentoa.com/article/10.1080/23311908.2016.1243194">higher rates of depression</a>, and obsessive compulsive behaviours towards <a href="https://onlinelibrary.wiley.com/doi/abs/10.1002/erv.1088">exercise and diet</a>. For example, people may prioritise training over <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/erv.1016">work or social activities</a> or <a href="https://www.sciencedirect.com/science/article/abs/pii/S1740144512000125">strictly eat every three hours</a> to ensure muscle gain. And if these behaviours are disrupted, it causes anxiety and emotional disturbance.</p>
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Read more:
<a href="https://theconversation.com/exercise-addiction-is-a-real-mental-health-condition-yet-still-poorly-understood-133577">Exercise addiction is a real mental health condition, yet still poorly understood</a>
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<p>Muscle dysmorphia tends to affect men in their <a href="https://connect.springerpub.com/content/sgrjcp/31/4/255">mid-20s to mid-30s</a>, though average age of onset is <a href="https://www.tandfonline.com/doi/abs/10.1080/hrp.9.5.254.259">19 years old</a>. Research suggests it’s most common in <a href="https://journals.sagepub.com/doi/10.1177/0004867415614106">weightlifting</a> and <a href="https://www.karger.com/Article/Abstract/12362">bodybuilding</a> communities. </p>
<p>However, research also shows <a href="https://link.springer.com/article/10.1186/s12967-014-0221-2">almost 6% of US students</a> have it. Another study found 4.2% of women and 12.7% of men in the US military <a href="https://academic.oup.com/milmed/article/181/5/494/4158268">have muscle dysmorphia</a>. So while it appears to predominantly affect young men, there’s limited research on its prevalence in other populations.</p>
<h2>The ‘ideal’ body</h2>
<p>There are many reasons a person may develop muscle dysmorphia, and it’s unique to each person. However, research suggests that the media (and social media), as well as pressure from family and friends, are likely causes.</p>
<p>For example, media portrayals of men over time have become more muscular. Specifically, over several decades <a href="https://onlinelibrary.wiley.com/doi/10.1002/1098-108X(200101)29:1%3C90::AID-EAT15%3E3.0.CO;2-F">male models in magazines</a> have become significantly larger and leaner. Even <a href="https://onlinelibrary.wiley.com/doi/10.1002/%28SICI%291098-108X%28199907%2926%3A1%3C65%3A%3AAID-EAT8%3E3.0.CO%3B2-D">male action figures</a> have changed over time, becoming unrealistically muscular.</p>
<figure class="align-center ">
<img alt="Superhero action figures, including Captain America." src="https://images.theconversation.com/files/362642/original/file-20201009-19-1sr4k9m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/362642/original/file-20201009-19-1sr4k9m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/362642/original/file-20201009-19-1sr4k9m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/362642/original/file-20201009-19-1sr4k9m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/362642/original/file-20201009-19-1sr4k9m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=501&fit=crop&dpr=1 754w, https://images.theconversation.com/files/362642/original/file-20201009-19-1sr4k9m.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=501&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/362642/original/file-20201009-19-1sr4k9m.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=501&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Portrayals of unrealistic male physiques are everywhere.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/kuala-lumpur-malaysia-october-6-2018-1197291274">Aisyaqilumaranas/ Shutterstock</a></span>
</figcaption>
</figure>
<p>Muscle dysmorphia is linked to the belief that a <a href="https://www.tandfonline.com/doi/full/10.1080/23311908.2016.1243194">muscular physique is ideal</a>. So being exposed to these images and ideals in the media may cause concern and a distorted view of one’s body. Studies also show <a href="https://link.springer.com/article/10.1007/s10964-019-01190-0">social media use</a> is directly linked to the idolisation of muscularity in young boys. Viewing images of <a href="https://psycnet.apa.org/buy/2020-23347-001">fit people on social media</a> also predicts a fixation with becoming more muscular.</p>
<p>The view that <a href="https://www.sciencedirect.com/science/article/abs/pii/S2211266920300207">being muscular is valuable</a> is typically learned from friends and family, and pressure to be muscular may come in the form of <a href="https://www.tandfonline.com/doi/full/10.1080/23311908.2016.1243194">comparisons or comments</a> about appearance from loved ones. Research shows some men even seek a muscular physique to cope with bullying and emasculation from <a href="https://www.semanticscholar.org/paper/The-Muscled-Self-and-Its-Aftermath%3A-A-Life-History-Sparkes-Batey/009cb96b6a5be6fed9b0d99d8c0576198d9fe697">family members</a> and <a href="https://psycnet.apa.org/doiLanding?doi=10.1037/men0000072">romantic partners</a>.</p>
<p>Some researchers also believe believe a so-called “<a href="https://journals.sagepub.com/doi/10.1177/000276486029005004">masculine crisis</a>” may be contributing to increased cases of muscle dysmorphia. This reflects the perceived belief there are less opportunities for men to <a href="https://www.semanticscholar.org/paper/The-Fitness-Revolution.-Historical-Transformations-Andreasson-Johansson/b67cca687f646e256b97d97ac6383d21f032d7dc">assert their masculinity</a> through manual and industrial labour. This may leave some men feeling threatened and emasculated. </p>
<p>As a result, men have learned to use a muscular physique to <a href="https://books.google.co.uk/books/about/Little_Big_Men.html?id=z-ax2426Kw0C&redir_esc=y">visually show their masculinity</a>. Increasingly, masculinity in modern culture represents not what you do, but <a href="https://journals.sagepub.com/doi/abs/10.1177/1469540519846196?journalCode=joca">how you look</a>. So, the value that society has placed on being muscular may explain why muscle dysmorphia is more common in men.</p>
<p>Given muscle dysmorphia is potentially under-reported, we cannot accurately know how common it is. Instead, we can only speculate based on the limited evidence we have. The uncertainty is partly because of inconsistent diagnostic tools, and the notion it’s <a href="https://psycnet.apa.org/doiLanding?doi=10.1037%2Fa0025923">taboo</a> for men to be concerned with appearance or sharing their feelings.</p>
<p>Little research has explored the treatment options for muscle dysmorphia, but <a href="https://connect.springerpub.com/content/sgrjcp/31/4/255">one review</a> suggests that cognitive behavioural therapy, thought restructuring (a technique that helps people understand and challenge their thoughts, feelings, and beliefs), and family therapy could all be beneficial. </p>
<p>Given that internal experiences are hard to change, people suffer with the condition long-term. But seeing as the condition is similar to <a href="https://www.nhs.uk/conditions/body-dysmorphia/">body dysmorphic disorder</a>, which causes people to obsess over perceived flaws in their appearance more generally, researchers may already have promising potential solutions to help manage emotions and symptoms associated with muscle dysmorphia.</p><img src="https://counter.theconversation.com/content/147706/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ieuan Cranswick does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Social media and changing ideas about masculinity are making more and more young men believe their body is too small, skinny or insufficiently muscular.Ieuan Cranswick, Senior Lecturer in Sport and Exercise Therapy, Leeds Beckett UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/906932018-02-23T04:58:01Z2018-02-23T04:58:01ZChildren with facial difference have a lot to teach us about body image<figure><img src="https://images.theconversation.com/files/207203/original/file-20180221-161923-1axu1ki.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The film Wonder tells the story of a boy with severe facial defects.</span> <span class="attribution"><a class="source" href="http://www.imdb.com/title/tt2543472/mediaviewer/rm178017792">IMDb/Lionsgate, Mandeville Films, Participant Media, Walden Media</a></span></figcaption></figure><p>The recently released film <a href="http://www.imdb.com/title/tt2543472/"><em>Wonder</em></a> is based on the true story of Auggie, a boy born with a severe facial deformity. The film picks up at the point where Auggie, having been home-schooled by his mother, attends a regular school for the first time and must negotiate the varied reactions – not just of his new peers, but of their parents and the other adults.</p>
<p>Auggie was born with <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/treacher-collins-syndrome">Treacher Collins syndrome</a>, a genetic disorder that affects the development of the skull, jaw and cheekbones and causes facial defects and hearing loss. People can be born with facial differences, or they can be acquired through trauma, burns or treatment of facial tumours.</p>
<p>Either way, these differences can have as big an impact on life as loss of a limb or a chronic illness. People often associate plastic surgery with enhancement of beauty, but a more common aim, especially for surgeons who work with children, is to restore facial appearance to the point where a normal life becomes possible.</p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/ngiK1gQKgK8?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Auggie has had 27 surgeries to help him see and breathe.</span></figcaption>
</figure>
<p>Much more than just a loss of attractiveness, a facial defect affects every aspect of daily life, because faces are so important to us as social beings. And yet, despite significant challenges, children with facial difference tend to score better on perceptions of body image than their “normal” counterparts. </p>
<p>By studying how people with facial difference overcome their challenges, we may not only find ways to help other such children, but also learn how to help all young people be comfortable with how they look and who they are. </p>
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Read more:
<a href="https://theconversation.com/why-we-dont-know-what-causes-most-birth-defects-78592">Why we don't know what causes most birth defects</a>
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<h2>The wonder of faces</h2>
<p>Try to draw someone’s face. Unless you’re a skilled artist, it’ll be difficult to produce an image that actually looks like that person.</p>
<p>This is because within the very narrow parameters of facial features (eyes, a nose, a mouth) faces are so different we expect to be able to recognise a particular face in a crowd, possibly having seen it only once and from a different angle. With more than 7 billion people in this world, it’s truly extraordinary that everyone’s face is unique.</p>
<figure class="align-right zoomable">
<a href="https://images.theconversation.com/files/207207/original/file-20180221-161935-11c0act.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/207207/original/file-20180221-161935-11c0act.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/207207/original/file-20180221-161935-11c0act.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=924&fit=crop&dpr=1 600w, https://images.theconversation.com/files/207207/original/file-20180221-161935-11c0act.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=924&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/207207/original/file-20180221-161935-11c0act.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=924&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/207207/original/file-20180221-161935-11c0act.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1161&fit=crop&dpr=1 754w, https://images.theconversation.com/files/207207/original/file-20180221-161935-11c0act.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1161&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/207207/original/file-20180221-161935-11c0act.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1161&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">It’s very difficult to capture another person’s face in a drawing, because of the nuances of human perception.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure>
<p>Of course it’s not the face itself that’s extraordinary, but our ability to perceive it. We are programmed to effortlessly identify the most subtle differences between faces in a way we are not for other shapes or body parts. </p>
<p>This is one reason why, despite all the advances in plastic surgery in the last century, from microsurgery to face transplantation, our surgical efforts to reconstruct faces still sometimes appear inadequate.</p>
<p>Our sensitivity to subtle differences in facial appearance contributes to the challenges people like Auggie face each day. Faces are the primary means through which we navigate the many minor social exchanges of daily life. </p>
<p>Studies show that, in casual interactions, people <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1559-1816.1982.tb00855.x/full">tend to have certain responses</a> to those with a facial difference, such as standing further away, or to the side. These changes are subtle, but full of social meaning.</p>
<p>A more pervasive problem is unwanted attention in public spaces, from rude and intrusive comments to invasive curiosity. In <em>Wonder</em>, when Auggie first walks across a busy schoolyard, conversation stops as faces turn to him. Psychologist <a href="https://slideheaven.com/facial-disfigurement-problems-and-management-of-social-interaction-and-implicati.html">Frances MacGregor</a> has elegantly described this unique problem faced by people with a visible difference: </p>
<blockquote>
<p>The ‘civil inattention’ that is normally conferred by strangers on one another and that makes it possible to move anonymously and unhindered in public spaces is a right and a privilege most longed for by facially disfigured people who […] are victims of intrusions and invasions of privacy, against which they have little or no protection.</p>
</blockquote>
<h2>Facial difference and body image</h2>
<p>Given the challenges of looking different, and the important role of the face in identity, it might be expected adolescents with facial difference would score poorly on measures of body image and well-being.</p>
<p>However, <a href="http://journals.sagepub.com/doi/full/10.1597/15-167">research done in the UK</a> has shown when a standard body image questionnaire was administered to adolescents with cleft lip and palate or a craniofacial condition like Auggie, those with facial difference actually scored, on average, better on some measures of body image than their “normal” counterparts. </p>
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<a href="https://images.theconversation.com/files/207202/original/file-20180221-161932-1wfcx5b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/207202/original/file-20180221-161932-1wfcx5b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/207202/original/file-20180221-161932-1wfcx5b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/207202/original/file-20180221-161932-1wfcx5b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/207202/original/file-20180221-161932-1wfcx5b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/207202/original/file-20180221-161932-1wfcx5b.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/207202/original/file-20180221-161932-1wfcx5b.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/207202/original/file-20180221-161932-1wfcx5b.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Children with a cleft palate generally score higher on body image tests than those who have ‘normal’ faces.</span>
<span class="attribution"><span class="source">from shutterstock.com</span></span>
</figcaption>
</figure>
<p>There may be several reasons for this. Studies <a href="https://www.sciencedirect.com/science/article/abs/pii/S1740144503000056">consistently find</a> that the severity of a visible difference is a poor predictor of its psychological impact. Much more important is the quality of a person’s social skills. People with facial difference often develop strategies for smoothing over social awkwardness, such as ways of introducing the issue into conversation early and quickly moving on, or using humour to deflect attention. </p>
<p>Better body image scores may reflect greater social maturity and a comfort in their own skin, which adolescents who have not had to face such problems have not yet achieved.</p>
<p>On the flip side, children without a visible difference don’t score as well on body image measures as children who actually do. This and a wealth of other research indicates that, in the age of social media, selfies and consumer culture, we’re facing <a href="http://www.bbc.com/news/health-41972951">a rise in body image dissatisfaction</a>. </p>
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Read more:
<a href="https://theconversation.com/social-media-can-damage-body-image-heres-how-to-counteract-it-65717">Social media can damage body image – here's how to counteract it</a>
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<p>Australian teenagers <a href="https://www.missionaustralia.com.au/what-we-do/research-evaluation/youth-survey">consistently rate</a> body image as one of their greatest concerns in life – above bullying, drugs and a range of problems that might be thought more important. </p>
<p>Body dissatisfaction is a key risk factor for eating disorders, and a key symptom of a condition known as <a href="https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/body-dysmorphic-disorder-bdd">body dysmorphic disorder</a> (BDD). People with BDD develop obsessive concerns with particular aspects of their appearance, including features others perceive as normal.</p>
<p>They <a href="https://link.springer.com/article/10.1007/s00266-017-0869-0">often seek surgery</a> to correct their perceived problems and, not surprisingly, are rarely satisfied with the outcome. They can undergo multiple cosmetic operations, often from a series of different surgeons, before their condition is recognised. Plastic surgeons have anecdotally reported seeing increasing numbers of <a href="https://www.surgery.org/media/statistics">young people seeking cosmetic procedures</a>.</p>
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Read more:
<a href="https://theconversation.com/body-dysmorphic-disorder-and-cosmetic-surgery-are-surgeons-too-quick-to-nip-and-tuck-74234">Body dysmorphic disorder and cosmetic surgery: are surgeons too quick to nip and tuck?</a>
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</p>
<hr>
<p>An important and unanswered question concerning BDD is whether it’s an isolated condition or one extreme of a <a href="https://journals.lww.com/psnjournalonline/Abstract/2010/07000/Psychosocial_Predictors_of_an_Interest_in_Cosmetic.11.aspx">spectrum of behaviour</a>. Body dissatisfaction in young people could have serious consequences for their mental and physical health.</p>
<p>Researchers will now focus on how children and adolescents <a href="http://www1.uwe.ac.uk/hls/research/appearanceresearch.aspx">cope with facial and other differences</a>, and how the knowledge gained can be applied to help others with a facial difference. This will inform ways to better <a href="https://www.youtube.com/watch?v=RxNhE0iGkzo">educate young people</a> to feel better about how they look.</p><img src="https://counter.theconversation.com/content/90693/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Anthony Penington receives funding from the Jigsaw Foundation. He is chair of the scientific committee of the Australasian Foundation for Plastic Surgery.</span></em></p>People with facial difference often develop strategies for smoothing over social awkwardness, such as ways of introducing the issue into conversation early or using humour to deflect attention.Anthony Penington, Professor of Paediatric Plastic and Maxillofacial Surgery, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/742342017-04-18T19:47:18Z2017-04-18T19:47:18ZBody dysmorphic disorder and cosmetic surgery: are surgeons too quick to nip and tuck?<figure><img src="https://images.theconversation.com/files/163017/original/image-20170328-3819-1g49c50.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The highest rates of body dysmorphic disorder are found among people seeking help from cosmetic surgeons, cosmetic dermatologists and other such specialists.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com">Shutterstock </a></span></figcaption></figure><p>Most of us have some insecurities about how we look, and some aspects of our appearance that we might secretly wish were different. But for people with body dysmorphic disorder, these issues become an obsession and constant focus of concern.</p>
<p>Body dysmorphic disorder is a psychiatric condition that leads people to adopt<br>
extremely distorted negative beliefs about their appearances: seeing themselves to be ugly, malformed, misshapen or hideous. Such beliefs do not reflect the reality of how they appear to others. The degree of concern and distress they may feel about their appearance is vastly out of proportion to any actual physical “defect”. </p>
<p>A small minority of the population is believed to experience the condition. One study found about <a href="http://onlinelibrary.wiley.com/doi/10.1080/13284200601178532/full">2.3%</a> of participants had the condition.</p>
<p>The mirror is a major problem for people with body dysmorphic disorder. Some sufferers become fixated with mirror checking, with hours of their day absorbed in inspecting their appearance. Mostly this checking is counter-productive, making them feel worse and increasing their distress. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/163070/original/image-20170329-1642-mdlopq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/163070/original/image-20170329-1642-mdlopq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=295&fit=crop&dpr=1 600w, https://images.theconversation.com/files/163070/original/image-20170329-1642-mdlopq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=295&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/163070/original/image-20170329-1642-mdlopq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=295&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/163070/original/image-20170329-1642-mdlopq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=371&fit=crop&dpr=1 754w, https://images.theconversation.com/files/163070/original/image-20170329-1642-mdlopq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=371&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/163070/original/image-20170329-1642-mdlopq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=371&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Body dysmorphic disorder should not be dismissed as extreme vanity.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/fixersuk/15425017231/in/photolist-pCoZcF-j38YYW-j2SP4L-j2Rc8r-j2PQXF-j2Mbey-j2JGne-j376dw-j2LkJB-gbBes-G66z2-j38YJY-hn4kkB-pv4fdX-vuZD7E-uQBbNq-vMZ6TP-uQA5oo-vv8tji-pda5TU-puDRng-pdax8A-punywa-puDRpk-pdax8W-vKhudC">fixersuk/flickr</a></span>
</figcaption>
</figure>
<p>Other people with the condition may avoid mirrors altogether. Some can even have catastrophic reactions should they happen to glance at themselves in a reflective surface such as a shop window. Lots of sufferers conceal themselves under hats, scarves, wigs, dark glasses or excessive layers of makeup or concealing clothing in an attempt to hide their supposed defects.</p>
<p>Body dysmorphic disorder should not simply be dismissed as an expression of extreme vanity or insecurity about looks. This condition often leads to substantial distress and social and occupational impairment. Rates of depression are high, while suicide is not an <a href="https://www.ncbi.nlm.nih.gov/pubmed/16816236">uncommon outcome</a> for those who do not receive appropriate treatment. Many avoid social situations for fear of others judging them negatively because of how they look. </p>
<h2>Cosmetic solutions?</h2>
<p>Because people with body dysmorphic disorder “see” themselves as having a cosmetic problem, it’s not surprising they often seek a cosmetic “solution”. </p>
<p>The highest rates of body dysmorphic disorder are found among people using cosmetic services like plastic surgeons, cosmetic dermatologists and cosmetic dentists. One study found up to <a href="https://www.ncbi.nlm.nih.gov/pubmed/19332010">70%</a> of people with body dysmorphic disorder had sought cosmetic procedures, and half had received such interventions.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/163015/original/image-20170328-3772-ilirzt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/163015/original/image-20170328-3772-ilirzt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/163015/original/image-20170328-3772-ilirzt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/163015/original/image-20170328-3772-ilirzt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/163015/original/image-20170328-3772-ilirzt.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/163015/original/image-20170328-3772-ilirzt.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/163015/original/image-20170328-3772-ilirzt.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Cosmetic procedures of all types are becoming increasingly available and accessible to a wider public.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com">From www.shutterstock.com'</a></span>
</figcaption>
</figure>
<p>The tragedy is that cosmetic procedures – by definition – do not solve the underlying psychological problem. They leave a majority of sufferers worse off: they pay for the procedure and suffer the pain and inconvenience of it, yet “see” the resulting cosmetic outcome as unsatisfactory, even if objectively the result is excellent. </p>
<p>This often leads to requests for more treatments, with ensuing worsening of the mental state of the patient and increasing frustration on behalf of the cosmetic specialist. The situation can become so heated that <a href="https://www.ncbi.nlm.nih.gov/pubmed/19332010">legal action</a>, physical threats and even homicide have been known to be perpetrated by body dysmorphic disorder patients. </p>
<h2>How can these outcomes be avoided?</h2>
<p>Cosmetic interventions of all types are becoming increasingly accessible to a wider public. Therefore, it would be ideal for cosmetic specialists routinely to screen for body dysmorphic disorder.</p>
<p>Australian cosmetic specialists are not mandated to screen for body dysmorphic disorder and there’s no available information on the proportion of cosmetic clinics that screen for the condition. From my experience of speaking to patients who have sought cosmetic intervention, screening is variable at best.</p>
<p>There are certainly some practitioners who are very aware of the risks associated with body dysmorphic disorder and ensure their clients are screened and offered referral for further help if required. Unfortunately, too often screening is not performed and patients suffer as a consequence.</p>
<p>Screening should be mandated for people seeking any cosmetic procedure that might be seen as “enduring”: this includes surgical procedures. My colleagues and I have developed a questionnaire for practitioners, which through a series of simple questions can help diagnose body dysmorphic disorder. </p>
<p>For those who may body dysmorphic disorder, careful further questioning and referral to a body dysmorphic disorder specialist is required. A range of psychological therapies (such as cognitive behaviour therapy) and medications (mostly antidepressants) can be very effective at treating the condition’s underlying problems.</p>
<p>Simply providing cosmetic clinics with screening tools won’t guarantee all doctors accurately assess for body dysmorphic disorder. This is because we cannot expect all clients to answer questionnaires truthfully. However, in my experience, having seen hundreds of people with body dysmorphic disorder, they usually do. </p>
<p>At the end of the day, it would be ideal if cosmetic specialists did everything in their power to fulfil their ethical obligations. To not screen and then deliver cosmetic procedures to people who may have body dysmorphic disorder goes against the medical dictum “first do no harm”.</p><img src="https://counter.theconversation.com/content/74234/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>David Jonathan Castle does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>To not screen, and then deliver cosmetic procedures to people who may have body dysmorphic disorder, goes against the medical dictum “first do no harm”.David Jonathan Castle, Chair of Psychiatry, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/643332016-08-25T10:29:09Z2016-08-25T10:29:09ZIs social media to blame for the worsening mental health of teenage girls?<figure><img src="https://images.theconversation.com/files/135313/original/image-20160824-30249-ocl2mq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-298283600/stock-photo-filtered-photo-of-two-friends-using-their-smart-phones-outdoors-lifestyle.html?src=3ufjIuUxwnE-ar3up_CStA-1-78">Kaponia Aliaksei/Shutterstock</a></span></figcaption></figure><p>New <a href="https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/540563/LSYPE2_w2_research_report.pdf">research</a> by the Department of Education has found that the mental well-being of teenage girls in the UK is worsening. The survey, which took the views of 30,000 14-year-old pupils in 2005 and 2014, found that 37% of girls suffer from psychological distress, up from 34% in 2005. (This compares with 15% for boys in 2014, down from 17% a decade earlier.) The report’s authors noted that one of the things that has changed between 2005 and 2014 is the “advent of the social media age”.</p>
<p>The adolescent years are a time of rapid physical, cognitive and emotional development. Teenagers interact with people in order to learn how to become competent adults. In the past they would engage with parents, teachers and other adults in their community as well as extended family members and friends. Now we can also add social media to that list of social and emotional development. But why should the advent of social media be a problem?</p>
<p>Research indicates that girls may be at higher risk than boys from the <a href="http://christopherjferguson.com/BodyImageProspective.pdf">negative aspects</a> of social media. Young girls, with their limited capacity for self-regulation and susceptibility to peer pressure, are at risk of having bad experiences online that could negatively affect their development into healthy adults, and could lead to depression and anxiety disorders.</p>
<p>During adolescence, people develop traits such as confidence and self-control. Because teenage brains have not fully developed, and won’t fully develop until they reach young adulthood, they lack the cognitive ability of awareness and privacy and can post inappropriate messages, pictures and videos without understanding the long-term ramifications. What they are posting may not stay in their small circle of friends and can be circulated far and wide with devastating consequences. </p>
<p>Unlike their male peers, girls are more likely to over share personal information or post false information about themselves or others, increasing the possibility of experiencing a bad reaction from peers such as bullying or negative comments. </p>
<h2>False ideals</h2>
<p>Social media also gives the “X Factor” generation aspirations of celebrity status and impossible expectations. Social media sites are filled with photographs of stunning models for teenage girls to aspire to. Body image for the young adolescent girl is shaped by emotions (need to be liked), perceptions (adequate breast size) and is further influenced by cultural messages and societal standards. Social media allows girls to make comparisons among friends as well as celebrities and then provides them with “solutions” such as extreme dieting tips and workouts to reach their goals. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/135314/original/image-20160824-30212-fl6q6c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/135314/original/image-20160824-30212-fl6q6c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/135314/original/image-20160824-30212-fl6q6c.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/135314/original/image-20160824-30212-fl6q6c.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/135314/original/image-20160824-30212-fl6q6c.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/135314/original/image-20160824-30212-fl6q6c.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/135314/original/image-20160824-30212-fl6q6c.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Trying to attain the ‘perfect’ body can lead to body dysmorphic disorder.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-237891442/stock-photo-sport-fitness-lifestyle-technology-and-people-concept-young-woman-with-smartphone-taking-mirror-selfie-in-gym.html?src=JJOOnCxYJ8ubj6DEw0I9Sw-1-66">Syda Productions/Shutterstock</a></span>
</figcaption>
</figure>
<p>Research has indicated that adolescent girls are at risk of developing eating disorders as well as body dysmorphic disorder (the need to <a href="https://www.researchgate.net/publication/236948797_NetGirls_The_Internet_Facebook_and_body_image_concern_in_adolescent_girls">surgically correct a perceived imperfection</a>, such as small breasts). Concerns about body image can negatively impact their quality of life preventing them from having healthy relationships and taking up time that could be better spent developing other aspects of their personalities. </p>
<p>Social media can also have a negative impact on puberty encouraging young girls to join the “adult” world and become sexually active before they are mature enough to cope with all of the ramifications that this can have on their lives. Sexting has become a common occurrence with 20% of adolescents sending or <a href="http://pediatrics.aappublications.org/content/129/1/13.full">posting nude or seminude photographs or videos</a> of themselves to other adolescents. People who have been betrayed face the humiliation of having their picture shared far and wide by someone they trusted with intimate information. The extreme emotional distress these girls have felt has been widely documented as have the accompanying mental health conditions that result. </p>
<p>Adolescence is also a time when people begin to develop advanced reasoning skills and further expand their cognitive development. This is a time when they begin to think about how they are perceived by others. Adolescent girls have a tendency to obsess over the mundane, going over and over actions and thoughts because they are attempting to assimilate and process the information. This is healthy, but research is finding that when it is combined with social media it can intensify into an unhealthy activity and become a <a href="http://www.psych.rochester.edu/research/starrlab/wp-content/uploads/2014/08/1-s2.0-S0140197108001139-main.pdf">precursor to depression and depressive symptoms</a>. </p>
<p>Social media can be a friend or foe and instead of constantly focusing on the negative aspects we should instead use it as a tool to help adolescent girls to understand that the images that are constantly being projected on social media do not reflect the average person and that there is a wide diversity in physical appearance and rates of development. We should encourage girls to think critically about social media. </p>
<p>Adolescent girls spend a great deal of their time online, simply attempting to ban or control this behaviour will only push them into secretive online activities. Instead parents should become more involved in helping their teenagers negotiate social media obstacles and promote a healthy self-confidence.</p><img src="https://counter.theconversation.com/content/64333/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Pam Ramsden does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Psychological distress among teenage girls has risen by 4% in the past decade.Pam Ramsden, Lecturer in Psychology, University of BradfordLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/310622014-09-02T04:39:59Z2014-09-02T04:39:59ZScapegoating steroids won’t make for a safer night out<figure><img src="https://images.theconversation.com/files/57971/original/hnmrxb24-1409621895.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Steroid use is growing in Australia but not among the usual suspects.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/japokskee/4391428993">Jhong Dizon/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p>Steroids are easy to scapegoat. Users are viewed as aggressive, violent and mentally unstable, able to snap at any moment and cause great harm to the people around them. </p>
<p>Ostensibly, it is this perception of steroid users that has led the Queensland government to enact <a href="http://www.premiers.qld.gov.au/publications/categories/plans/assets/safe-night-out-strategy.pdf">tougher penalties</a> for steroids. The Safe Night out legislation increases the maximum penalty for possession or supply of steroids to 25 years in jail. </p>
<p>But tougher steroid laws are unlikely to have an impact on violence in the community because a) most steroid users are not violent, and b) other substances, including alcohol, are stronger risk factors for violent behaviour.</p>
<h2>Who uses steroids?</h2>
<p>The public perception of steroid users doesn’t match the reality. </p>
<p>The first red flag comes from demographic data. It turns out that in the United States, the <a href="http://www.ncbi.nlm.nih.gov/pubmed/21923602">typical steroid user</a> is male, around 30 years old, has a bachelor’s degree, is employed full-time in a white-collar occupation, earns an above-average income, and does not play any form of competitive sport. Local data is lacking, but smaller studies of Australian steroid users <a href="http://www.sciencedirect.com/science/article/pii/S0376871600800113">corroborate this profile</a>.</p>
<p>In a <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2131752/">large US study</a> of nearly 2,000 steroid users, the most-commonly reported occupations were in sales and marketing, information technology, banking and finance, health care, management and executives, and skilled labour. The least-commonly held occupations? Athletes, coaches, personal trainers and the military. </p>
<p>So these men don’t sound like a particularly violent bunch, but aren’t steroids still linked with increased aggression and violent behaviour?</p>
<h2>How steroids affect behaviour</h2>
<p>Some <a href="http://www.sciencedirect.com/science/article/pii/S0018506X96900215">studies suggest</a> that steroid users are more aggressive and irritable than non-users. Further, some <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2636528/">population-based studies</a> have <a href="http://www.ncbi.nlm.nih.gov/pubmed/8355384">found links</a> between self-reported anabolic steroid use and self-reported involvement in aggressive and violent behaviour. </p>
<p>Arguably, however, the best data comes from studies where anabolic steroid use is objectively tested and violent behaviour is confirmed through legal records rather than self-report. </p>
<p>To this end, a <a href="http://www.ncbi.nlm.nih.gov/pubmed/17088508">Swedish retrospective cohort study</a> that compared registered criminal activity among individuals who had tested positive for anabolic steroids to those who had tested negative for steroids found that those who tested positive were no more likely to have committed violent crimes. </p>
<p>In fact, after controlling for substance abuse, the researchers found a lower risk for crimes against property among those individuals who tested positive for anabolic steroids. </p>
<p>A general limitation of studies on steroid use and violent behaviour is that few have controlled for other forms of substance use, including alcohol. </p>
<p>A <a href="http://uu.diva-portal.org/smash/record.jsf?pid=diva2:601819">recent Swedish study</a> examined the link between anabolic steroid use and violent crime in a sample of 3,594 remanded prisoners and found that 28% reported using steroids at least once in their lifetime. Prisoners who reported any lifetime use of steroids were 1.7 times more likely to be suspected of a violent crime. However, there was no temporal relation between the use of anabolic steroids and the suspected violent crime. </p>
<p>In contrast, there was a four-fold increase in the risk of violent crime if alcohol had been consumed 24 hours earlier. The average amount of alcohol consumed in the 24 hours prior to a violent offence was 107 grams, equivalent to 10.7 Australian standard drinks.</p>
<p>A <a href="http://uu.diva-portal.org/smash/record.jsf?pid=diva2:601819">second Swedish population study</a> of 10,365 men found that 4.9% had been convicted for a violent crime and 0.7% reported anabolic steroid use. Further examination showed that violent offenders were five times more likely to report anabolic steroid use than non-offenders. </p>
<p>But after controlling for other forms of lifetime substance abuse, including alcohol, this association lost statistical significance. In other words, once the researchers looked at alcohol and other drugs, it appeared that anabolic steroids were not at all associated with violent crime. </p>
<p>Steroid use is probably not a proximal risk factor for violent behaviour. Rather, co-occurrence of abuse of other substances, including alcohol, are probably more to blame. Another possibility is that using anabolic steroids <a href="http://www.ncbi.nlm.nih.gov/pubmed/12048171">makes people more susceptible</a> to the violence-inducing effects of other substances such as alcohol or <a href="http://www.ncbi.nlm.nih.gov/pubmed/15763599">amphetamines</a>, an idea which has some support in animal research.</p>
<h2>Cost of penalising steroid users</h2>
<p>The potential benefit of tougher laws on steroid use to curb violence and antisocial behaviour must be weighed against the potential costs. The proportion of steroid users who disclose their use to health professionals, which is already low, will likely fall. </p>
<p>Community health-promotion services, such as needle exchanges, may see a drop in visits from steroid users concerned about the potential for discovery and prosecution.</p>
<p>Steroid use is undoubtedly growing in Australia. In New South Wales in 2007, <a href="https://kirby.unsw.edu.au/sites/default/files/hiv/resources/ANSPS_2008_2012%20KI.pdf">the proportion</a> of needle exchange service-users who reported that their last injection was steroids was just 2%. But by 2012 this had increased sixfold to 12%. Queensland <a href="https://kirby.unsw.edu.au/sites/default/files/hiv/resources/ANSPS_2008_2012%20KI.pdf">fared no better</a>: rising from 2% in 2007 to 11% in 2012. By 2012, almost two-thirds of all new service-users, or “new initiates,” reported that their last injection was anabolic steroids. </p>
<p>These men are not competitive athletes or criminals. Overwhelmingly, they are men who are unhappy with their appearance and want to look better. </p>
<p>For some, large parts of their self-worth or self-esteem are tied to their bodies and their appearance. If building muscle becomes a preoccupation, a mental condition called <a href="http://www.ncbi.nlm.nih.gov/pubmed/9427852">muscle dysmorphia</a>, formerly named <a href="http://www.ncbi.nlm.nih.gov/pubmed/8131385">“reverse anorexia”</a>, may develop. Little wonder that <a href="http://ajp.psychiatryonline.org/article.aspx?articleID=174271">up to 50%</a> of men with muscle dysmorphia also use steroids. </p>
<p>Derisively labelling steroid users as vain or narcissistic “gym bros” and disparaging their culture as “<a href="http://www.abc.net.au/news/2014-08-27/qld-beefs-up-steroid-laws-after-drastic-rise-in-seizures/5698532">bruss</a>” betrays a deep lack of compassion. There is a reason why extreme dieting and self-induced vomiting <a href="http://www.jeatdisord.com/content/1/S1/O23">grew faster</a> among Australian males than Australian females between 1998 and 2008 and a reason why teenage boys <a href="https://www.missionaustralia.com.au/2020-strategy-page/doc_download/198-mission-australia-youth-survey-2013">consistently rank</a> body image among their top three major life concerns. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/57972/original/qfmk7zq3-1409621973.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/57972/original/qfmk7zq3-1409621973.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/57972/original/qfmk7zq3-1409621973.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/57972/original/qfmk7zq3-1409621973.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/57972/original/qfmk7zq3-1409621973.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/57972/original/qfmk7zq3-1409621973.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/57972/original/qfmk7zq3-1409621973.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Male action figures are becoming bulkier.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/ntxpeach68/6785168533">SandyJo Kelly./Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
</figure>
<p>Our culture celebrates physically attractive and “masculine” men: tall, muscular, stiff upper-lipped. <a href="http://www.ncbi.nlm.nih.gov/pubmed/18089212">Research shows</a> that media portrayals of men have become <a href="http://www.sscnet.ucla.edu/comm/haselton/papers/downloads/frederickbodyimage.pdf">more and more muscular</a> during the past few decades and the rise in steroid use in contemporary Australia is a symptom of men succumbing to body image pressures. </p>
<p>Solving this problem demands a compassionate understanding of the psychology behind why men start to use steroids. Too often we turn to outright denigration. We do not publicly berate girls for their attempts to look more attractive, so why do we berate men?</p>
<p>Tougher steroid laws are unlikely to have an impact on violence in the community. Rather, the steroid-using community will be driven further underground, making it more difficult to deliver health services to this misunderstood and under-served group of people, allowing the problem of steroids in Australia to grow even larger.</p><img src="https://counter.theconversation.com/content/31062/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>I am currently affiliated with the Butterfly Foundation, the Redleaf Practice, the Australian and New Zealand Academy of Eating Disorders, and the National Association for Males with Eating Disorders.</span></em></p>Steroids are easy to scapegoat. Users are viewed as aggressive, violent and mentally unstable, able to snap at any moment and cause great harm to the people around them. Ostensibly, it is this perception…Scott Griffiths, PhD candidate, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/126092013-06-13T04:44:10Z2013-06-13T04:44:10ZBody dysmorphic disorder puts ugly in the brain of the beholder<figure><img src="https://images.theconversation.com/files/25372/original/csz9wjq2-1371003806.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">People with body dysmorphic disorder have an excessive fear of looking ugly or disfigured.</span> <span class="attribution"><span class="source">DeeAshley/Flickr</span></span></figcaption></figure><p>When people think of mental problems related to body image, often the first thing that comes to mind is the thin figure associated with anorexia. Body dysmorphic disorder is less well known, but has around five times the prevalence of anorexia (about 2% of the <a href="http://www.ncbi.nlm.nih.gov/pubmed/18408651">population</a>), and a high level of <a href="http://www.sciencedirect.com/science/article/pii/S1740144509000308">psychological impairment</a>. </p>
<p>It’s a mental disorder where the main symptom is excessive fear of looking ugly or disfigured. Central to the diagnosis is the fact that the person actually looks normal.</p>
<h2>Neither vanity nor dissatisfaction alone</h2>
<p>People with body dysmorphic disorder think there’s a particular feature of their face (such as nose, lips or ears) or another body part (such as arms, legs or buttocks) that’s unbearably ugly. Many seek unnecessary cosmetic surgery or skin treatments – but sadly only a few receive appropriate psychological support.</p>
<p>In general, people with the disorder are very shy and some choose to stay home out of fear of being judged or laughed at because of the way they look. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/25370/original/rr38cjtx-1371003179.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/25370/original/rr38cjtx-1371003179.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=921&fit=crop&dpr=1 600w, https://images.theconversation.com/files/25370/original/rr38cjtx-1371003179.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=921&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/25370/original/rr38cjtx-1371003179.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=921&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/25370/original/rr38cjtx-1371003179.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1157&fit=crop&dpr=1 754w, https://images.theconversation.com/files/25370/original/rr38cjtx-1371003179.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1157&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/25370/original/rr38cjtx-1371003179.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1157&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Body dysmorphic disorder should never be dismissed as body dissatisfaction or vanity.</span>
<span class="attribution"><span class="source">Suzy Forcella</span></span>
</figcaption>
</figure>
<p>Many people with the disorder spend hours every day looking at themselves in the mirror. Others have unusual grooming habits to try and cover up their perceived flaw.</p>
<p>These people have significant difficulties with their social lives and experience high levels of anxiety and depression. Body dysmorphic disorder is clearly a serious problem and should never be dismissed as body dissatisfaction or vanity.</p>
<p>But distinguishing between these can be difficult, so the following questions are often used as a guide:</p>
<ul>
<li><p>do you think about a certain part of your body for more than two hours a day?</p></li>
<li><p>does it upset you so much that it regularly stops you from doing things?</p></li>
<li><p>has your worry about your body part affected your relationships with family or friends?</p></li>
</ul>
<p>If someone answers yes to these questions, further professional evaluation is needed. A full assessment would entail a few sessions with a mental health clinician to talk about these worries and an assessment of grooming behaviours.</p>
<h2>Brain research</h2>
<p>My research using <a href="http://www.ncbi.nlm.nih.gov/pubmed/23473554">brain imaging</a> has shown there are clear differences in the brains of people with body dysmorphic disorder that lead to changes in the way they process information. We found that people with the disorder had inefficient communication between different brain areas. </p>
<p>In particular, the connections between areas of the brain associated with detailed visual analysis and a holistic representation of an image were weak. This could explain the fixation on just one aspect of appearance. </p>
<p>There was also a weak connection between the the amygdala (the brain’s emotion centre) and the orbitofrontal cortex, the “rational” part of the brain that helps regulate and calm down emotional arousal. </p>
<p>Once they become emotionally distressed, it can be difficult for someone with body dysmorphic disorder to wind down because the “emotional” and “rational” parts of the brain simply aren’t communicating effectively.</p>
<p>People usually develop body dysmorphic disorder during their teenage years, which happens to be an important time for brain development. They also often report childhood teasing about their looks, which may act as a trigger that rewires the brain to focus attention on physical appearance.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/25207/original/kq8stm7x-1370576843.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/25207/original/kq8stm7x-1370576843.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=338&fit=crop&dpr=1 600w, https://images.theconversation.com/files/25207/original/kq8stm7x-1370576843.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=338&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/25207/original/kq8stm7x-1370576843.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=338&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/25207/original/kq8stm7x-1370576843.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/25207/original/kq8stm7x-1370576843.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/25207/original/kq8stm7x-1370576843.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">One-on-one psychological therapy should be first-line treatment for body dysmorphic disorder.</span>
<span class="attribution"><span class="source">benbuchanan.com.au</span></span>
</figcaption>
</figure>
<h2>Cosmetic procedures</h2>
<p><a href="http://www.ncbi.nlm.nih.gov/pubmed/11815686">Many people</a> with body dysmorphic disorder seek cosmetic procedures such as nose jobs, breast implants or botox injections. The problem is that the vast majority (83% in some <a href="http://www.ncbi.nlm.nih.gov/pubmed/11815686">research</a>) experience either no improvement or a worsening of symptoms after it. And most are dissatisfied with the procedure.</p>
<p>This differs from people <em>without</em> body dysmorphic disorder who are <a href="http://journals.lww.com/plasreconsurg/Abstract/1998/11000/Quality_of_Life_Outcomes_after_Cosmetic_Surgery.53.aspx">generally satisfied with cosmetic procedures</a> and even report psychological benefits on follow-up.</p>
<p>Researchers estimate <a href="http://www.ncbi.nlm.nih.gov/pubmed/20561712">about 14%</a> of people who receive cosmetic treatments have diagnosable body dysmorphic disorder, indicating that psychological screening practises are inadequate. Given the likelihood of causing psychological harm, it may be wise for cosmetic surgeons to assess all potential clients before operating.</p>
<h2>Psychological treatment</h2>
<p>It can be difficult to persuade someone with the disorder to accept psychological help given the belief in their physical defect is likely to be very strong. But once someone receives psychological therapy, <a href="http://www.ncbi.nlm.nih.gov/pubmed/19160252">symptoms are likely to reduce</a>.</p>
<p>The first-line of treatment is cognitive behavioural therapy (CBT), focusing on exposure and response prevention with the option of antidepressant medication. This helps patients modify unhelpful daily rituals and safety behaviours, such as mirror checking or camouflaging the perceived defect with make-up. </p>
<p>Body dysmorphic disorder is under-diagnosed because those with it persistently deny they have a psychological problem, preferring to opt for physical treatments instead. Evidence suggests that symptoms are underpinned by differences in the way the brain processes information and that psychological therapy can help people overcome the preoccupation their with appearance.</p><img src="https://counter.theconversation.com/content/12609/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ben Buchanan is involved in research and treatment of body dysmorphic disorder. The brain research referenced in this article was funded by a Monash Strategic Grant. Ben conducts research at MAPrc (Monash Alfred Psychiatry Research Centre), School of Psychology and Psychiatry, Faculty of Medicine, Nursing and Health Sciences, Monash University and The Alfred Hospital, Melbourne, Australia.</span></em></p>When people think of mental problems related to body image, often the first thing that comes to mind is the thin figure associated with anorexia. Body dysmorphic disorder is less well known, but has around…Ben Buchanan, Psychology Doctoral Candidate, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.