6 Questions That Can Help Determine Whether It’s More Than Just Low Self-Esteem
We all have things we don’t like about our bodies. We think our eyes are too close together or our noses are too big. We worry about ‘losing those last x-number of pounds’ and mourn the appearance of wrinkles or cellulite as we age. We have bad hair days, days when acne pops up out of nowhere, and days when clothes just don’t seem to fit the way they should. Some of us have more trouble than others in the self-esteem department, crafting laundry lists of things we’d like to change if given the chance. But no matter how long the list of bodily woes, most people are able to move on without letting it affect their daily lives.
But what if you can’t move on? For some, these preoccupations are not spread out occurrences but constant nagging anxieties that make life difficult. This distinction is important because if it’s happening, it might be more than just low self-esteem. You may be suffering from Body Dysmorphic Disorder (BDD).
BDD is a mental health disorder where an individual has a preoccupation with a perceived flaw or defect in their appearance that is unnoticeable or imagined. These obsessions usually impact daily life in a profound way. Unfortunately, not a lot of research exists about BDD. We know that symptom onset usually begins in adolescence and that it affects both men and women equally. We know that it is often misdiagnosed as obsessive-compulsive disorder or social anxiety. And most troubling is the estimate that about 1 in 100 people suffer from the disorder but that number is debatable (and could be much, much higher) because most will not seek treatment.
It’s hard to draw a line between BDD and low self-esteem. Here’s a list of questions you can ask yourself to help make the distinction:
1. How do I act around mirrors?
Many who suffer from BDD act differently from the average person around mirrors. For some, it’s an obsession with avoiding them and if they catch a glimpse, they may get extremely anxious, even to the point of a panic attack. It can go the other way as well. You may find yourself transfixed by mirrors, checking every single one you pass in order to see if your perceived flaws look any different from one to the next. The term ‘mirrors’ is also used liberally. You may find yourself obsessed with or avoiding any reflective surface: the sides of cars, windows, etc.
2. Do I camouflage my body?
When you sit on a couch, do you grab the nearest throw pillow and set it in your lap in order to cover your stomach? For those who carry a purse: when you go out to eat, do you leave it in your lap to conceal your midsection? Do you wear layers or long sleeves even when it’s hot outside to keep hidden? Do you leave your jacket on indoors solely for the purpose of staying covered? Do you have a strict makeup routine that must be completed before leaving the house? Do you comb your hair a certain way to conceal parts of your face? If you religiously camouflage your body, you may be suffering from BDD.
3. Do I pick at my skin or pull out my hair?
If one of your preoccupations is skin or bodily hair related than BDD may physically manifest as skin-picking or hair-pulling. You may find yourself unconsciously engaging in the behavior or even compulsively engaging. You might pick at scabs, acne scars, or dry skin until it bleeds. Hair pulling can also occur. This can happen at the scalp, eyebrows, eyelashes, even in the pubic area.
4. Do I obsessively change my clothes?
If you suffer from BDD you may change your clothing five, ten, maybe even a dozen times or more every single morning until you find something that adequately covers your perceived bodily flaws. There’s also a good chance you have a closet or dresser full of clothing but cycle through the same loose-fitting or concealing outfits day after day.
5. What do I do when I get a compliment?
If someone compliments you: Do you get anxious? Do you think they said it because they pity you? Or that they’re just being mean or sarcastic? Do you obsess about whatever they mentioned for the rest of the day? Do you find it hard to say thank you, instead saying negative things about yourself to counter it? If someone complimenting you negatively alters your mental state, there’s a possibility you might be suffering from BDD.
6. Does thinking about my appearance impact my daily life and my decisions?
It’s more than low self-esteem when you find yourself unable to live a happy, productive life. Have you skipped work, school, or a social function because of your appearance? Have there been days where you were unable to leave the house because of how you looked? Do you find it hard to concentrate because you’re preoccupied with a perceived flaw? Are there certain places that are hard for you to go because it causes extreme body-related anxiety (gyms, clothing stores, certain family member’s houses)? Do you spend more than an hour a day consumed by a body-related obsession? If you suffer from BDD, your life is greatly impacted by the disorder.
I am not a medical professional. I circulate information about BDD because there are people out there suffering from body anxiety they can’t control, obsessing over flaws that likely don’t even exist, thinking it’s just low self-esteem, thinking it’ll never get better. If after reading this there’s any possibility that what you thought was low self-esteem may actually be BDD, please seek the help of a licensed mental health professional. If left untreated, BDD may lead to additional mental health disorders like anxiety, eating disorders, depression, or in severe cases, thoughts of suicide. There is hope. Many of those who have been diagnosed with BDD report finding relief from their symptoms through Cognitive Behavioral Therapy and in some cases, antidepressant medication. Please seek help if you are suffering.
For more information about BDD, please visit the ADAA website.
To find a mental health professional in your area, check out this search feature at Psychology Today. 
