# Body Dysmorphia in the Age of Filters, Fillers & GLP-1s

An episode of [Vain-ish](https://invisiblenetwork.ai/podcast/1824105551), 7 Apr 2026, 50 min.

Audio: https://enrichment.soundstack.com/4vjqq8/episode.flightcast.com/k1lnvfnqmkoa7mgoo8gkattb.mp3

Trigger warning: This episode discusses body image and mental health. If this conversation raises concerns for you, please seek support from a qualified professional or contact Lifeline Australia on 13 11 14 or via lifeline.org.au. You’re not alone. Clinical psychologist and BDD researcher Dr Toni Pikoos breaks down body dysmorphic disorder (BDD or body dysmorphia) - what it is, the signs to look for, and how it can impact everyday life. We explore what makes someone vulnerable, common triggers, and the role hormones can play. Plus, we unpack the influence of social media, the conversation around cosmetic procedures, the rise of GLP-1 medications and their impact on body image, and what effective treatment and support can look like. Find us on Instagram: @vainishpodcast and thanks to our guest Dr Toni Pikoos Hosts: @becjudd and @jessierobertsx Producer: Liza Altarejos Audio Imager: Chris Marsh Video Producer: Justin Hill Find more great podcasts at www.listnr.com See omnystudio.com/listener for privacy information.

## Transcript

[0:02] a listener production.
[0:05] I'm Bec Judd.
[0:06] And I'm Jess Roberts.
[0:07] And we're done with the smoke and mirrors.
[0:09] Fainish shares honest stories about what it takes to look amazing because we did not wake up like this.
[0:15] And you should know the stuff that we chat about on this podcast is based on our personal experiences.
[0:21] We're sharing it for your entertainment.
[0:23] It's definitely not medical advice.
[0:26] And we'll always be clear with you when something is a paid endorsement.
[0:29] Please always chat with your qualified healthcare team before making any decisions about your health.
[0:49] Hey everyone, I'm Jess Roberts.
[0:51] And I'm Bec Judd.
[0:52] And welcome to Veinish.
[0:54] How are you, babe?
[0:55] I'm good.
[0:55] How are you?
[0:56] So good.
[0:56] We've got a big episode today.
[0:58] We do.
[0:58] It's sensitive.
[0:59] It is sensitive.
[1:00] And trigger warning for everyone listening.
[1:04] Today we are talking about body dysmorphic disorder.
[1:07] And if...
[1:08] something in this episode triggers you or resonates with you.
[1:12] You're not alone.
[1:13] Help is available.
[1:14] BDD is a real and treatable condition.
[1:17] So consider reaching out to a trusted person, a GP or a mental health professional.
[1:22] If you do need immediate support in Australia, you can contact Lifeline on 13 114 for 24-7 confidential help.
[1:30] All of the details are in our show notes.
[1:33] So Jess,
[1:34] You and I host Fainish, right?
[1:37] And we are very transparent about what we've done, what we do.
[1:43] Our whole mission is to educate our listeners on current wellness, beauty and trends.
[1:52] And in a lot of the ways when we talk about things with professionals, we are de-influencing people.
[1:57] We are.
[1:57] People.
[1:58] We're not promoting things.
[1:59] We are giving people, I would say, a better education about...
[2:04] topical treatments, surgeries, supplements, you name it, we'll cover it.
[2:09] Yeah.
[2:09] We did not wake up like this.
[2:11] We are so transparent about what we've had done.
[2:16] And also we get fantastic people come on and share with us what they've had done as well.
[2:21] We do know that in this vanity space, there would be people in our listenership who have body dysmorphic disorder.
[2:28] And we want to acknowledge that and also help people to be able to identify it either in themselves or their family members or their friends.
[2:40] And to be able to kind of go, when is it I'm having a bad body image day versus this?
[2:45] this is actually a problem that's impacting my life.
[2:49] Personally, I'll talk to me.
[2:50] I do things to empower myself and give me confidence.
[2:56] So for example, a really big one for me was back in high school, I used to have quite bad skin.
[3:02] I used to get cystic acne on my chin and I'd walk into a room and I thought everyone was looking at it.
[3:08] If I had really...
[3:09] a really bad breakout, it would make me not want to go to that party that night.
[3:14] It really affected my confidence.
[3:15] When I went on some prescription medication for it and got some lasers, it cleared up.
[3:19] And my confidence around my skin, it was actually for me personally, it was life-changing.
[3:25] So when I do cosmetic things or wellness treatments, it's
[3:30] for confidence and empowerment.
[3:33] And people assume, oh, she got plastic surgery on her eyes.
[3:37] She must have body dysmorphic disorder.
[3:39] No, no, I don't.
[3:40] I actually don't.
[3:41] There's things about my body that I don't love, but I actually don't care.
[3:44] They don't need to be fixed.
[3:46] So when I do things, it's for confidence for me.
[3:49] What about you?
[3:50] I've mentioned it on the podcast before.
[3:52] So every morning when I wake up, I might rock up to school in my pajamas or walk the streets of Brighton.
[3:57] In your Ugg boots.
[3:58] In my Ugg boots.
[3:59] Your pajamas are usually inside out.
[4:03] I don't know what the hell that's about, but they're always freaking inside out with your Ugg boots and your boobs out and your nipples sticking through.
[4:09] Yeah, I actually walked up to school today.
[4:11] I didn't get out of the car, but I had my pajama top on and my sports bra over the top.
[4:18] Of my pajama top because what had happened in the middle of the night, my boobs were just feeling sore and big and I needed support.
[4:24] So I literally grabbed my jacket sportswear top and I popped it on over the top because I didn't want to take my top off and then put it on and then put my top off.
[4:32] I would get too awake.
[4:33] That is so funny.
[4:34] And then you went to school drop like that.
[4:35] I went to school.
[4:36] But I'll always have a glam on my face.
[4:39] So like my thing is always I will have makeup on my face and that's just my thing now.
[4:45] for me.
[4:45] Empowerment.
[4:46] Yeah, it just makes me feel better about myself and that man, what is she wearing but her face looks great.
[4:52] She looks hot in those pajamas and a bra over the top of her pajamas.
[4:56] I think for me it's like my thing is wake up and I do a glam before I leave the house.
[5:03] I learnt that a couple of years ago, about four or five years ago, my grandmother in COVID and she's just like, just put a face and makeup on it and make you feel better.
[5:10] And I did and it did and I've just continued doing that.
[5:13] And then I'll go home and shower with my face out.
[5:16] The steam gives me like this...
[5:18] The glow.
[5:18] The glow, the dewy glow.
[5:19] So, yeah.
[5:20] But that's my little thing that I do.
[5:21] Yeah.
[5:22] But I won't say it's brought into the smog here.
[5:23] If something bad happened and you needed to leave the house and go to the shop and you didn't have your glam on, but there was an emergency...
[5:29] You're going to leave the house.
[5:30] Like you actually don't care that much.
[5:31] No.
[5:32] Yeah.
[5:32] No, I will.
[5:32] And that's the difference.
[5:33] Yeah.
[5:34] If my kids are sick at school, I'll just leave and I haven't got makeup on.
[5:36] Yeah.
[5:37] I see you out and about every now and again without anything on it.
[5:39] Without makeup on.
[5:39] Yeah.
[5:39] Yeah.
[5:40] Yeah.
[5:40] Yeah.
[5:40] So there is a difference.
[5:43] I do feel there is this stigma in society that if you care about your appearance and you actively care...
[5:50] partake in procedures or use certain products or get your lashes done or your nails done, that you must have body dysmorphic disorder.
[5:58] No, it's not.
[6:00] It is very different.
[6:01] It is.
[6:01] But it can be a very serious mental health disorder and it is treatable.
[6:07] Yeah.
[6:07] So that's what today's episode's about.
[6:09] Yeah.
[6:10] So we are getting on clinical psychologist and BDD researcher, Dr. Tony Pickles.
[6:17] I think this is so important.
[6:19] Welcome, Dr. Tony.
[6:21] Is that how we should refer to you?
[6:22] Yes.
[6:22] Dr. T?
[6:23] That's perfect.
[6:24] Dr. T is great.
[6:24] Dr. T. Tell us about your qualifications.
[6:27] So I'm a clinical psychologist and a researcher as well, and I have a special interest in body image and body dysmorphic disorder in particular, and the intersection between mental health and cosmetic procedures.
[6:40] So I'm really passionate about promoting safety in the cosmetic industry and making sure that
[6:45] People who get treatments are well-informed or well-equipped to deal with the psychological challenges along the way or get that support to just talk it out maybe before doing something that they might regret.
[6:55] Yeah.
[6:57] What actually is body dysmorphic disorder and how is it different from just having like a bad body image day?
[7:02] It's such an important question because I think in the media, a lot of the time when they talk about body dysmorphia, they do talk about weight.
[7:09] And so people develop a misconception that that's all it is.
[7:13] But body dysmorphic disorder is a mental health condition where people can become focused or obsessed on perceived flaws in their appearance.
[7:22] And that can be anything.
[7:23] It can be their skin, their hair, their nose, facial features.
[7:27] It can be their body shape and proportions, but not always.
[7:30] And it causes a lot of distress and people tend to think about it for many hours a day.
[7:36] So often with body dysmorphic disorder, people are thinking about their appearance for more than an hour a day.
[7:41] Is that how you kind of diagnose it?
[7:43] Like these are the more than an hour a day?
[7:46] Depending on the industry that you work in, if you're in a very appearance-focused, visible industry, it would be natural to think about your appearance for more than an hour a day.
[7:53] So just not eight hours a day, that's fine.
[7:58] I'm 10.
[7:58] So that's one of the criteria.
[7:59] But then is it causing distress?
[8:01] Is it really upsetting them when they see themselves?
[8:03] Is it making it hard to function day to day, to go out and date or to do their job or to even leave the house?
[8:10] And that's quite different from just general body image concerns that most of the population have.
[8:15] So all of us have things about ourselves that we don't like and that we would change if we could.
[8:19] But with body dysmorphia, that distress is just much more significant and it starts to impact you a lot more.
[8:25] Okay.
[8:26] Yeah.
[8:26] And when you say...
[8:28] impact you a lot more.
[8:30] What kind of negative things do we see from BDD and their effect on people's lives?
[8:36] So it varies a lot.
[8:37] There are people with BDD who can function really, really well and most people would look at them and not know that they had it.
[8:44] They can still have relationships and they can still go out and work and things like that.
[8:48] But constantly while they're
[8:52] How am I appearing to other people?
[8:53] Are they seeing my bad angle?
[8:55] Can they see how big my nose looks?
[8:57] And so it's really hard to be present a lot of the time, even while they're doing all the things because they're so conscious of themselves.
[9:04] But then I also see people who are way more impacted functionally
[9:09] to the point where I have people who I've seen who won't even let their family look at them.
[9:13] They will cover their faces when they're around their family members because they just think they're so ugly and so unattractive that they don't want to be seen or will wear makeup and never, ever take it off while they sleep.
[9:25] Yeah, we actually know people like this.
[9:27] And even growing up through high school, there were girls who started doing that.
[9:30] They would never let their boyfriend see them.
[9:32] They quickly get up in the morning and go and put a full face on.
[9:35] Yeah.
[9:35] Like there's partners who have never seen their wives without makeup on.
[9:40] We've got friends that we've never seen without makeup.
[9:43] Yes.
[9:43] Yeah.
[9:44] We've got friends who sleep in their makeup.
[9:46] Yeah, literally.
[9:47] They do, yeah.
[9:48] Yeah.
[9:49] Then there's also that thing like that gives them confidence and makes them happy even though it's kind of, it seems like BDD, but if it kind of helps them to live every day, how do you navigate that?
[10:04] It's such a good question.
[10:05] Because appearance-focused behaviors, like doing your hair nicely, putting on makeup, choosing a good outfit, they're things that most of us do day to day to help us to feel good.
[10:14] And the question is, is this something that I do because it makes me feel good, because it makes me feel confident?
[10:21] Or do I do it because I have to?
[10:22] Because I can't bear for someone else to see me without this?
[10:26] Right.
[10:27] Okay, that's it.
[10:28] Am I doing this because it makes me feel good or am I doing it because I'm scared of other people seeing me in a surgery?
[10:32] Yeah.
[10:33] And then the main things are, so how much time is it taking up?
[10:37] How much distress is it causing?
[10:39] And how much is it interfering with your functioning?
[10:41] And what about how much money?
[10:43] You know, people have gambling addictions or other things.
[10:47] I could imagine that when you become obsessed with surgeries or weight loss drugs or whatever, and you are spending all of your money on that, I'm sure you've seen patients like that.
[10:57] Is there a cut-off?
[10:58] I don't think there's like a specific number.
[11:00] Once you've spent more than that, you've definitely got body dysmorphia.
[11:02] Yeah, yeah, yeah.
[11:03] Because it depends on the individual.
[11:04] You know, I have people who dream of having all these procedures but would never have the money to afford it as well.
[11:10] And so they haven't had any work done, even though they wish they could.
[11:13] And then on the flip side, people who have lots of money get lots of procedures but don't have body dysmorphia as well.
[11:18] They just do it, as we said, you know, for empowerment.
[11:20] It makes them feel good.
[11:22] That's me.
[11:22] Yeah, that would be me soon.
[11:24] When I have my finances in order.
[11:27] Oh, okay.
[11:29] Are there certain personality traits, life experiences, or environmental factors that make someone more vulnerable to developing BDD?
[11:37] Absolutely.
[11:38] So it's a combination of factors.
[11:40] We wouldn't say there's just one specific thing that would trigger body dysmorphic disorder.
[11:44] Usually there are biological factors involved.
[11:47] So there might be a genetic contribution.
[11:49] People in your family have had BDD or been quite obsessive about things.
[11:54] Or that we even see neurobiological differences in people who have body dysmorphia in that the way that they process faces is different.
[12:02] So when they look at someone's face, usually we would look at a face holistically.
[12:06] We would see the whole face and I'd be like, oh, that's Jess, that's Beck.
[12:10] But someone with BDD is looking at specific features all the time.
[12:14] There's an eyes, there's nose, there's a mouth instead of processing the whole.
[12:17] Okay.
[12:18] And when you do that, you start to become really aware of subtle flaws and imperfections that other people wouldn't see.
[12:23] Right.
[12:24] That's really interesting because Jess talks about one side of her face is more concave.
[12:30] And then I've built a career of 20 years of only being shot on my left side because it is, I would say, like the more attractive side.
[12:38] And when we've tried to shoot the right-hand side, when photographers have said, we've got your left, let's do the right.
[12:43] And I said, oh, the left's better.
[12:44] And they go, let's just try it.
[12:45] And then I'll do the right.
[12:46] And they're like...
[12:47] Oh, yeah.
[12:47] You're correct.
[12:48] The left side shoots better.
[12:49] I'm like, it just does, right?
[12:51] But then when I say that to people, they're like, oh, we've never noticed that about you.
[12:54] And the photographer, who's a beauty photographer, who's shot me so many times, never noticed that about me until I pointed out and we had the side-by-sides.
[13:01] He's like, you're right, your left's a lot better.
[13:03] Jess, with your concave side, I couldn't even tell you what's your concave side, but you notice it.
[13:08] I notice it.
[13:08] It's filled now, so.
[13:10] But no one else would ever notice it.
[13:12] Yeah.
[13:12] Yeah.
[13:13] So...
[13:14] That is a real thing.
[13:15] And what you think people are noticing about your face and your insecurities, 99% of the time, I reckon you're the only one seeing it.
[13:22] It's so true.
[13:23] Totally.
[13:23] And I think having that perspective and that self-reflection makes you go, I'm good.
[13:28] Does that kind of mean maybe you don't have BDD if you can have that self-reflection and go, oh, this is a me thing and it's all cool and I'm just going to let it go?
[13:36] Yes.
[13:37] So often people vary in their insight about the problem.
[13:40] And so we see about one third of people with BDD have pretty good insight and can think of it like you just described.
[13:46] Like, yeah, this is something I really don't like.
[13:48] I feel like my nose is too big.
[13:50] My skin is too wrinkly.
[13:51] But I think that I'm probably seeing it this way and maybe it doesn't look as bad to other people.
[13:56] Whereas two thirds of people actually have poor or absent insight where they're very convinced this is a problem.
[14:03] Everyone is seeing my big nose when I walk into a room and that's all they're looking at.
[14:07] And they really struggle to accept that there could be some psychological reasons behind it as well.
[14:12] Right.
[14:12] So what actually causes BDD?
[14:15] Is it hereditary?
[14:16] Is it something that's been triggered in the past?
[14:19] Yeah.
[14:19] That's by someone saying something about them?
[14:21] Yeah, like life trauma.
[14:22] Yeah.
[14:22] Trauma.
[14:23] Sometimes it can be one little comment.
[14:26] I actually, I remember back in high school, I had someone say to me, because I used to surf,
[14:31] And I remember someone saying to me, it was a girl, and she's like, oh, my gosh, you've got the broadest shoulders.
[14:36] You could never wear a halter neck.
[14:39] I still to this day can't put a halter neck top on.
[14:42] Every time I put one on, I'm like, I can't wear it because I've got these broad shoulders.
[14:47] You do not.
[14:47] And that one negative comment stick and positive ones just wash away.
[14:53] My thing was I used to get teased sometimes.
[14:56] This started young by this awful boy at school because I've got Maori heritage.
[15:01] I'm naturally quite hairy.
[15:03] So I always have like a little bit of a moustache, right?
[15:05] Yeah.
[15:05] So I used to get bullied for having this moustache, even though after the first time he mentioned it, I went home to my mum and I said...
[15:12] This boy's saying I've got a moustache.
[15:13] And mum's like, no, you don't.
[15:14] You're just darker because you've got Maori heritage.
[15:16] I was like, no, we're getting rid of it.
[15:18] So I would bleach.
[15:19] He'd bought me some bleach so I could bleach it.
[15:20] So then after that, I never had a moustache.
[15:22] Yeah.
[15:22] But he was stuck on that idea.
[15:24] So he used to bully me about it for like five years until primary school finished that I always had one.
[15:29] Yeah.
[15:29] Right?
[15:30] So that's in my head now, that facial hair.
[15:32] Whenever I see anything, I pluck it all out.
[15:34] I still bleach my whole face.
[15:36] I bleach from my eyebrows down where I'm darker.
[15:39] Like it's a full thing.
[15:40] I've walked into your house and bleach all over my face because of this one dickhead Michael in year two or whatever, year two or year three.
[15:48] Isn't that crazy?
[15:49] And then Billy, my daughter's naturally got darker hair.
[15:52] She's got a bit on her face.
[15:53] She doesn't give a shit.
[15:55] Yeah, yeah, yeah, yeah.
[15:57] And she's got a fairer skin as well.
[15:58] Yeah, so hers is more noticeable.
[16:01] And yeah, she gives like zero fucks.
[16:03] No zero fucks.
[16:04] Yeah, literally.
[16:05] Isn't that crazy?
[16:06] Exactly.
[16:06] Yeah.
[16:07] So you touched on it there.
[16:08] Like those negative comments, bullying, teasing, those experiences have a massive role in triggering BDD as well.
[16:14] And everyone remembers those negative comments, as you said, that they once received from some random on the bus or that random kid at school or something like that.
[16:24] and they really stick.
[16:25] On the flip side, I also see people who received a lot of positive feedback about the way that they looked.
[16:31] And so it might not have been a negative comment, but all the way growing up, they were told how beautiful they were.
[16:36] They felt like maybe it impacted their popularity or their success.
[16:39] And so self-worth was built around that.
[16:41] Exactly.
[16:42] And then they develop this need, well, I have to maintain this.
[16:45] And so anytime there's a change in their appearance, it creates a lot of distress.
[16:49] I'm going to lose that beauty.
[16:50] I'm going to lose that worth and that value to other people.
[16:52] I need to maintain it.
[16:54] So that can definitely play a role.
[16:56] And then we obviously see social media and society.
[16:59] Oh, yeah.
[17:01] Social media is a huge one.
[17:03] Everyone listening, when you see these pictures, I know Jess and I have touched on it on Vanish so many times, but...
[17:10] Everyone's using AI filters.
[17:12] Everyone's only posting the best photo.
[17:14] They take a thousand photos and they post the one best one and then they put an AI filter on it that makes them look like...
[17:22] They've had all types of surgery.
[17:23] Even plastic surgeons come out and say, I can't do surgery that makes that person look like an AI filter.
[17:30] It is impossible.
[17:31] It is absolutely impossible.
[17:33] Even with lighting with like being a blonde, I have so many people message me going, oh my gosh, your blonde is amazing.
[17:39] how did you get it that blonde, my hair's so yellow?
[17:42] And I'm like, no, it's just how the photo's been taken.
[17:45] Yeah, it's lighting.
[17:46] It's lighting.
[17:47] I've put the photo up where my hair is.
[17:49] Looks the best.
[17:50] The best.
[17:50] It looks like this, you know, nice, white, crispy blonde.
[17:54] It is, you know, the first couple of weeks after getting a color, but after that it goes brassy.
[17:58] Yeah.
[17:59] I feel that pattern.
[18:00] Pat on the back to us because we actually own it and be like, girls, we took 500 photos.
[18:05] We've showed the good.
[18:05] It's good lighting.
[18:06] We've done this.
[18:07] I've overdrawn.
[18:07] Like this is not real life.
[18:08] We did not wake up like this.
[18:10] No, we didn't.
[18:10] Okay?
[18:11] This is not real life.
[18:12] Yeah.
[18:12] And as soon as everyone accepts that, it'll be better for us all.
[18:16] Yeah.
[18:16] Instagram is fake, guys.
[18:18] It's all fake.
[18:19] 100%.
[18:19] From how we look to the lives to the... You put your highlights up.
[18:23] Yeah.
[18:23] It's just be so aware of that.
[18:27] And it's hard to...
[18:29] not to compare, but Instagram, social media, it is all, well, it's not fake, but what would you say?
[18:36] It's the 1% of the best bit of your life.
[18:39] It's curated.
[18:39] It's a highlight reel.
[18:40] Yeah.
[18:41] And, you know, in your stories is what you really look like.
[18:43] But even then, it's like everyone's got a Paris filter on.
[18:46] Just slide one across.
[18:47] It's just... Slightly blurred.
[18:49] Just slightly blurred.
[18:50] It gets rid of your fine lines a little bit.
[18:52] Yeah.
[18:52] That's the realest you're going to get of me, guys.
[18:54] Yeah.
[18:54] Well, we've all bought this camera recently.
[18:56] It's the Canon... What is it?
[18:57] The Canon G... G. G7X.
[18:59] The Canon G7.
[19:00] They're so hard to get.
[19:01] But the reason everyone's buying this particular camera is because they have this scene on it that you can choose.
[19:06] It's a portrait scene.
[19:07] And every time...
[19:08] You take a photo with the flash on.
[19:10] It makes your skin look insane.
[19:14] And there's some kind of inbuilt, maybe it's an AI mode that just makes your face look better.
[19:19] No, I like to think that it's actually how I look.
[19:21] But anyway, burst my bubble.
[19:23] I literally put the photos up.
[19:24] I'm like...
[19:25] I've got no filter on that photo.
[19:26] Look how good I look.
[19:27] Don't burst it for me, baby.
[19:29] There's no filter.
[19:30] You don't need a filter because the filter's inbuilt into this camera.
[19:33] Don't tell me that.
[19:34] I thought it looked really good.
[19:35] When you're looking at everyone's photos and you go, oh, that looks like it's taken on a proper camera.
[19:39] It is, but it's got this inbuilt filter.
[19:41] So for this reason, this camera, I think I was on a wait list for like nine months to get this bloody camera that makes everyone look hot.
[19:47] Yeah.
[19:47] Right?
[19:48] Yeah.
[19:49] It's a good camera.
[19:50] It's a good camera.
[19:51] I think iPhone even does that now, doesn't it?
[19:53] When you take a photo, it's automatically adding some slight filter to it.
[19:57] Yeah.
[19:58] Yeah, it really does.
[19:59] It's really nice when you look at that photo, but then you step away and you look in the mirror and you're like, hold on.
[20:04] I don't look like that.
[20:05] Reality.
[20:05] Reality check.
[20:06] Yeah.
[20:07] Okay.
[20:08] So we live in a hypervisual world, filters, injectables, tweakments, constant comparison.
[20:13] What does the research say about how this environment influences BDD risk?
[20:17] Well, BDD was there before social media came about.
[20:21] So it's not created the problem, but it's definitely intensified it.
[20:25] And in the past, you know, in the early 2000s, in the 90s, people were looking at magazines, they were comparing themselves to celebrities, but we could close that magazine and put it away and not have to think about it after that.
[20:36] Whereas social media is just with us all the time.
[20:39] It's all around us.
[20:40] It's constant.
[20:42] And we're getting more and more advanced in filters, in AI, that what we're seeing online is often not real or not realistic.
[20:48] Yeah.
[20:49] And so when you're constantly exposed to that, it elevates the standards for how we feel we should look.
[20:54] We're supposed to have that flawless skin that then we step away and we look at the mirror and we're like, that's not what I look like.
[21:00] That creates this distress and this mismatch between how I want to be and how I am.
[21:05] And then makes you think about, okay, well, how am I going to fix that?
[21:08] Do I need to now go get a procedure or a treatment that can help me to look like that perfect version of myself?
[21:14] So how do you help people with BDD to realize, to help to accept that how they look in real life doesn't align with their filters and that that's okay?
[21:24] Like how do you get someone to love their body and themselves?
[21:29] Look, it takes work.
[21:30] It definitely takes work.
[21:31] And living in this society where there's so much pressure around the way that we look, it's not something that comes easily or naturally to people at all.
[21:38] So we know with BDD, the best treatment is psychological treatment.
[21:42] And it works on rewiring the way that we think about ourselves, the way that we talk to ourselves, the self-critical conversations that are always going on in our brain, developing new kinder ways of relating.
[21:53] Mm-hmm.
[21:54] And I always say to my clients at the beginning that, you know, we might not finish treatment and you feel super hot.
[22:00] That like you walk out thinking that you're gorgeous and when you've come started from hating yourself or being really self-critical.
[22:07] But if you can walk out of here and say, okay, I don't love my nose.
[22:11] It's a little bit crooked or it's bigger than I would like, but it doesn't define me.
[22:16] In fact, I have so much more to me that people love about me, so much more worth and value in this world, and that's a great result.
[22:23] And so it's re-evaluating the importance that we place on that particular body part or on our appearance that is a successful treatment.
[22:31] Yeah.
[22:31] So with someone with BDD, how do they know when to see you?
[22:35] Is it an intervention or is it like they go, you know what, I'm actually not okay.
[22:41] I really need someone.
[22:42] Yeah.
[22:42] Because I'd imagine a lot of people with BDD would never even get to the point where they realize they need help.
[22:47] A lot of the time it is someone else encouraging them to seek treatment.
[22:50] So their family, their friends, their partners have noticed how much they're worrying about their appearance and telling them that it's a problem and that might bring them in.
[22:59] Another way that people come and see me is actually after they hear a podcast episode like this or they see a segment on TV about BDD, which is why I think it's so important that you guys are talking about this on your podcast.
[23:11] Because sometimes people might not even have heard the term BDD before and then they get exposed to it and start to think, hey, this actually sounds a bit like me or a family member or someone that I know.
[23:22] And this could be the trigger to get them to seek the help that they need.
[23:26] So hopefully they hear an episode like this and know that it's a treatable mental health condition that support is available for.
[23:32] Sometimes it's a cosmetic doctor saying, hey, this treatment's not right for you.
[23:37] We think that you should go talk to someone first and then maybe we'll revisit it later on.
[23:42] In those cases, it has to be, that conversation has to be had really sensitively and in a nice way for someone to actually come and see me.
[23:49] Because a lot of the time they walk out and think, oh, this doctor's not for me.
[23:52] I'll just go to the next one who will do the treatment.
[23:54] Yeah.
[23:55] Like it's a big thing telling people, I think, because BDD, like you said, is a mental health disorder.
[24:00] When you're telling someone you've got a mental health disorder, people take that as this person's telling me I'm crazy.
[24:06] Yeah, yeah.
[24:07] I must be crazy.
[24:07] There's this whole stigma.
[24:09] How do they navigate that conversation?
[24:11] That would be so hard.
[24:13] It is.
[24:13] It's a really difficult conversation.
[24:15] And I say, you know, it's never good to try to challenge someone on the way that they're seeing themselves.
[24:20] Like tell them your nose isn't big because it's subjective.
[24:23] That's what they're seeing when they look in the mirror.
[24:25] And so it's more about talking about the impact that it's having on them.
[24:29] You know, I can see that this is a problem that's causing you a lot of stress, that it's really making it hard for you to live your day-to-day life at the moment.
[24:36] And I think it might be helpful to talk to someone about that.
[24:39] So it's not saying you're crazy.
[24:41] It's not saying you're seeing yourself weirdly, like you're not seeing yourself correctly.
[24:44] It's just this is obviously having an impact and let's get some support.
[24:48] Oh, you're good.
[24:49] Yeah, you're good.
[24:50] Yeah, you're really good.
[24:51] Are you seeing a lot of teenagers coming in?
[24:53] Yes.
[24:54] I was like, that would be...
[24:55] huge influx at the moment with them on social media.
[24:59] Exactly.
[25:00] And the point where BDD typically develops is around like 15, 16 years old.
[25:06] And so that's when, you know, your body's going through all the changes in puberty.
[25:10] Often people are mean, kids are mean, they say mean things.
[25:14] Yeah.
[25:14] And then you're exposed to social media as well.
[25:16] Yeah.
[25:17] Boom.
[25:18] And just that having...
[25:20] such an undeveloped frontal lobe and not being able to process these thoughts and feelings and be rational because that doesn't come until what, the mid-20s?
[25:32] Yeah, exactly.
[25:33] What are the signs of them starting to go down this path?
[25:36] Because when you're 14, 15, 16, the kids are quite secretive and you kind of see it when it's a bit almost too late.
[25:43] Is there signs that we can see?
[25:45] Good question.
[25:46] Yeah, great question.
[25:47] Yeah.
[25:48] I think some of the early things that parents might notice is like their kids taking a really long time to get ready for school.
[25:53] And so that, yep.
[25:54] Yeah.
[25:55] And maybe gently questioning on, you know, I noticed it took a while to get ready today.
[25:59] Like what was going on?
[26:00] What was taking so long?
[26:02] So not, you know, you're taking too long for school.
[26:04] Why are you doing that?
[26:05] Just gently exploring that with them.
[26:06] What was, what was taking so long for you?
[26:09] I guess also if kids are experiencing some kind of teasing or bullying at school, a lot of the time parents don't know about that, unfortunately, but creating a safe space so that your kids do feel comfortable to tell you when that happens.
[26:21] And then again, it's that gentle exploration, that curiosity about, you know, someone made a comment about your teeth today.
[26:27] Like, how did that feel?
[26:28] What did that make you think when you heard that comment?
[26:31] So not immediately dismissing it, not saying, oh, you know, they're mean and they're this and they're that, but just gently exploring it with them.
[26:38] to actually make them feel comfortable to open up about it.
[26:41] The other tricky area is where a child might come home and complain about something like, you know, the hair example.
[26:48] And then as their parent, you want to help them, right?
[26:50] You want the best for them.
[26:51] You want them to feel confident.
[26:52] So you're like, all right, let's go fix it.
[26:54] Let's go laser it off.
[26:55] He's that little shit.
[26:55] Let's go over to his house.
[26:57] If that was Billy now, I'd be like, let's go over there.
[27:00] I'm going to talk to his parents.
[27:02] That is me.
[27:02] I do that constantly.
[27:04] I'm going to the school.
[27:05] I'm calling the principal.
[27:06] I'm calling the parents.
[27:07] My kid's like, mum, we can't even tell you anything.
[27:09] Yeah, because you overreact.
[27:11] I overreact.
[27:11] I'm like going to rock up in the kid's parents' house and like.
[27:14] Yeah, so then they say nothing.
[27:15] I know.
[27:16] Yeah.
[27:16] So instead of going into that solution mode right away, take a step back and explore.
[27:21] Okay.
[27:21] Like, what does this mean to you?
[27:23] How did it affect you when that happened?
[27:25] Yeah.
[27:26] And sometimes I think when we say, okay, a child made a comment about your weight or your hair and now we're going to go fix it, it's sending the message that they were right, that they were right to comment on that.
[27:37] And now we need to change something about you, which sometimes I think it's helpful for parents to take a step back and actually say, maybe this is about them and not about you.
[27:46] Maybe you're fine just the way that you are.
[27:48] And let's explore that a little bit more together.
[27:51] It's really interesting and it's a fine line.
[27:53] There was a girl at school who wasn't allowed to shave her legs until she was 13.
[28:00] And her legs were really, really hairy.
[28:02] And she was getting bullied every day by the boys at school for having these hairy legs.
[28:07] But her mum wouldn't let her shave them because the mum said, 13's the rule when I grow up and it's 13 for you.
[28:13] Yeah.
[28:13] So the child cried every single day for a whole term until her birthday.
[28:18] And it's kind of that fine line of do you let it go and we build up your confidence or do we actually protect this child from this severe bullying of now?
[28:26] It's hard.
[28:27] It's so hard.
[28:28] Where do you draw the line of actually we need to enact the solution now to save this child?
[28:33] I think being clear then on why you're doing it.
[28:35] Like I see that this is having an impact every day and so we'll do the thing that might help to prevent the bullying but at the same time we're going to reinforce these messages that that's not what makes you confident.
[28:47] Like that's the problem with them.
[28:49] It's not you.
[28:50] It's not your self-worth.
[28:51] It's not what makes you who you are.
[28:53] Yeah.
[28:54] Oh, God, parenting's hard.
[28:55] It's so hard in this day and age.
[28:57] God.
[28:58] It's so hard.
[28:59] It really is.
[29:07] What does the research tell us about the relationship between BDD and cosmetic procedures, like getting fillers, getting anti-wrinkle injections, getting cosmetic surgery?
[29:16] So because BDD often involves thinking that there is a problem with your appearance or a flaw, most people at some point think about getting beauty treatments or cosmetic procedures to fix the problem.
[29:29] And so we see that in the general population, it's about 2% to 3% of people who have BDD.
[29:35] But then in a cosmetic setting, in a cosmetic clinic or a surgery, that goes up to 20%.
[29:39] Wow.
[29:40] Yeah.
[29:41] So it's about 10 times higher, which means that cosmetic doctors end up encountering patients with BDD a lot of the time.
[29:48] Yes.
[29:49] And typically, cosmetic treatments don't help BDD.
[29:52] BDD.
[29:53] So it's kind of like trying to fix a bullet hole with a Band-Aid, right?
[29:57] There's a deeper psychological issue there that isn't going to be fixed with a physical solution.
[30:04] And so when they get the treatments, often we see that most people are not satisfied with the outcomes, that they then start to think about other things that they need to fix.
[30:13] It just shifts somewhere new.
[30:14] Yeah, and then they keep going back and they become a frequent flyer.
[30:16] Yes.
[30:17] We've all been there.
[30:18] Have you?
[30:18] Yeah.
[30:19] Well, no, no.
[30:19] Yeah, like anti-wrinkle.
[30:20] I'm like, I need anti-wrinkles done.
[30:22] They're like, Jess, you're here like four weeks ago.
[30:24] I'm not doing it again.
[30:25] I'm like, I can see emotion.
[30:27] Please give me a chance.
[30:30] They're like, no, no, no.
[30:31] They send you away.
[30:32] I will go, oh, oh.
[30:34] They won't do it for me.
[30:35] But I'm like, that's a good thing.
[30:37] Then you get over it.
[30:38] I get over it.
[30:39] I get over it.
[30:39] You have bad body image days.
[30:41] I don't think you have bad body.
[30:42] Yeah, it's just like that one week of the month.
[30:45] Yeah.
[30:45] Yeah.
[30:46] So do hormones impact that?
[30:48] Yeah.
[30:48] Definitely.
[30:48] That ovulation week, day seven to 14, best time of the week.
[30:52] I'm just, everything's good.
[30:53] Everything's good.
[30:54] The body's image is amazing.
[30:56] I'm plump everywhere.
[30:57] Everything looks good.
[30:58] Everything feels good.
[31:00] And then the week before, I look like crap.
[31:03] Yeah.
[31:04] Yeah, but that's just the perception, right?
[31:06] Well, it is.
[31:06] I can't be bothered putting makeup on that week because I'm just in a foul mood.
[31:09] Yeah.
[31:09] So, you know, yeah.
[31:11] Exactly.
[31:12] You said 2% to 3% of the population have...
[31:14] BDD.
[31:15] Is that the female population or men and women?
[31:17] Men and women.
[31:18] Okay.
[31:18] We actually see, interestingly, equal proportions of men and women.
[31:22] Yeah.
[31:23] And I see now a lot more men seeking treatment for BDD, which I think is so important.
[31:28] Like a few years ago, it looked quite different.
[31:31] It was probably mostly women that I was seeing.
[31:33] And now I would say it's about equal as well.
[31:35] Is it mostly body more than it is cosmetic?
[31:38] Yeah.
[31:38] Sometimes.
[31:39] So typically for men, muscularity is a big thing.
[31:42] Also hairline is another one.
[31:44] And genitals, like they'll focus on penis size and things like that will be a big focus.
[31:49] Really?
[31:50] Yeah.
[31:50] I always found it really interesting going back some years that men who obsessed about what they ate
[32:00] It was part of being kind of masculine and that gym bro culture and they would not eat certain things and, you know, count their calories and their protein grams and obsessively.
[32:12] And I feel like that's more like accepted in society.
[32:15] Especially with athletes.
[32:15] When women do it, it's an eating disorder.
[32:18] It's an eating disorder for the men as well, but it's kind of, it's more accepted.
[32:22] What's that about?
[32:23] Yeah.
[32:23] I think there are so many double standards for men and women in our society as well.
[32:27] Like, I think you're absolutely right.
[32:29] There are certain things that men can do that, like going to the gym for hours a day and things like that, where if a woman did that, that would not be considered healthy.
[32:38] She's got BDD and an eating disorder.
[32:40] Yeah.
[32:41] And they're just eating like a protein and like an egg and just got their protein shake and then they're working out for so long obsessively.
[32:49] So true.
[32:50] Yeah.
[32:50] If you saw me eating an egg in a protein bar and spending five hours in the gym, you'd be like, she needs help.
[32:55] Yeah.
[32:55] Yeah.
[32:56] From a psychological perspective, we would probably think about it the same way.
[32:59] If a man came to me describing that sort of gym routine and that diet, I would be thinking, okay, this is potentially an eating disorder or BDD.
[33:07] But for the general public, you're right, the conversation about it looks very different.
[33:11] Yeah.
[33:12] Let's talk about rhinoplasty or nose jobs.
[33:15] Something you said before just got me thinking about this person that I know.
[33:19] She got a nose job and hated the results so much.
[33:25] I feel like a nose really defines your overall look.
[33:29] You can completely change your entire face by changing your nose.
[33:35] And you can look at some before and afters on some famous plastic surgeons on Instagram.
[33:39] Instagram and it is literally like a completely different person.
[33:42] Yeah.
[33:42] So I know someone who went and she got her nose done.
[33:44] She had a bump on her nose.
[33:46] And then when she got the cast off and there was the reveal, she just burst into tears and she hated it so much because it didn't look like her.
[33:54] She felt like a complete stranger looking back at herself.
[33:57] And then she needed a lot of help after that to process.
[33:59] It was kind of like, what have I done to myself?
[34:02] Do you see patients like that?
[34:03] Yes, definitely.
[34:04] Yeah.
[34:05] It's quite common, like the emotional journey after surgery, when your body or your face undergoes this massive change really quickly, that it takes time for your brain to catch up and process it and develop a new identity around it.
[34:19] So it's not uncommon for people to look in the mirror and be like, whoa, I look different and that's what I wanted, but it doesn't feel like me.
[34:25] Yeah, and that can be really upsetting for a while.
[34:28] Typically, in most cases, it's just an adjustment period, that it takes a little while to get used to it, to be seeing that face in the mirror each day, and then eventually they can integrate it and they're quite happy with the results.
[34:40] But for some people, it just continues, that it just doesn't feel like them and they never quite come around to it.
[34:46] And that's when they might start thinking about revision procedures and how can I fix this or undo this.
[34:50] Yeah.
[34:51] And a lot of the time there's that self-blame that comes through.
[34:54] Like how could I have done this to myself?
[34:56] Yeah.
[34:57] And then that kind of self-blame but also the shame.
[35:00] Yeah.
[35:00] I'm so vain.
[35:01] I can't believe I did that to myself.
[35:03] I spent that money.
[35:04] I went and did for this that I'm not happy with.
[35:06] Who even am I as a person?
[35:08] Yeah.
[35:09] Yeah, I know people have gone through that and it's…
[35:11] Sad.
[35:12] It is.
[35:12] It's a big thing to put yourself through general anesthetic and a surgery.
[35:16] And also a lot of money.
[35:16] For something that's elective and high risk.
[35:19] So high risk.
[35:20] Yeah.
[35:20] People die from elective surgeries.
[35:22] Yeah.
[35:23] So true.
[35:23] What responsibility do cosmetic practitioners have in screening for BDD?
[35:28] So in Australia, they are obligated to screen for BDD before any cosmetic surgery and also a non-surgical cosmetic procedure as well.
[35:38] So that is veneers to injectables, anything that has the primary focus of changing a person's appearance, they have to assess for BDD.
[35:47] Do you run that?
[35:48] Do you educate people?
[35:49] Yes.
[35:49] Okay, this is what you're looking for.
[35:50] Yes.
[35:51] So I do a lot of training with cosmetic practitioners on how to identify BDD, how to use screening tools to help with that process, how to have the sensitive conversations, because that's always the most challenging part.
[36:02] We can pick up the issues there, but then how do I actually talk to someone about it?
[36:06] When I had my blepharoplasty done, so my eyelid surgery, I saw the surgeon and I was like, yep, book me in.
[36:14] I want to do it.
[36:15] And they're like, no, no, we can't book you in.
[36:17] You need to go and have a think about it.
[36:19] And then if you want to book it in, you can come back after a certain amount of time.
[36:22] That's law, right?
[36:23] Yes.
[36:23] New regulations to protect people.
[36:25] Exactly.
[36:27] So you're saying, so you see your surgeon, have a consult, and then you go, I want to book it in straight away.
[36:33] They're like, no, no, no, you can't.
[36:34] You have to come back and have another consult.
[36:36] Is that what it's called, the cooling off period?
[36:37] Yeah.
[36:38] Is this new?
[36:39] Yeah.
[36:39] So that came in for surgery in 2023, those new guidelines.
[36:43] And then last year, they brought out similar guidelines for non-surgical procedures, but there's no cooling off for mandatory two consultations for non-surgical.
[36:51] Okay.
[36:52] Okay.
[36:52] but they are expected to be assessing for mental health or body dysmorphic disorder.
[36:57] So Dr. Tony, from a psychological perspective, how might significant body changes, whether from medication or other interventions, interact with body image and or BDD vulnerability?
[37:08] So with any major change in appearance, particularly something that happens quite quickly, like the weight loss that we're seeing on GLP-1s or getting a cosmetic surgery, it's...
[37:17] your brain has to adjust to the change.
[37:19] And so sometimes that happens quite quickly and the brain hasn't caught up and people are still feeling like they're in a much larger body than what it appears to other people.
[37:28] Like shallow hell.
[37:29] Yeah, exactly.
[37:30] So they still see themselves the way that they were.
[37:33] Potentially there was stigma attached to that body that they were in that it takes a
[37:41] they might just see themselves as being bigger than they are and therefore continue the medication or try to lose more and more weight beyond the point that might actually be helpful for them.
[37:50] We're also seeing, obviously, a lot of people who are already feeling quite sensitive about their body image might not be suitable medical candidates for GLP-1s, but able to access it from remote prescribers or from their, you know, other sources, unregulated sources.
[38:06] Yeah, exactly.
[38:08] And that's really scary as well.
[38:10] Are you seeing a lot of BDD related to GLP-1 medications in your practice?
[38:16] Yeah.
[38:16] Yeah.
[38:17] Yeah.
[38:17] It's definitely something that's coming up.
[38:19] Whether there was BDD there already and then they've started taking this medication and it's really intensified it.
[38:25] People are developing eating disorders from being on GLP-1 medications as well because it just becomes so easy not to eat or not to eat enough food.
[38:34] At the same time, they're getting a lot of social feedback from other people telling them they look great.
[38:38] You've lost so much weight.
[38:39] You look fantastic.
[38:40] And therefore, I need to maintain that, I need to keep that going.
[38:42] But then it becomes a point where it's like, whoa.
[38:45] Whoa, yeah.
[38:45] Whoa.
[38:46] Yeah.
[38:46] Are you okay?
[38:47] Yeah.
[38:48] Yeah.
[38:48] But then there's also this other thing, because I've got a friend.
[38:52] She went on a GLP-1.
[38:55] She was prescribed it from a doctor for health reasons.
[38:57] Yes.
[38:58] Okay.
[38:59] And she lost a lot of weight.
[39:01] Yeah.
[39:02] From then, she was feeling fantastic about herself.
[39:05] She was eating well.
[39:05] She was going to the gym.
[39:06] She looks great.
[39:07] She was like so good.
[39:08] Yeah.
[39:08] And then it's like I've done all this hard work.
[39:11] I've done the right thing.
[39:12] Now I've got all this loose skin around my stomach that I can't dress properly now.
[39:17] Like she's gone to like a size – she's probably gone from like a size 18 to a size 8 or 10.
[39:21] But she can't wear things because she's got all the skin.
[39:24] Yeah.
[39:24] Right?
[39:25] So then –
[39:26] The next part is doing the tummy tuck and then the boobs have lost all the fat.
[39:30] So the boobs are down past the belly button.
[39:32] So then it's getting the breast lift to accompany the new size of her frame.
[39:37] And then it's the face has sagged.
[39:39] So it's kind of like, I would say in this case, it's not like a BDD issue.
[39:43] It's a
[39:44] I've got to this size and now everything else functionally doesn't look right, doesn't work right.
[39:49] Now I need to amend these things as well.
[39:52] Then you would hope that it would finish.
[39:54] It's like when it doesn't end right.
[39:56] But I think with drastic weight loss, I can see how after that then people would pursue other things.
[40:02] Yeah.
[40:04] to finish what they started.
[40:06] Started, yeah.
[40:07] I agree.
[40:07] I agree.
[40:08] And we see that a lot with like bariatric surgery and the massive weight loss that comes from that.
[40:13] And that was around, I guess, for a while before GLP-1s were.
[40:16] And a lot of the time, part of the informed consent process for that is telling people like, yes, you might lose a lot of weight and that could lead to other aesthetic changes, which might mean that you end up considering surgeries, abdominoplasties and things like that later down the track.
[40:31] Whereas I don't think those conversations are happening enough with GLP1s.
[40:34] People aren't prepared for the aesthetic changes that are going to happen.
[40:38] And particularly if they're motivated to do it for aesthetic reasons, I think that can be very upsetting and quite distressing when suddenly it's the loose skin and the facial aging and these things that they really weren't prepared for.
[40:49] Prepared for, yeah.
[40:50] So if someone recognises themselves with BDD.
[40:55] Yeah.
[40:55] Or a friend or family member.
[40:56] If you're listening, you're like, gosh, this sounds like such and such.
[40:59] Yeah.
[41:00] What evidence-based treatments are available and what does the recovery realistically look like?
[41:05] So first line treatment for BDD is cognitive behavioral therapy, retraining the way that you think about your body and the way that you talk to yourself about your appearance and then also developing some behavioral changes like reducing the amount of time people spend looking in the mirror or taking photos or videos of themselves or reducing the safety behaviors they might be using like putting on lots of makeup or fixing their hair all the time and things like that.
[41:31] And as well as exposure therapy.
[41:33] So a lot of the time people are avoiding going out or avoiding going to certain places and we have to slowly expose them to doing those things again and getting the evidence that they can go and possibly enjoy themselves.
[41:45] Nobody comments on their appearance, maybe they don't have a bad time.
[41:49] And then their brain starts to unlearn these messages.
[41:51] Mm-hmm.
[41:52] And, you know, recovery looks different for everyone.
[41:56] I love the small wins, like when people are so proud of themselves for being able to just go to a shopping centre, which was something they could never have done before because there are so many mirrors around.
[42:06] But then there are things, you know, people...
[42:08] being able to go back to work and have healthy relationships and have a day where a pimple pops up and it doesn't ruin their whole day.
[42:15] Like that's often the biggest success stories where a pimple before might've sent them into a spiral and they would have stayed at home for three weeks.
[42:22] They can have that pimple.
[42:24] They can be a little bit bothered by it and then get on with their day.
[42:29] Talking about, you know, someone going out and no one commented on their perceived physical flaw, I feel like it's also really important when someone goes out not to tell them they look good as well, right?
[42:42] Like, just don't comment on someone's body.
[42:44] If you know that there's someone who might have trouble with this and they come out and it's almost like you don't say, you look fantastic, you look amazing, you've lost so much, like, just...
[42:54] Comment on, it's so lovely to see you.
[42:57] It's so important, right?
[42:59] I feel like positive body comments are bad too.
[43:01] Yeah, both can be harmful.
[43:04] And when you get a positive comment about your appearance, it's like, oh gosh, what did I do today to get that comment?
[43:09] Now I need to do that every time I go out.
[43:11] Or what about the last time I didn't get that comment?
[43:13] What does that mean about me?
[43:14] Yeah.
[43:14] Yeah.
[43:15] So I think a good rule of thumb is the five-second rule, that if you're going to comment on someone's appearance, it has to be something they can change in five seconds or less.
[43:24] And if they can't, don't do it.
[43:26] So if it's like they've got some food in their teeth, tell them.
[43:29] Let them know so they can take the food out of their teeth.
[43:31] Always, P.S., if you're listening, always call it out.
[43:33] Yeah, yeah.
[43:34] Even if it's a stranger, just wait, oh, just a little.
[43:36] Yeah, yeah, yeah.
[43:37] Yeah.
[43:37] Yeah.
[43:37] toilet paper hanging out your pants, let them know.
[43:39] Yes, call it out.
[43:40] Yeah, yeah.
[43:41] But if it's something like, you know, their skin's not looking as bright today or something like that.
[43:46] Or you look really tired under your eyes.
[43:48] Yeah, yeah, yeah.
[43:49] Exactly, that's a great one.
[43:50] It's like, oh, go get a lower blepharoplasty and a fat transfer after that one comment.
[43:53] Yeah, yeah.
[43:54] Exactly.
[43:55] Don't mention it.
[43:56] Five-second rule.
[43:57] Love that.
[43:58] And if you want to give them a compliment, compliment something that's not appearance related.
[44:02] You're such a great friend.
[44:03] Like I love it when you listen to me.
[44:04] Your voice is amazing.
[44:05] Yeah.
[44:06] Exactly.
[44:07] I'm always so glad you're here.
[44:08] When you're here, the energy is just so good.
[44:10] Yeah.
[44:11] Exactly.
[44:12] Yeah.
[44:12] Yeah.
[44:13] I have a question about cognitive behavioral therapy and about talking to yourself in a more positive way and how that can reshape the brain.
[44:24] does saying things out loud, you look amazing today, you're great, your body's strong and fit.
[44:31] And even if you don't feel it, if you say it out loud, because I say these things on Instagram, they're like, if you say it out loud, you'll trick your brain into believing it.
[44:40] I do that.
[44:41] Does that work?
[44:42] I do it sometimes when I'm feeling anxious about work.
[44:44] Like if I have to go do a speech or a piece to camera and film or go live TV and I'm anxious.
[44:49] I'll be like, you're great at this.
[44:50] You've done this for 10 years.
[44:52] You're a big judge.
[44:53] You do this.
[44:53] This is like bread and butter for you, right?
[44:55] Can you do that about your physical appearance?
[44:58] Like, your nose is amazing.
[44:59] You've got the best nose in the world.
[45:01] Your tits look great.
[45:02] I'm fucking over my nose.
[45:03] You've got the greatest, bestest nose ever.
[45:06] Does that work?
[45:09] So different things work for different people.
[45:11] Definitely like those affirmations can pump people up and just give them that little confidence boost to get out the door and then hopefully have a good experience when they're out.
[45:20] Some people find it doesn't land for them because they're like, I hate my nose.
[45:23] Telling myself it looks amazing just feels like I'm gaslighting myself.
[45:26] So you can't, because sometimes you see people promote that as fact.
[45:29] No, no, you can rewire your brain by saying positive things.
[45:32] Your brain will start believing it.
[45:34] Yeah.
[45:34] So that's not always the case?
[45:35] So what I work with people on is not necessarily developing positive thoughts to challenge negative thoughts, but let's develop realistic and balanced thoughts to challenge an unrealistic thought.
[45:46] Okay.
[45:46] So for example, like... Yeah, reframe that.
[45:48] Yeah.
[45:48] Like if I am going to walk into a room and I think everybody is looking at my big nose, mm-hmm.
[45:54] then it might be thinking, okay, well, what's the evidence for that?
[45:56] When was the last time I walked into a room and people made comments about my nose?
[46:00] Actually, that didn't happen since I was 10 years old, maybe.
[46:03] So, you know, I can walk into a room and say, people probably aren't paying attention to my nose.
[46:09] So it's not trying to say to yourself, people aren't looking at me or I look great.
[46:13] It's what's actually the realistic possibility here?
[46:15] Probably people aren't thinking about it.
[46:17] Yeah, and what if someone comes up to you and you're like,
[46:20] Like, hey, babe, how are you going?
[46:21] Good.
[46:22] Oh, my gosh, but I've got this and this and this, and they're pointing out their defects.
[46:27] We do that a lot.
[46:27] Women do that a lot.
[46:28] I just, like, if I... Oh, I've got this big pimple.
[46:30] Yeah, how are you going?
[46:31] I've got a cold sore.
[46:32] Oh, my God.
[46:33] Like, how do you, as receiving those messages from someone...
[46:38] What do you say to them back?
[46:40] I would probably go with the changing the subject and just kind of moving on talking about something else because sometimes when we make those comments, we're either looking for that reassurance, like, no, you look fine, it's not as bad as what you think, or we think, oh, we need to tell people that it's there so that they're not thinking about it first before I've let them know.
[46:57] Like, I just want them to know I can see it too.
[46:59] Mm-hmm.
[47:00] And either way, I think if you comment on it, it can reinforce some unhelpful thinking about it.
[47:05] Like, oh, yeah, I see it, but it's not that bad or something like that.
[47:09] Often people will then have stories in their head like, oh, they're just being nice to me or they're not being honest.
[47:14] Yeah.
[47:14] So I might just kind of brush past it and keep on moving on rather than engaging with the conversation more.
[47:21] Right.
[47:22] There you go.
[47:22] So many things we've learned today.
[47:23] Wow, that was awesome.
[47:24] Yeah.
[47:25] I was kind of a bit scared going into this topic.
[47:27] Well, it's a big topic.
[47:29] It is.
[47:30] And it's a sensitive one.
[47:31] Yeah.
[47:32] And we're on a podcast that talks about vanity and promotes, promotes, no, no, it doesn't promote.
[47:38] I would say we de-influence a lot, actually.
[47:41] Yeah, I feel like we de-influence a lot.
[47:42] We discuss...
[47:43] current wellness and cosmetic trends, surgeries.
[47:47] There's a lot of people who naturally in our audience would have BDD, right?
[47:52] And there's also people like us who don't, but we are all about enhancements for empowerment and for confidence.
[47:57] Yeah.
[47:58] So...
[47:59] Body dysmorphic disorder is something that is real amongst our audience.
[48:03] But it's still something very touchy and difficult to talk about.
[48:07] And especially, we're lucky, we partake in these procedures.
[48:11] But we're also very naturally thin and there's...
[48:15] Yeah, it's just felt a bit funny driving in today going, we're talking about this.
[48:19] Yeah.
[48:20] There's, yeah.
[48:21] And I think it's because, you know, it's obviously mental health.
[48:24] It's, you know.
[48:24] It's a sensitive subject.
[48:25] It's a sensitive subject.
[48:26] And I'm always, you know, very cautious and aware and also very scared to talk about like these things because I don't want people to just think.
[48:32] It's more like what would you know?
[48:34] Yeah, yeah.
[48:34] You were born like this or you don't have these issues.
[48:37] Yeah.
[48:38] But it's also like I've learned so much and I'm so happy we had these conversations, like especially when we've got teenage kids.
[48:44] Totally.
[48:44] Totally.
[48:45] And like, what are the signs?
[48:46] And I didn't know that body dysmorphia was just, I just thought it was weight, but it's actually like a whole, it's treatments as well.
[48:53] So anyway, it was really good.
[48:55] It was really good.
[48:56] It was so good.
[48:57] And I think what we're about on Vanish is being very transparent with our audience, not gaslighting our audience and pretending that we wake up.
[49:08] looking a certain way.
[49:09] We do not wake up like this.
[49:10] We do a lot of the things.
[49:11] We do all of the things, the lasers, the surgeries, the injectables, the hair, the lashes, the extensions, the teeth whitening, the saunas, the supplement, the every, we do it.
[49:18] This ain't genetics, babe.
[49:19] Right.
[49:20] So we're hoping that we can, throughout this journey, like share some real talk with you and educate and help along the way.
[49:29] And yeah, we hope you've got something from this today.
[49:31] And if you recognize BDD in yourself,
[49:34] or in any of your friends or family, then pass this on.
[49:39] Reach out to Dr. Tony.
[49:41] And if you need further help, there's always that lifeline number.
[49:45] It's in the show notes.
[49:47] Yeah, thanks for listening.
[49:48] We think it's been a really important one.
[49:49] It has been.
[49:51] Thank you.
[49:51] Thanks, Dr. Tony.
[49:52] Thank you so much for having me.
[49:54] Thanks for coming out.

Shows are listed from Apple Podcasts' charts and directory, and Podcast Index where it is used. Every show and episode belongs to its publisher and plays from the publisher's own feed; this site hosts none of them.