Signs You Might Have Body Dysmorphia in Pregnancy | Antenatal Mental Health

Pregnancy brings about significant physical and emotional changes, many of which can have a lasting impact on a woman’s self-image. While it’s normal to experience some level of body changes and discomfort, for some women, these changes may trigger more intense feelings of dissatisfaction or distress. In extreme cases, these feelings may be indicative of body dysmorphia. This mental health condition, characterised by an obsessive focus on perceived flaws in physical appearance, can sometimes surface or worsen during pregnancy. Understanding the signs of body dysmorphia and how it affects antenatal mental health is essential for women to seek the support they need during this important time.

What Is Body Dysmorphia?

Body dysmorphia, also known as body dysmorphic disorder (BDD), is a psychological condition where an individual becomes preoccupied with perceived defects or flaws in their physical appearance, which may or may not be noticeable to others. This preoccupation can lead to distress and impair daily functioning. Although it is more commonly associated with specific body parts, such as the skin, face, or weight, it can affect any part of the body, including the abdomen, hips, and thighs during pregnancy. The experience of antenatal body changes, such as weight gain, stretch marks, or changes in skin tone, can trigger or exacerbate the symptoms of body dysmorphia. Pregnancy itself is often associated with weight gain, increased fluid retention, and other physical changes that may make women feel uncomfortable or disconnected from their bodies.

Understanding the Role of Hormones

Pregnancy introduces a significant shift in a woman’s hormone levels, with increased oestrogen and progesterone influencing mood, emotional regulation, and physical appearance. These hormonal fluctuations can sometimes trigger or amplify pre-existing mental health conditions, including anxiety, depression, and, in some cases, body dysmorphia. If a woman has a history of body image issues or eating disorders, pregnancy can act as a trigger for body dysmorphia symptoms. For others, the condition can develop during pregnancy as the body changes and the self-image becomes more sensitive to those changes.

Signs You Might Have Body Dysmorphia in Pregnancy

It’s important to distinguish between normal pregnancy-related concerns and signs that might point to body dysmorphia. Below are some common signs and symptoms to watch out for:

1. Constant Preoccupation with Physical Appearance

One of the primary signs of body dysmorphia is an overwhelming obsession with a particular part of your body. This might manifest as:

• Focusing excessively on weight gain or the size of your abdomen.
• Being fixated on stretch marks or changes in skin appearance.
• Frequently checking your reflection, whether in mirrors, windows, or photos, to scrutinise perceived flaws.
• Comparing your body to others, particularly other pregnant women or celebrities, and feeling distressed if you don’t measure up. It is natural for pregnancy to change your body, but constant negative focus on your appearance—often to the point of distress or self-criticism—is a key sign of body dysmorphia.

2. Distorted Self-Image

Another key characteristic of body dysmorphia is the distorted perception of one’s body. In pregnancy, this can manifest in several ways:

• Believing that you are much larger or smaller than you actually are.
• Perceiving normal pregnancy-related changes, like a growing belly, as a sign of being “unattractive” or “out of control.”
• Feeling disconnected from your body, unable to accept the changes as part of the natural process of pregnancy. This perception is often out of proportion with the reality of your physical state, and can cause emotional pain and hinder the joy of pregnancy.

3. Excessive Grooming or Camouflaging Behaviours

Women with body dysmorphia often engage in behaviours meant to conceal or alter their appearance in order to feel more acceptable or confident. During pregnancy, this could look like:

• Over-exercising to lose weight or “tone” areas of your body that feel “out of control.”
• Excessively using makeup, clothing, or other products to hide perceived flaws such as stretch marks, swelling, or skin changes.
• Constantly seeking out or applying anti-stretch mark creams or treatments, to the extent that it interferes with daily life. While some grooming behaviours are typical, when they become obsessive or feel like they are required for basic functioning, this could signal body dysmorphia.

4. Social Withdrawal or Avoidance of Certain Situations

Pregnancy can lead to changes in social engagement, but in women with body dysmorphia, these changes may be more pronounced:

• Avoiding public places or social events because of fear of being judged for your appearance.
• Declining invitations for family photos or refusing to let anyone take pictures of you, as you fear how you will look.
• Avoiding looking at your body in mirrors or in photos altogether because it triggers distressing emotions.

5. Excessive Seeking of Reassurance

People with body dysmorphia often seek reassurance from others to alleviate their anxiety about their appearance. During pregnancy, this might look like:

• Frequently asking your partner or friends if you look “okay” or if they think you are gaining too much weight.
• Constantly seeking validation about whether your body looks “normal” or “beautiful.”
• Comparing yourself to other pregnant women or looking for constant reassurances from social media, leading to an unhealthy obsession with idealised images of pregnancy. While seeking reassurance from loved ones is common, excessive reassurance seeking can be a sign that anxiety about body image has become unmanageable.

6. Impact on Mental Health

Body dysmorphia can significantly affect overall mental health during pregnancy. If you are experiencing the following, it may indicate that body dysmorphia is at play:

• Feeling increasingly depressed or anxious about your changing body.
• Experiencing panic attacks, insomnia, or general emotional distress due to concerns about your appearance.
• Difficulty enjoying pregnancy or connecting with your baby due to self-criticism or self-loathing. Pregnancy should ideally be a time for bonding with your growing baby and preparing for the exciting changes ahead, but body dysmorphia can rob you of that joy and replace it with unnecessary worry and stress.

The Importance of Antenatal Mental Health Care

If you recognise these symptoms in yourself, it’s crucial to address your mental health needs. Antenatal care is not just about physical health—it also involves looking after your emotional well-being. It’s important to talk to your healthcare provider, especially during antenatal appointments, so that they can help guide you to appropriate support, which may include therapy or counselling.

Professional Help for Managing Body Dysmorphia

Psychotherapy, particularly Cognitive Behavioural Therapy (CBT), has been found to be effective in treating body dysmorphia. CBT helps individuals challenge their distorted thoughts and replace them with healthier, more realistic perceptions. Speaking to a mental health professional who specialises in antenatal mental health can help you develop coping strategies to manage the condition. In addition to therapy, prenatal yoga and relaxation techniques can be extremely helpful for reducing stress, improving body awareness, and fostering a healthier relationship with your physical self. Antenatal yoga provides an opportunity to connect with your body in a calm and accepting way, focusing on breathwork and relaxation, which can reduce anxiety and improve emotional regulation.

Support from Loved Ones

Having a strong support network is crucial during pregnancy. Whether it’s a partner, close friends, or a support group, being able to talk about your body image struggles can alleviate some of the emotional burden. Letting people around you know what you’re experiencing can make a huge difference in reducing isolation and anxiety. Pregnancy brings a multitude of changes to the body, and for some women, these changes can trigger or worsen body dysmorphia. It’s important to recognise the signs early and seek appropriate help. Body dysmorphia is a serious condition that can affect your emotional well-being during pregnancy, but with the right antenatal support, you can manage it effectively. Talk to your healthcare provider about your concerns, engage in activities like prenatal yoga to promote body acceptance, and remember that you’re not alone. Taking care of your antenatal mental health is just as important as any other aspect of your pregnancy care.