Miley Cyrus: “Hannah Montana Gave Me Body Dysmorphia!”

In her September Marie Claire cover interview, Miley Cyrus explains how her time growing up on “Hannah Montana” was grueling and lead her to unhealthy body image issues. Telling Marie Claire writer Allison Glock:

“I was told for so long what a girl is supposed to be from being on that show. I was made to look like someone that I wasn’t, which probably caused some body dysmorphia because I had been made pretty every day for so long, and then when I wasn’t on that show, it was like, Who the fuck am I?”

Miley also said that playing the role of recording star Hannah Montana gave her “unrealistic body standards.”

“From the time I was 11, it was, ‘You’re a pop star! That means you have to be blonde, and you have to have long hair, and you have to put on some glittery tight thing.’ Meanwhile, I’m this fragile little girl playing a 16-year-old in a wig and a ton of makeup. It was like Toddlers & Tiaras. I had fucking flippers.”

The long work hours and constantly trying to look perfect also caused Cyrus to have anxiety attacks.

Cyrus admits that she still thinks about body image and opens up on how she dislikes the way media portrays women.

“When you look at retouched, perfect photos, you feel like shit. It’s a total bummer. It’s crazy what people have decided we’re all supposed to be.”

What is body dysmorphia?

Body dysmorphic disorder (BDD) is a relatively common body-image disorder characterized by persistent and intrusive preoccupations with an imagined or slight defect in one’s appearance. It is commonly believed to be part of the OCD (Obsessive-Compulsive Disorder) spectrum.

The diagnostic criteria (as in DSM-5) include:

• Preoccupation with an imagined defect in appearance. If a slight physical anomaly is present, the person’s concern is markedly excessive.
• The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
• The preoccupation is not better accounted for by another mental disorder (eg, dissatisfaction with body shape and size in anorexia nervosa).
• Repetitive behaviors or mental acts in response to preoccupations with perceived defects or flaws in physical appearance.

BDD is relatively common, with a prevalence of 0.7 to 2.4% of the general population. These estimates are probably low. Many patients do not report their symptoms to a physician as they are ashamed of their perceived defect and their preoccupation with it. BDD is slightly more common in women than men, although both sexes are affected. BDD usually begins in adolescence.

The most common preoccupations focus on the skin (73%) , hair (56%), or nose (37%), although any body part may the focus of attention. Skin complaints include scarring, acne or color. Patients can be concerned about hair loss or excess hairiness, or nose size or shape.

About 40% of patients with BDD actively think about the disliked body part for 3 to 8 hours/day and 25% think about them for more than 8 hrs/day!

Patients may also have what is called delusions of reference, meaning that they believe others “take special notice of them in a negative way or mock or ridicule them because of how they look.”

Compulsive, repetitive behaviors are also common, such as frequent checking in the mirror, picking at the skin, or frequent facial washing or hair brushing. As in OCD, these behaviors are not considered pleasurable. Although they may temporarily relieve anxiety, they are considered embarrassing. Other repetitive behaviors include tanning, seeking reassurance from others, excessive shopping for beauty products, excessive exercise and frequent clothing changes to find the most flattering outfit.

Safety behaviors include hiding disliked body parts with hats, sunglasses, makeup or clothing in the attempt to prevent embarrassment.

What is the prognosis for those with BDD?

Studies show that BDD tends to have a chronic course unless it is treated. It can be associated with substantial impairment with psycho-social functioning and a decreased quality of life. Patients with severe BDD are unable to work, be in or attend school or have healthy relationships.

The rates of suicidal thoughts, suicide attempts and suicides are very high in patients with BDD. About 80% of patients admit to having suicidal thoughts at one time or another, and 25% have attempted suicide.

Many individuals with BDD also abuse alcohol or drugs problems. Other mental health disorders, such as depression or social phobias are also more common in patients with BDD.

A majority of patients with BDD (approx. 75%) seek cosmetic treatment for their perceived flaws. However, of those who undergo surgery, only a small percentage (about 4%) actually have improvement of their BDD symptoms.

How is BDD treated?

The main treatment options for BDD are:

1. Medication with selective serotonin reuptake inhibitor (SSRI) drugs. These include: fluoxetine (Prozac®), fluvoxamine (Luvox®), escitalopram (Lexapro®), and citalopram (Celexa®). These medications are being prescribed “off label” as the FDA has not yet approved any medication for the treatment of BDD.
2. Cognitive Behavioral Therapy. CBT is “problem focused” (undertaken for specific problems) and “action oriented” (therapist tries to assist the client in selecting specific strategies to help address those problems). Early research suggests that CBT may be helpful in treating those with BDD.

Source: Bjornsson, et. al, Dialogues in Clinical Neuroscience