Updated: Mar 16
Since the start of COVID-19 plastic surgery consults (cleverly rebranded as #facialoptimization by some dermatologists) have increased 64% . Last month, a group of dermatologists at Harvard published a survey of more than 100 board-certified American dermatologists looking at the relative changes in cosmetic consultations during the pandemic. They noted that 86% of respondents reported that [COVID related] videoconferencing—or “Zoom Dysmorphia”—was a major factor their patients were referencing as a reason for their new cosmetic concerns. People have become increasingly unhappy with their appearance. As one twitter user aptly put it, “I am Narcissus and my little zoom square is my lake” (she received 27K retweets and 132.5K likes—clearly, this resonated). And if Narcissus has taught us anything, it is that staring at our reflection does not end well.
Yet despite being confronted daily with our own reflection, there is a disconnect between how we perceive ourselves onscreen and how we actually appear to others. Zoom does not come with the required warning on the side mirrors of cars: "objects in mirror are closer than they appear.” But maybe it should.
The disruption of normal social interaction, with both business and social activities taking place exclusively on Zoom and FaceTime necessitates prolonged use of high-definition web cameras, which can only heighten and exacerbate any self-perceived flaws and imperfections. Web cameras used in videoconferencing distort appearances and inaccurately represent one’s true appearance by altering facial proportions: factors such as camera angle, focal distance, dimension (2D onscreen versus 3D in person) make a difference in the image that appears on screen.
Zoom Dysmorphia is the new version of “Snapchat Dysmorphia,” which similarly caused a surge in the demand for plastic surgery, especially in people with Body Dysmorphic Disorder. Body Dysmorphic Disorder (BDD) is a common, underrecognized anxiety disorder related to Obsessive Compulsive Disorder (OCD) affecting around 1 in 50 people. People with BDD struggle with intrusive thoughts about their appearance and engage in avoidance of situations which trigger distress about their appearance (such as mirrors, social situations, being in pictures, or intimacy) and rituals (like comparing their appearance to others, selfie-taking, mirror checking, camouflaging a perceived flaw with makeup, or researching and/or receiving cosmetic surgery) in an effort to relieve anxiety. Surgery is not a solution to appearance concerns and can make symptoms worse.
Several studies in the last few years have linked social media use and selfie-taking with body dysmorphia, negative self-esteem, self-image and a desire to change one’s face, hair and skin. The increased reliance on and use of social media resulting from the social isolation caused by COVID has intensified perceived imperfections, which arouse and exacerbate anxiety and depression. Influencers with six packs doing lunges while meal prepping in crop tops and biker shorts create a distorted standard of beauty and unhealthy comparisons for both women and men. People with BDD selectively attend to perceived flaws: obsessing over our own appearance can lead to perceptual distortion and encourages continued obsessing over perceived flaws. This has been implicated in the development and maintenance of BDD. Studies have shown that shown that people with BDD have abnormalities in visual processing: when processing faces, they primarily use the left half of their brain which may account for the overfocusing on at the expense of seeing the larger picture.
BDD causes avoidance, impairment, and in a quarter of cases, suicide. Effective treatment is available. Cognitive behavioral therapy (CBT) for BDD is effective and CBT delivered via telehealth is just as beneficial as seeing a therapist in person. Working from home likely won’t end any time soon. To help mitigate this crisis, we can first acknowledge the role Zoom plays in appearance dissatisfaction in general and increase in BDD symptoms in particular.
How do we adjust to the “new normal?
1. Turn off/hide self-view on Zoom: Hide the self-view during Zoom calls or meetings, so you are less likely to overfocus on the areas of your appearance you do not like. Place a post-it on top of your zoom square. This is the tech equivalence of covering mirrors in your home.
2. Keep a journal of your negative thoughts: Practice reframing these thoughts using apps such as MindShift or MoodKit which can walk you through the steps to shift your thoughts related to your appearance and generate more balanced, adaptive responses.
3. Mirror work: Engaging in mirror work can help people see the gestalt rather than overfocusing on problematic areas (which then become magnified). Usually, people focus only on the body parts of concern and get very close to the mirror, which magnifies perceived imperfections and maintains negative beliefs. Practice standing at a normal distance from the mirror (e.g., two to three feet). Describe your whole body (from head to toe) in a neutral, nonjudgmental way without any negative self-talk.
4. Be intentional about screen use: We have so much time at home to stare at screens. Before you go on your phone, tablet or computer, ask yourself why you’re going online, what you want to accomplish and how long you want to be online. What is your intention? Before you go on a Zoom call, take a break from screens and social media.
5. Expand the source and focus of your self-worth to include factors beyond appearance. If you put all of your value into a single domain and you have a ‘bad face day,’ your self-worth will plummet. Take inventory of your life; where do you find meaning—in your relationships, work, volunteer activities, spiritual practice, recreational activities? You are more than your appearance:
6. Practice self-compassion: Start a daily mindfulness practice—even if it’s just two minutes. This will enable you to become aware of thoughts and feelings with curiosity and non-judgmental awareness. To be human is to be imperfect. We are all in the same leaky boat. Give yourself room to be imperfect and not be defined by that imperfection.
7. Mindfulness: Dr. Katharine Phillips recommends practicing mindfulness if you find yourself becoming distracted or scrutinizing other’s appearance. Try noticing the sound and tone of other people’s voices, details or the topic of the conversation. Like any skill, this requires practice and patience with yourself.