How Body Dysmorphia Affects Motherhood

woman in a grey tank top and khaki shorts negatively looking at herself in the mirror

Do you think you have body flaws? Do you hate your reflection? You may be suffering from Body Dysmorphia. Here’s how it affects motherhood!


by Laura Onstot | Laura Onstot, registered nurse and mom of 2 young kids, rarely pees alone, only frequents restaurants with Kraft Mac N Cheese, and blogs at Nomad’s Land. In her spare time, she can be found sleeping on the couch while she lets her kids watch endless episodes of Mickey Mouse Clubhouse. Her parenting advice is questionable, but at least she’s honest. Follow her on Twitter @LauraOnstot.

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Motherhood brings a whole swath of changes: sleepless nights, changing roles, and adjustment to the crushing responsibility of keeping a tiny human alive. With these changes comes the increased possibility of mental health challenges. 

While depression, anxiety, and obsessive-compulsive disorder (OCD) receive a lot of attention in the postpartum mental health world, a mental health condition within the same family as OCD, Body Dysmorphic Disorder (BDD), also known as Body Dysmorphia, is less commonly highlighted.

What is Body Dysmorphic Disorder?

The American Psychological Association defines Body Dysmorphic Disorder (BDD) as “a disorder characterized by excessive preoccupation with an imagined defect in physical appearance or markedly excessive concern with a slight physical anomaly. The preoccupation is typically accompanied by frequent checking of the defect.”

The International OCD Foundation reports that around two to three percent of the general population has BDD, making it as common as OCD, and more common than anorexia nervosa and schizophrenia.

Photo by Canva

Diagnosis

A diagnosis of BDD requires a preoccupation with an appearance flaw, and repetitive behavior, such as: checking the mirror, picking at skin, seeking reassurance, comparing self to others, etc. Diagnosing BDD can be tricky. Patients might not be willing to reveal the full extent of their struggles, and BDD shares similarities with other psychological disorders, such as OCD, depression, anxiety, and eating disorders. A correct diagnosis can be difficult to pin down; however, it is necessary to ensure optimal treatment.

Treatment

BDD is treated with a combination of cognitive behavioral therapy (CBT) and a Serotonin Reuptake Inhibitor (SRI) medication, such as fluoxetine (Prozac), sertraline (Zoloft), paroxetine (Paxil), citalopram (Celexa), escitalopram (Lexapro), or fluvoxamine (Luvox).

CBT is a form of therapy that works to expose patients to their fears, intending to reduce rumination and unhealthy coping strategies. 

Body Dysmorphia in Motherhood

While there is little research on the connection between Body Dysmorphia and motherhood, Michelle L. Miller, Ph.D. at Indiana University School of Medicine, led a team of researchers to study a group of 276 pregnant women. In 2022, she and her team published the article, “Obsessive–compulsive and related disorder symptoms in the perinatal period: Prevalence and associations with postpartum functioning” in the journal, Archives of Women’s Mental Health.

Participants completed an online questionnaire and two interviews – one during their pregnancy and one at 6-8 weeks postpartum. These questionnaires and interviews collected data about OCD-related disorders (OCRD), such as hoarding disorder, body dysmorphic disorder, trichotillomania (hair pulling), and excoriation disorder (skin picking). 

Almost 15% of these women reported clinically significant Body Dysmorphia symptoms during pregnancy, with the number dropping to around 12% in the postpartum period. Most of those who reported clinically significant OCDR symptoms during pregnancy also had clinically significant depressive symptoms.

In this trial, the Body Dysmorphia symptoms women reported were often related to body discomfort rather than dissatisfaction with body appearance. When asked if the symptoms participants reported during pregnancy had more to do with the discomforts of pregnancy rather than BDD, Miller responded, “there is so little literature that we need more studies to better understand what is normative discomfort in pregnancy/postpartum and what is more indicative of BDD. Something we didn’t assess was (the) number of women who had a past/active eating disorder, disordered eating, or BDD in the past, which are all variables that could influence that number and let us know what may be related to pregnancy and what is more BDD.”

Participants with elevated OCDR symptoms during pregnancy had more difficulty adjusting in the postpartum period. Miller and her team concluded that OCD symptoms are “relatively common during pregnancy and postpartum,” with BDD symptoms being the most common of the OCDR symptoms reported. They concluded that more severe OCDR symptoms were associated with poorer postpartum functioning.

While the trial revealed large numbers of women struggling with symptoms consistent with Body Dysmorphic Disorder, the authors offered an alternate perspective. “Normalizing perinatal body changes that are inconsistent with the Western ideal may be a larger public health goal rather than considering a woman’s perception of her body as flawed as pathological.”

When to Seek Help

Miller recommends that people seek help if “they are struggling with the amount of time spent focusing on a body part, the amount of distress they feel, or if it is starting to interfere with other parts of their life (e.g. social relationships, work, etc.).” She suggests seeking care from a doctor and a mental health professional specializing in anxiety and OCD-related disorders. 

Resources for more information: 

International OCD Foundation


Sources

Miller, M. L., Roche, A. I., Lemon, E., & O’Hara, M. W. (2022). Obsessive–compulsive and related disorder symptoms in the perinatal period: Prevalence and associations with postpartum functioning. Archives of Women’s Mental Health, 25(4), 771–780. https://doi.org/10.1007/s00737-022-01239-3 

Miller, Michelle. Email Interview. Conducted by Laura Onstot, 15 July 2022.


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