What Is "Zoom Dysmorphia" and Why Does It Hurt So Much?

By Nina Savelle-Rocklin, Psy.D.

When you hate how you look on a tele-meeting, that may actually be Zoom Dysmorphia.

Source: Andrey Popov for Getty Images via Canva

“I can’t stand to look at myself,” said Britt, positioning a yellow Post-It note over her image on the computer screen.

“My nose is huge,” Ben winced. “It’s distracting to see that all day long. Sometimes it’s all I can think about in meetings.”

If you can relate to Britt or Ben, you’re not alone. During the Covid-19 quarantine, the only way to see others was to connect on Zoom or other virtual platforms. Video conferencing, social events and video dating became the norm.

For some people, this increased “facetime” created a lot of distress.

What Is "Zoom Dysmorphia?"

Many of us have occasional insecurities about our appearance. We might have “a bad hair day” or think a photo was taken from a bad angle. Being self-conscious differs from the crippling anxiety of body dysmorphic disorder (BDD), a mental health condition that’s similar to obsessive-compulsive disorder.

Zoom dysmorphia refers to a type of BDD known as facial dysmorphia. Those who suffer from this condition scrutinize their noses, skin, teeth, ears and other aspects of their faces, fixating on what they think needs to change and avoiding social interactions. Seeing themselves on a computer screen is like looking into a funhouse mirror and believing the distorted image reflects reality.

Although Zoom Dysmorphia doesn’t appear in the Diagnostic and Statistical Manual (DSM,) and thus not an official diagnosis, it's an important concept.

Here are some signs of Zoom dysmorphia:

• Anxiety about attending video meetings with your camera on
• Attempting to look perfect before video calls
• Focusing on your on-screen appearance and finding flaws
• Believing that others are focused on your perceived flaws

From a psychoanalytic perspective, the origins of dysmorphia go back to the earliest stages of development. During what’s known as the mirror phase, babies see themselves reflected in the faces of their parents. When parents are warm and loving, babies feel loved and lovable.

When there is no reliable and consistent loving gaze, or when there’s parental indifference or absence, babies cannot take in the sense of themselves as appealing and lovable. Instead, they may feel rejected or humiliated. Our sense of self is very much influenced by what we see, or don’t see, in the eyes of others.

People with dysmorphia feel intense shame, which refers to a deeply painful idea that there’s something fundamentally wrong with them. Shame carries with it the expectation of rejection or withdrawal of love. Focusing on appearance is a way of managing shame. The idea is that if you can change the way you look, or if you conceal perceived defects, you will change the way others relate to you.

To do this, you first have to see what you need to hide. As psychoanalyst and author Phil Mollon says, “The mirror is scrutinized to ensure that no untoward, uncontrolled or embarrassing aspects of the person are in evidence." The Zoom screen has become a modern-day mirror, one that we all peer at much more often than ever before.

A patient who I’ll call "Lindsay" often reported she “felt ugly” and was astonished to learn that “ugly” is not a feeling. She recalled being a small child watching her beautiful but depressed mother get ready for a night out. After she applied the lipstick to her own mouth, her mom sharply stated that she looked “like a clown.” Lindsay interpreted that moment and many similar such interactions as meaning she was not pretty enough and must be “too ugly” to love. She imagined that I, her therapist, must also experience her as hideous.

We explored how “ugly” was code for the shame of failing to make her mother happy and lift her out of depression. By working through the pain of the past, Lindsay released the ugly feelings and was able to see herself anew.

Just as Lindsay thought I was repulsed by her appearance, people with dysmorphia are convinced everyone is scrutinizing and criticizing the way they look. This can be understood as the projection onto other people of their own harsh perspective about themselves. In this case, you experience co-workers, family, friends and even strangers as looking at you harshly, even though it’s really your own judgments that you’re seeing reflected on them. Your criticisms become theirs, resulting in emotional torture.

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How to Address Dysmorphia

Treating any type of dysmorphia, including Zoom dysmorphia, means turning shame to self-acceptance. In treatment, patients have a different experience with their therapists than with their original caregivers. When they are reflected and deeply understood in therapy, the earlier ruptures and deprivations that led to feelings of shame are replaced with a new foundation for self-esteem.

Just as the origins of dysmorphia may occur in the early parent-child relationship, healing also takes place in a relationship. When Lindsay was able to take in my warm and accepting view of her, she slowly began to experience herself as acceptable and likeable, and she said she stopped feeling ugly.

We live in an age when being physically acceptable is often the only way to feel good enough. Zoom dysmorphia highlights the deficits in self-esteem that many people feel. To create changes in self-esteem, we must journey within ourselves, optimally led by an interested guide, such as a therapist, who helps us discover ways to soothe, love, and appreciate ourselves. Healing the past and shifting our thoughts and feelings can transform the way we see ourselves, literally and figuratively.

Nina Savelle-Rocklin, Psy.D. is a psychoanalyst specializing in eating disorders. She maintains a private practice in Los Angeles.