How Face Masks Became a Coping Tool for People With Body Dysmorphia

Key TakeawaysPatients with body dysmorphic disorder (BDD) related to their faces are finding that face masks ease their symptoms.By neutralizing their environments, face masks allow BDD patients to abandon compulsive coping habits.Experts say these effects are most likely temporary, but that there is a chance they may influence behavioral patterns after the pandemic.

Key Takeaways

Patients with body dysmorphic disorder (BDD) related to their faces are finding that face masks ease their symptoms.By neutralizing their environments, face masks allow BDD patients to abandon compulsive coping habits.Experts say these effects are most likely temporary, but that there is a chance they may influence behavioral patterns after the pandemic.

“What you see in the mirror is not what others see when they look at you,” Dalia recalls her psychiatrist telling her at 16. She was diagnosed withbody dysmorphic disorder(BDD), a psychiatric illness involving an intense, debilitating preoccupation with a perceived flaw, usually in the facial region. Dalia remembers staring at her hands—bruised and bandaged from breaking her bedroom mirror earlier that week—as her psychiatrist discussed treatment options.

“I always felt like people were staring at me in disgust, and I just couldn’t do it anymore," she tells Verywell. “I couldn’t handle the anxiety of being outside. I couldn’t handle people seeing me as a monster.”

Therapy didn’t ease her symptoms, and antidepressants only made her sleep more and eat less. Somehow, though, she’s found a makeshift remedy in the form of face masks. They’ve served as a situational blindfold that prevent people from seeing her perceived flaws. Dalia says that face masks have helped her carve out a quiet existence outside of her illness. And she’s not the only one. Multiple people who experience face-related BDD are discovering a protective effect from face masks.

“Face masks have made my life so much easier. It’s like I can breathe. I can go to the gym without feeling like people can see my face. I can do other activities without feeling like the whole world sees my flaws. Even if people stare, I feel okay because they can’t really see me,” Lauren, a brand manager in Florida, tells Verywell. “If there was an option to go around town without people actually seeing you, I would have taken that option a long time ago.”

Jaime Zuckerman, PsyD, a clinical psychologist based in Pennsylvania who treats anxiety disorders such as BDD, tells Verywell that there is a scientific backbone to this phenomenon.

“On a surface level, wearing a mask will temporarily reduce the frequency of checking behaviors, the need for social referencing, and obsessive thought patterns," Zuckerman says. “Because everyone in their environment is wearing masks, the actual number of facial features that are publicly viewable is the same for everyone. So, in a sense, the differences in facial features have been removed. The aesthetics have been neutralized. Everyone is covering their face except for their eyes. Facial differences, as well as the opportunity for BDD preoccupation, is greatly minimized because of this now neutral playing field. No one stands out from the crowd.”

Dismantling Coping Rituals

Emma, BDD patientMasks are freeing. They make me feel less judged, anxious, and scrutinized for my appearance.

Emma, BDD patient

Masks are freeing. They make me feel less judged, anxious, and scrutinized for my appearance.

However, Zuckerman says that these ritualistic behaviors are not sustainable, and instead make patients’ negative emotions and thoughts related to their BDD more pervasive.

“One aspect of this vicious cycle is the associations that people make between neutral stimuli and the removal of internal discomfort. For example, checking a mirror a specific amount of times—let’s say five—temporarily reduces anxiety,” she says. “What begins to occur, however, is the person starts to believe that it is the actual checking of the mirror five times that is responsible for the anxiety reduction. This leads people to create illogical associations which may lead to magical thinking, like, ‘If I step on an even-numbered step something bad will happen.'”

Such is the case for Emma, a retired high school librarian based in Canada, who has a severe form of BDD centered on her skin, nose, teeth, and body. For years, she’s designed her life around very strict rules in order to shield herself from the trauma of self-exposure. She skips birthday parties, funerals, and family gatherings. She doesn’t let anyone see her stripped down or in swimsuits. She spends hours applying and reapplying makeup. In the end, she says her endeavors are fruitless, but she can’t stop herself from repeating them. She describes them as OCD-like compulsions.

Understanding Obsessive Compulsive Disorder and Eating Disorders

“I have wasted hours, days, weeks, months, and years obsessing, avoiding, hiding, ruminating, crying, canceling plans, buying useless products, and generally feeling miserable because of my BDD,” she tells Verywell. “But things are easier now. I never went out without makeup pre-COVID, but now with masks, I can. Masks are freeing. They make me feel less judged, anxious, and scrutinized for my appearance.”

Dissolving coping rituals like Emma’s is a key element of exposure therapy, which is one of the main forms of treatment used for BDD.Here, psychologists create a safe environment and then slowly expose patients to their fears. The goal is to eventually have the patient confront their fears without relying on their compulsive behaviors as a crutch.

However, Zuckerman points out that there are limits to this. Even though BDD patients are being exposed to their fears—in this case, the anxiety associated with their faces being seen in social settings—they are only doing so because they are cloaked in masks, and therefore in a false sense of security.

“While fears are being slowly faced during COVID with the help of wearing a mask, the fear that people with facial BDD are being exposed to is, in a way, a watered-down version of their actual fear,” she says. “I would compare this to a person doing exposure therapy for an elevator phobia, but while doing their exposure, they take a benzodiazepine to reduce their anxiety. Therefore, the fear that exposure therapy is targeting has been muted from the start and is not an accurate representation of the true fear the person feels when having to ride an elevator.”

She says that as a result of this, people with BDD may simply retreat into their ritualistic compulsions once the masks come off: with Emma, for example, hiding her face behind heavy layers of makeup, and Dalia avoiding the hours between sunrise and sunset.

Looking Beyond the Surface

The question that persists for these patients is if it’s possible to retain any of the benefits derived from masks once they no longer have to wear them in a post-COVID-19 world.

Jaime Zuckerman, PsyDIt could be that the social reinforcement and new experiences people with BDD are now getting will be enough of a reinforcer to take their masks off socially post-pandemic.

Jaime Zuckerman, PsyD

It could be that the social reinforcement and new experiences people with BDD are now getting will be enough of a reinforcer to take their masks off socially post-pandemic.

Julian, a military sergeant based in Florida, desperately wants that to be the case; but isn’t too optimistic after agonizing over his BDD for the past 14 years. He thinks his teeth are too big for his mouth and that his jawline looks garish and unstructured.

“There’s a lot of comfort in wearing a mask in public: I feel like I don’t have to worry about what people see because they can’t see a whole lot," he tells Verywell. “Unfortunately, I’m pretty sure my obsession with people’s thoughts about my looks will come flooding back once the pandemic ends.”

However, there may be some strands of hope. The same mechanisms that reinforce compulsory behaviors in people with BDD could be the same mechanisms that undo them.

Body Dysmorphic Disorder and Eating Disorders

The idea is that if patients have enough exposure to positive events without their distorted thinking sullying their experiences, they might find a way to climb out of their illness.

Cognitive Behavioral Therapy for Social Anxiety Disorder

While they’re not a miracle cure, Dalia says that these experiences are reminding her that she can still find beauty around her, even if she can’t find it within her.

Dalia’s BDD symptoms began after her high school boyfriend told her she should see a dermatologist and then broke up with her shortly after. She was convinced he left her because of her skin and stubbornly viewed herself through that lens of deformity in the years after.

“So maybe there can be life after,” she says.

The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit ourcoronavirus news page.

3 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Anxiety and Depression Association of America.Body dysmorphic disorder (BDD).American Psychological Association.What is exposure therapy?Anxiety and Depression Association of America.ACT with CBT for BDD: More than alphabet soup.

3 Sources

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Anxiety and Depression Association of America.Body dysmorphic disorder (BDD).American Psychological Association.What is exposure therapy?Anxiety and Depression Association of America.ACT with CBT for BDD: More than alphabet soup.

Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

Anxiety and Depression Association of America.Body dysmorphic disorder (BDD).American Psychological Association.What is exposure therapy?Anxiety and Depression Association of America.ACT with CBT for BDD: More than alphabet soup.

Anxiety and Depression Association of America.Body dysmorphic disorder (BDD).

American Psychological Association.What is exposure therapy?

Anxiety and Depression Association of America.ACT with CBT for BDD: More than alphabet soup.

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