Too small, too big, too fat, too skinny – so what is just right?  Can we ever be truly satisfied with how we look?

Dissatisfaction with how we look is not unusual in this day and age. With advertising and media pushing appearance at us from all sides, it is quite normal for many of us to think we don’t quite fit the mold of perfection. Appearance can play a big part in life for most people, but never in history have we witnessed so many issues and potentially harmful trends arising out of striving for that perfect body.

It isn’t difficult to recognize that we live in a culture obsessed with “the perfect body.” In fact, this obsession is showing up at younger and younger ages:

• 42% of 1st-3rd grade girls report wanting to be thinner.
• In a recent study of 4th graders: almost half the girls “wished they were thinner.”
• 81% of 10 year olds are afraid of being fat.
• 8th and 9th grade girls have reported that the ideal female is 5 feet 7 inches tall, and weighs between 100 and 110 pounds. It is interesting to note that at this height and weight, most women would be considered clinically anorexic.
• On any given day, approximately 25% of American men and 45% of American women are on a diet.
• 40-60% of high school girls are dieting on any given day and over half of eighth grade girls report dieting during the past year.

The diet industry is a $40 billion dollar industry in the United States and growing every day. What is interesting is if diets worked so well, why would we need to keep throwing money away trying new ones? In fact, 95% of all dieters will regain their lost weight, and more, within 1-5 years. This is not a result of failed will power, but damaged metabolisms by trying to force their bodies to attain unrealisitc goals, and probably, unhealthy sizes.

Many people worry about their appearance, especially in their teens and twenties, when physical attractiveness, changing bodies, and social pressures come together to make appearance seem more important than ever. Who wouldn’t want perfectly clear lustrous skin, a beautiful head of richly colored hair, and the perfect physique? The answer for most people is sure, why not? But for some people, normal appearance concerns cross over into preoccupation or even obsession with their appearance. In more severe cases, these concerns seriously interfere with school work and relationships, and can cause significant distress. This relatively common but underrecognized disorder is known as body dysmorphic disorder, or BDD. Because BDD can cause so much suffering and disruption of normal functioning, it’s important to know about it. BDD, which usually begins during adolescence, can cause depression, social isolation, academic impairment, and, in more severe cases, unnecessary cosmetic surgery, psychiatric hospitalization, and even suicide attempts.

When we think of compulsive dieting, and what we might think of as a typical person with body dysmorphic disorder, anorexia and bulemia probably come to mind.  Never would we imagine that the bodybuilder or exercise fanatic, with “perfectly” toned and defined muscles would have an issue with body image.  Yet, for some bodybuilders, their body image is far from perfect. No matter how large they become, they may see themselves as small. What seems to others nothing more than exaggerated physical vanity may be a manifestation of distorted body image, or dysmorphia.  According to several ongoing studies of bodybuilders, it is speculated that as many as 10 percent of bodybuilders or as many as 500,000 to 1 million individuals may suffer from what is being termed muscle dysmorphia or “bigorexia”.

The physical risks of this type of BDD  or muscle dysmorphia are perhaps less life threatening than anorexia or bulemia, but are still quite serious as they are related primarily to substance abuse and secondarily to diet.  Muscle dysmorphia is a disorder defined mainly by obsessive thoughts about body size and shape, compulsive behavior regarding exercise and use of a variety of supplements and steroids in an attempt to bulk up and get lean. Anabolic steroids are the most commonly abused drug by those with the disorder and pose a host of physical and psychiatric risks. Chronic use may increase susceptibility to cardiovascular disease and other medical problems. Other drugs, including stimulants, pituitary, adrenal, and thyroid hormones, laxatives and diuretics may also be used and can pose dangers if used over an extended period of time.  Other health problems may also show up in the form of overtraining or continuing to exercise with injuries, often using analgesics to mask the pain.

Muscle dysmorphia may cause social problems, with going to the gym  as their exclusive social activity.  They may exercise to the exclusion of dating and sex, and may even alter their careers to spend more time at the gym.

For many people who have the disorder, they see their behavior as normal and are comfortable with their symptoms. Although it many seem that BDD and their variants are trivial illnesses, they’re not. People can have their lives totally consumed by this disorder which can cause substantial impairment in social and occupational functioning, as well as increased risk of death or suicide.

The criteria for muscle dysmorphia, as a recently identified variant of body dysmorphic disorder (BDD), are as follows.

• The person has a preoccupation with the idea that his/her body is not sufficiently lean and muscular. Associated behaviors include hours of weight lifting and excessive attention to diet.
• The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. Individuals often forgo dating and recreational activities, or slack at work to maintain workout and diet schedules. They may also avoid situations where their body is exposed to others or exhibit great anxiety when they are in such situations. They may continue working out, adhering to a strict diet, or using performance-enhancing drugs even when suffering adverse physical and psychological side effects of their regimen.
• The main focus of their preoccupation and behavior is on being too small or inadequately muscular, as distinguished from fear of fat or other aspects of appearance typical of other forms of BDD.

It is important to remember that BDD is not a rare disorder, only an underrecognized one. Diagnosing BDD can be challenging because sufferers often keep their symptoms secret due to embarrassment and shame. People with BDD often worry that other will consider their concerns superficial and vain, thereby making themselves feel worse for having the symptoms of this disorder. Others may see the BDD sufferer’s concerns as attention getting and will become irritated with them. In addition to being underdiagnosed, BDD can be misdiagnosed by professionals, partially because it is not yet widely recognized and also because BDD sufferers are often reluctant to discuss their symptoms. But BDD of any kind is nothing to be ashamed of and nothing to keep secret – it is a serious yet very treatable disorder.

It’s critical for people today to be educated, empowered, and inspired to create a change in the unattainable standard of beauty and the ideal body in our society. We must work to create a world where self-worth is based upon the qualities of one’s character, the strength of one’s convictions, the impact of a person’s accomplishments, and the power of one’s voice rather than by their weight on a scale or the size of their jeans.