Distorted Body Image

Clearing the Confusion Between Distorted Body Image & Body Dysmorphic Disorder

January 29, 2024

Do you tend to obsess about how you look? Maybe there’s something in your appearance that really bugs you but isn’t even noticed by other people. Does it bother you so much that you think about it 24-7? Are you so anxious about it that you avoid social situations? I had the opportunity to interview bariatric psychologist Dr. Connie Stapleton on my podcast where she explained the difference between a negative or distorted body image and body dysmorphic disorder. She cleared up a lot of confusion that exists between the two, especially on social media.

A distorted body image, also called a negative body image, is an unrealistic view of yourself and your body, while body dysmorphic disorder is an obsessive pathological mental health disorder.

Distorted Body Image

Weight loss happens quickly after bariatric surgery and people often talk about having body dysmorphic disorder because they no longer recognize the person they see in the mirror. But according to Dr. Connie, this lack of recognition is not body dysmorphic disorder, or BDD, but rather a distorted body image. Actually, only one percent of the population, both men and women included, experience BDD which is a serious obsessive-pathological mental health disorder and is not typically seen in bariatric surgery. In fact, Dr. Connie said that in 30 years of being a therapist, she has not seen a case of BDD, but negative body image is very common. BDD is characterized by a continued disrupting obsession with the appearance of one or more parts (typically imagined flaws or minor flaws) of the body, resulting in such severe distress that it interferes with your daily functioning. There is the firm belief that the flaw or defect makes you ugly or deformed, and there is constant comparison of your body to others.

For example, in BDD, an imagined defect would be a small mole that no one but you really notices. But to you, it’s the only thing you think another person sees and you become consumed by it. This excessive concern or preoccupation can occupy 3-8 hours a day and sometimes up to every waking moment. According to Dr. Connie and Johns Hopkins, the cause of BDD is not known but usually begins in adolescence or teenage years. Sometimes there is a family history or similar mental disorder such as obsessive compulsive disorder, or someone has been bullied or picked on, maybe there are abnormal levels of some brain chemicals or perhaps a combination of a number of these things. BDD is not the same at all as a negative body image where you don’t recognize your new body.

Warning signs of BDD:

  • Obsessive preoccupation with a perceived flaw
  • Belief that others are mocking you constantly
  • Constantly checking the flaw in the mirror
  • Social isolation
  • Being a perfectionist

At first glance, BDD and distorted body image seem very similar but they are not. One big difference is body dysmorphia is a diagnosable mental disorder whereas a negative body image or distorted body image is negative feelings and an unrealistic view or thoughts and feelings regarding your appearance.

Internal and External Triggers

Dr. Connie also shared that another area where BDD and negative body image differ is in the triggers, both internal and external. In body dysmorphia, the belief that you have a deformity, a specific fixated issue, is internally driven by a personal need for perfection. Negative body image is different as it is externally driven by society and culture, especially with comparison to unrealistic beauty standards which then fuel negative thoughts and perception of your body and appearance and can affect your self-image. Negative body image is more of a general dissatisfaction of how you look whereas BDD fixates on a singular imperfection where someone will go to extremes to correct it such as plastic surgery, cosmetic procedures, restrictive dieting, or heavy makeup but nothing really helps because it’s a psychological disorder.

I asked Dr. Connie about how treatment varies between the two and what type of help you should seek. She suggested that treatment for both BDD and body image issues may include cognitive behavioral therapy. Specific medications may be helpful for BDD especially if there is co-occurring OCD, depression, anxiety, etc.

Consider Seeking Help

If you suspect you have BDD, please see a mental health practitioner such as a psychologist or psychiatrist instead of your primary care physician. Check ahead of time to see if they have any experience dealing with this diagnosis. Are you dealing with rapid weight loss and changes in physical appearance and body image…the new you? It’s very normal and common. Struggling with the psychological effects of the weight loss? Consider seeing a therapist for cognitive behavioral talk therapy. Talk it out. Work toward acceptance. In either case, this doesn’t go away overnight. It’s a process. Give yourself grace and allow yourself the time to do the work. You will overcome the stinkin’ thinking, celebrate the new you, and celebrate living your life to the fullest.

Bariatric dietitian Dr. Susan Mitchell is host of the podcast Bariatric Surgery Success.

Distorted Body Image
Susan Mitchell


Bariatric dietitian Dr. Susan Mitchell is host of the podcast Bariatric Surgery Success. Selected as one of the Best 35 Dietitian Podcasts, Bariatric Surgery Success was chosen from thousands of podcasts on the web ranked by traffic, social media followers, domain authority & freshness. Dr. Susan helps you conquer cravings, emotional eating and weight regain after bariatric surgery with a focus on your nutrition and health, journey and success. Read more articles by Susan!