Do you feel mentally, physically, and medically healthy but still fret about tiny imperfections in your appearance? Are you constantly thinking about your weight? Do you obsess over how you look? If you answered affirmatively to any of these questions, you may have body image issues.

Mental illnesses that involve obsessions about the body are critical to recognize. Nine percent of the U.S. population (28.8 million) will have an eating disorder of some kind at some point in their lives. 10,200 deaths each year are the result of an eating disorder—one death every fifty-two minutes. Approximately 13 percent of women over age fifty have eating disorder symptoms, 6 to 8 percent of adolescents have an eating disorder of some type, and the rate of children under the age of twelve who have been admitted to the hospital with an eating disorder has risen 119 percent in the last ten years.

Body dysmorphic disorder (BDD) is a mental health condition in which a person cannot stop thinking about and disparaging one or more perceived defects or flaws in their appearance. It is a non-food dysmorphia, but it also occurs in eating disorders such as anorexia, bulimia nervosa, and binge eating.

Anorexia is characterized by starvation and/or an exercise addiction brought on by a distorted body image and the unrelenting fear of being overweight. Up to 3.7 percent of women will develop anorexia at some point in their lives. The risk of death in an individual with anorexia is twelve times greater than that of the general population of the same age. Not only are there medical complications associated with starvation, but there is also a one in five risk of suicide amongst anorexics. Signs of anorexia include early anemia, muscle wasting, weakness, brittle hair and nails, dry skin, fine hair, severe constipation, low blood pressure, slow heart rate, brain dysfunction, feeling cold, severe tiredness, osteoporosis, and infertility.

In contrast, bulimia nervosa is characterized by recurrent binge-eating episodes of large amounts of foods. Binging leads to a feeling of disgust for the lack of self-control, which ushers in forced vomiting, the excessive use of laxatives or diuretics, fasting, or a combination thereof. Because bulimics can be normal weight, overweight, or underweight, they are harder to diagnose. About 1.5 percent of women will have bulimia in their lifetimes. One in ten bulimics have a comorbid substance abuse disorder, usually alcohol. Signs include a chronic sore throat, swollen glands, decaying teeth, worn tooth enamel, acid reflux, intestinal issues, dehydration, and electrolyte imbalance. 

A third disorder, binge eating disorder (BED), is the most common and is characterized by the loss of control and recurring episodes of food binges in a short period of time. However, in contrast to bulimia, these binges are not followed by purging, excessive exercise, or fasting. Binge eaters typically eat alone or in secret to avoid embarrassment, eat fast, eat when not hungry, eat until uncomfortable, and are typically overweight or obese. They are constantly dieting without success. Approximately 3.9 percent of women will have binge eating disorder in their lifetime. This is the most common body image/eating disorder in the U.S. 

Body Dysmorphic Disorder (BDD), a non-food related body dysmorphia, is seen in about 2.9 percent of the population and is characterized by a constant worry and obsession over perceived or very mild imperfections of the body.  People with this disorder are unable to get past what they see in the mirror. A flaw may be minor or sometimes even imagined. This obsession may lead to eating disorders, unnecessary cosmetic procedures, or overexercising to an unhealthy degree. These individuals frequently look in the mirror, constantly compare themselves to others or to photos, constantly change clothing, use clothing to camouflage or conceal, avoid the public, and become anti-social. They commonly have obsessive thoughts and repetitive behaviors related to their appearance.

About 33 percent of people with BDD obsess about their perceived flaws for one to three hours a day, 40 percent obsess for three to eight hours, and about 25 percent obsess for more than eight hours daily. Individuals with BDD lack the knowledge that their body image beliefs are distorted and believe it is entirely normal to worry about their appearance for hours every day. This disorder is typically in response to some sort of negative remark or experience about their body or self-image from the past, leading to an almost PTSD-like disorder. 

Individuals with eating disorders share similar negative emotions to those with BDD, such as shame, disgust, and anger. The difference is that people with eating disorders have body weight dysmorphia and might view their underweight body as too fat, whereas those with BDD have body image dysmorphia and see themselves as ugly or disfigured even though they appear attractive or normal to others.

Individuals with severe body dysmorphia have neurochemical imbalances with associated depression or anxiety, and they will generally have a higher suicide rate than those with eating disorders. Although both eating disorders and BDD can be severe and life threatening, people with BDD experience more impairment in daily functioning than those with eating disorders. Body image disorders can affect people of all ages, races, ethnicities, body weights, and genders, and the occurrence rate has gone up 70 percent since the pandemic.

Researchers have found that these disorders stem from a complex interaction of genetic, biologic, behavioral, psychological, and social factors. There are ongoing genetic studies and known DNA variations linked to an increased risk of these dysmorphia disorders. Brain imaging studies have demonstrated a difference in brain activity between women with eating disorders and those of healthy women.

Body image disorders are hard to diagnose but it starts with education, recognition, and the realization that there is a need for professional help. Most importantly, believe that despite the imperfections that we all have, we are beautiful in our own way. Believe in yourself and move forward.