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Skin dysmorphia


Since I started doing skin consultations, I have noticed a pattern in the way people view their skin. No one knows what skin looks like anymore. Everyone expects a 60 year old woman to look like she did when she was 20 years old, and if she doesn't there is something wrong with her (or she "hit the wall"). Everyone thinks skin should be smooth as glass and pimples only happen to those who haven't discovered a skin care "secret".  And everyone thinks that skin is supposed to look like how it is portrayed on Instagram. 

The false view on how skin is supposed to look has caused a lot of people to be perpetually dissatisfied with how they look because how they look isn't represented online. And by only seeing edited images, it creates a false sense of what is real and a distorted way thinking. The result is obsessive behavior to change what we look like. 

This warped mindset of what skin is supposed to look like, and the destructive, obsessive measures taken to "fix it" is what I believe to be a new kind of mental disorder. I call it skin dysmorphia. Skin dysmorphia is a type of body dysmorphia 

Body dysmorphia is a type of mental disorder that the Diagnostic and Statistical Manual of Mental Disorders (DSM) defines as:

Preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others.

And describes the following characteristics of the disorder:

At some point during the course of the disorder, the individual has performed repetitive behaviors (e.g., mirror checking, excessive grooming, skin picking, reassurance seeking) or mental acts (e.g., comparing his or her appearance with that of others) in response to the appearance concerns. 
The preoccupation causes clinically significant distress or impairment in social, occupational or other areas of functioning.

 

Body dysmorphia typically manifests as obsession with a particular body part such as the nose, stomach or legs, which the person perceives to be "ugly" or unacceptable in some way. And those who experience the disorder will take extreme measures to alter the appearance of the fixated upon body part.

Skin Dysmorphia

Through my experience, I have noticed that those who have a preoccupation with their skin meet the above criteria and exhibit the above mentioned behaviors:

1. Preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others.

Typically, those who I see in consultations are seeing me to fix a specific skin issue. Most customers are very direct, they tried A to fix B with no result and are motivated and eager for a solution. And once their skin issue is gone they are satisfied, continue with their normal skin care regimen and move on to other matters of their life.

However there are also customers whose issues appear to be more than just a skin issue. These customers are usually quite distressed and have "tried everything" to fix their skin to no avail. I receive a small summary of their skin issues before the consultation begins, and this subset always describe their skin in highly negative terms. I expect to see the worst, but that never ends up happening. Typically all I see is maybe a little redness, minor lines and a few pimples. Nothing major and nothing that I would notice unless I was looking for it. And certainly nothing so significant that would warrant the level of obsessive anguish that the customer is reporting.

During the consultations I ask about the customers history with their skin, how much time they spend on their skin and what they are currently doing. And for the subset that seems to be distressed, there is a pattern: Their obsession with their skin always begins with a single significant event. Usually its acne or microneedling damage, but sometimes it is something else, such as subscribing to a certain account on Instagram, having a child, or moving to a new location. The singular event then leads to an obsession with their skin. This obsession takes on many forms.

2 . At some point during the course of the disorder, the individual has performed repetitive behaviors (e.g., mirror checking, excessive grooming, skin picking, reassurance seeking) or mental acts (e.g., comparing his or her appearance with that of others) in response to the appearance concerns. 

The repetitive behaviors with skin dysmorphia are constant checks in the mirror. Every single customer who is obsessive with their skin reports looking at themselves in the mirror constantly and looking at their skin within inches of the mirror to hyper-examine their appearance. Customers typically report a need to check their skin on a near constant basis.

While looking at their skin in the mirror, customers report picking at their skin, popping blackheads, scratching out pimples, rubbing out hyperpigmentation and obsessing over fine lines, wrinkles and skin sagging.

Customers will also report certain physical "checks" to make sure their skin is not aging, such as poking at their skin to re-assure that firmness and elasticity is still present. 

Customers also compare their skin to photos of celebrities on Instagram and other social media, and use the photos they find online as a foundation or "goal" for their own skin. The comparison between real skin and skin imaged online leads to even more distress because the images online and in social media are edited, and therefore represent an unobtainable goal. I do not believe customers realize that all of the photos they see online are edited, which creates a false standard that isn't humanly possible to live up to. When customers are trying to live up to a false standard, which they are not aware is false, this creates a distorted view of oneself and an obsession to change their skin to what they believe is perfection.

 

A famous model depicted in an edited photo and showing acne in an unedited photo.

A well known singer in an edited vs. unedited photo. The edited photo covers up signs of aging that are normal for a woman in her 50s. 

A "celebrity" covers up normal skin texture in edited photos (left). Unedited photo (right) shows normal skin characteristics such as pores.

I also believe that those who have skin dysmorphia will also seek out validation in online communities and spend inordinate amount of time in skin care communities or skin care blogs to discuss their skin and consume (true or false) information on skin care. Spending hours a day online devoted to skin discussion and exposure to images of skin and skin care rituals to change the skin is harmful, disordered behavior. 

3. The preoccupation causes clinically significant distress or impairment in social, occupational or other areas of functioning.

It is common to hear from customers that they feel uncomfortable at work or school out of fear that others are judging them for their skin. Customers have also reported not going to work or school during times when they perceive their skin to be unsightly.

I have also noticed that customers will forgo work, school or their obligations to their work or schooling to go online to shop for skin care, to read about skin care or to go to various stores to find skin care. Customers also report spending extreme amounts of money on esthetician treatments or cosmetic surgery. The obsession with shopping or consuming information about skin care is a closed loop for many and just creates a cycle of endless shopping and endless online browsing without any satisfaction. 

 Additional points

Customers will engage in self harm that is socially acceptable in an attempt to "fix" their skin. These self harm behaviors include going to estheticians or surgeons for harsh treatments such as peels, dermabrasion, filler and Botox. All of which severely harm the skin, often beyond repair.

What also is self harm is wearing makeup when the skin is experiencing disease such as acne or rosacea. Covering up the "problem" with makeup ends up making the original issue worse, which creates an endless cycle of worsening disease and increasingly destructive measures to cover it up. 

How I believe skin dysmorphia can be treated

If you have acne, skin dryness, aging etc. and you are trying to fix it, this does not mean you have skin dysmorphia. I believe in always putting a modest effort into ones appearance, including skin care to keep the skin looking its best and youngest. And it is perfectly understandable if you have a skin issue to learn more about it, get information to become educated on skin and to go through trial and error to find improvement. 

However, if you have made your skin the subject of your day, every day for months, then you may be developing skin dysmorphia. The reason why I developed OUMERE and the simple regimen with no unnecessary products is because I wanted to go against the skin care industry's standard of endless products, endless problems and no solutions. No solutions means more products, more shopping and no happiness. It is not healthy to be obsessing about the size of your pores, it is not healthy to take the day off of work to shop for skin care, and it is not healthy to compare your skin to edited photos of celebrities. 

When I created OUMERE I was going through the same skin care problems: I had acne, I was always online reading articles looking for that "secret" cure one person in some message board found, I was always looking for that one product that would solve my skin issues once and for all, and every failure just represented another challenge to overcome. It wasn't until I started looking at things rationally, pragmatically and proactively did I find the solution. Which was developing the OUMERE range to solve the acne problem no one was able to fix.

And through this time from the beginning of OUMERE until now, I believe in the following things to do to help with skin dysmorphia:

1. Be realistic

Being realistic means understanding that looking at celebrity photos all day may be hurting your mental health. It may be creating an unrealistic standard (subconsciously) in your head that will lead to a dissatisfaction with yourself and obsessive behaviors. I recommend taking note of how you feel now and then taking a 2 week break from social media and noting how you feel then to see the difference. 

2. Recognize when you are punishing your skin

I think the line I have to say the most during any consultation is: Your skin isn't bad, stop punishing it. Skin punishing behavior include needing to look at your skin up close in the mirror to make sure it is "ok," or that it isn't "acting" up, as if it were a delinquent child that needed to be kept in check. I always follow up my statement with the following question: whenever you look at your skin in the mirror, is it to praise it or is it to damage it? When you go and look at your skin in the mirror, do you just look or do you poke and prod at it? Do you praise your appearance or do you criticize it? Since the answer is always on the negative side, I recommend just avoiding mirrors until you can stop using it as a tool of punishment. 

3. Use the arms length rule.

To have your best skin and best mindset on skin, always keep arms-length distance between yourself and your mirror. Keeping your distance will prevent you from over-scrutinizing your skin at a magnification that no one else sees but yourself. No one else puts their eyes an inch away from your skin, so why are you looking that close for imperfections? If you look for something, anything, you will find it. And if you magnify your skin to find an imperfection, you will find it and the result is never a positive one. 

4. Pick out good skin care that helps your skin and makes you like your appearance

There is good skin care and there is bad skin care. Bad skin care damages your skin, makes it worse and creates an endless cycle of shopping and online browsing. Good skin care that is minimal and makes you look and feel good puts an end to the cycle of consumption. Once you're free of obsession and consumption you are also free to go on to matters more important than your appearance. 

5. Have a real support network

I think a lot of people forgo real contact for online contact, which isn't a good thing. Online communities are echo chambers and you will never have your ideas or actions challenged in a healthy way by getting your only communication and information from cherry-picked to your bias internet corners. 

In my experience the best way for a healthy mindset, which leads to healthy behavior is to actually go out in the world and have real contact with real people. A lot of people use the excuse of "anxiety" to not go out and do something, but sometimes to make a change you have to be a little brave and do something you're uncomfortable with. Its easy to stay home, go online and wallow in self pity. But those who see real change take a pro-active approach by finding hobbies, making friends and being around real people who do not care what they look like. I believe this is the best way to overcome dysmorphia.

6. Improve the rest of your body

Eating right and exercise are how you become happy with yourself and will have a strong impact on how you view your skin. In addition to diet and exercise playing a key role in keeping skin healthy, when you feel better on the inside, it becomes easier to shape how you view yourself externally. 

7. Recognize when you are engaging in obsessive behaviors

Endless shopping online, obsessively reading and consuming information online about skin and constantly thinking about your skin are obsessive behaviors and they aren't healthy. If you find yourself engaging in the above behaviors, it is best to recognize what is going on and to take a step back and question why you are doing it. And ask if these behaviors are helping or harming you.

 

 

 

 References:

Lemma, Alessandra. "Being seen or being watched? A psychoanalytic perspective on body dysmorphia." The International Journal of Psychoanalysis 90, no. 4 (2009): 753-771.

Substance Abuse and Mental Health Services Administration. DSM-5 Changes: Implications for Child Serious Emotional Disturbance [Internet]. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2016 Jun. Table 23, DSM-IV to DSM-5 Body Dysmorphic Disorder Comparison. Available from: https://www.ncbi.nlm.nih.gov/books/NBK519712/table/ch3.t19/

 

 

If you believe you may be experiencing symptoms of mental or physical illness, please consult with a medical professional right away. The above post is not meant to be a substitute for guidance or treatment from a medical care professional. If you need help finding a healthcare provider, please click here