At its most extreme, obsession with appearance has a label: body dysmorphic disorder, or BDD. Celebrities from Bruce Jenner to Hayden Panettiere, and of course, Michael Jackson, have been rumored to suffer from it.
BDD is an obsession with a perceived flaw—a supposed defect that appears minor or even non-existent to most observers. It could be an obsession that one’s Adam’s apple is too big, feeling tortured over some minor acne scars, or an absolute certainly that one’s perfectly-normal-looking-to-others nose will draw ridicule and humiliation if anyone sees it. The distress about the flaw is so strong that some sufferers only go out at night, cover the perceived flaw with clothing or oddly combed hairstyles, check a mirror hundreds of times a day, or undergo multiple surgeries (many of which are elective and paid out of pocket – again, Michael Jackson is the perfect example). Sadly, surgery or dermatologic treatment doesn’t cure the problem. That’s why individuals with BDD often run from doctor to doctor, or throw their money away on sham miracle cures.
There is a specific subtype of BDD called muscle dysmorphia, nicknamed “bigorexia,” whose sufferers, usually men, have an irrational, obsessive belief that they are too skinny or not muscular enough. This isn’t just a preoccupation with size, it’s a near-delusion, and it most often affects men whom most people would consider muscular.
The Broken Mirror by Dr. Katharine Phillips is the BDD treatment bible, and many people with BDD—who make up 1-2% of the U.S. population—report feeling more understood and hopeful after reading it. Another book called The Adonis Complex by the same author addresses muscle dysmorphia and men and boys’ quest for physical perfection to the detriment of everything else.
BDD is often treated with a class of antidepressants called SSRIs and cognitive-behavioral therapy, a structured type of therapy that challenges the beliefs underlying BDD, like “I can’t go out because my abs aren’t chiseled enough,” plus the behaviors that go along with those beliefs.