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This is Scary!

Does this gym make me look fat? When BDD is your BFF

Sometimes I schedule (or cancel) meetings around the gym. Otherwise, if I don’t, and end up missing the gym, I feel fat.

Although things seem to work out (generally), I now wonder if this is becoming a problem. Is the very act of going to the gym — a habit that changed my life — now a hinderance, preventing me from achieving other goals?

“Maybe you have BDD” a friend suggested. Hmm, maybe I do.

What is BDD?

Body Dysmorphic Disorder occurs when one can’t stop thinking about a flaw with your appearance. It is a disorder characterized by physical symptoms that cannot be explained by an actual physical disorder. In a nut shell (ha ha), the disorder is supposedly “imaginary.”

How do you get BDD?

BDD is similar to an eating disorder in as much as they both center around body image. BDD sufferers, unlike those with an eating disorder, are more concerned with a specific body part. It typically manifests during teen years and affects both men and women equally.

This makes me wonder, can being fit — and staying fit —  lead to BDD? I posed this question to three individuals in the field of psychiatry. Their responses follow.

  • Dr. Kim Dennis, medical director and board certified psychiatrist at Timberline Knolls Residential Treatment Center
  • Libby Neal, MA, LPC, Executive Clinical Director of Training and Education. Rosewood Centers for Eating Disorders
  • Dr. Stacey Rosenfeld, a licensed clinical psychologist

Can being fit — and staying fit —  lead to body dysmorphic disorder?
Dr. Kim Dennis: For some people, it starts with a normal interest in being healthy and fit, and develops into an obsession that interferes with major areas of normal functioning on a day to day basis. With severe BDD, we have seen women who have multiple cosmetic surgeries, costing thousands of dollars, and none of them are ever sufficient to solve the problem with their perception of their appearance. Many people in the behavioral health field believe that it is a combination of life experiences and a genetic predisposition that eventually can lead someone to have full-blown BDD.

Libby Neal: I don’t think one has anything to do with the other. It seems genetic predisposition is the determining factor. People with BDD focus on one, small part of their body, such as the nose, ears or stomach. Studies show, these people actually see sizes and shapes in a distorted manner. For example, a long term research study at UCLA found that a person with BDD sees the size of their hand as being much larger than it actually is. This seems to be consistent with other body parts as well. This in turn kicks in enormous anxiety and depression.

Dr. Stacey Rosenfeld: Being or staying fit can’t cause BDD, as we know that most people who practice regular fitness don’t develop BDD.  However, for those with a predisposition to the disorder, it is possible that beginning a fitness program and spending significant time focusing on appearance/shape may contribute to the emergence of symptoms.

People often say that they only want to lose ten pounds or they have ugly fat here (points to neck or tug on their arms). Assuming they were to lose those “ten pounds of ugly fat,” what is the likelihood that more perceptual fat would appear? 
Dr. Kim Dennis: For people with BDD, it is the rule that the focus would soon shift to another area of their body. People with body image disturbances of all kinds rarely have anything wrong with their physical bodies. Many times, what they perceive as their physical body is actually emotional memory stored in the tissues of their bodies and in their brains.

Libby Neal: If a person loses enough weight to go below 80% BMI, their perceptions change and they believe they are over weight no matter how much they lose.

Dr. Stacey Rosenfeld: For many, thin is a moving target. We see this consistently in eating-disordered populations. Patients lose the weight they had set out to lose and then, at the new goal weight, still see themselves needing to lose more.  For those with BDD, the unhealthy focus on certain body parts may shift over time (as they “resolve” one feature through fitness, cosmetic surgery, etc., they may move onto another).

Based on societal influences, do you think instances of body dysmorphia have increased or decreased?
Dr. Kim Dennis: Increased. I believe the increase is a result of better awareness and access to care, as well as increasing absurd societal and media pressures to look a certain way.

Libby Neal: BDD is not a societal issue, but distorted body image has definitely increased based on Reality TV shows, social networking, increased pressures to be thinner than ever in history, and plastic surgery is the norm.

Dr. Stacey Rosenfeld: Societal influences can cause body dysmorphia to increase. Cultural ideals can influence psychopathology. When male mannequins with 27-inch waists were unveiled, it set a new bar for men, for instance. Men are now expected to be excessively thin and muscular at the same time. The development of a seemingly endless array of cosmetic surgeries also contributes to a raising of the cultural bar with regard to facial features, body fat, etc. When our peers choose to go under the knife, and we see the results (younger, thinner, more defined), it’s easy to want to follow suit. The prevalence of cosmetic surgeries convinces us that there are “easy fixes” to our problem areas. But, for some, one “easy fix” leads to many, and satisfaction is always a procedure away.

Studies have shown that clothing sizes that were once labeled “M” are now labeled “S,” has perception of what is an acceptable body size changed in accordance with the growing obesity epidemic?
Dr. Kim Dennis: Unfortunately, I think perception of acceptable body size has changed, in the direction exactly opposite of the average body weight for height trends we have seen in the U.S., the extremes are getting more and more extreme, on both ends of the spectrum. It’s a vicious and unhealthy cycle.

Libby Neal: Yes.

Dr. Stacey Rosenfeld: On the one hand, there’s a greater obesity epidemic today than historically because definitions changed in 1998.  Many more people became obese then according to the new definition. On the other hand, it does seem that we seem to be getting bigger, regardless of classification. The more we learn of the obesity epidemic and the more we try to be thin, it seems that the bigger we get. It is estimated that there is a 60 billion dollar diet industry, but that greater than 95% percent of all diets fail, with dieters gaining back then weight (and then some). It seems that the more we try to lose weight, the more we gain, and my belief is that it’s because we’ve lost our ability to eat and move intuitively. Clothing sizes that make us feel larger than we are can work in a similar way. We’re, as a nation, bigger, but trying to be smaller, and that can backfire, as we’ve seen.

Research suggests that BDD often occurs in people with major depression and anxiety, categorizing the affliction as a “mental disorder,” if this is indeed true, what is the benchmark for an acceptable body image?
Dr. Kim Dennis: Acceptable body image has a lot more to do with self-acceptance that how one’s body looks. There are a lot of factors that define each of us as human beings, with physical appearance being one of them. For some people, the over focus on physical appearance serves as a distraction or self-medication of deeper issues such as depression and anxiety. The underlying roots of depressive and anxiety disorders are almost always associated with some type of trauma by neglect or abuse, and many people take extreme measures to avoid looking at that.

Libby Neal: Eating when hungry, stopping when full, exercising often without obsession, taking time for self care including meditation, learning, being with loved ones, and breathing deeply into one’s lungs.

Dr. Stacey Rosenfeld: Yes, BDD will often occur with other psychological disorders. Most of us have things that we like and dislike about our appearance. It’s when the things that we dislike begin to take center stage, occupying a great deal of our thoughts and behaviors, preventing us from living our lives in an effective way, that this becomes disordered.


  • Great site and I seriously commend you on your amazing journey! The battle of the bulge is a tough one. I recently lost 45 pounds and I am not done yet! Keep up the good work!


    3:09 pm

  • Haha I have to admit that I found this article informative. I’ve told people I’m a bit fay even when I get told countless times that I’m not. And I don’t do it just to fish for compliments too lol. I really feel that way. I never new that there was an actual name for the condition till now though, so thanks for the info. I suppose it’s because I used to be fat and I’ve always had this image in my head of the level of fitness that I want to be at. And until i reach that point I think I’ll always feel somewhat inadequate. Thankfully in my case BDD doesnt have too much effect on my confidence.


    12:55 am

  • I know I get twitchy when I don’t get -some- sort of activity every day. I train five days a week, and then do SOMEthing just to get the blood moving. For me, the gym is a sanctuary from all the other stressors in my world, but I also have no problem occasionally cutting things short if I have a conference call or meeting I need to get to.

    You don’t have BDD just for a “feeling”. If you get obsessed with training to the exclusion of all else, and can’t see your own progress, and you’re never “big” enough or have trained enough . . . then, maybe. I know I have issues with seeing my own progress in a mirror, but I can see it in photos, which is why I take so many progress pics. In the mirror, I still see the same sort-of “skinny fat” guy I started with 4 years ago.

    I’m told I have a mild case of BDD by my therapist because of that. I’m not obsessed with the issue; it doesn’t affect my sense of self-worth, and doesn’t make me obsessive-compulsive to the exclusion of a balanced life, but I am aware of the issue, and able to recognize it, which helps a lot.

    Jim Davis

    7:17 pm

  • You might be just noticing that the exercise endorphins didn’t kick in on days when a workout got missed. That’s a normal physiological reaction. Doing something daily to improve health and fitness is commendable. You don’t want to place a job or business in jeopardy for sake of working out but if you are going to the gym for sake of training, you wouldn’t be there for more than an hour anyway so that would never be a problem

    Lief Ericksen

    11:47 am

  • If I could go back and talk to my younger self, I would give me far better information and advice about health and wellness.
    I can’t, but what I know is I don’t want to look back on myself in 10 years and wonder why I didn’t get my ass off the couch and make a difference starting now. Trying to see yourself as anything but either a failure or a long-journey ahead is difficult, not impossible, but at the least frustrating. Trying to figure out the best journey for me, well that’s even more annoying than seeing my hips in a swim suit, but it’s doable and each day I have to remind myself that I’m more than that number on the scale or on my jeans–I’ve accomplished so much, I can do this too. Thanks for the article–it helps on those days when things seem very difficult to accomplish.


    2:03 am

  • nice article. BDD can be whole body though #iknow #ihaveit

    Crystal Chambers

    2:48 pm

  • I think everyone would like to improve some part of their body. I don’t know anyone that is completely satisfied by the way they look, however that is what makes us special and unique individuals, and there is nothing wrong with going to the gym to use the gifts we have been given to be the best we can be. I go to the gym everyday, but my workout varies so I don’t get bored.

    Clifton Farrington

    2:40 pm

  • I dont think there is anything wrong with going to the gym everyday as long as you are not there for hours upon hours you should have 1 rest day just to let your body recoup . i think a lot of people use the gym as a de-stresser so instead of being stressed out, a little cardio or wt training will help make you feel better . I love going to the gym i feel so much better mentally .


    2:20 pm

  • I go everyday too. I don’t have BDD. Sure we all wish we looked better or had a little less here or a little more there but its not always about the way we look. I honestly love to work out.

    Chris Paquin

    3:20 pm

  • Yep, I’m totally on board with the genetic predisposition theory toward this disorder. Not all folks think alike when it comes to their health. The pressures of modern society can cause one seemingly reasonable person to over think their image to the point of obsession. As with everything, moderation is the key. A healthy (no pun intended!) dose of self-acceptance can prevent a multitude of negative issues from rising as well. Unfortunately, that may take a few years to reach as a person matures. Thanks for posting this Stefan!


    2:27 am

  • This is an excellent post. I think many people do not know about BDD. Unfortunately as a teenage, I suffered from severe eating disorders. I ended up in the eating disorder treatment center and hospital several times. One particularly savvy counselor had large sheets of paper on the wall and asked us to draw a life size picture of how big we thought looked (size wise). She then had us stand against the drawing, we were much thinner than we perceived, of course. She also told us a study was done in the same way and the researchers found on average people with BDD portrayed themselves to be at least 20lbs heavier than they actually were. Interesting indeed. I find it useful to just take a break from thinking about and obsessing about your appearance (if your able to quiet your mind) when BDD creeps up on you. After a few days you can look at yourself in the mirror with new eyes and hopefully see the fit person everyone else sees.

    Hayley Rose

    9:14 pm

  • First of all, without the images of beauty that people get used to, there would be nothing for people to want to look like. Every person that is supposedly famous or in the public eye will have someone that wants to be like that. You have a great story and I bet that there are guys who want to be like you. Does that make it wrong?


    7:29 pm

  • Just look at the changing perception of what is acceptable in terms of beauty. The media heavily influences this. The really sad part about it is that the younger generation is influenced by these images. The youth have always been and this is why there is so much emphasis on youth in the media. It is a vicious cycle.

    Kay Atwood

    7:24 pm

  • I believe that society, the media, and various industries, such as the clothing industry, have powerful influences into one’s perception of self. Many people would prefer to be thinner and prettier according to societies standards. However, I agree with Dr. Rosenfeld in that to have a disorder, a person is taking the personification of themself to an extreme. On the otherhand, can these harmful influences create the disorder especially in those that are more impressionable?


    7:18 pm

  • Great post

    Janice W

    4:33 pm

  • I live in Mexico and a lot of the teens compare themselves to the novellas they watch on the television. They want to be pretty alll the time

    Jesse Moya

    4:32 pm

  • Thanks for posting this Stefan


    4:31 pm

  • I think it affects guys just as much as women. Have you seen how guys are at the gym. I don’t know, maybe it isn’t so bad. People get used to it, I guess.

    Michael H

    4:30 pm

  • BDD is a serious illness. And I agree with the doctors that society plays a big role in influencing people. Especially young people. Thank you for writing this article. All of your posts are educational.


    4:29 pm

  • Very smart article Stefan.


    4:28 pm

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