THE PERFECT DISORDER:

Every day, Natasha Esposito wakes up to her imperfections. The mirror shows her that her nose is too big, her lips are too thin, her skin is uneven, and her eyes are too small.

After she finally walks away from the mirror, the 29-year-old Swedish woman spends time on Instagram where she believes everyone looks happy and perfect.

Natasha Esposito, who suffers from Body Dysmorphic Disorder (Photo Courtesy of Esposito).

“Look at the Instagram models, they do nothing, they just look beautiful and people worship them,” she says. “The more beautiful you are, the happier your life is.”

Esposito closes her Instagram and takes a selfie, and then another — and another one. Depending on the light and the angle of the picture, her nose is too big and other times too small. In some photos, the fine lines around her mouth seem to run forever. And in some selfies, she says, her eye bags are so dark that she looks “like a monster.”

As the day goes by, Esposito continues to wrestle with her image in the mirror, “Do people see the monster I see in my pictures?” She looks at her pictures and she corrects her “flaws” with the help of photo editing applications like FaceTune or AirBrush. Her goal, she says, “is to look good in every angle and light.”

The editing apps help Esposito to make her nose smaller, her lips bigger and her skin flawless. “I constantly check what I can change. I don’t post pictures often, but if I do, they have to be perfect,” she says. “The filters help me to make them perfect.”

But altering her pictures with filters often isn’t enough for Esposito. In some photos, she says “I look like an ugly girl and in some like a pretty girl. How can I know how everybody sees me? It is so scary if people see me, like, in the worst pictures.”

Eventually, Esposito decided to turn to face fillers, substances designed to be injected beneath the surface of the skin to add volume and fullness, but they didn’t provide the results she was looking for. So, she paid for a facelift, a surgical procedure that aims to hide visible signs of aging in the face and neck, according to the American Society of Plastic Surgeons, but she “wants to do more.”

Last winter, Esposito was diagnosed with Body Dysmorphic Disorder, also known as BDD. “BDD is a disorder where people obsess about some physical defect or perceived defect in their physical appearance,” says Dr. Karen North, a psychologist who specializes in the effects of social media. The disorder, explains Dr. North, is built up to the level where it interferes with people's daily life and motivates them to go to extremes to try to improve their appearance.

A recent report in the U.S. medical journal JAMA Facial Plastic Surgery suggested that filtered images produced with apps like Face Tune, Instagram, and Snapchat could help trigger selfie Dysmorphia, also known as Snapchat Dysmorphia. A phenomenon that is motivating people to undergo plastic surgery to resemble their doctored pictures, according to the report.

While in the past people would watch TV or look at popular magazines to figure out beauty standards, people are now more likely to turn to social media for that reference. However, many people don’t realize that images on social media platforms are often modified by photo editing programs.

The rise of social media means that many people are exposed to hundreds of doctored images every day. “Patients often come in with photos of Instagram models or influencers asking to look like them and they don’t realize that those images have been altered,” says Dr. Deniss Dass, a plastic surgeon at Beverly Hills.

Before social media was popular, people would already have unrealistic expectations of what could be achieved through plastic surgery. "Patients would look at pictures that had been altered by a computer program, and they would try to resemble them," says Dr. Dass. "The same happens nowadays but at a much larger scale."

Todd Richmond, a researcher at USC who specializes in emerging technologies and their implications for society agrees with Dr. Dass. “As a society, we value youth and beauty and the internet enables us to be bombarded with images of youth and beauty all the time. It's no wonder that we don't have more and more people who are suffering from psychological problems due to this,” says Richmond.

While it is hard to determine the scale at which social media is affecting people’s psychological well-being, a recent Pew Research survey suggests that the use of social media very often leads to greater social pressure.

Yana Carr, a social media influencer with almost 50,000 followers, says she often finds comments of people saying that they wish they could look like her.

Yana Carr, social media influencer in photo edited with FaceTune (Photo Courtesy of Carr).

“It's sad when people say they want to look like me or they don't like how they look, and they would rather have my features. I encounter that type of comments very often,” says the influencer. “But, the reality is that if I'm going to make this a job and I'm going to get paid I have to present myself in a way that will get me that result.”

Ultimately, influencers are often paid to look flawless and portray themselves as having a perfect life. Balancing their moral and business standards can be very hard.

“Influencers do have a lot of power. That's why they get paid,” Richmond says. “A lot of the influencers don't even realize the power that they hold, and the ones that do, oftentimes discover that having a moral, having an ethical code doesn't get them the clicks.”

Carr who sometimes encounters pressure to look flawless in her posts and videos says that her sponsors often remind her that what sells on social media is perfection. So she often edits her pictures to look better.

“Every influencer edits their pictures,” says Carr. “I think people don't really understand the behind the scenes part of being an influencer, all they see is the finished product.”

Consequently, people, especially young people, often develop false impressions of what influencers and models look like in reality and of what plastic surgery can and cannot achieve.

“The most affected by selfie dysmorphia are people who are very young, probably in their 30s or even younger,” says Dr. Dass, “although as social media platforms become more popular older generations are also affected.”

While social media does affect the way people perceive themselves, experts warn against blaming social media for causing Body Dysmorphic Disorder in the first place.

“Social media and traditional media can influence or have an impact on people with various conditions. However, the fact that people have a significant diagnosable condition, like a dysmorphic disorder, cannot be attributed directly to social media,” says Dr. North. “When you have somebody with a diagnosable condition like a mental illness or disorder, it comes from something other than social media. Social media, however, can exacerbate those conditions.”

Richmond agrees with Dr. North. He says humans have been concerned about their appearance for centuries.

“We have had mirrors for a long time. As humans, we have been concerned, or curious, or obsessed with our appearance and the way that others perceive us. That's really not a new thing,” says the researcher. “What has changed is our ability to easily manipulate the images with filters and the fact that we get opinions not only from people who know us personally but from the entire world when we’re posting on Facebook or Snapchat or Instagram.

Digitization has enlarged the community we have to worry about and our insecurities, putting more pressure on people to modify their appearance. “All of a sudden, we're not only worried about our immediate friends and family,” says Richmond, “we're worried about our virtual family as well.”

Darian Allen, a 22-year-old from Ohio who began to suffer from symptoms of BDD when she was 12-years-old, says her dysmorphia has gotten worse because of social media.

"Selfie" (Illustration by Loris Sunda Dogana IG: doctor_sunda)

“I'm scrolling through Instagram and I'm seeing all these people and I'm just like, ‘Oh my gosh, how can they look like this?’ they just have no flaws whatsoever. And it makes me look at myself and just think, why don't I look like this? What's wrong with me? It just makes me feel more insecure about myself.”

Allen says that she had self-confidence problems before using social media, and the trolling she endures on sites like Facebook have not helped. “I keep receiving comments of people telling me that I look masculine both in real life and in social media, so it makes me feel very subconscious.”

So far, Allen hasn’t resorted to plastic surgery, but like Esposito, she says she has thought about altering her image multiple times. “I definitely consider it. And I think the older I get, the more plastic surgery ideas I consider.”

Both Esposito and Allen are aware that they have BDD and they have sought professional help to overcome the disorder. Esposito, who has visited a therapist since last year, says her overall symptoms have improved, but she still struggles with selfie addiction.

“We started by not taking my phone when I am going out. If I have it with me, I am not allowed to take pictures. It is really hard not to do it, but when I have avoided it, I have felt less anxiety. It is a hard battle,” Esposito says. “It is a mental illness and like any illness, it takes time to get better.”