Can a Gym Addiction Lead to Body Dysmorphia?

by Stefan Pinto,

“I don’t want to look back on myself in ten years and wonder why I didn’t get my ass off the couch and make a difference starting now,” a commenter wrote in response to my blog post on body dysmorphia. It’s been ten years since I first stepped on a stationary bicycle — a decision that has changed my life.

But has the very act of going to the gym, the stimulation and satisfaction now become any activity that may be referred to as an addiction?

What is BDD?

Body Dysmorphic Disorder, or BDD, 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 nutshell (ha ha), the disorder is supposedly “imaginary.”

How is it caused?

BDD is similar to an eating disorder in as much as they both center around body image. BDD suffers, 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.

So, can being fit — and staying fit —  lead to BDD? I posed this question to three individuals in the field of psychiatry:

  • Medical director at Timberline Knolls
  • 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 (BDD)?

Timberline Knolls Medical Director: 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? 

Timberline Knolls Medical Director: 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 overweight 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?

Medical Director: 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.”

When BDD is your BFF

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 hindrance, 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.

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?

Medical Director: Unfortunately, I thinkthe 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?

Medical Director: 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.

Learn more about Timberline Knolls by browsing through our eating disorders and body dysmorphia pages.