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Megan Fox AFP

Megan Fox spoke in a recent interview about her struggles with body image and the challenges of living under the microscope of Hollywood.

"I have body dysmorphia. I don't ever see myself the way other people see me. There's never a point in my life where I loved my body," Fox, 37, said in a video interview for the Sports Illustrated Swimsuit 2023 issue. The actress has spoken about having body dysmorphia and other mental health issues in the past.

People with severe body dysmorphia disorder can become reclusive, struggle in relationships and suffer from other mental health issues, experts say.

We spoke to experts about body dysmorphia, including how to know if you have it and potential treatment options and risks. Here's what they said.

What is body dysmorphia, also known as body dysmorphic disorder?

Body dysmorphic disorder, or BDD, is a mental health condition. It's defined as an obsession with a perceived flaw in physical appearance - one that is usually imperceptible to others.

BDD, which shares similarities with obsessive-compulsive disorder (OCD), can cause severe distress to those who struggle with it. One form, known as muscle dysmorphia, more often affects men.

The disorder can harm people's mental health and self-esteem. Many with body dysmorphia also struggle with anxiety, depression and even suicidal ideation.

Ramani Durvasula, a clinical psychologist in Los Angeles, said it is important to note that body dysmorphia is not the same thing as an eating disorder, which is a preoccupation specifically with body shape and weight and typically leads to eating, exercising and other compensatory behaviors.

Also, the preoccupation is not because of a noticeable deformity or malformation such as a large scar. "It's the idea that this perceived defect is usually quite minor compared to the amount of distress and preoccupation it's causing," Durvasula said.

What causes body dysmorphia? Who is at risk?

There isn't one specific cause of BDD, which affects about 1 in 50 people in the United States, and affects men and women roughly equally, according to the Anxiety and Depression Association of America.

Experts say the disorder typically presents in adolescence, a particularly tough time for young people because of all the changes in their physical appearance.

In some cases, there may be a genetic predisposition to BDD or OCD, said Ann Kearney-Cooke, a psychologist in Cincinnati who specializes in treating body image and eating disorders.

Other times, she said, the disorder may be triggered by a negative childhood experience such as abuse, neglect or bullying that made the person overly sensitive to perceived flaws in their appearance.

Culture can play a role. And perfectionism can intensify the obsessions, Kearney-Cooke said.

"It really doesn't get better on its own and, when not treated, can actually get worse over time," she said.

How do I know if I have body dysmorphia? What are the symptoms?

Signs of body dysmorphia can present differently in each person. But the hallmark symptom is a preoccupation with a perceived flaw in physical appearance.

This prompts people to engage in obsessive behaviors such as checking themselves in the mirror for extended periods of time or taking photos on their smartphones to better assess the perceived flaw. They often feel embarrassment or shame and try to cover it up. They seek reassurance and compare themselves to other people - which has only become more tempting in the social media age, experts said.

In addition to the psychological harm, the disorder can take a financial toll, Durvasula said. In many cases, people seek expensive cosmetic medical care from dermatologists, dentists and surgeons. These compulsive behaviors may temporarily relieve the distress, experts said, but then it builds again, creating a need for further checking and fixing.

How is body dysmorphia diagnosed?

There are no universal tests to conclusively diagnose BDD, but people who think they may have the disorder should speak with a medical or mental health professional, who can assess their symptoms and diagnose the disorder.

"We look to see whether this preoccupation is taking a toll on their life," Durvasula said.

"This is a person for whom the preoccupation is causing what we call 'social and occupational impairment,'" such as spending excessive amounts of time or money, making it difficult to attend school or hold down a job, she said. "They are displaced from friendships. They're burning bridges with people."

Can body dysmorphia be treated?

BDD is treatable, though it cannot be cured. Treatment options differ for each patient, but health-care providers tend to recommend a combination of cognitive behavioral therapies and medication.

"We try to teach people to identify what are their thoughts and how they can challenge the distortions in their thinking," Kearney-Cooke said.

In cases involving additional mental health conditions such as anxiety and depression, medications may be added to the treatment plan.