Why Am I So Ugly? It Turns Out This Is a Disease

Why Am I So Ugly? It Turns Out This Is a Disease

"Why am I so ugly?" You might ask yourself this question every time you look at your photos or see yourself in the mirror. You might think your skin isn't smooth enough, your eyes aren't big enough, or your nose isn't perfectly shaped. While it's normal for everyone to care about their appearance, when someone becomes excessively preoccupied with their looks, constantly feeling unattractive, and this anxiety begins to interfere with social activities and daily life, they might be suffering from Body Dysmorphic Disorder (BDD)—also known as "imagined ugliness syndrome."

01) What Is Body Dysmorphic Disorder?

Body Image was first proposed by Austrian psychoanalyst Paul Schilder, referring to the mental representation of our own body—how our body appears to ourselves. People always hold specific views about their bodies, whether positive or negative, so body image encompasses our perceptions of our body's aesthetics and sexual attractiveness.

When someone holds a negative attitude toward their body image, believing their body is unsatisfactory or doesn't meet social beauty standards, they experience body image anxiety. While body image anxiety is widespread, if someone becomes excessively worried about it, experiencing significant distress that severely impacts their personal life and social or occupational functioning, they may have Body Dysmorphic Disorder.

Body Dysmorphic Disorder, also known as BDD, is described by psychologists Cororve and Gleaves (2001) as a condition where a person obsessively believes that certain parts of their body have severe defects and takes special measures to conceal or "fix" them. These perceived defects are usually imagined; even if a defect exists, its severity is exaggerated. These thoughts are pervasive, intrusive, and time-consuming.

The American Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), classifies BDD as an obsessive-compulsive and related disorder.

02) Which Body Parts Do People with BDD Focus On?

Body Dysmorphic Disorder is a relatively common mental disorder, affecting 0.7% to 2.4% of the general population—more common than schizophrenia or anorexia. These statistics typically come from clinical settings and likely underestimate the prevalence of BDD, as many people with the disorder feel ashamed of their appearance and don't seek treatment (Bjornsson, Didie & Phillips, 2010).

The disorder can occur across a wide age range, from 5 to 80 years old, but the onset is concentrated mainly in early adolescence, with an average age of 16-17. This may be because people become more concerned about their appearance during this age.

While it's commonly believed that women care more about their appearance than men, BDD doesn't show significant gender differences. DSM-5 mentions that the point prevalence in American adults is 2.4%, with 2.5% in women and 2.2% in men—quite similar. German data shows similar patterns.

For people with BDD, any part of the body can become a focus of concern. The most common areas include:

• Skin imperfections: Including skin tone, wrinkles, scars, acne, blemishes, and texture
• Hair: Hair on the head or other body parts, or hair loss
• Facial features: The nose is the most commonly focused area, along with overall facial shape and size
• Weight or muscle tone

Other areas of concern include muscles, chest, thighs, buttocks, genital size, and specific body odors (WebMD, 2016).

Additionally, Muscle Dysmorphia is another manifestation of BDD, appearing almost exclusively in men. Those affected primarily believe they are too small or not muscular enough. Most people try to become stronger through exercise, anabolic steroids, etc., sometimes leading to physical injury.

03) What Are the Typical Behaviors of People with BDD?

While concerns about appearance may be difficult for others to detect, the suffering of people with BDD is very real. BDD primarily affects four types of emotions: anxiety, shame, depression, and disgust.

It's normal to have occasional body image anxiety—like noticing less smooth skin while washing in the morning or discovering weight gain in a fitting room. However, this anxiety is sporadic and non-persistent, and can be effectively alleviated by adjusting one's perspective. In contrast, anxiety caused by BDD is difficult to resist or control. On average, people with BDD spend 3-8 hours per day affected by their preoccupations (Phillips, 2004).

People with BDD always feel the fear of possible rejection and have very low self-esteem. As a result, many avoid social activities to prevent uncomfortable feelings and negative evaluations from others. When they must attend public events, they remain highly sensitive and may use excessive decoration to conceal perceived defects, such as heavy makeup, special hairstyles, or bulky clothing.

People with BDD may compulsively repeat specific, time-consuming behaviors, such as:

• Constantly checking their appearance in mirrors, or completely avoiding mirrors
• Picking at skin or pulling out hair
• Comparing themselves to people on the street or models in magazines
• Frequently reapplying makeup with dissatisfaction
• Constantly asking others for opinions about their appearance
• Worrying that their appearance will negatively impact their life and work

These behaviors can be divided into three categories:

1. Compulsive behaviors: Such as constantly checking mirrors or picking at skin. These are reactions to obsessive thoughts, aimed at reducing anxiety and other distressing emotions.

2. Safety behaviors: Primarily concealing disliked body parts, such as wearing hats, glasses, or makeup, to reduce or avoid distressing emotions or negative events like embarrassment or humiliation.

3. Avoidance behaviors: Patients often avoid social situations, fearing others will say they're ugly. Like compulsive behaviors, these aim to reduce anxiety, but long-term clinical experience shows these behaviors don't reduce the intensity of preoccupations or anxiety, and may even make BDD more chronic and severe (Bjornsson, Didie & Phillips, 2010).

As a result, the quality of life for people with BDD is significantly impaired. Many patients are single or divorced, finding it difficult to start and maintain relationships. Daily work, study, and family life are also greatly affected, with many losing jobs or choosing to drop out of school. Partners, friends, and family members are also affected, feeling distressed because they can't help the patient (BBD Foundation, N.D.).

Some people with BDD isolate themselves for long periods, feeling worthless and unloved, leading to violence, substance abuse, and suicidal thoughts and behaviors. One-third of patients have engaged in violent behavior related to BDD, such as attacking others or destroying property. Many patients abuse alcohol or drugs. In one study, nearly half of people with BDD were diagnosed with lifetime substance use disorders, primarily alcohol and cannabis abuse.

The most dangerous thoughts and behaviors BDD can trigger are suicidal. Nearly 80% of people with BDD have had suicidal thoughts, and about one-quarter have attempted suicide due to BDD symptoms (Bjornsson, 2010).

04) What Causes Someone to Always Feel Ugly?

Anxiety about body image can sometimes be triggered by social culture or one's own perfectionist tendencies. However, research on the causes of BDD is still limited and lacks depth.

The current understanding is that, like many mental illnesses, BDD may result from multiple factors working together, including:

• Brain differences: One study suggests that BDD is related to the size or function of specific brain regions that process body image information (WebMD, 2016). Neurochemistry also plays an important role, with research finding that serotonin imbalance can trigger BDD.

• Genetics: Some studies show that BDD is more common in people whose blood relatives also have the disorder or have obsessive-compulsive disorder or depression.

• Environment: Personal upbringing, life experiences, and culture may trigger BDD, especially if someone has received negative evaluations about their body or self-image, or experienced neglect or abuse in childhood.

• Personality traits: People with certain personality traits are more likely to develop BDD, such as perfectionism or low self-esteem (Mayo Clinic, 2016).

05) What to Do If You Have BDD?

If anxiety about your body has seriously affected your work and life, and you're increasingly unwilling to participate in social activities, constantly being troubled by obsessive thoughts about your appearance, you should take this condition seriously.

If you suspect you have BDD:

First, understand that BDD is a mental illness, not a temporary mood fluctuation about your appearance. BDD doesn't resolve automatically but gradually worsens. So, when you start to suspect it, seek professional diagnosis promptly.

Many people with BDD choose cosmetic treatments for their perceived appearance defects, but one study showed that only 3.6% felt their condition improved, with the vast majority dissatisfied with medication consultations or surgery. These results are negative for both patients and cosmetic surgeons, with 40% of surgeons having been threatened by patients (Bjornsson, Didie & Phillips, 2010).

Currently, more effective treatment methods include medication and psychotherapy:

• Selective Serotonin Reuptake Inhibitors (SSRIs) are a group of medications effective for BDD patients. People with BDD taking SSRIs typically find that their focus on perceived defects decreases, anxiety, depression, and suicidal intent are alleviated, and self-esteem improves.

• Cognitive Behavioral Therapy (CBT) is also an effective treatment for BDD. Additionally, there's Exposure and Response Prevention (ERP): the former exposes patients to situations that usually trigger avoidance behaviors, while the latter helps patients stop performing compulsive behaviors related to defects, to reduce anxiety triggered by avoidance situations (Phillips, 2004).

If someone close to you has BDD:

BDD is sometimes not just an individual matter but also affects families, friends, and partners. You may spend a lot of time trying to convince someone with BDD that they're not as ugly as they imagine, but to no avail. You may find that no matter what you say or do, it doesn't help much. This can make you feel impatient and frustrated.

Here are some general principles for interacting with people with BDD:

• No matter how strange their behavior, don't think it's madness or vanity—consider whether they're troubled by this disorder.

• Establish consistent personal boundaries with people with BDD, regardless of whether the behavior is related to BDD. For example, everyone needs to start their morning routine, and if someone stays in the bathroom too long, you should remind them normally without psychological burden.

• BDD is not a disease that can be easily cured; it takes time and gradual guidance to improve quality of life, so be patient and stay optimistic.

• Avoid mutual blame, encourage them to seek help, help them understand their problems more clearly, encourage formal treatment, and provide regular encouragement, no matter how small the progress (BBD Foundation, N.D.).

People with BDD have a preoccupation—a dominant idea in their minds that their appearance has defects. When looking in mirrors, they're influenced by this idea and exaggerate the defects. When others try to persuade them, they always feel others are deliberately comforting them.

What if there were a more objective way to present their appearance? Some researchers have tried using phones to photograph people who think they're too overweight, then showing them the photos or videos. As a result, some people developed more positive views of their body image.

So, what you might need more is to understand what you really look like.

If you're curious about your appearance and want a more objective perspective, consider taking our free beauty test to discover your attractiveness score and gain insights into your facial features through AI-powered analysis.