When the Mirror Can Lie: Body Dysmorphia

Tracy Smith, LPC, NCC, ACS
August 28, 2019

Several times a day, people sneak a peek at their reflection in the mirror.  They make sure that they look good before a hot date, take a glance on the way out before work, or check the status of their frizzy hair on a rainy day.  They peer at themselves while washing their hands in the bathroom, take a glimpse while putting jewelry on in front of the vanity, and assess their appearance while shaving and brushing their teeth.  Most people are able to look in the mirror and see an accurate representation of themselves, but there are some individuals who see something very different staring back at them.


Body dysmorphia is a mental health condition where people constantly think and obsess over perceived imperfections or failings in appearance.  This obsession can cause intense feelings of shame and anxiety and can result in the avoidance of socializing or going out into public.  These imperfections may be conjured up, negligible, or not obvious to others.    

People with body dysmorphia tend to incessantly check the mirror, fixate on their body type and appearance, and consistently seek reassurance from others.  The perceived blemishes can cause significant anguish and considerable impairment in a person’s day to day functioning.  A person may go to extreme lengths to correct perceived flaws through surgical or cosmetic procedures, which usually tends to result in temporary fulfillment.  However, satisfaction is fleeting and eventually fades back into a dark hole of anxiety and unhappiness.

Individuals with body dysmorphia truly believe that deficiencies in their appearance make them revolting, unattractive, or deformed.  People commonly focus on their facial features, including nose, acne, wrinkles, or complexion.  They may fixate on the thickness, color, or texture of their hair, or the appearance of their skin. They are often under the assumption that others are staring at or mocking them.  This belief causes extreme preoccupation, which others often fail to see or understand. 

People can go to extraordinary lengths to hide or tame perceived flaws by consistently checking their reflection in the mirror, grooming, or hiding imperfections behind makeup, accessories, or clothes.  People tend to incessantly compare their body type or appearances to others, have perfectionist inclinations, and always seem to be looking for validation and reassurance from others. 

The preoccupation on appearance often results in significant impairment in various areas of a person’s life, including academic, occupational, or social functioning.  People tend to avoid going out in public, which results in the failure to meet important personal and professional responsibilities.  The isolation can also cause difficulties in social and personal relationships.

A person’s insight regarding their body dysmorphia can vary widely.  People may be aware that their perceived flaws are inaccurate or non-existent, while others may have the sneaking suspicion that they are true.  Then, there are others who are one hundred percent certain that they are true.  Body dysmorphia usually begins in adolescence and can impact both males and females. 

People may not seek treatment because of intense humiliation and shame about their appearance.  However, body dysmorphia does not remedy itself and can worsen over time, leading to other mental health disorders such as depression, or anxiety.  Treatment for body dysmorphia often includes a combination of psychotherapy and medication.  Cognitive-behavioral therapy helps people alter negative thoughts to change feelings and behaviors and provides them with healthy coping mechanisms.  Medications used to treat other mental health conditions, such as depression, may help to alleviate symptoms of body dysmorphia.

When checking their appearance on a daily basis, people with body dysmorphia tend to see distorted reflections, almost like the mirrors in a circus.  They see images that are stretched out, too tall, too fat, or difficult to make out all together.  Regardless, body dysmorphia is a treatable condition and individuals can learn how to remove distortions and see themselves as they truly are.

Tracy Smith, LPC, NCC, ACS

Tracy is a Licensed Professional Counselor and is a clinical supervisor for the Community YMCA, Counseling & Social Services branch. Tracy has over 12 years of experience working in many settings including partial care hospitalization and intensive outpatient programs, community agencies, group practice, and school-based programs. Tracy works with clients of all ages, but especially enjoys working with the adolescents. Tracy  facilitates groups using art therapy, sand play and psychodrama.

More For You