Relationships Australia NSW CEO Elisabeth Shaw: The Truth About Body Dysmorphia

What Your Mother Never Told You About The Female Body
Elisabeth Shaw

Aug 26, 2020

Elisabeth Shaw, CEO Relationships Australia NSW examines the truth and complexities surrounding body dysmorphia.

Body Dysmorphic Disorder (BDD) is considered to be in the “obsessive/compulsive” category of mental health issues, involving a preoccupation with perceived defects and flaws that are not observable or appear mild to others, and repetitive behaviours such as checking the mirror, excessive grooming or persistent seeking of reassurance about appearance.. People with BDD can be anxious, depressed, feel ashamed, avoid social situations and have low self-esteem.

ME time

They can believe that they are very noticeable (or not) for the feature/s that worry them and can believe everyone is looking at or mocking them as a result. About 1.8% of people may be diagnosed with BDD where its persistence is impairing their work, social life or other functioning, and causing significant distress. The common age of onset is the early teen years.

What many of us are more familiar with, are the common experiences of feeling inadequate and lacking confidence about how we look, and how we are (or are not) attractive enough to others. Certain times of life can lend themselves to more self-focus and preoccupation, for example adolescence. Both young women and young men can be very body-image conscious, constantly comparing how they stack up against others, such as “the cool group”, and assess themselves as falling short. Painful as it seems, for young people searching for reasons to explain their social position in the school pecking order, “knowing” concrete reasons, like “my thighs” or “my nose” are the problem can almost feel like a relief.


Other times in life, like during pregnancy, just after childbirth, watching those first wrinkles appear, can all draw attention, and we are more vulnerable to that if where we are in our lives is not satisfying to us. Kids in the “cool” group, might be more resilient about “their nose”, or a very well loved and successful 60-year-old might call their laughter lines “lived experience”. Moments of negative self-assessment are buffered by other areas of confidence such as friends, in love, work, and other types of success, such as still being chosen for jobs, or skilled at a hobby. If we are feeling less confident and life has taken a bit of a downturn on a few fronts, then body issues can escalate in importance and feel like they define us by superficial yet inescapable characteristics.

Get to know your body type

Inescapable? Perhaps not anymore. Body dysmorphia can underpin the quest to pursue fad diets, dental treatments, various cosmetic remedies or even cosmetic surgery. Social media feeds this preoccupation with before and after shots of seemingly magic interventions. There is growing evidence of younger cohorts of women seeking Botox as a preventative measure… in case they don’t like what they might look like in the future. Dermatologists and Cosmetic Surgeons are now facing greater moral dilemmas about whether to provide intervention or not, and it is unclear who gets to decide. Research shows that there will be a proportion of their patients suffering from BDD. Indeed, some might believe that anyone seeking cosmetic procedures at the very least suffer BDD-lite. Is the customer always right?

Anti-ageing therapist

For people with BDD interventions such as getting teeth fixed, a face lift, rhinoplasty etc tend to make little difference to their feelings about their appearance, this may lead to multiple similar pursuits in an endless quest to feel better.

Across history, fashion has always played a part in what embellishments we reach for, and how we evaluate ourselves. So, when has it gone too far?

Considerations are:

  1. Does there seem to be a fixation about it, as if it explains everything (e.g. why not to go out, why love hasn’t happened).
  2. Is there an issue? Get a reality check from your GP.
  3. Do a stock-take. Are there other times in life where you were generally much happier? Do you know that another solution (e.g. a change in job) could feel equally better?
  4. If you are considering a more dramatic decision, like surgical intervention, then a few sessions of counselling is always worth doing to double check the source of the need to do it. Much cheaper and less risky than surgery!
Staycation Sensations For Aussies Seeking Winter Sun

If you are in a relationship with someone with body preoccupations (not at the clinical level of BDD), then things to try are:

  • Providing an alternative way of seeing things. If there is an issue, talk about it honestly e.g. “yes your teeth are not as straight as others, but I think you are seeing it far more negatively than you need to.”
  • Reassure with other knowledge you have of their qualities and value. It has to be attached to thoughtful and considered feedback that even the person themselves can’t deny.
  • Encourage multiple sources of self-esteem. This could be time to branch out with new hobbies and contacts.

Relationships Australia (NSW) is here to assist. Call 1300364277 for an appointment.


By Elisabeth Shaw

Elisabeth Shaw is CEO of Relationships Australia NSW and a clinical and counselling psychologist specialising in couple and family work.


The Carousel