Body Dysmorphic Disorder: Obsession With a Flaw Interferes With Life

By: Loren A. Olson, MD

Body dysmorphic disorder is a syndrome in which a person can’t stop thinking about some perceived flaw in their appearance.

Body dysmorphic disorder is a mental disorder in which a person can’t stop thinking about some perceived flaw in their appearance. It may be a flaw that doesn’t exist or is so minor it isn’t noticed by anyone else. It leads to feelings of embarrassment and shame.

Sometimes people with the disorder avoid social situations because they feel their “defect” will be on display. A fairly common example is a person who has had multiple rhinoplasties to fix their imagined nose defect. And yet, after each surgery, they are always dissatisfied with the results.

Before I dive into a more detailed discussion of body dysmorphic disorder, let me share my personal story of the “flaw” that bugged me: man boobs.

I was ashamed of my body

Ever since I was a teenager, I’ve been ashamed of my body. It never looked like I wanted it to.

But most of my self-hate centered on the excess fat tissue in my breasts. Man boobs further undermined my fragile sense of manhood. I think I understand why transgender men always first want to get rid of their breasts.

When I was about fifty, I finally had enough money to consider seeing a plastic surgeon to have a breast reduction. I contacted a plastic surgeon who’d gained his reputation by creating lips out of vaginal tissue. Perhaps that should have been a clue.

When I arrived for my appointment, he said, “Loren, take off all your clothes and stand here in front of me.” That was just the beginning of the trauma. I didn’t like being naked in front of anyone.

As I stood there, he took out a Magic Marker and began drawing black lines all over my body. “We can nip this, tuck this, suck that.” And on and on he went. He found flaws on every part of my body, a lot more than I thought I had.

He recommended several procedures, gave me a cash-only price for the overhaul. Then he suggested I would probably want to schedule a three-week vacation in the Caribbean for my recovery.

I had no idea my body was so disgusting. The entire visit was traumatizing.

I’ve also got hooding

Several years later, I reconsidered having the surgery. I had a patient who was a nurse who worked for a plastic surgeon. I asked her, “Who do you think is the best plastic surgeon in Des Moines?”

In response, she asked, “Oh, are you going to do something about the hooding over your eyes?”

Hooding? What hooding? I didn’t know I had hooding. I asked, “What’s hooding?”

“It’s all that loose, baggy skin that hangs down over your eyes so you can’t see very well.”

She was barely out the door when I called the plastic surgeon. “I want to consult with you about a breast reduction and to have you look at my hooding.”

I called my husband and said, “I’ve scheduled a visit with a plastic surgeon to have a breast reduction. And I’m also going to talk to him about my hooding.”

“What’s hooding?” he asked.

By the time I got home, he had scheduled an appointment with the same plastic surgeon to have his hooding removed, too.

Then I hit the tree

That evening we were going out. I was still wound up about the surgeon. As I backed the car out of the garage, I backed it into a tree that had been there for twenty years.

“Watch where you’re going!” Doug said, less supportive than I’d hoped.

“I can’t see. I’ve got hooding!”

I had the breast reduction and the “hooding-ectomy.” I was pleased with the results, and I felt more comfortable in my skin, albeit with less of it.

My life didn’t change dramatically following the surgery. The only change was in my attitude about my body.

Now, I often joke, “Apparently God wanted me to have boobs because they seem to have grown back.” And yet my attitude remains improved.

Other stories by this author: Seizing Permission to Live Life on Your Own Terms

Body dysmorphic disorder

Psychiatrists make diagnoses of a “disorder” when a collection of the symptoms reach such a degree that they begin to interfere significantly with one’s life.

People may have some of the symptoms of a disorder without having those symptoms interfere in their lives. I was distressed by my man boobs. However, I didn’t spend hours and hours checking them in the mirror every day.

However, I have seen men at the gym check out their muscle definition in the mirror three times during a single workout. That’s the difference.

Common symptoms of Body Dysmorphic Disorder include:

  • Preoccupation with a “flaw” in appearance that isn’t apparent to others
  • A belief that this flaw makes you ugly
  • The belief that others take special, negative notice of the flaw and may mock you
  • Constant and unfavorable comparison with others
  • Seeking frequent reassurance from others
  • Socially isolation
  • Seeking repeated cosmetic procedures with little satisfaction.

Men and body image

The perception that men are protected from concerns about body image is false. A preoccupation with your body build being too small or not muscular enough occurs almost exclusively in males.

When I was a child, people measured men’s attractiveness by their behavior and achievements. Our parents told us: Never hit a woman. To me, the implied message was: Never hit a woman, but always hit a man when you need to.

We were told to be confident, one of the guys, and tough enough to take a beating. Any preoccupation with the appearance of our bodies was considered a girl thing.

Today, men also pursue masculinity by demeaning femininity.

The stereotype of fat men

The stereotype of fat men is that we are lazy, unmotivated, and undisciplined. Being fat leads to discrimination in employment, healthcare, and education. Men are judged by body size, muscle definition, and fat composition.

The optimal male body is lean and athletic, V-shaped, with well-defined muscles. Men crave more muscles and less body fat even at the expense of their health and well-being.

We have in our heads an image of the ideal body. We judge others by that idealized image. We also judge ourselves by it.

Depression and obesity

Is depression a cause or an effect of obesity? The answer is yes. This is because it is both.

We isolate ourselves if we are fat. And we eat to lose the pain of loneliness.

Then we isolate ourselves even more because the added weight makes us even more depressed. We begin to feel hopeless. But we want some immediate relief. So, we eat.

It becomes a vicious cycle.

To lose weight means continuous self-denial of things we love. To deny ourselves those things, we must believe that there is a brighter future ahead. What if we lose hope that a brighter future is possible?

My trials and tribulations with weight loss

To lose significant amounts of weight, you need to become obsessed with it — every thought and conversation centers on your diet.

The last time I had an acceptable BMI and body weight, I was running six miles 4–5 days per week and biking over 100 miles per week.

I couldn’t maintain that lifestyle. It required too much time and too much sacrifice of other things I loved like time with family and friends.

I always felt hungry. I was pissed off because others seemed to maintain their weight without those sacrifices.

My dominant mood was self-pity. It made me bitchy and irritable.

I didn’t like feeling that way about myself. So, I wanted to do something, anything, that would give me some relief.

Often that momentary relief came in a bag of Oreos. And then the guilt returns like a yo-yo with more feelings of hopelessness.

Currently, I’m using an intermittent fasting plan. I eat my first meal at 10:00 a.m. and I don’t eat after 8:00 p.m. Calories are not monitored.

Calorie restriction is accomplished only by limiting the time in which they can be consumed. It’s too new to me to analyze its effects, but one effect is clear: I don’t feel the self-pity, the bitterness, or the constant preoccupation over food.

Someone finds me attractive?

At a gay resort a few years back, I ambled back to my room from the pool in my swimming trunks. I met a man on the sidewalk. As we approached each other, he put his finger beneath my chin and slid it below my belly button. He smiled and said, “Delicious!”

I was shocked by his remark. I thought Does he see what I see when I look in the mirror? The answer is “No.”

I believed that since I am not attracted to someone with my body type no one else could be either. I expected him — if he noticed me at all — to feel the same way about my body as I felt about it.

I felt uncomfortable about exposing my body. I expected him to be as uncomfortable seeing my body as I was displaying it. I couldn’t believe my body would ever be attractive to anyone else.

Getting over the shame of my body

Oddly enough, I got over the shame of my body at clothing-optional resorts. Being with a group of naked people boils life down to the basics. You are a blank slate with no pretenses.

Nothing is more authentic than being naked in the presence of others.

Finding acceptance — without adornments and disguises — can be very liberating. When you find that others welcome you as you are, it’s possible to accept yourself as you are.

The gay men at clothing-optional resorts are no different from anyone else except they like to take their clothes off. If you put a group of gay men together, naked or clothed, sexual tension will be in the air you breathe.

In a nude resort, sexual attractions persist but are not amplified. Sex happens, but it isn’t the entirety of the experience.

On being “gay fat”

The “body positive” movement is designed to help people with marginalized shapes learn to love their bodies. Advocates base this campaign on the idea that privilege should not fall only to the thin and fit. The crusade has been expanded to advocate for bodies of color, disabled bodies, and extremes of tall or short.

For a larger gay man like me, trying to fit the queer men’s definition of beauty is like the ugly step-sister trying to fit into the glass slipper. When compared to heterosexual men of the same size, bigger gay men are more likely to be ignored, treated rudely, or mocked. Many gay men say that their Body Mass Index (BMI) is healthy, but they don’t feel normal by gay standards.

The LGBTQ community’s binding principle is supposedly diversity. But the politics of exclusion leaves many men feeling left out. Those who don’t believe a hierarchy of body image exists in the gay community probably find themselves near the top of the pyramid.

Some gay men join gay “bear” groups because they recognize they can never fit the ideal. Bears protest being denied fun and loving relationships based on weight and size.

But some big men have felt rejected by the bear group because they aren’t hairy enough. Or they don’t have the right belly shape, or aren’t muscular enough. One said, “Not just any fat, hairy guy can qualify.”

Over-weight men are often their own harshest critic of their weight. They make comments like “Most of the fat-shaming I’ve experienced is aimed inward.”

It isn’t just average-weight people who incorporate the stereotype that fat men are lazy, unmotivated, and undisciplined. All of us do.

Body-shaming is real

I’ve always been a big person. I have gone into stores to shop for clothes and find that none fit when I try them on. I have had a clerk say to me, “We don’t sell anything here for men who look like you!”

People have recommended stores for big men where nothing was stylish or had any fit or structure. I cried in a dressing room in a store for big men that had stylish, well-made clothes designed to enhance the attractiveness of larger men. And they fit me.

Choosing not to date someone who is fat is one thing, but believing that fat people are lazy, unmotivated, and lacking in self-discipline is quite another.

Telling a large man he is fat is redundant. He knows. Body shaming is real. It happens in personal contacts, dating apps, and social media.

Body shaming is not saying “You’re not my type.” It is when fat people are ridiculed, insulted, demeaned, and told they’re ugly. Or lazy. Or unmotivated.

These remarks come from those who do not understand how impossible attaining and maintaining the desired weight is for some.

When someone in response to your interest says, “You’re not my type,” it may hurt, but it hurts much more when people shame us.

Words become weapons if we believe that an insensitive comment is correct. Cultural change and the reduction of stigma occur only slowly. But we can’t change culture through humiliation and insults.

Promoting inclusion

To promote inclusion, we must first recognize the ways we exhibit exclusion.

We must acknowledge that the LGBTQ community is not free from prejudice. When a person says they feel too fat to attend a Gay Pride rally that is supposed to be a celebration of diversity, we have a problem. When someone has the wrong body shape to be a bear, we have a problem. When a person feels it’s necessary to respond to a “ping” on a dating app with a humiliating response, we have a problem.

We must also understand that sometimes the harshest judgments we make are those we make against ourselves. Those of us who struggle with our weight must advocate for ourselves. We must understand that we are just as worthy of loving and being loved as anyone else.

Extreme weight loss can result in many different problems: eating disorders, compulsive exercising, body dysmorphic disorder, low self-esteem, depression, appearance obsession, cosmetic surgery, and dangerous nutritional practices. Some turn to steroids and street drugs, sacrificing health to achieve the body-ideal.

You are delicious to someone

Many people believe “ No one will want me with the body I have.” Mirrors are dangerous for men who feel marginalized. But the truth is not everyone sees us the way we see ourselves. Your body, as unappealing as you think it is, may be just the ticket for someone else.

A personal weight loss plan must focus on the goals of health and improved activity. You may not find the elusive love of your life. Further, if you don’t feel worthy of being loved, surgery, and other forms of aggressive weight loss won’t solve the problem.

The task is to believe that you are delicious to someone just the way you are.

Dr. Loren A. Olson completed his undergraduate degree at the University of Nebraska at Lincoln NE and then continued his education in medical school at the University of Nebraska Medical Center in Omaha. He spent an internship year at Bryan Memorial Medical Center in Omaha. After medical school, he spent four years in the Navy as a Flight Surgeon during the Viet Nam era. After his discharge, he entered his psychiatry residency at Maine Medical Center in Portland Maine. During his final year he served as Chief Resident in Psychiatry. He has been board certified by the American Board of Psychiatry and Neurology since 1975.

Dr. Olson is a Distinguished Life Fellow American Psychiatric Association for exceptional service to the profession of psychiatry. He has received awards from the American Psychiatric Association for his writing and editing from the APA. Dr. Olson received the Exemplary Psychiatrist Award from the National Alliance on Mental Illness.

Dr. Olson has presented at the World Congress of Psychiatry in Prague, the Gay and Lesbian Medical Association, and the Association of Gay and Lesbian Psychiatrists. He is also a member of the American Medical Association. Dr. Olson “retired” from Innovative Psychiatric Services in June 2018. His love for the practice of psychiatry, pulled him out of retirement to work as an independent contractor for United Community HealthCare in Des Moines. His most recent position has been practicing adult outpatient psychiatry for Mercy One Psychiatry in Waterloo, Iowa.

Dr. Olson came out as gay at the age of forty and began to wonder if his experience coming out in midlife was like others who came out later in life. His research let to the publication Finally Out, first published in 2011 with a second edition published in 2017. The second edition won the Ben Franklin Gold Award for the best LGBT non-fiction book from the Independent Book Publishers Association in 2018.

After publication of Finally Out, Dr. Olson began speaking to groups throughout the United States and Canada. Not only did he speak about his story but also through personal interviews and correspondence, expanded his exposure to the lives of hundreds of mature gay men from many different cultures and socio-economic groups around the world.

Dr. Olson has always enjoyed the challenges of writing, initially focusing on subjects related to psychiatry. After coming out, his primary interests have been writing about LGBT experiences and the challenges and opportunities that come with growing older.

Dr. Olson’s essays in Psychology Today have been accessed over one million times. He has also written for The Advocate, Huffington Post, Medium, and many other local and national newspapers

He has been interviewed many times for the print, radio and TV media, including an appearance on ‘Good Morning America.”

Loren A Olson MD is a gay father, psychiatrist, popular speaker, and author of Finally Out. Dr. Olson helps people find ways to keep emotional pain from becoming needless suffering.

Dr. Olson’s former wife, Lynn, and his now husband, Doug, have been known to cook Thanksgiving dinner together for their children and grandchildren. Their children and grandchildren just shrug their shoulders and smile when asked why they have two grandmothers and three grandfathers.

Originally published at on November 11, 2020.

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