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Unrealistic beauty standards and body dysmorphic disorder treatment

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 minutes read
Last updated on 
October 23, 2023
In this article

The marketing ploy that leads to body image issues

Over the last 100 years, the notion of what qualifies as attractive has varied significantly, but body image problems have always existed. Culture and advertisements contribute to the standard of how individuals should dress, look, and weigh. When a marketing campaign can convince someone to be dissatisfied with their body, their house, car, or any object or personal item, it makes that person more likely to spend money on whatever that company is selling. Marketing includes not just the product, but: (1,9)

  • Creating the concept of a product
  • Selling this concept
  • Ingraining this concept into society

Creating an unrealistic body standard

Edward Bernays (the nephew of Psychiatrist Sigmund Freud) earned the title as the Father of Public Relations. He developed the origins of modern advertising which hinges on manipulating the masses. 

Almost all commercials and ads depict unrealistically thin or fit and beautiful people because psychologically, they want to sell the concept that you must be thin and beautiful to be happy. The viewer first buys this concept before they ever spend money on the product associated with the individual in the ad. With enough exposure to these ads, anyone can become unintentionally convinced, thereby creating an unrealistic body image standard. In the 1970s, individuals were exposed to roughly 500 ads a day. Some sources predict that this has increased to over 5,000 ads today. (6) As Naomi Wolf writes in The Beauty Myth, the constant barrage of women’s imagery in advertisements continues to negatively impact self-esteem, and body image. (8)

Spending “whatever it takes” to chase that beauty standard

In an effort to acquiesce this deeply ingrained body image deficit, the consumer will spend whatever it takes to look and feel young, thin, and attractive. If at any point in time the consumer feels content with their body image, then purchasing stops. From an advertising perspective, the goal is to keep consumers as dissatisfied with their bodies as possible, for as long as possible, to encourage more spending. It’s an insidiously addictive ploy and hamster wheel. (6)

The more recent, younger generations unfortunately were exposed to marketing at a very young age, which has resulted in a higher prevalence of body dysmorphic disorder (BDD), self-esteem deficiencies, and subsequent mental health consequences. (6,7)

What is body dysmorphic disorder and how does it relate to body image?

Feeling unhappy with one’s appearance can spiral into body dysmorphic disorder (BDD) rather quickly. This is characterized by an all consuming obsession with seemingly nonexistent or slight perceived defects in physical appearance. Individuals dealing with BDD believe that they look abnormal, unattractive, ugly, overweight, or deformed, and will compulsively check themselves in the mirror. BDD causes severe emotional and mental distress, frequently resulting in eating disorders (ED), and often co-occurs with obsessive compulsive disorder. Simply feeling unhappy with one’s appearance is not the same as BDD. (2)

Currently, BDD affects between five and ten million Americans, which averages to about one in fifty people. (4) Those with body dysmorphic disorder often seek out dermatologists, plastic surgeons, gynecologists, and dentists to perform excessive cosmetic procedures. None of these procedures alleviate their symptoms, which cause them worsened distress as they seek to have many more cosmetic procedures. Often, this preoccupation with their appearance results in additional psychologicsl problems like depression, anxiety, and suicidal ideation. (3) Some studies show that BDD is more prevalent than social anxiety disorder and obsessive compulsive disorder. (4)

Those with BDD experience intense ruminations that markedly impair their day to day living. In reality, the individual will be of general normal appearance, but often describe themselves like a “freak, monster, or elephant man.” They falsely believe others mock and reject them behind their backs, and ruminate on how others perceive their appearance. (5)

Typically, those with BDD focus intensely on a certain body parts, such as their: (3,5)

  • Skin (acne scars, color, or wrinkles)
  • Hair (balding or too much facial hair)
  • Nose shape and size
  • Body fat
  • Length/width/circumference of arms, legs, chest, or torso
  • Eyes
  • Symmetry between body parts (uneven nostrils, eyes, or ears)

Rituals in body dysmorphic disorder

Individuals with a formal diagnosis of BDD perform recurring rituals to combat their emotional distress. They might try to hide, fix, inspect, or constantly obtain reassurance about their disliked body parts. These rituals are time consuming, distressing, unbearable, disconcerting, and impair their activities of daily living. Here are some of the following most common rituals: (2,3)

1. Camouflaging

Studies show that as many as 90% of people with BDD compulsively try to hide their disliked body parts. This includes wearing baggy clothes or excessive amounts of make-up. Some may tan to reduce acne scars and wrinkles, or obsessively seek out dermatological treatments on the skin, like botox and fillers. They may shop excessively for new clothes and constantly seek affirmation from others regarding their appearance. These compensatory measures might help alleviate emotional distress for only a short time, or until the individual fixates on an additional body trait.

2. Comparing

Some of those who suffer from body dysmorphic disorder will uncontrollably compare themselves to others. This becomes so consuming that they cannot focus in conversations or at work, and have difficulty watching TV programs or reading magazines. Sadly, this destructive habit causes them to overvalue the attractiveness of others and distort their own appearance.

3. Excessive grooming

Someone must have a mirror on them at all times and will spend hours a day compulsively adjusting or fixing their appearance. For those who suffer from obsessive compulsive disorder, some may develop a compulsion to pull out their hair, which is called trichotillomania. They may apply make up numerous times a day, brush their hair constantly, or even pick their skin.

4. Excessive exercising

Someone may over exercise to the point of injury or exercise numerous times a day, which is often seen in men who suffer from muscle dysmorphia.

5. Distorted self-image

The most damaging aspect of body dysmorphic disorder is the ensuing preoccupations that people can develop regarding their appearance. While someone may have no noticeable difference in appearance when an individual struggling with body dysmorphic disorder looks in the mirror, they see something completely distorted. Social anxiety and isolation ensue, with lasting emotional distress.

How can you overcome body image problems?

The current standard of care shows that counseling in the form of cognitive behavioral therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs) or tricyclic antidepressants are most efficacious at treating symptoms of body image problems. While some do require inpatient treatment for a co-occurring mental health diagnosis like an eating disorder, those who struggle with BDD hide their symptoms out of fear and embarrassment. Most do not seek treatment. (3)

A large culprit of body image problems is advertisements and how appearance is portrayed in the media. If you or someone you love struggles with body dysmorphic disorder, the single best thing involves separating yourself from advertisements that overvalue unrealistic appearance. Take a break from triggering magazines, TV shows, and social media. Try to remove unnecessary ads on smartphones. While it’s impossible to completely remove all ads, identifying someone’s triggers can help decrease the severity of the ruminations. For individuals with BDD in the modeling industry, recovery may be more attainable by finding a career less focused on body appearance. (11,12)

Therapy also involves challenging rituals. It will feel difficult in the beginning, but with time and a desire to change, the ruminations and habits will decrease. Set a reasonable exercise schedule if appropriate, pause wearing makeup for a while if that is something you do, or stop carrying a mirror. Practice saying loving and encouraging things to yourself in the mirror, or place stickies around the mirror with positive affirmations. Discussing your symptoms with a therapist ,support group or family member can invite them to help keep you accountable. While BDD can be distressing, recovery is possible with consistent commitment to therapy. (11,12)

Some of the following are helpful techniques used in cognitive behavioral therapy for BDD: (11,12)

  • Psychoeducation
  • Motivational Interviewing
  • Goal setting
  • Cognitive restructuring
  • Exposure to avoided situations in safe, controlled environments
  • Do not enable rituals (habit reversal)
  • Retrain perceptions around the undesired body part(s)
  • Advanced cognitive strategies focusing on self-esteem
  • Relapse prevention
  • Establish supportive family or friend relationships

Improving body image with body dysmorphic treatment

Within Health offers an online eating disorder treatment program that teaches body neutrality. Learn to challenge negative body image thoughts by understanding how neutrality and appreciation can start to change how you see yourself. Understand how conditioning has shaped your body image and how to become empowered and your own kind of beautiful.

Disclaimer about "overeating": Within Health hesitatingly uses the word "overeating" because it is the term currently associated with this condition in society, however, we believe it inherently overlooks the various psychological aspects of this condition which are often interconnected with internalized diet culture, and a restrictive mindset about food. For the remainder of this piece, we will therefore be putting "overeating" in quotations to recognize that the diagnosis itself pathologizes behavior that is potentially hardwired and adaptive to a restrictive mindset.

Disclaimer about weight loss drugs: Within does not endorse the use of any weight loss drug or behavior and seeks to provide education on the insidious nature of diet culture. We understand the complex nature of disordered eating and eating disorders and strongly encourage anyone engaging in these behaviors to reach out for help as soon as possible. No statement should be taken as healthcare advice. All healthcare decisions should be made with your individual healthcare provider.


  1. Wilson, M. (2020, July 28). The five marketing concepts explained: Avalaunch Media. Avalaunch Media - Full Service Digital Marketing Agency. Retrieved August 16, 2022, from https://avalaunchmedia.com/the-five-marketing-concepts/
  2. Philips, K. (2021). Body dysmorphic disorder: Epidemiology and pathogenesis. UpToDate. Last Updated Dec 15, 2021. Accessed August 16, 2022. 
  3. Phillips, K. (2020). Body dysmorphic disorder: clinical features. UpToDate. Last updated Aug 11, 2020. Accessed August 16, 2022. 
  4. Prevalence of BDD. BDD. (n.d.). Retrieved August 16, 2022, from https://bdd.iocdf.org/professionals/prevalence/ 
  5. Phillips, K.A., Wilhelm, S., Koran, L.M. (2010). Body dysmorphic disorder: some key issues for DSM-V. Depress Anxiety. 2010;27(6):573.
  6. Johnson, C. (2007, February 1). Cutting through advertising clutter. CBS News. Retrieved August 16, 2022, from https://www.cbsnews.com/news/cutting-through-advertising-clutter/
  7. Advertising and mental health. Adblock Bristol. (2020, February 24). Retrieved August 16, 2022, from https://adblockbristol.org.uk/advertising-and-mental-health/ 
  8. Naomi Wolf, The Beauty Myth (Vintage 1991).
  9. American Psychological Association. (n.d.). Report of the APA task force on the sexualization of girls. American Psychological Association. Retrieved August 16, 2022, from https://www.apa.org/pi/women/programs/girls/report 
  10. Edward Bernays, Propaganda, 1928.
  11. Wilhelm S, Phillips KA, Steketee G. Cognitive-Behavioral Therapy for Body Dysmorphic Disorder: A Treatment Manual, The Guilford Press, New York 2013.
  12. Rasmussen J, Gomez AF, Wilhelm S. Cognitive-behavioral therapy for body dysmorphic disorder. In: Body Dysmorphic Disorder: Advances in Research and Clinical Practice, Phillips KA (Ed), Oxford University Press, New York 2017. P.357.


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