Body Dymophic Disorder

[moneyman]

How many of you think that you might have this disorder?? My tells me that i must have this disorder because Im always thinking that I need to get bigger. Does any of you bros have this problem or know more about it?

[Ian Smith]

You should check out Bob Smith's book on penis enlargement,, maybe that will help...

[moneyman]

funny guy but do you know anything abou tthis disorder?

[DrMCM]

Originally Posted by moneyman

funny guy but do you know anything abou tthis disorder?

Yeah, I've got it. What's it to ya'. I figure everybody has at least one disorder, and this is the one I want. I guess if you don't like it, see a shrink. What is your friend, perfect?

[Massive690]

Originally Posted by moneyman

funny guy but do you know anything abou tthis disorder?

tell me what it is, im dumb

[Ian Smith]

Originally Posted by moneyman

funny guy but do you know anything abou tthis disorder?

Ya, I actually have read about it,,, its been awhile back... I think anything can become a problem if it isnt kept in check.

[Tank01]

its like reverse anorexia...


anorexics think they are fat... when they are skeletons...

Body Dysmorphics see themselves as skinny and nothing when they may (or may not) be very big.. muscular....

its the whole thing where you want to be some IDEAL... and you never think you are there... that you are always smaller than you could be or in the case of anorexics... fat as hell

[Massive690]

Originally Posted by Ian Smith

Ya, I actually have read about it,,, its been awhile back... I think anything can become a problem if it isnt kept in check.

what is it!!!!! GRRRRRRRRRR

[Massive690]

Originally Posted by Tank01

its like reverse anorexia...


anorexics think they are fat... when they are skeletons...

Body Dysmorphics see themselves as skinny and nothing when they may (or may not) be very big.. muscular....

its the whole thing where you want to be some IDEAL... and you never think you are there... that you are always smaller than you could be or in the case of anorexics... fat as hell

whoops, you beat my last one thanks tank
yeah i have that shit, it just means you have goals thats all. i saw some thing one time, probably in a Muscle and Gayness magazine or something, lol. anyways "you've built your temple, never stop remoldeling" its like that

[Ian Smith]

I wonder id there is such a thing as reverse anorexia/canabolism.

[jbrand]

Originally Posted by Tank01

its like reverse anorexia...


anorexics think they are fat... when they are skeletons...

Body Dysmorphics see themselves as skinny and nothing when they may (or may not) be very big.. muscular....

its the whole thing where you want to be some IDEAL... and you never think you are there... that you are always smaller than you could be or in the case of anorexics... fat as hell

Yeah, it's gotten some real publicity. I read the book "Making Weight" recently and they talked about the dysmorphia leading someone to hibernate in their houses too embaressed to face society, those of which generally had bodies that were far better than the 'norm'.

[bigpmp]

I am eaten up with it and I am glad. That is why I work so hard.

[moralanimal]

A treu body dismorphic disorder has 3 parts
1. preoccupation with an imagined defect in appearence (the preoccupation is markedly excessive)
2. it cuases signifigant distress and impariment in other areas such as social, occupational, etc.
3. it is not better accounted for by another disorder
Adonis complex and reverse anorexia are "newer" concepts that are not very clear and agreed upon. They tend to blend body dismorphic, obsessive compulsive disorder and anorexia.
If someone has what we as weight lifters talk about as body dismorphic d/o it would look like someone who misses work or fails to spend time with family, for example to go to the gym. Can't go to dinner b/c a need to keep to a diet. Takes for ever to get ready b/c a fear they look to small. Wears ver baggy clothes to hide what they feel is a flaw. It would have to be pretty distressing to the person or they would have to suffer problmes as a result of the fear of being to small.
One problem with making a diagnosis is the failure to consider the persons culture. In todays culture many people would meet criteria for an eating disorder. Almost all serious athletes would. To look at it from another point of view- a person in our culture would be given some type of psychotic diagnoisis if they expereinced command auditory hallucinations (like hearing the vioce of God). In Africa this person would be considered gifted and a shaman.
Psychology has a tendency to make people sicker then they are. We typically would treat this type of disorder as a symptom of something else (likely an underlying depression). IMO body dismorphic d/o is a coping skill that uses a common defense where peope transform emotional pain into more physcial symptoms and part of a normal depressive thought process. It is also no different then what we call sublimation, whihc is transforming negitive energy into positive and prosocial behavior. Sublimation is what advances society and if we are lucky we all do it.
It is only a problem if it causes other problmes.

[moralanimal]

This is not a great article but may offer information for those who want it:
PSYCHOPATHOLOGY Editor: Katharine A. Phillips, MD
Mirror, Mirror on the Wall, Who’s the Largest
of Them All? The Features and Phenomenology
of Muscle Dysmorphia
Roberto Olivardia, PhD
Just when men thought that looking in the mirror was safe,
more and more of them are discovering that they don’t like
what they see. For many men today, muscles—literally—
make the man. Although the fear of being and looking like a
“97-pound weakling” is not new,1 men in the new millennium
are becoming obsessed with their body image in higher numbers
than ever before and in ways different from those seen
in women. Many men fear that they are too small, weak, or
skinny. They feel like Clark Kent and long to be Superman.
In 1997 the term “muscle dysmorphia”2–4 was coined for a
form of body dysmorphic disorder (BDD) previously referred
to as “reverse anorexia” or “bigorexia.”5 As with many new
diagnoses, there is much room for misunderstanding and
misconception. For one, this is a disorder seen primarily in
men, which is almost antithetical to how sufferers of bodyimage
disorders are perceived. Muscle dysmorphia is also
commonly misperceived as an attempt to pathologize the
sport or hobby of weightlifting or bodybuilding. Clearly,
weightlifting and exercise are bene.cial, especially given
the sedentary lifestyle and increasing rates of obesity that
Western culture is witnessing. But although muscle dysmorphia
affects a large number of men, it is found in only a small
percentage of weightlifters.2,4,6 Many factors distinguish
muscle dysmorphia from ordinary weightlifting.
The prevalence of muscle dysmorphia is unknown. However,
previous research provides some clues. In a 1994 study
of 156 unselected weightlifters,6 16 subjects (10%) perceived
themselves to be less muscular than they were in reality. In
a 1997 study of 193 men and women with BDD,2 18 (9.3%;
all of them male) had muscle dysmorphia. Selection bias is
certainly an issue in both of these studies. Severely ill in-
Reprint requests: Roberto Olivardia, PhD, Biological Psychiatry
Laboratory, McLean Hospital, 115 Mill St., Belmont, MA 02478 (email:
roberto_olivardia@hms.harvard.edu).
Harvard Rev Psychiatry 2001;9:254–59.
_ 2001 President and Fellows of Harvard College
dividuals may not enroll in a study; alternatively, embarrassment
and shame may have prevented one or more persons
from reporting muscle dysmorphia, since neither study
was speci.cally selecting for it. The prevalence of muscle
dysmorphia is therefore probably underestimated in these
investigations. If we assume that even 5% of weightlifters
have muscle dysmorphia, and roughly 5 million men currently
hold membership in a commercial gym,2 500,000 men
might have this condition. In addition, if 9% of men with
BDD have muscle dysmorphia and at least 1 million men
have BDD,7 90,000 men with BDD might have muscle dysmorphia.
It becomes clear that hundreds of thousands of men
experience some aspects of this problem. Such estimates,
however, remain speculative at this point because no scienti
.c epidemiological studies of muscle dysmorphia have
been conducted.
PRISONER OF PREOCCUPATIONS: COGNITIVE
MANIFESTATIONS OF MUSCLE DYSMORPHIA
Muscle dysmorphia is characterized by a preoccupation with
the idea that one’s body is not suf.ciently lean and muscular
(see box).2 It involves a disturbance in body image similar to
that seen in anorexia, except that individuals with anorexia
perceive themselves as fatter than they truly are, whereas
men with muscle dysmorphia see themselves as smaller or
weaker than others perceive them. Many men with muscle
dysmorphia sport very well-de.ned physiques and have a
low percentage of body fat. They may recognize that other
men are muscular but think they themselves are not, despite
similar body dimensions.
Whereas ordinary weightlifters report spending about 40
minutes a day thinking about being too small, not being big
enough, or getting bigger, men with muscle dysmorphia report
being preoccupied with such thoughts approximately
325 minutes (more than 5 hours) per day.4 Their insight varies.
In a recent study4 fewer than half of the men with muscle
dysmorphia had “excellent” or “good” insight, recognizing
that their perception of their body size was inaccurate. Fifty
254
mirror-checking. Olivardia and colleagues4 found that men
with muscle dysmorphia reported checking mirrors 9.2_3.4
times per day, whereas weightlifters without muscle dysmorphia
reported checking 3.4 _ 3.3 times per day (p _
0.001). Some men with muscle dysmorphia also look at
themselves in store windows, pocket mirrors, or even the
backs of spoons. One young man got into several car accidents
because he compulsively checked a large hand-held
mirror while driving to ensure that he wasn’t getting
smaller. They are usually dissatis.ed with their re.ection
and may resolve never to look at it again. However, the obsession
with being too small and the compulsion to check becomes
so strong that the checking continues.
Men with muscle dysmorphia give up important social,
occupational, or recreational activities because of a compulsive
need to maintain their workout and diet schedule.2 This
should not be confused with the sacri.ces that individuals
may make to adhere to a consistent exercise schedule. As
mentioned above, men with muscle dysmorphia are so consumed
by working out that they may miss an important
event. One man, for example, missed the birth of his child so
he could lift weights. He feared that even a single lost workout
would cause his body to shrink. An attorney was .red
because he couldn’t limit his workout to his 1-hour lunch
break and sometimes spent 3–4 hours per day at the gym,
much to the annoyance of his colleagues.Asenior honors student
missed an important .nal exam because it con.icted
with his workout time. Men may also struggle to adhere to a
strict diet—for example, never eating in restaurants because
the caloric content of the food is unknown. One man
lost his job because he insisted on mixing his protein/weight
gain shakes in a noisy blender on his desk every hour on the
hour. Forced to choose between the blender and the job, he
opted for the blender.He is now a personal trainer. Men with
muscle dysmorphia usually report feeling very depressed,
and they regret missing important events. However, the fear
of getting smaller overrides concerns about a ruptured relationship
or problems at work.
Men with muscle dysmorphia scrutinize others’ appearance
as well as their own. They often observe how muscular
other men are in an attempt to “measure up” to them. This
scrutiny, however, often leads the individual to feel even
smaller and worse about himself. Men with muscle dysmorphia
tend to avoid situations in which their body will be exposed
to others, or they endure such situations only with
marked distress or intense anxiety.2 Unlike some muscular
men who proudly remove their shirt to reveal their body,
men with muscle dysmorphia tend to do the opposite. For example,
they do not take their shirt off at the beach and may
wear multiple layers of clothing to look more muscular. One
man refused to take his shirt off during a physical exam, requesting
that the doctor place the stethoscope underneath
it. Some men admit being housebound for days because they
percent of the men had “fair” or “poor” insight, and 8% lacked
insight altogether: nothing could convince them that they
were not small. Although some individuals with muscle dysmorphia
may be psychotic, the majority of them are not.
These preoccupations cause signi.cant anxiety, much
like feeling fat can be devastating to someone struggling
with anorexia nervosa. The thoughts are very intrusive and
consuming. Some men with this disorder report that their
self-esteem rests entirely on how big they are.7 Thoughts
of not being big enough often interfere with concentration.
The time and energy necessary to process these obsessive
thoughts are excessive.
JUST TEN MORE REPS AND TWO MORE MIRROR
CHECKS: BEHAVIORAL MANIFESTATIONS OF
MUSCLE DYSMORPHIA
Behaviors associated with muscle dysmorphia include long
hours of lifting weights, excessive attention to diet, and
Criteria for Muscle Dysmorphia
1. The person has a preoccupation with the idea that
his or her body is not suf.ciently lean and muscular.
2. The preoccupation causes clinically signi.cant distress
or impairment in social, occupational, or other
important areas of functioning as demonstrated by at
least two of the following four criteria:
a. The individual frequently gives up important social,
occupational, or recreational activities because
of a compulsive need to maintain his or her workout
and diet schedule.
b. The individual avoids situations in which his or
her body is exposed to others, or endures such situations
only with marked distress or intense anxiety.
c. The preoccupation about the inadequacy of body
size or musculature causes clinically signi.cant distress
or impairment in social, occupational, or other
important areas of functioning.
d. The individual continues to work out, diet, or
use performance-enhancing substances despite
knowledge of adverse physical or psychological consequences.
3. The primary focus of the preoccupation and behaviors
is on being too small or inadequately muscular,
and not on being fat, as in anorexia nervosa, or on
other aspects of the appearance, as in other forms of
BDD.
Harvard Rev Psychiatry
Volume 9, Number 5 Olivardia 255
feel so out of shape. Social avoidance is reinforced by a temporary
reduction in anxiety.
The thoughts of being too small are often detrimental to
relationships. One man avoided sex with his wife for fear
that he would waste energy better used in workouts, while
another abstained from kissing his girlfriend for fear that
she might transmit calories through her saliva.7 Many men
with muscle dysmorphia report sexual problems because of
their negative body image, believing that they are too ugly
and puny-looking for anyone to see their body.
Anabolic steroid use is another common symptom of
muscle dysmorphia. In one study4 46% of male weightlifters
with muscle dysmorphia reported a history of steroid use
versus only 7% of those without muscle dysmorphia. The onset
of muscle dysmorphia preceded the steroid use in 73% of
cases. Thus, muscle dysmorphia appears to be a risk factor
for steroid use. Men may continue using these drugs despite
experiencing adverse effects, such as increased aggression,
acne, breast enlargement, and impotence, and awareness of
longer-term effects, such as atherosclerosis or stroke.8–13
Many men with muscle dysmorphia keep on training
even when they are injured.7 One man, for example, developed
a hernia from intense weightlifting; others break bones
and damage joints and ligaments from excessive exercise.
Such individuals often feel compelled to maintain the same
level of exertion for fear that they would get too small if
they don’t.
WHAT CAUSES MUSCLE DYSMORPHIA?
The hypothesized etiology of muscle dysmorphia follows a biopsychosocial
model.2,4,7 BDD, including the muscle dysmorphia
form of it, has been conceptualized as part of the spectrum
of obsessive-compulsive disorders (OCDs)14,15 in the
belief that conditions such as OCD, Tourette’s syndrome,
and muscle dysmorphia share an underlying biological or genetic
predisposition. These conditions share some phenomenological
features and may run in families. Psychologically,
men with muscle dysmorphia typically have low self-esteem
and may have issues with masculinity.7 The drive for muscularity
may be a means of compensating for a sense of inadequacy
about one’s masculinity. In a study of 154 college
men,16 individuals with more-traditional masculine beliefs
and attitudes idealized a higher level of muscularity. Achieving
a body that is well chiseled and very muscular can be a
powerful symbolic expression of one’s manhood, inspiring
the respect, admiration, and envy of both men and women.
For some men, the purpose of being very muscular is to convey
strength and power, causing others to be fearful or to feel
intimidated. Peer experiences may also in.uence the development
of a body-image disorder. Some men with muscle
dysmorphia report having been very underweight or overweight
during childhood and adolescence and having been
harassed and teased for it, leading them to focus overly on
their appearance and physique in an effort to stop the harassment.
A sociocultural theory has received the most attention.
This theory proposes that men are now experiencing
appearance-related societal pressures similar to those that
women have experienced for decades (references 7, 17, and
18; also Pope HG Jr, Olivardia R, Cohane G, Borowiecki J,
unpublished manuscript, 2000). Boys and men are exposed
to action toys and an array of images in the media (e.g., advertisements,
movies, sports broadcasts) extolling the desirability
of the muscular, .t body. Many such bodies are unattainable
for the average male, however. Although the impact
of media messages on women has been widely studied and
discussed,19 the literature on males is still in its infancy. It is
important to emphasize that the media may greatly affect
how men view their bodies but are not the only or the most
dominant etiological factor. If this were the case, many more
men would be suffering from muscle dysmorphia. Overly focusing
on the media also does a disservice to patients, since
clinicians may neglect or deemphasize important psychological
or psychiatric factors.
Body-image consciousness is not necessarily pathological;
it is the extreme that is problematic. In fact, it is normal
in adolescence.20 The body goes through a major transformation
during puberty that can leave boys trying to make sense
of their changing appearance. Since sexuality and conformity
are also important themes of development, the body becomes
a salient symbol of a new identity.21 The only controlled
study of muscle dysmorphia published to date4 found
that the age of onset is 19.4 _ 3.6 years, although most subjects
reported having symptoms of the condition from early
adolescence. The men in this study were between the ages of
18 and 30.
There are several differences between normal adolescent
body-image concerns and muscle dysmorphia. First, muscle
dysmorphia involves a major body-image distortion,
whereby the level of muscle mass is underestimated. Second,
in persons with muscle dysmorphia, self-esteem may
rest solely on appearance, while in other adolescents it involves
a variety of factors including appearance. Third, ful-
.lling the preoccupation with size interferes with normal
functioning, whereas in adolescents without muscle dysmorphia,
working out does not interfere with functioning. Finally,
engagement in unhealthy behaviors such as steroid
use, rigorous dieting, or binging and purging is more typical
of muscle dysmorphia than of normal adolescence.
COMORBID DISORDERS
Muscle dysmorphia is associated with a number of other psychiatric
disorders. For example, excessive dieting sometimes
develops into a full-blown eating disorder, such as bulimia
Harvard Rev Psychiatry
September/October 2001 256 Olivardia
Future studies should be conducted to elucidate the role of
personality disorders in muscle dysmorphia.
TREATMENT OF MUSCLE DYSMORPHIA
The treatment of muscle dysmorphia has yet to be systematically
studied. However, the treatment of OCD, BDD, and
eating disorders provides clinicians with a framework that
may be useful in working with persons who have this condition.
Individuals with muscle dysmorphia rarely seek treatment.
If they do, it may be for depression due to their poor
body image, or for substance abuse (although usually not for
steroid abuse). Their reluctance to seek help appears to be
due to the intense shame and embarrassment that they feel
about their bodies and having this condition.2,4,7 They may
feel emasculated, vain, and effeminate, which can prevent
them from disclosing the problem to anyone. A clinician is
often the .rst person to whom persons with muscle dysmorphia
reveal their secret obsession. In addition, treatment
presents a catch-22 dilemma for these individuals. If they
don’t seek treatment, they are riddled with preoccupations
about being too small and may take dangerous drugs to become
muscular. But treatment would include decreasing
time at the gym and ceasing steroid use, which will inevitably
result in some decrease of muscle mass—their biggest
fear. The idea that treatment may diminish their obsession
often does not enter into the equation. Finally, persons with
muscle dysmorphia are often at the gym, another barrier to
active engagement in treatment.
When individuals with muscle dysmorphia do engage in
treatment, the clinician must establish a strong rapport
with them, validate their experience, recognize their courage
in seeking treatment, and acknowledge their reservations
about treatment. Through this process, the clinician
gains credibility and strengthens the therapeutic alliance.
Several methods of intervention can be used. A psychoeducational
aspect is a necessary part of treatment. Clinicians
can assess the patient’s body-image ideals and how realistic
they are. Education should be provided on proper
nutrition, the dangers of steroids, and the fact that media
images are not always an accurate representation of what
people do—or should—look like. It is important to get a
sense of how the muscle dysmorphia developed, paying attention
to the age at which it emerged. Psychotherapy can
explore any peer experiences or important events that may
have contributed to the development of appearance concerns.
For some patients, a discussion of gender and sexual
identity may be necessary.
Cognitive-behavioral techniques appear effective for
BDD24–27 and might also be helpful for muscle dysmorphia.
Cognitive strategies include identifying distorted thinking
patterns, based on Beck’s cognitive distortions.28 One type of
cognitive distortion is “all or nothing thinking”: for example,
nervosa. Olivardia and colleagues,4 using the Structured
Clinical Interview for DSM-IV, found that 29% of men with
muscle dysmorphia had a history of an eating disorder. Furthermore,
men with muscle dysmorphia had scores similar
to those with eating disorders on all subscales of the Eating
Disorder Inventory,22 suggesting that they have perfectionistic
traits, maturity fears, feelings of ineffectiveness, and a
drive for thinness. A high score on the Drive for Thinness
subscale may seem odd, given that these men are obsessed
with increasing muscle mass; however, this scale must also
tap into a drive for leanness, which is common to both anorexia
and muscle dysmorphia. Men with muscle dysmorphia
obsess about their percentage of body fat as opposed to
being overweight. For example, they may not be concerned
if they are 20 pounds overweight, provided the 20 pounds is
in the form of lean muscle mass.
Mood and anxiety disorders also commonly co-occur with
muscle dysmorphia.2,4 Using the Structured Clinical Interview
for DSM-IV, Olivardia and colleagues4 found that 58%
of men with muscle dysmorphia had a history of a mood disorder
compared to only 20% of normal controls (p _ 0.005).
In addition, 29% of men with muscle dysmorphia had a lifetime
history of an anxiety disorder, compared to only 3% of
normal controls. The sequence of onset of comorbid disorders
and muscle dysmorphia varies, but at least some men appear
to be “self-medicating” a mood or anxiety disorder with
compulsive weightlifting.
Although no systematic studies have been conducted on
Axis II disorders, comorbid personality disorders of the Cluster
B type are probably common. Despite similarities, the
symptoms of these disorders can be distinguished from those
of muscle dysmorphia.An unstable sense of self, identity disturbance,
and feelings of emptiness are common to both.7,23
However, since the thoughts and behaviors experienced with
muscle dysmorphia are ego-dystonic, this condition is probably
not merely an extension of a personality disorder. Unlike
narcissistic personality disorder, in which individuals
are uncomfortable if they are not the center of attention,
men with muscle dysmorphia have the opposite experience:
they are viscerally uncomfortable if they are the center of attention.
7 They avoid public situations, primarily because
they believe that such exposure brings attention to their
supposed lack of muscularity. The high level of grandiosity
expressed and experienced by individuals with narcissistic
personality disorder is antithetical to how men with muscle
dysmorphia view themselves. They report having little to no
self-esteem and never think of themselves as important,
which partially explains their desperate pursuit of the perfect
body as a way of gaining some importance or acceptance.
7 Finally, individuals with Cluster B personality disorders
tend to be impulsive, whereas men with muscle
dysmorphia are more compulsive. They engage in thought
(although the thought may be irrational) before acting out.
Harvard Rev Psychiatry
Volume 9, Number 5 Olivardia 257
thoughts that if one’s body isn’t perfect and very muscular,
then by default it is puny and ugly. Patients need to learn to
observe and challenge these thoughts, recognizing that perfection
is unattainable. “Filtering,” another cognitive distortion,
involves magnifying the negative aspects of one’s appearance
while discounting or ignoring the positive aspects.
Challenging this distortion would include work on highlighting
one’s assets. Behavioral strategies are borrowed directly
from the literature on eating disorders and BDD. They
emphasize control of impulsive behaviors, such as binge
eating or purging, and limiting repetitive behaviors, such
as weightlifting, mirror-checking, and reassurance-seeking.
Behavioral treatment also includes social exposure, such as
taking one’s shirt off in public or attending a social event
after skipping a workout at the gym. Stopping steroid use
should also be a major goal; a substance abuse model of
treatment may be appropriate. Serotonin-reuptake inhibitors
may be effective for the obsessions and compulsions
characteristic of this disorder.29–31 It must be emphasized,
however, that the treatment of muscle dysmorphia per se
has not been studied and that all of these treatment recommendations
should be considered preliminary. Future research
is expected to identify effective treatment for muscle
dysmorphia and to delineate many other aspects of this understudied
condition.
REFERENCES

[Neodavid]

Great post.

Originally Posted by moralanimal

A treu body dismorphic disorder has 3 parts
1. preoccupation with an imagined defect in appearence (the preoccupation is markedly excessive)
2. it cuases signifigant distress and impariment in other areas such as social, occupational, etc.
3. it is not better accounted for by another disorder
Adonis complex and reverse anorexia are "newer" concepts that are not very clear and agreed upon. They tend to blend body dismorphic, obsessive compulsive disorder and anorexia.
If someone has what we as weight lifters talk about as body dismorphic d/o it would look like someone who misses work or fails to spend time with family, for example to go to the gym. Can't go to dinner b/c a need to keep to a diet. Takes for ever to get ready b/c a fear they look to small. Wears ver baggy clothes to hide what they feel is a flaw. It would have to be pretty distressing to the person or they would have to suffer problmes as a result of the fear of being to small.
One problem with making a diagnosis is the failure to consider the persons culture. In todays culture many people would meet criteria for an eating disorder. Almost all serious athletes would. To look at it from another point of view- a person in our culture would be given some type of psychotic diagnoisis if they expereinced command auditory hallucinations (like hearing the vioce of God). In Africa this person would be considered gifted and a shaman.
Psychology has a tendency to make people sicker then they are. We typically would treat this type of disorder as a symptom of something else (likely an underlying depression). IMO body dismorphic d/o is a coping skill that uses a common defense where peope transform emotional pain into more physcial symptoms and part of a normal depressive thought process. It is also no different then what we call sublimation, whihc is transforming negitive energy into positive and prosocial behavior. Sublimation is what advances society and if we are lucky we all do it.
It is only a problem if it causes other problmes.