Fox is one of the 2023 Sports Illustrated Swimsuit cover girls, and she got real in an interview for the magazine.
"I don't ever see myself really the way other people see me," Fox told Sports Illustrated.
"There is never a point in my life where I loved my body. Never, ever. When I was little, that was like an obsession I had, that I should look this way.
"The journey of loving myself is going to be never-ending, I think."
Fox’s candid comments spurred an online discussion about body dysmorphia and how it can impact even those who are thought to be the most conventionally attractive.
The truth is, body dysmorphia has nothing to do with how someone looks, but everything to do with how they see and feel about themselves.
What is body dysmorphia?
Body dysmorphic disorder (BDD) is the technical term used by mental health professionals to describe body dysmorphia.
It is a condition in which people worry or obsess about a perceived flaw in their appearance, according to chief of adolescent and young adult medicine at Mass General Brigham Dr. Scott Hadland. These perceived flaws can be related to any physical features.
Hadland told Yahoo Canada the mental illness can affect anyone, "regardless of how they look or what others think of them.
"Our society puts enormous pressure on people to look a certain way, and celebrities in the limelight likely feel this pressure more than many other people," he said.
"So even someone who seems to match society’s unrealistic ideals can develop BDD if they have developed a negative view of their body, even if it doesn’t seem to match up to reality."
One 23-year-old Canadian woman has struggled with poor body image since she was about eight years old. Earth, who asked her last name be kept private, told Yahoo Canada she began to experience intense body dysmorphia when she was around 13.
"It makes me feel hyper-aware of my appearance at all times — I’m either too big or too small," Earth confessed.
"I also struggle with facial dysmorphia and even though people tell me I’m pretty, sometimes when I look in the mirror, I genuinely look disfigured and scare myself."
The International OCD Foundation estimates BDD currently affects between 1.7 per cent and 2.9 per cent of the general population, including between 5 and 10 million people in the U.S. alone. However, experts estimate it's likely more common as individuals with this disorder often experience shame and may be reluctant to reveal their symptoms.
How does it feel to have BDD?
Earth said she struggles to be herself around others as a result of her body dysmorphia, because she’s constantly fixated on hiding her insecurities.
Similarly, 30-year-old JK, who was also granted anonymity, said her experience with BDD is frustrating and exhausting.
"You constantly judge yourself and compare yourself to other people," she said.
It’s a weird feeling, to hate the skin you’re in.JK, 30
These are common experiences for those with BDD, according to Dr. Hadland. Someone struggling with the disorder may fixate on a "flaw" that is minor, or even invisible to others, but it often causes the patient severe distress and anxiety, he explained.
BDD can contribute to general anxiety and depression, and can also lead to social isolation, low self-esteem and relationship problems. JK has experienced this first-hand.
"Relationships are hard when you don’t feel comfortable with your own body," she said.
Dr. Jenna DiLossi, a licensed clinical psychologist who works with non-profit Minding Your Mind, told Yahoo Canada the fixation on a particular aspect of appearance often creates a mental block between the individual and their loved ones.
This can manifest as seeking constant reassurance — which can feel annoying to others — as well as a refusal of physical intimacy or creating a sense of preoccupation and distraction in social activities.
BDD on its own isn’t inherently dangerous, but it can put someone at risk of self-harm or suicide, according to the experts.
Individuals also sometimes suffer from an eating disorder in addition to BDD, such as anorexia or bulimia nervosa — which have the highest overall mortality rate of any mental illness, according to the National Initiative for Eating Disorders.
BDD might also lead someone to undergo medical procedures or changes to their body that could be costly and harmful — or both, DiLossi added.
How to treat BDD
Fortunately, there are treatment options available for those who suffer from BDD.
According DiLossi, research indicates cognitive behavioral therapy (CBT) — a form of psychotherapy that focuses on changing thought patterns — combined with and a high dose of a selective serotonin reuptake inhibitor (SSRIs, also known as an antidepressants) can be effective in serious cases.
But every person and every case is different, said Dr. Hadland, who recommends people consult their doctor or a mental health professional about options. There are also support groups and resources online, he said.
The Body Dysmorphic Disorder Foundation, for example, offers a number of online resources including a test developed by clinicians to help determine whether you might have BDD. It also includes personal recovery stories from individuals with BDD and a list of self-help books.
For JK, trying to practice body neutrality — a concept that refers to just existing in your body without having strong opinions about it one way or another — has been helpful.
"Everyone has a body and that’s just it," she said. "Sometimes body positivity can feel overwhelming."
While mental illnesses of all kinds can feel isolating and lonely, Handland said it’s important for people with BDD to know they aren’t alone.
Talking openly about this disorder — as Megan Fox is doing — can help to reduce the stigma surrounding it.