Body Dysmorphic Disorder (BDD) is a mental health disorder where an individual obsesses over a single or multiple feature(s) of their body that they perceive as abnormal, deformed, ineffective, or unattractive. The perceived flaws are often imperceptible or insignificant to others.² BDD affects people of all ages, genders, and sexualities. It is often correlated with anxiety and low self-esteem. A common misconception about BDD is that it only affects women, but it is prevalent across all genders. One group that is especially affected by BDD are men who have sex with men (MSM).

The research around BDD and its connection to sexual minorities is limited, but a growing body of research demonstrates its effects and prevalence within MSM. The community has become more socially accepted over the past few decades, but MSM still face social barriers within their community and outside of it. There are many social issues such as toxic masculinity and minority stress that perpetuate BDD in MSM. These factors compound on each other and worsen BDD symptoms. By dismantling these factors, we can destigmatize BDD in men and help people feel more comfortable in their bodies.

Gay Community Culture and BDD

MSM culture promotes unrealistic body standards, which can negatively impact self-esteem. MSM may fear that their imperfections will make them undesirable to other men. MSM with BDD want to connect with others, but their poor body image may make them feel isolated from the community. They may also resent the MSM community for its unrealistic beauty standards.² Without community support, MSM with BDD can feel like their presence in the gay community only amplifies their symptoms.

Toxic Masculinity and BDD

Toxic Masculinity is when traditional stereotypes and expectations held about men correlate with harm to men or society.²Toxic masculinity promotes unrealistic body standards and heteronormativity. MSM experience pressure to conform to masculinity standards, which can contribute to lower self-esteem and BDD.

Many MSM that identify as gay receive criticism from others throughout adolescence and adulthood for being too masculine or feminine. These criticisms are upheld within the gay community to discourage men from conforming to stereotypes.² The pressure to be more masculine or more feminine reinforces the negative ideologies of toxic masculinity and makes people with BDD feel like they need to change their bodies to be accepted. 

Minority Stress and BDD

Researchers have found that the minority stress model also affects BDD in MSM. According to this model, people in minority groups have increased stressors such as fear of rejection, concealment of sexual orientation, internalized homophobia, prejudice, discrimination, stigma, and violence.⁴ These stressors have a taxing effect on mental health, which can serve to intensify negative thoughts on body image in people with BDD. Minority stress is proven to correlate with BDD rates in sexual minority communities, like MSM. Research has found that there is a higher prevalence of BDD within MSM adolescents and adults in comparison to the general population.⁴

BDD and Subsequent Disorders

There are other forms of BDD that affect MSM including Muscle Dysmorphic Disorder (MDD) and Penile Dysmorphic Disorder (PDD). Individuals with MDD believe they are too skinny and their muscles are too small, although in some cases they are hyper muscular.³ MDD is more common among adolescent MSM. PDD is characterized as extreme anxiety and dissatisfaction with penis size.¹ MDD, PDD, and BDD are all related and they often affect the same people.¹

Some scholars have discussed that people with MDD gain muscle to protect themselves discrimination, and therefore BDD and related disorders can have a social function.¹

Effects of BDD

For MSM, BDD can feel like a never-ending quest to achieve the ideal body type as it is determined by their community. BDD can lead to health-related and social consequences such as: 

• Disordered Eating, including the usage of diet pills⁴
• Discomfort with intimacy, which can lead do:
  • Not seeking out intimate relationships
  • Hypersexual Behavior¹
• Engaging in sex without a condom
• Depression
• Isolation from the gay community ¹

BDD has tangible behavioral effects which can be detrimental to physical and emotional well-being. Destigmatizing BDD can help to alleviate its effects and promote health and self-esteem in all communities. 

Resources

If you or someone you know has BDD, consider using these resources:

1. Body Dysmorphic Disorder: International OCD Foundation
2. National Eating Disorders Help
3. Body Dysmorphic Disorder Foundation: Helping a Loved One with BDD

This list is non-exhaustive and there are many other resources available for people with BDD.

Hope for the Future

There is, however, hope for a brighter, healthier future. The increasing body of research on BDD in MSM is beginning destigmatize it within society. We must work to change our communities’ body standards and deconstruct social forces such as toxic masculinity that only contribute to BDD. By practicing acceptance, people with BDD may not feel less pressure from society to change their appearances. 

Concluding Remarks

BDD is a mental health disorder that commonly affects MSM. Social factors such as toxic unrealistic beauty standards, toxic masculinity, and minority stress can exacerbate its effects. BDD is associated with MDD, PDD, and other mental health disorders. It can lead to harmful behaviors affect the individual, their mental health, and relationships. To overcome BDD, we have to change our views and culture around body image. We can also practice self-love by embracing the positive qualities in ourselves and accepting our flaws. Mental health professionals can help individuals with BDD manage their symptoms through counseling and support. 

References

1. Fabris, M. A., Longobardi, C., Badenes-Ribera, L., & Settanni, M. (2020). Prevalence and co-occurrence of different types of body dysmorphic disorder among men having sex with men. Journal of Homosexuality, 1–13. 
2. Morgan-Sowada, H., & Gamboni, C. (2021). Needing to be “perfect” to be loved: The intersection of body dysmorphic disorder, sexual identity, and gay culture in gay men. A qualitative study. Sexual and Relationship Therapy, 1–19. 
3. Nagata, J. M., Compte, E. J., Cattle, C. J., Lavender, J. M., Brown, T. A., Murray, S. B., Flentje, A., Capriotti, M. R., Lubensky, M. E., Obedin-Maliver, J., & Lunn, M. R. (2021). Community norms of the Muscle Dysmorphic Disorder Inventory (MDDI) among cisgender sexual minority men and women. BMC Psychiatry, 21(1). 
4. Oshana, A., Klimek, P., & Blashill, A. J. (2020). Minority stress and body dysmorphic disorder symptoms among sexual minority adolescents and adult men. Body Image, 34, 167–174. 

Last Updated: 30 November 2021.