How do I look?
I can’t recall my daughter ever asking me that directly, but she has been known to twirl in front of me in an outfit and expect me to say something. She’s 9.
The other day she assembled an outfit for school consisting of a print top, neon yellow shorts, black leggings and a blue My Little Pony hoodie. To me, nothing matched. She twirled that in front of me and looked at me expectantly.
How do I look?
Before I tell you my answer, I want to tell you about Danny Bowman.
He’s a teenager from Newcastle-upon-Tyne, England, and he almost killed himself. Why? Danny kept asking himself, and others on social media, “How do I look?” and never seemed to get precisely the answer he wanted.
Danny posted a picture of himself – a “selfie” – and posted it online when he was 15. One kid made fun of his nose. Another kid made fun of his skin.
So he took another selfie. And another. And another.
It consumed so much of his time that his grades suffered. He starved himself and worried himself into losing almost 30 pounds. At his worst, he would spend up to 10 hours a day taking up to 200 pictures of himself.
“I started taking more and more to try to get the approval of my friends,” he said. “I would be so high when someone wrote something nice but gutted when they wrote something unkind.”
Danny likely displayed the classic symptoms of body dysmorphic disorder. I hadn’t heard of that until I talked to Christian Lemmon. He’s a professor in the Department of Psychiatry and Health Behavior at Georgia Regents University’s Medical College of Georgia.
Body dysmorphic disorder is a preoccupation with one or more perceived flaws in your physical appearance – little traits often not even observable by others. It’s a form of obsessive-compulsive disorder. At some point, sufferers can perform a lot of repetitive behaviors.
Like snapping thousands of selfies.
Or, if they can afford it, undergoing numerous plastic surgeries. Pop superstar Michael Jackson springs to my mind.
According to the most recent diagnostic literature, only about 2.4 percent of U.S. adults have body dysmorphic disorder. But among dermatology or cosmetic surgery patients, here and abroad, that number doubles and even triples.
People with the disorder compare themselves to others. In a 21st-century world where websites are full of examples showing often impossible standards of beauty, comparisons get dangerous.
Take body asymmetry. Every human is naturally asymmetrical. You can change that through, say, plastic surgery or digitally tweaking a photograph.
“What the media does is it causes us to compare ourselves to unrealistic images, which may not even be real,” Dr. Lemmon said.
When comparisons get out of control, they impair social functioning, job performance or, in Danny’s case, school.
Social media isn’t necessarily the cause – people suffered from this disorder long before Facebook or Snapchat.
“But I think social media doesn’t help it,” Dr. Lemmon said. “I think we’re more likely to compare ourselves to unrealistic representations of what we should look like because of social media. Also the cyberbullying that goes on, too. It’s so easy to anonymously slam somebody after they put up a photo, a picture on there that they think is wonderful.”
Folks with body dysmorphic disorder crave reassurance. It’s a tonic that keeps their anxieties at bay, but it doesn’t solve the problem, Dr. Lemmon explained.
“When a person asks for reassurance and gets it from someone else, that they look OK, or if they engage in some sort of body-checking behavior, that process gives them a temporary respite from the anxiety and reinforces the behavior of doing that,” he said.
So what about, say, a well-adjusted 9-year-old girl?
“Now I’m not saying you shouldn’t compliment your daughter and reassure her,” he said. “But with someone with body dysmorphic disorder, no you don’t. That’s the worst thing you can do, actually.”
So what does solve the problem? Medication helps, combined with “cognitive behavioral therapy,” Dr. Lemmon said. Doctors help patients overcome their irrational thoughts – to confront and challenge the patterns that allows the disorder to persist. When they start repetitive behaviors, they’re encouraged to stop and think about what’s really behind what they’re doing.
Danny has undergone treatment, and brags now that he hasn’t taken a selfie in seven months.
I promised I’d tell you how I answered my daughter. She twirled. She looked at me with her beautiful brown eyes.
How do I look?
I leaned down and our foreheads touched.
“I love you.”