Dread Zoom Meetings? Severe Aversion May Be 'Zoom Dysmorphia' | AAD 2024

Almost everybody has dreaded a Zoom meeting or some other kind of virtual meeting or participated with the camera off because of a bad hair day or not-suitable-for-viewing attire.

But researchers say there are people for whom Zoom avoidance is far more serious. They have what researchers have dubbed “Zoom dysmorphia,” a subcategory of well-characterized body dysmorphic disorder (body dysmorphia) that involves negative thoughts about facial features and resulting behaviors

George Kroumpouzos, M.D.

Facial dysmorphia was existed “but it came to the surface because people use social media and platforms like Zoom all the time now. Before COVID it was less common,” said George Kroumpouzos, M.D., a clinical associate professor of dermatology at Alpert Medical School of Brown University and the owner of GK Dermatology, a cosmetic dermatology practice in South Weymouth, Massachusetts.

Kroumpouzos gave a presentation today about Zoom and body dysmorphia at the annual meeting of the American Academy of Dermatology in San Diego. His presentation was one of six given at an educational session on psychocutaneous disorders and treating the difficult patient.

In a brief interview after his talk, Kroumpouzos said it was important for dermatologists to identify patients with Zoom or body dysmorphia, even if they don’t meet the full criteria, because they may tend to be dissatisfied with the outcomes of dermatologic procedures or treatments, particularly any concerning the face and done for cosmetic reasons.

“If you perform a procedure on the patient, he will be unhappy, he will come back, he will complain,” said Kroumpouzos.

In his talk, Kroumpouzos listed the features of Zoom dysmorphia: excessive concern about facial features, including a fixation on features that the person believes needs improving; anxiety about attending video meeting with the camera on and attempts to look perfect in anticipation of meetings; focusing on perceived facial flaws and believing that others are focusing on them as well; and, in extreme cases, seeking cosmetic procedures to correct the perceived flaws.

Zoom dysmorphia can interfere with daily living depending on how often a person with the condition wants or is required to attend meetings conducted via video platform, Kroumpouzos said in this talk. It may also trigger or worsen broader body dysmorphia that features negative thoughts about other parts of the body,

Kroumpouzos and his colleagues have developed a screening tool for Zoom dysmorphia that begins with two open-ended questions: “Are you comfortable with being interviewed in a virtual appointment? and “How do you feel about your appearance during virtual meetings?” A second part begins with the question, “Are you concerned with facial flaws?” and has six others, including “Have you tried to hide or camouflage your face with your hands, hair, makeup or clothing” and “Do you often use the filter featureof the video conferencing platform.” A third has a question about self-perception of physical appearance more generally, answers to which might lead to screening and evaluation for body dysmorphic disorder.

“If we see a patient in a cosmetic consultation virtually, we should know how to identify the patient that has a dysmorphia,” said Kroumpouzos. “If you come across a patient who is shy, who doesn't want to look at the camera, etc., you need to know which questions to answer to identify if they have that dysmorphia.

Zoom dysmorphia is not in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders. Body dysmorphia is and is a classified as an obsessive-compulsive disorder condition. Kroumpouzos said the most common repetitive behaviors of body dysmorphic disorder are camouflaging (hiding the part of the body that the person believes is flawed), comparing (comparing physical appearance to famous people whose physical appearances are considered ideal or desirable ) and checking (looking in the mirror at perceived flaws).

People with body dysmorphic disorder can be treated with one of the selective serotonin reuptake inhibitors, a class of antidepressants that includes Prozac (fluoxetine), Celexa (citalopram) and Zoloft (sertraline) and with cognitive behavioral therapy, Kroumpouzos said.

If someone lacks insight into their body dysmorphia, a dermatologist will likely need to refer the patient to a mental health provider, he said.