While social media revolutionises how we connect with friends, it has contributed to an array of problems in adolescents and adults, such as anxiety, depression, and lower self-esteem. Due to excessive comparison with peers and ideal images on social media, the rise of dysmorphic concerns (DC), if not body dysmorphic disorder (BDD) in young adults, has drawn attention from psychologists. “Snapchat Dysmorphia” was even coined to describe the obsession of users with Snapchat-filtered images1.
BDD, part of the DC spectrum, refers to an excessive preoccupation about one or several physical characteristics perceived as defects or imperfections usually unnoticeable by others2. Even before the emergence of social media platforms, like Facebook, Instagram and Snapchat, DC had become a self-image issue in teenagers and young adults since the popularisation of mass media. With the increasing prevalence of social media, our society may face an even more brutal battle against BDD.
How Does Social Media Amplify BDD?
According to a study conducted in Spain with 796 participants in 20203, there appeared to be a relationship between Instagram use and DC. Instagram, a photo-sharing application, is a platform designed to foster user interaction with peers and idols. In the survey, questions regarding usage patterns of Instagram, including active or passive use, duration, and the perceived importance of recognition, were asked.
The associations between DC and the study variables were evaluated, among which appearance-related comparisons were shown to have the closest correlation with DC (rs=0.58). This highlighted the significant role of peer and idol comparison in DC. However, direct effect of Instagram use on DC was not statistically significant. The investigator postulated that if one had little difficulty regulating emotions while using Instagram, one would be less obsessed with the ideal image online. This was also confirmed by the significant correlation between emotion regulation and DC. Hence, DC could be mitigated if social media users have good emotional regulation while surfing the platforms.
From Social Media to Muscle Dysmorphia
Contrary to the preconception that males are less prone to self-image issues, research found that social media affects the self-image of males and females to a similar extent3. However, the ideal image pictured by both sexes are entirely different.
Despite extensive studies on the correlation between media exposure and DC, in-depth studies on males were limited. As images of the perfect male physique are ubiquitous on social networking sites, more men work out hard in the gym to sculpt an ideal figure. For males, masculinity, manifested by muscularity, is most emphasised on social media. By frequently taking selfies, checking on mirrors and posting on social media, male gymgoers may be more susceptible to lower self-esteem, even DC. Muscle dysmorphia (MD), a type of dysmorphia happening in gymgoers, is associated with the fear of not being muscular, big, or lean enough, and the obsession with an ideal physique4. Patients may exhibit compulsive eating, excessive exercise, and use of performance enhancing drugs, such as anaerobic steroids, to achieve their body goals.
In 2018, an online survey conducted by Scott Griffiths, and his team in Australia and New Zealand with 2733 men, discovered more frequent use of image-centric social media platforms was associated with greater body image concerns and eating disorder symptoms5. The survey covered various forms of media, some of which were more image-centric, such as Instagram, Facebook, and Snapchat. The study determined which media platform contributed the most to self-image issues, which included dissatisfaction with body fat ratio, muscularity, height, eating disorder symptoms and thoughts about using anabolic steroids. Among the self-image issues, body fat and muscularity dissatisfaction were demonstrated to have the strongest correlation, Spearman coefficient of 0.075 and 0.067 respectively, for image-centric social media platform. On the contrary, non-image centric platforms, such as WordPress and Blogspot, showed a much weaker correlation with self-image issues. From here, we could see that exposure to image-centric applications could amplify self-image issues, thus triggering body dysmorphia.
Zoom Dysmorphic Disorder ¡V A By-product of the Pandemic
As video conferencing has surged since the COVID-19 pandemic, workers have been forced to confront their self-image for a prolonged period when working remotely. However, the impacts of video conferencing apps on users may have been overlooked.
In 2020, a survey involving 134 physicians, 82% of whom were dermatologists, was conducted to explore how video conferencing has led to increased DC and cosmetic surgeries6. 77% of participants reported patients concerned about upper-face wrinkles, 64.4% for dark circles and 53% for facial dark spots. As reported by the dermatologists, the most frequently requested procedures included injection of neuromodulating agents (e.g. Botox and Dysport), filler and laser treatment. Furthermore, 82.7% of physicians noted patients had been more upset with their appearance since using video conferencing more heavily during the pandemic.
The investigator explained since users can inspect their looks on the screen, video conferencing applications allow users to fine tune and alter their appearance, fixing any blemishes they believe they have. This has led to compensatory behaviours, e.g. wearing excessive make-up, dressing in expensive clothes, applying background filter, and wearing jewellery to mask their flaws. It is a commonplace that users adjust their hairstyles, colours, and more importantly, camera angle, to make their faces look slimmer7. These compensatory behaviours may cause increased self-consciousness in users and dissatisfaction with facial features, thereby increasing their likelihood of BDD.
BDD, Cosmetic Surgery and Management
Given the strong link between BDD and cosmetic surgery, the rate of BDD in customers seeking medical service in dermatological clinics and cosmetic surgery is higher than that of the general population8. Since cosmetic surgery is contraindicated for BDD, physicians should assess the true surgical needs and whether cosmetic surgery will lead to good outcomes for patients.
Meanwhile, patients are encouraged to limit the time spent on social media, have more real-life interactions, and have less comparison with others. While we embrace the “new normal” of post-pandemic eras, we should be cautious about our use of technology.
References
1. Ramphul, K.; Mejias, S. G. Cureus 2018. https://doi.org/10.7759/CUREUS.2263. 2. Aoife Rajyaluxmi Singh; David Veale. PMC. Indian J Psychiatry. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6343413/ (accessed 2022-10-11). 3. Senín-Calderón, C.; Perona-Garcelán, S.; Rodríguez-Testal, J. F. Int J Clin Health Psychol 2020, 20 (3), 253. https://doi.org/10.1016/J.IJCHP.2020.06.005. 4. Cerea, S.; Bottesi, G.; Pacelli, Q. F.; Paoli, A.; Ghisi, M. Scientific Reports 2018 8:1 2018, 8 (1), 1–8. https://doi.org/10.1038/s41598-018-27176-9. 5. Griffiths, S.; Murray, S. B.; Krug, I.; McLean, S. A. Cyberpsychol Behav Soc Netw 2018, 21 (3), 149. https://doi.org/10.1089/CYBER.2017.0375. 6. Rice, S. M.; Siegel, J. A.; Libby, T.; Graber, E.; Kourosh, A. S. Int J Womens Dermatol 2021, 7 (2), 213–216. https://doi.org/10.1016/j.ijwd.2021.01.012. 7. Sarangi, A.; Yadav, S.; Gude, J.; Amor, W. Cureus 2022, 14 (3). https://doi.org/10.7759/CUREUS.22965. 8. Higgins, S.; Wysong, A. Int J Womens Dermatol 2018, 4 (1), 43. https://doi.org/10.1016/J.IJWD.2017.09.007.
