Understanding Skin Dysmorphia and Its Impact
Ashlea Perry recalls the years of her twenties when she would look in the mirror and see nothing but imperfections. “I saw gaping pores and deep craters,” she says, describing the intrusive thoughts about her appearance that consumed her. “My internal dialogue was always the same: ‘They’re staring at my face. They think I’m hideous. Why are they even talking to me?’ It consumed my thoughts.”
Now 44, Perry is one of many individuals who suffer from skin dysmorphia, a condition where the person perceives flaws on their face that are either minor or not visible to others. This condition can lead to obsessive skincare routines, driven by the unrealistic standards often seen on social media platforms like TikTok and Instagram Reels.
Perry’s experience took a different turn when a friend found an old photo of them taken before the era of Photoshop and filters. “My skin looked normal – good, even,” she reflects. “I asked former classmates about it, and they told me they never noticed my skin being bad.” This revelation was shocking for Perry, who had always believed she would be remembered as the girl with terrible acne.
Skin dysmorphia is increasingly recognized as a mental health condition. It involves an intense preoccupation with perceived physical flaws, which can significantly impact a person’s daily life. The signs include excessive mirror checking, dissatisfaction with aesthetic treatments, compulsive use of skincare products, and emotional distress over minor skin issues. People may even avoid social situations due to their self-perceived appearance.
The condition often coexists with depression, anxiety, and isolation. Sufferers become trapped in a cycle of self-criticism and attempts to “fix” their skin through various means, sometimes leading to financial and emotional strain. For Perry, the costs were enormous. “I have likely spent tens of thousands of dollars on skincare,” she admits.
Excessive skincare routines can also pose health risks. These include scarring, irritation, and sun damage. In some cases, the use of certain ingredients can lead to more severe consequences. One example is a 44-year-old woman who suffered a seizure and liver toxicity hepatitis due to prolonged exposure to titanium dioxide in her skincare products.
While this case is extreme, it highlights how fears about acne can keep patients engaged in intense treatments for longer than necessary. Maddie Ogle, 22, experienced similar challenges. She was prescribed spironolactone for her hormonal acne, which initially cleared her skin. However, she became too afraid to stop the medication, despite being weaned down to 20mg. “I kept having side effects, but my skin looked good, so I thought I’d rather deal with a few weird things than the depression of having acne,” she explains.
Ogle credits her support system for helping her make the decision to come off the medication. “I’m glad I listened to them,” she says, reflecting on how her skin responded well after discontinuing the treatment.
For Perry, the psychological effects of skin dysmorphia were profound. “It deeply impacted my self-esteem and self-worth and made me more vulnerable to abusive relationships,” she shares. “I was just exhausted; my skin was literally the only thing on my mind.”
Skin dysmorphia is a specific form of body dysmorphic disorder (BDD), a mental health condition characterized by an obsessive preoccupation with imagined or slight flaws in physical appearance. Those suffering from this condition often seek treatment from dermatologists rather than mental health professionals, which can delay proper care.
Awareness of the condition is growing. In January 2026, doctors recommended further steps for identifying symptoms through a new Skin Dysmorphia Scale (SDS) published in the Journal of Cosmetic Dermatology. However, the use of this scale remains optional for practitioners.
Dr Eleanor Chatburn, a psychologist and mental health researcher, emphasizes the need for better communication between dermatologists, aesthetic practitioners, and mental health specialists. “I’ve worked with dermatologists who are very ethical,” she says. “They’ll screen for dysmorphia and decline to treat people who have it or refer them first to a psychologist. But there are also plenty of people who will happily take people’s money and offer them a whole course of various treatments.”
Chatburn advises anyone concerned about their symptoms to conduct an audit. Ask others if you spend a lot of time checking yourself in the mirror. Consider if you are spending excessive money on skincare products and time comparing yourself to flawless influencers on social media. Reflect on how these behaviors impact your life.
Those affected often withdraw from social interactions, neglect hobbies, and avoid going outside. “There’ll be a whole bunch of stuff they’re avoiding,” Chatburn explains. “Sitting under bright lights, being too close to people; things that we call ‘safety behaviours’ because they make sufferers feel secure, but actually they can inadvertently keep the preoccupation going.”
She also suggests looking for signs of low mood, depression, hopelessness, and low self-esteem. “I’ve heard people say, ‘My skin is bad, so I’m bad.’ So, it gets internalised in a really, really toxic way.”
Excessive skincare purchasing has become worse than ever. Nicola Liberos, a registered nurse prescriber and aesthetic practitioner based in London, often sees patients with 50 different highly chemical products in their bathrooms. “It’s ridiculous,” she says. “I’ll give them three that are less toxic and then also look at their overall wellbeing; mental health, internal health, gut health, blood tests, because that all links to your skin.”
Liberos highlights the dangers of harmful ingredients in products accessible to children, noting that Gen Alpha’s access to platforms like TikTok, Instagram, Boots, and Superdrug can expose them to dangerous substances.
If you are experiencing feelings of distress or struggling to cope, consider reaching out to the Samaritans for support. You can speak to them confidentially on 116 123 (UK and ROI), email [email protected], or visit the Samaritans website to find details of your nearest branch.
