HealthyGamerGG - Male Body Dysmorphia

Episode Date: October 26, 2022

Today Dr. K dives into body dysmorphia in men. He covers image issues, how dysmorphia manifests differently, rational vs irrational, and more! Support this podcast at — https://redcircle.com/healthygamergg/donationsAdvertising Inquiries: https://redcircle.com/brandsPrivacy & Opt-Out: https://redcircle.com/privacy Learn more about your ad choices. Visit megaphone.fm/adchoices

But the key thing is that if you really look at the root, it's that something about the way that I judge the way that I look is unacceptable. So I feel unattractive. I feel unacceptable. I feel like I should look differently. And that's kind of the core, core, core feature of both of these buckets. Today, what I want to talk to you all about is something that's a little bit different. I want to talk to you all about eating disorders and body image issues. And I think that to start off with, I kind of want to dive into a little bit of like a psychiatric history. And then what we're going to sort of discover is that the way that we perceive eating disorders and body image issues is actually like quite gender specific. And I believe there are a couple of changes that are going on in our society right now, possibly due to things like social media, which have suggested to me that we may even have like emerging manifestations of body dysmorphia or eating disorders that are a little bit different in men.

So let's start with sort of a historical perspective. So if you look at kind of like psychiatric diagnoses related to body image in the way that people look, we tend to see two major buckets. The first is something called eating disorders. So these are things like anorexia nervosa, bulimia nervosa, binge eating disorder. So these are situations where, you know, someone engages in disordered eating. So eating in which they severely restrict their eating, which is the case in anorexia. Or sometimes they'll binge and purge, so they'll eat a large amount of food. and sometimes they'll vomit the food later in order to avoid getting the calories and changes to their body image. And so that's kind of like the eating disorder buckets. And then we have a separate bucket, which is body image-related issues where we think of diagnoses like body

dysmorphic disorder. So in body dysmorphic disorder, there may be some kind of disorder eating associated with it. But this is a situation where usually people are preoccupied with a particular feature of their physical form. And they feel really, really, really, really unsatisfied with a particular feature. So sometimes we'll see body dysmorphic disorder manifest in different places. So oftentimes not with a psychiatrist, but plastic surgeons, for example, will see body dysmorphic disorder. E&T doctors will oftentimes see body dysmorphic disorder where someone is very hung up on their nose or their appearance and people will come in for surgery. I almost wonder a little bit about all of these leg lengthening surgeries that I hear about

nowadays and whether that's actually associated with body dysmorphic disorder. But the key thing is is that generally speaking in psychiatry, we tend to, if someone is unhappy with the way they look, we tend to bucket them into an eating disorder or a body dysmorphic disorder. The thing is, if you sit down and you talk to these people, or at least this has been my experience, and you ask them, okay, so I understand that you want to get plastic surgery. Help me understand a little bit about why you want this surgery in the case of body dysmorphic disorder or people who are getting implants in particular parts of their body. And if you talk to someone who's got, let's say, anorexia and you ask them, okay, tell me a little bit about like what's in your head. So I understand

that you're quite restrictive with your eating or you're careful about what you eat, right? So we don't want to use a judgmental diagnostic word. But when you talk to these actual people, what you discover is that what the root for me, at least, appears to be exactly the same, which is both of these diseases, I think, are manifestations of a core image issue. So when they look in the mirror, there's something fundamentally that they don't like. When they look in the mirror, they see something that they do not like. And then what they try to do is try to move towards an ideal body image in their mind through these different paths. So for some people, it manifests as like restrictive eating. For other people, it manifests as some kind of surgery or whatever else we can see from body

dysmorphia. But the key thing is that if you really look at the root, it's that something about the way that I judge the way that I look is unacceptable. So I feel unattractive. I feel unacceptable. I feel like I should look differently. And that's kind of the core, core, core feature of both of these buckets. So oddly enough, even though we sort of diagnose them quite differently, like the diagnostic criteria are very, very different. When I sort of think about these patients, I almost kind of treat them the same way, especially in psychotherapy, which is sure there may be particular behaviors that are kind of the end manifestations of their core psychological issue. But the core psychological issue is essentially the same, which is unacceptable, not accepting the way that we look,

or being very, very bent out of shape about the way that we look. Now, the interesting thing is that if you look at these diagnoses, what you'll sort of discover is that there's a big gender difference in terms of how often people get diagnosed with this stuff. So, for example, anorexia nervosa has somewhere between 0.6 and 2.2% of the population has anorexia nervosa. So we're talking less than 1 in 100, up to maybe about 1 in 50. The other thing that we notice about anorexia is that,

it tends to have a very, very strong gender skew. So for every man who is diagnosed with anorexia, three women are diagnosed with anorexia. We also see this pattern exist in other eating disorders, like binge eating disorder is like about a two to one kind of ratio. Seems to be a little bit more even. So we know that there are, that women seem to be suffering from eating disorders more than men are. And you could also sort of extend that out into an assumption or extrapolate that out that disordered image is more common in women than it is in men. And there's kind of a really interesting reason that I think we're starting to discover is that our initial diagnostic criteria for something like anorexia

was very, very culturally and gender-specific. So just to give you all an example, so if we look at the diagnostic criteria for anorexia, or sorry, not the diagnostic criteria, if we look at the screening questions that people ask for when we're trying to screen for anorexia. And by the way, so certain organizations like, you know, primary care physicians in the United States, the standards of care that are determined by the U.S. government suggests screening all women for eating disorders, but not screening all men. Now, I don't think that that is any kind of like discrimination.

I think that that's just sort of valid, right? So, like, for example, we don't screen men for cervical cancer because they don't have a cervix. we don't ask men to get mammograms on a, you know, every five years to screen for breast cancer because the incidence or prevalence of this illness within a particular gender population doesn't really suggest that screening is appropriate. At the same time, I think what we're starting to discover is that a lot of our assumptions about eating disorders were very, very culturally specific and also gender specific. So, for example, as we've learned more about eating disorders, so a lot of the research on

eating disorders and diagnostic criteria essentially came out of studying women and Caucasians. And so now as we're sort of starting to see like do more culturally sensitive psychiatry, we're starting to see, for example, that eating disorders and body image issues manifest differently depending on your culture, even your sexuality. So we know that, for example, body image issues in people who are homosexual manifest differently from the way they manifest in people who are heterosexual. We know that, for example, body image issues in the Singaporean and Chinese community are different than in the Caucasian community, are different in, let's say, African communities or Latin American communities. And so we're starting to discover that our initial assumptions about,

you know, how we diagnose an eating disorder was very, very culturally and gender bound. And I think this is best exemplified by the U.S. preventative task force, forces screening question. for eating disorders. So what I'm going to do right now is just read a couple of these questions out to you. So here's how we screen for eating disorders. So for example, do you make yourself sick because you feel uncomfortably full? Do you worry you have lost control over how much you eat? Have you recently lost more than one stone or 14 pounds or 6.35 KGs in a three-month period? Do you believe yourself to be fat when others say you were too thin? Would you say that food dominates your life. Hey, chat. If y'all have wanted to try coaching, your first session is now on us.

All coaching packages also include access to Dr. Kay's guide, which includes the new guide to ADHD and doing stuff. So book a coach today using a link in the description. So if we listen to those screening questions, what we notice is that these are screening questions that have to do specifically with weight loss. And that's because if you look at people who have anorexia, right, they're very, very, very concerned about having a low weight. But if you kind of go back a little bit and step away from the manifestation of the eating disorder and go to the core issue, the core issue is when I look in the mirror, I really, really don't like what I see. And this is almost like an irrational belief, right? Because I can look at myself and I can be unsatisfied. That's a normal human experience. And we can

move to make changes to our diet or exercise or whatever to start to feel better about the way that we look. The key thing, though, is some of those beliefs are rational and some of them are irrational. And how do you tell the difference? Well, it's like, do the beliefs change depending on your appearance? So if I look in the mirror and I say, hey, I'm a little bit overweight or I'm overweight, and then I proceed to lose five pounds or lose 10 pounds. And then when I look in the mirror, does my response change? So as I start to get healthier, do I feel more satisfied with myself?

Or do I persistently believe that what I see in the mirror is unacceptable? And that's really the key difference between sort of unhealthy body image and a healthy body image, which is that is it responsive to feedback. And so what we tend to see is our screening questions are really focused on weight loss. But really the core issue here is a body image issue. And as we've done more and more research on different cultures and different genders, what we're actually starting to discover is that core issue of body image manifests in different groups of people in different ways. So for example, if you try to screen a man for body image-related potential diagnoses, the screening questions that we have, which are screening questions for eating disorders, may not actually apply to men because as we've discovered and we're about to get into,

body image issues for men are actually quite different. So as we've learned a little bit more, we've discovered, okay, what kind of body image issues do men have? So I think these are really best described by sort of like the mesomorphic ideal. I'd want to say maybe 60 or 70 years ago, there was. a physician who sort of described that there are three body types. So one is sort of like thin and bony. One is what we would call kind of like big bone. So these people have tend to have like rounder frames or stockier built, tend to be like wider as opposed to taller. So we sort of know that there are these different kinds of body types. And the middle type is something called

mesomorphic. And so mesomorphic people have wide chests, narrow waists. So wide like shoulder length, actually. So the width of the shoulders are wide. Narrow waists compared to shoulders, a high degree of muscular definition. So like very, very visible muscles, a low body fat percentage. And so this is kind of like the mesolimbic, I mean, mesomorphic body type. And so if you look at sort of perceptions of male ideals and you look at men and the kinds of bodies that they aspire to, they tend to essentially focus on this mesomorphic ideal. And so the key thing is that I'm interested in a mesomorphic ideal. If you ask me, have I lost weight over the last, you know, three months? That's something that I'm not going to be interested. My goals or my,

my insecurity in the way that I appear won't map on to the screening questions, right? Because what I actually want to do is I want to put on weight. I want to build muscle. I want to be bigger. I'm not interested. It doesn't bother me that I lost any weight. Like, that's not an issue. I don't try to control myself by slimming down, slimming down, slimming down. What I actually want to strive to do is bulk up, bulk up, bulk up. And so as we're sort of learning more about changes in male body image and body image related diagnoses, what we're sort of discovering is that the old systems of diagnosis don't appear to map on to men kind of nearly as much. And so there are even some studies of there's kind of a new diagnosis that people are kind of considering called muscle dysmorphia.

So this is where people are like really, really concerned about their lack of musculature and really strive to be like more muscular. And sometimes to the extent of really engaging in very harmful behaviors like anabolic steroid use or things like that, that actually like really negatively impact them. So muscular dysmorphia is an example of a new diagnosis that people are starting to explore. If you talk to people who have muscular dysmorphia are sort of in that vein, and by the way, men, about 2.2% of men have muscular dysmorphia according to some research. So remember, once again, that like the prevalence of anorexia for women is also around 2.2. It's like less than 1% for men.

And so what we're starting to see is that if you have a core image with the way that you look, and for women it may be that I need to be thinner and women have unhealthy ideals that are portrayed to them by the media and things like that. But those ideals tend to be like gender specific, right? So for women, it tends to be focused on thinness. For men, it tends to be focused on muscularity. And if you take those men who are very, very focused on muscularity and feel, like they have insufficient, their body is not acceptable enough. And you start to ask them more

specific questions, what you sort of discover is that you kind of get the same number of people, men and women who are unsatisfied with their body. And the number tends to be around 2%. So that's kind of like an interesting discovery. So as we've done more and more research on men and how their appearance, what we started to discover is that it just looks different in men, that the root is still the same. That when I look in the mirror, I'm fundamentally unsatisfied with what I see. But the way that that dissatisfaction with my appearance manifests in the kinds of questions that need to be asked are not actually the standard screening questions for things like eating disorder or even body dysmorphia, which is usually focused on a particular feature like your

nose or chin or whatever. So this is kind of a really important discovery because I think what it sort of suggests is that probably for the past two generations, we've had men who have probably had something similar to an eating disorder or a body dysmorphic disorder, but our diagnostic criteria have not really been able to pick that up. This is becoming increasingly problematic because what we're sort of seeing is that changes in social media and technology tend to be propagating this phenomenon. So this is where I just made a statement that for the past two generations, there's a chance that we've been sort of missing diagnoses for lots of men.

But that may not necessarily be the case. What we could actually be seeing is that actually it wasn't that. bad, let's say one generation ago, 50 years ago, 60 years ago. But now what we're seeing is an acceleration of body image-related mental health issues in men because of things like social media. And so as we've done a lot of research, we've discovered a lot of really interesting things. So the first is about 85% of college students in one study that was done in France are unsatisfied with their muscularity. Now, this doesn't mean that they have muscular dysmorphia. what this sort of means is that 85% of college-aged men in France at least, and this is, I think, pretty generalizable, tend to be pretty unhappy with the way that they look. And that probably is influenced by social media. So what we sort of see is that much like the same factors that drive unhealthy body image in women also drive unhealthy body image in men. And social media is a big part of that. So as we tunnel down and we start to ask men who feel uncomfortable with the way that they look,

okay, what's going on in your life? Like, where do these thoughts come from? What has your upbringing been like? What we discover is actually quite shocking. Okay? So we're going to talk a little bit about that. So as awareness that body image issues in men may be worse or look different from body images, the way that body images look in women, as awareness of this has grown,

researchers and clinicians have started to dive more into men who struggle with body image issues. And what they've tried to do is figure out, okay, how big of a problem. is this? And more importantly, how do we detect the problem? How do we catch all the people who have fallen through the net? And what we've discovered is actually incredibly fascinating. So the first thing is that anywhere between 25 and 68% of men with body image issues have very, very critical or emotionally abusive parents. So emotional abuse by parents or being neglectful or parents chiding your appearance or making fun of your appearance seems to correlate very, very, very highly with having male body image issues.

Once again, this may not be very different compared to women. So women may experience sort of the same numbers. And that's sort of shared, right? So we know that if you've got critical parents, that there's a greater chance that you'll develop body image-related issues. Other really shocking things include, so sometimes we'll see high incidences of trauma. So including like 28% in one study of men with body image issues

were actually sexually abused. So that's a shockingly high statistic. that I think is probably a bit of an outlier. But we definitely see a history of abuse or emotional neglect or very, very critical parents and especially parents who are critical of appearance. Another thing that we tend to see when we explore what's it like to have body image issues as a man, we tend to see that there's a lot of social anxiety. And so this is kind of interesting, but it seems like one of the most common manifestations

of body image issues is what men will describe is socially anxious. So if you kind of tunnel down into this, what you find is that they compare a lot. And they also do upward comparisons. So some people in their head will be constantly or commonly comparing themselves to someone else or some kind of ideal and will be falling short. The interesting thing is that when you ask this person, okay, like, what do you experience? They won't say, oh, yeah, I have body image issues. What they will describe subjectively is that,

I'm socially anxious because what that sort of means is that when they go into social situations, why do they think they have social anxiety? It's because their mind is constantly making image-related comparisons with other people around them. That's really what their manifestation of social anxiety looks like. We also tend to see that men with body image issues are high on the alexothymia scale. So Alexa thymia is the inability to recognize or name your emotions. So they tend to feel a lot, but they're not really sure what they feel, and they're almost colorblind to it. And when we become colorblind to our feelings, what tends to happen is we start to form

complex, almost logical narratives in our head about the way we feel about ourselves and the way society is and things like that. So those emotions, we don't recognize them as emotions. They almost transform into something like logic in our minds. And so as we tunnel down into like what we know about men who struggle with body image issues, and this is another huge problem with the research, is that most of the research, I would say I read about 20 papers

in preparation for this, including textbooks and things like that. Sorry, not including textbooks and stuff. And I would say about 30 to 50% of the papers that I read actually focused on bodybuilders. So this is another problem that we have on research for men with body image issues, is that we tend to focus on people who are bodybuilders and sort of very, very obsessively exercise.

Whereas my guess is that actually a lot of what we're seeing in terms of male mental health problems may be more related to body image issues than something else. But it manifests in kind of a different way. It manifests as social anxiety. It manifests as shame. It manifests as all of these different things. But as you actually tunnel down, my guess is that there's a lot of men out there who fundamentally don't feel good about themselves when they look in the mirror. Now, some of this may be within the normal.

range, right? It's not necessarily a psychiatric illness, like we sort of mentioned, 85% of college men in France in a particular study felt really, really unsatisfied with their appearance. And I would imagine that upwards of 50% of women, I don't know exactly what the number is, also probably feel very dissatisfied with their appearance when they look in the mirror. What we're sort of noticing, though, is that the manifestations of these body image issues may be masquerading as other things. They'll manifest to something like social anxiety or social withdrawal, is very common for men with body image issues. They also manifest as other things like emotional numbness,

as well as, what was it? I was going to say one other thing that's really common. Emotional numbness, social withdrawal. Yeah, like social isolation is another piece of it. And the other really interesting thing is that even if you look at this whole like alpha beta thing, right? So the alpha beta thing, if you really look at what's the foundational belief for this alpha beta conversation, at the bottom of the whole belief system,

is an image issue, right? It's that there's a particular ideal. Those people are the alphas, and people who don't fit into that ideal are the betas. The other interesting thing about a lot of the alpha-beta dialogue or discussion is that it shares a lot of features of that irrational, logical belief system, right? What do I mean by illogical, I mean, logical, I mean, logical irrational belief system. What I mean is that it's internally consistent in terms of logic, but it's not actually like based in science. Or more importantly, people who make progress in terms of their appearance don't actually feel better about themselves, right?

Once a beta, always a beta. And once an alpha, always an alpha. So these kind of unchangeable qualities, I actually wonder if a portion of those people are more in the bucket of actually having like a masculine body dysmorphia kind of diagnosis. Now, we can't diagnose people over the internet. That's not what we're designed to do. And we're also not, we don't even know that that diagnosis really exists.

The reason that I'm sharing this stuff with y'all is because I think that these core issues of body image are starting to manifest somewhat differently in men. And especially because of things like social media, we're seeing people check a lot of these boxes, right? So this is sort of the core reason I'm having, doing this lecture today is because I think if you look at people on the internet, they check so many of the boxes of what we've learned for like, male-related body dysmorphia. So emotional neglect in childhood, sometimes even rising to the level of emotional abuse, hypercritical parents. We're also seeing social avoidance, social withdrawal, a lot of appearance based on comparison and specifically upward comparison. So a lot of these people's thoughts are focused on how I look versus how someone else looks. We're also seeing a high degree of alexathymia amongst a subset of men on the internet. And then the last thing is that

there's sort of this intractable belief that no matter how much I change, it's never going to be enough. Right. So other people will be able to exercise, but I won't be able to exercise. Or even if I exercise, it won't be enough because my jaw line is insurmountable. So if we go back to thinking about, okay, what are like healthy responses to sort of being unhappy with the way a healthy response to it is, okay, let me go exercise. And then when I look in the mirror, I feel better about myself. But what I'm noticing is that there's a subset of people who are men on the internet who, no matter what they do for their appearance, it never feels like it's enough. And so when I see all of these sort of research-based risk factors for body image issues and I see a diagnostic system that was

sort of developed primarily by working with Caucasian women, I start to scratch my head and wonder, okay, if you check all these boxes, do you really have social anxiety? Or at the core of of all of this stuff is when you look in the mirror, no matter what is actually there or what you do, you're always going to feel unsatisfied by it. And if the answer to that question is yes, then I think we could be seeing sort of an emerging body image-related diagnosis for men. So if you feel like you kind of fit some of these boxes,

and this is the really challenging thing, is I would encourage you to go see someone like a therapist. Because, and this is also where things get a little bit tricky, because the therapist is also going to have to understand that, like, you may have a body image-related issue that may not look like anorexia or binge eating disorder, that it may manifest in a slightly different way or drastically different way. And so this is what's really tricky is that we're, even as psychiatrists, we're recognizing that the world is changing people are changing. Technology is changing the way that we perceive ourselves. And so we really aren't entirely

caught up with it. So even things like muscle dysmorphia, which is the most common kind of male-related diagnosis that's studied is not an official diagnosis. So it's like a proposed new diagnosis. So if this stuff kind of resonates with you, I'd strongly encourage you to get evaluated. But even if you get evaluated, consider that the default language that your therapist has may not really perfectly apply to this situation. And you may need to be a little bit more vocal about sort of sharing your thoughts and feelings. And sort of almost not really convincing, but really giving your therapist a window into what your mindset truly is. So hopefully that's helpful. Questions. Let me see if there's anything else we want to talk about. Oh, yeah,

there's one other thing that I wanted to talk a little bit about. So there are also a lot of things in social media, which I think could be propagating unhealthy body image issues that we actually don't think of as propagating unhealthy body issues. So obviously there's a bunch of stuff on social media that's like bad, makes us feel bad about the way that we look. But there's all kinds of things that are actually kind of like more acceptable, right? So if you look at someone who's got anorexia and they will frequently post a lot on social media, by the way, so this is a little bit different. But men who have body image issues, one of the things that correlates with how severe their

body image issues are is lack of posting. So oddly enough, like people who are very, very inactive, or inactive in the sense that they don't post selfies. So like for men, for example, correlation with body image issues or selfie, posting selfies is inversely correlated with body image issues. So the worst that you feel about yourself, the less likely you are to post. Whereas there's some data that suggests that the opposite is true of women. That's just like one example.

But I think a good example of this is like cheat days. So when we look in social media, like in people post about cheat days, right? So this is something that is generally viewed as like good and healthy and acceptable. But if you really look at it, like what cheat days kind of are is like a binge pattern of eating, right? It's like eating 2,000 calories in a particular day. And we'll sort of like socially glorify this in a lot of ways. Other examples of stuff that has been shown to really correlate with negative body image issues, especially for men, or things like fit spiration.

So these are situations where, like, you know, we'll have posts and people will like, we'll sort of accept that this is an ideal that we should all strive for. So even a lot of this like body, you know, this fitzpiration, like fitness oriented content that people make, like food related content that people make may actually be having like a negative damaging impact on our mental health, even though it's sort of like lauded, right? So these people who are like fitness influencers, for example, like we don't think about them as is damaging in any way. We think about them as inspiring. And I'm not suggesting that these people are culpable in any way. I'm just sort of saying this is kind of how our society is evolved where we sort of like, honor those people. We raise them up on a platform. We're like, wow, I really want to look like that.

And what we're starting to discover is that there may be some negative impacts of that kind of thing. We're also seeing just as an interesting tangent. There's another diagnosis that people are proposing, which is orthorexia nervosa. And orthorexia nervosa is like a very, very disordered perception around what you eat. But it's not about losing weight. It's about like wanting to be healthy. So we'll see some horror stories of parents, for example, that will deprive their children of particular, like, nutrition because they're very, very, very focused on, like, a particular, you know, dietary style that they view as, like, fitness-oriented. And in the most tragic cases, what we'll actually see is, like, children who are removed from parents or will suffer, like,

you know, medical complications. And drastic, drastic cases can even pass away from such, those kinds of nutrient deficiencies. And so if you really look at that, like, you know, what's going on here? We're starting to see a lot of different, almost obsessional beliefs about particular kinds of food. And in that case, you know, is it a disorder? Well, we'd sort of say, yeah, in psychiatry, because one of the ways that we define a disorder is that impairs function or damages your life in a particular way. So if you're so careful about the way that you eat because you, you know, I'm on this, like I saw this diet recently where people were eating raw meat and they were getting like parasitic infections because

that's what happens when you eat raw meat is you get parasitic infections. And so that would sort of like hit the threshold of what we would consider a psychiatric illness because it's negatively impacting your function. Now, I'm not diagnosing anyone on the internet who's doing that sort of thing. I'm just sort of saying, in general, how do we define psychiatric illnesses? Well, the line is, does it hurt you? And if it hurts you in some way, then we'll sort of consider it potential psychiatric diagnosis. My point is that there's a lot that's changing on the internet and these core psychological features of, you know, disordered eating or beliefs about health or body image

seem to be manifesting in different ways. And so you all need to be very careful about this kind of stuff. And if you're finding yourself having very, very rigid beliefs about what you should be eating, or rigid, rigid beliefs about how you feel about yourself or what you see when you look in the mirror, if you find yourself making upward comparisons and sort of assuming that there's an ideal body image

that you will never meet, this could be one of those emerging, body image kind of issues, and I encourage you to go seek help. Yeah, orthorexia is really interesting. So FIG 012 is saying, if I fit every description you gave, what are the odds of that being my diagnosis? The odds are very low, okay? So understand this. These are not official diagnoses. That's actually my whole point, is that I think something is going on in our society where the shape of mental illness or mental suffering is changing. And it's changing. And it's changing. so fast that our diagnostic systems are hopefully outdated, but sometimes they're like completely

off base. And so my point is that like I'm starting to wonder whether a lot of the people that I've worked with who are very, very like into this alpha, beta mindset or who describe themselves as being like emotionally numb and socially anxious. But when you tunnel down and you actually ask that person, okay, like what goes on in your head? At the root of it is I don't like the way that I look. And that person is way more handsome than I am. They have a mesomorphic body type. I don't have a mesomorphic body type. And that rest, that's the foundation of all of the thoughts. So because I'm embarrassed about my appearance, I don't want to go out. Because I'm embarrassed about my appearance, I don't want to take a picture of myself. Because I'm embarrassed about my

appearance because I don't look like this particular person, I experience a lot of social anxiety and social withdrawal. And when we think about these terms social anxiety and social withdrawal, we think about social anxiety disorder, right? We think about primarily anxiety-related disorders instead of body image-related issues. And that's my point is that I think that we may be like over-diagnosing people with social anxiety who actually have body image issues. That's actually like kind of the wrong move because what that person may need is something different.

These mesomorphic, et cetera, body types, do they even exist? Sort of. My answer is sort of. There's some evidence of them. It's an area of research that basically got abandoned like 40 years ago, 50 years ago. So someone's Lord Butt pirate is asking, how about, body dysmorphia due to height. This is another thing that I'm actually like noticing. So I don't know if you all have heard about this, but there may be body dysmorphia related to height too. This is what I

think needs to be explored. But there's a lot of interest nowadays in leg lengthening surgery. So I remember the first patient that I saw, which was seven years ago, who was interested in getting a leg lengthening surgery and was a college student. And it wasn't, I don't think it was legal or performed in the U.S. at that point. So they were telling me that they had found a surgeon who performed this surgery in a foreign country. They wanted to fly to the foreign country, get leg lengthening surgery, and like, because they had to do it overseas and it cost a certain amount out of pocket and stuff like that. And, you know, that was the first time I had heard of it. And it sounded very, very unhealthy to me. So we sort of treated that person kind of like a body dysmorphia of

sorts. But now what we're actually seeing is that like a lot more people are getting leg lengthening surgery. And I don't really know what to think about that. Like there's a part of me that's highly concerned that this could be another example of a body dysmorphia where people are like essentially going to a surgeon to fix something about their their body right but it may not be body dysmorphia who knows it could just be societal stuff it could just be like we allow people to change their appearance right so it's not like we anyone who goes and gets a rhinoplasti a nose job it has a psychiatric illness we just allow people to change their parts of their body and we don't necessarily diagnose them with an illness like people are allowed to change stuff

And so where's the line? The short answer is like, we don't know, but this seems to be changing very rapidly. That's why we're sort of trying to bring it to your attention. So one person is saying, I'm short, but that sounds way too extreme and painful. And someone else is saying leg lengthening is pretty safe. So I've heard a lot of mixed things about leg lengthening surgery in the sense of safety. Will you come out of the surgery alive? Sure. But I haven't looked at outcomes on this. It's something that I'm really curious about.

But I have heard that there can be quite debilitating pain that may not resort. resolve, actually, after surgery. So I'm super curious about what the actual numbers show of like long-term outcomes and pain specifically. If you found this video helpful, check out Dr. Kay's guide. We've spent hundreds of hours writing and filming to help people understand their mind so that they can build the lives that they want. So check out the link in the description below.