With the click of a computer key or smartphone app, anyone can erase their skin imperfections, enlarge their eyes, sharpen their cheekbones, plump their lips, add make-up, and create flawless images and videos to be distributed on social media. By choosing certain filters, we can pretend our imperfections don’t exist, and many of us —especially pre-teen and teenage girls — have become obsessed with these instant-beauty filters. But this technology is triggering significant psychiatric disorders in our young people, and we must combat the unrealistic standards of beauty that social media imposes on our children and adolescents.
As a dermatologist and director of a Psychoneurocutaneous Medicine Center at the University of Miami, I have seen many cases in my clinical practice of teenagers complaining of minor or non-existing defects in their appearance and requesting treatments for the “skin imperfections.” Once a teenage girl came to my clinic with her mother. As soon as she entered the office, she started crying, saying that her skin was covered by pimples and that she was too embarrassed to leave her home. She had only virtual friends and would only allow others to see her on social media through videos and pictures with filters. During the examination, she would point out areas of normal skin and insist that she saw pimples when, in reality, she had only a few enlarged pores on the nose; the rest of her skin was clear. Her mother was quite worried about her daughter’s wrong self-perception and explained that she tried many times to assure her that her skin was normal.
After an assessment, I determined that the teen appeared to suffer from body dysmorphic disorder (BDD), a disease that makes a person obsess about one or more perceived flaws in their appearance when it actually cannot be noticed by others. BDD affects both the skin and the mind and has physical and psychosocial components.
As scrutiny of Facebook and other social media platforms intensify, there is growing recognition of the harmful impact beauty filters can have on young women, especially teenage girls. The filters often reinforce negative body issues, leading to eating disorders and suicidal thoughts. It is important that clinicians quickly recognize these cases, make the appropriate assessment, and propose a multidisciplinary treatment. The treatment often includes a combination of medications and cognitive behavioral therapy.
Psychodermatology is a relatively new discipline that studies the connection between the skin and emotions. Dermatologists, psychiatrists, and psychologists are becoming specialized in this field to assist patients with skin conditions that are psychologically impacted or patients with psychiatric disorders that have skin manifestations. One such psychodermatological condition is BDD. BDD is not an uncommon disease; between 5 and 10 million Americans have this disorder. Most affected patients are females; the most common complaints are related to the face, breasts, hair, nose, and abdomen. Men complain more about hair, face, genitals, and body mass.
The causes of BDD are unknown, but genetic predisposition, abnormalities in the brain, and personal negative evaluations or experiences about one’s body, self-image, and poor self-esteem could be implicated. Social media plays a significant role when it comes to promoting unrealistic beauty standards and intensifying the BDD symptoms, especially in young girls.
Untreated, BDD can lead to other mental health issues such as anxiety, depression, or eating disorders. There is an alarming rate of suicidal ideation and suicide attempts among these individuals. The rate of suicidal ideation is as high as 80%, and up to 25% of the patients attempt to commit suicide in their lifetime.
This condition is very challenging to manage. Typically, patients first go to dermatologists and plastic surgeons to fix the perceived defect. The challenge is explaining to the patient that they have a psychiatric condition that needs psychiatric treatment instead of a cosmetic procedure.
It is a fact that social media can impact people’s mental health.
While Instagram and Facebook are committed to removing augmented reality (AR) filters that promote cosmetic procedures, parents should be aware of these harmful effects. Parents who are worried that social media is negatively impacting their child’s self-image should talk about it with their child, set realistic expectations, and perhaps propose “detox” for a few days. If you suspect that your child has body dysmorphic disorder symptoms, it’s time to seek medical help.
Katlein França, MD, PHD, Assistant Professor of the Dr. Philip Frost Department of Dermatology and Cutaneous Surgery and Department of Psychiatry & Behavioral Sciences; Faculty of the Institute for Bioethics and Health Policy, University of Miami Miller School of Medicine; Public Voices Fellow of The OpEd Project.