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by Stella Kim Hansen, LMHC and Michele T. Pato, MD

It wouldn’t be possible to write a blog post about body dysmorphic disorder (BDD) without acknowledging the stressful effects of the worldwide COVID-19 pandemic. Through our own experiences in clinical work and doing research on the unique disorder of BDD, I am struck by how people with BDD can be especially affected by the emotional isolation of COVID-19. Our own hospital, University Hospital at SUNY Downstate, was designated a COVID-only hospital by New York State Governor Andrew Cuomo in the spring. At that time, the stress and tension in the air was palpable. Essential workers were putting their safety and health on the line, and those quarantining at home were having to adjust to a new lifestyle of minimal social contact with others, restricted activities, and reduced time spent outdoors.

While this left everyone feeling isolated, this situation can be especially harmful for people with BDD because of the stress that comes with a pandemic, restricted daily activities, and more time spent isolated at home. There have been numerous articles talking about individuals with OCD and BFRBs experiencing an increase in symptoms during the COVID-19 pandemic. Individuals with BDD have had similar experiences — they are stuck at home for the whole day and might spend more time looking into the mirror, or may have limited access to exercise and other types of stress relief. As Zoom meeting frequency increased for work meetings, individuals discovered that Zoom had a feature for applying a filter to your face to enhance the appearance of it to coworkers through their screens. Even in times of a pandemic, it was hard to escape from the pressures of looking good.

In addition, talk about the novel coronavirus causing trauma — to individuals with the illness, healthcare workers witnessing the trauma firsthand, and those unexpectedly losing loved ones — became rampant. The link between trauma and mental health symptoms is always an important relationship to consider, but especially during a worldwide pandemic where individuals are under prolonged stress. The link between trauma and body dysmorphia has been examined by researchers and clinicians, and past studies have found a relationship between traumatic life events and psychopathology. As researchers of a large genetic study for the Genomic Psychiatry Cohort, we recently published a study that looked at data about past traumatic experiences in individuals with only OCD, and individuals with both OCD and BDD (Valderrama et al., 2020). The results showed that individuals with both OCD and BDD reported significantly higher rates of exposure to at least one traumatic event, and were more likely to have symptoms of PTSD. This group also reported significantly higher rates of major depressive disorder and panic disorder.

The inability to connect with others due to stay-at-home orders may have brought even more challenges. Many individuals with BDD report social avoidance due to the distress from their perceived flaws, and feelings of depression and isolation. The lack of positive interpersonal connection and relatedness, which trauma experts would say is a key to healing trauma, may be another risk that perpetuates the distressing symptoms of BDD for those who have experienced traumatic events and symptoms of PTSD.

So how do we regulate our minds and bodies during this time while managing symptoms of BDD? People use the saying “My body is my temple” to mean they keep themselves healthy through exercising, engaging in self-care, nourishing themselves, and living a healthy lifestyle. This has become increasingly difficult due to the pandemic. At the same time, the body can also encode the stressful and traumatic experiences that we go through. Trauma expert Bessel van der Kolk has talked at length about how “the body keeps the score” for individuals who have experienced traumatic life events. Experiences of prolonged abuse and neglect can also affect individuals’ autonomic nervous system and ability to self-regulate, feelings of shame, and perceptions of themselves.

Taking a cue from Dr. Bessel van der Kolk and his focus on connecting to others and to the body, utilizing technology to connect with friends and family during this time can be healing. Joining yoga classes have been recommended for both trauma and BDD, and online classes have become more accessible during these times. Many individuals new to the practice have joined online without turning on their cameras as a way to ease into it. Finally, being creative and compassionate with ourselves during these times is paramount. As Brené Brown says, “What we don’t need in the midst of struggle is shame for being human.”


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