What are common body image issues today? Who do they most affect?
Overall, our society is preoccupied with appearance, be it weight, wrinkles, or muscle tone. You can’t watch TV without having at least one advertisement pop up that touches on appearance, youthfulness or weight. So, it is unfortunately a fairly normal experience for people to be concerned or distressed about their appearance to some degree at some point in their life. However, there are some people who become preoccupied with various aspects of their appearance, leading to intrusive thoughts/obsessions and compulsions. This preoccupation paired with obsessive-compulsive behaviors is seen most often in BDD or eating disorders.
As with most researched clinical populations, women tend to be more represented. Eating disorders do not discriminate and can impact people of all ages, races, ethnicities, gender identity, sexual orientation and socioeconomic status. Previously believed to impact women more prominently, this has been debunked. BDD is also almost equally experienced by men and women, with some reports showing women having a slightly higher prevalence.
Someone with an eating disorder often has a preoccupation with weight, shape, size, etc., with focus being on overall size and weight, but also including focus on “problem areas” (e.g., stomach, arms, legs). Someone with BDD is preoccupied with a perceived flaw or defect in their appearance, or they may have a general overall perception of being ugly or a monster. This might look like beliefs that their teeth are crooked or yellow, that they are balding, that they have terrible skin, something is wrong with the size of their nose, etc. Recently, I have been seeing more patients, including those in Gen Z, who are focused on wrinkles and looking young.
Is AI’s attempt to keep people engaged part of the problem?
Definitely. It is all about keeping you engaged. Especially think of the current context we’re in: Cosmetic surgeries and nonsurgical aesthetic procedures such as Botox are at an all-time high. There's been a surge, especially in Gen Z and millennials. And I think if you're looking that stuff up, ChatGPT is going to pick up on that too and give you more suggestions on ‘what you need to do.’
Are there other dangers you see in this space?
AI models can provide harmful and hurtful advice. They may even promote dieting, weight loss, or other eating disorder behaviors. They may also provide inaccurate information, such as information about supplements or general health. People with compulsions may also become over-reliant on AI.
Overall, AI learns from existing data, and existing data related to appearance in western society is steeped in fatphobia, weight stigma and preoccupations with youth and beauty. So with AI, currently, we are looking at just perpetuating these unhelpful and potentially harmful perspectives, while also missing the mark on empathy and the nuances of the human experience. Additionally, AI may misinterpret user input, which could lead to inappropriate responses, such as misdiagnosis or inaccurate recommendations.
Some individuals with BDD will seek validation with how they look with family and friends and then ask an AI chatbot; is that shaky ground?
AI chatbots just complicate that relationship further. Those with BDD typically either have an overall sense of perceived defectiveness or ugliness that's often in the sphere of just being a monster essentially, or it's very focused on one specific aspect of their appearance, their teeth, their hair, et cetera.
Their loved ones are human. They’ll answer, "You look fine," or "You look beautiful just the way you are.” But the individual with BDD will respond internally, "Well, I don't believe them, because they're my mom.” At the other end, even with patience, it can lead to an exasperated, "I already gave you the answer to that."
So people are going to ChatGPT. From there, you have one of two scenarios. They upload their picture, and they either have ChatGPT provide them with reassurance that they look good, and their appearance is fine. Or their worst fear is true, and ChatGPT tells them, "Yes, actually, your teeth are extremely yellow and crooked, and here are the things you need to do to fix them." Which then just further sends them maybe into a spiral of worsened depression, worsened self-worth, worsened preoccupations and intrusive thoughts.
How can we support people with these disorders so that they don’t feel the need to go to a validation machine?
When it comes to appearance-related things – and I do this for my patients and friends – I will let them know, “I’m not going to comment on your appearance.” But I recognize I'm an eating disorder and OCD therapist, so I have more practice at that, and I think it's common in our society to tell someone they look fine to provide reassurance.
Instead, it’s helpful to ask how they are feeling and bring it back to their emotions. We want to validate emotions over the content.
Just think of your relationship with them and how they listen and process things. But try and remember to support them by focusing more on the emotions underneath it. "I'm here for you, and that sounds like a really hard thought to have, and I'm sad to hear you talking about yourself like that." They still might go to ChatGPT for that reassurance, but you're not the one providing it, and you’re offering a better path of human connection.
It seems that ‘emotion over content' and prioritizing the human connection in our lives is what we should be striving for.
Yes. Chatbots like ChatGPT are offering short-term relief for long-term conditions like BDD and eating disorders. The engagement loop is going to have diminishing returns – you have to use it more and more to get the desired effect you are looking for. I think they do have the potential to be a helpful tool in some areas. But there’s a lot of problematic things about how they are designed and how people are using them today.
