4 Ways to Spot Body Dysmorphic Disorder

— -- intro: Recently Tallulah Willis—daughter of Bruce Willis and Demi Moore—bravely shared her struggles with body dysmorphic disorder in a video for StyleLikeU. “I’m diagnosed [with] body dysmorphia,” Willis, 20, told the fashion blog. “[My biggest insecurity] is my face. That’s where my diagnosis came into play. Because of the position I was born into, I would read these things on the Internet and I was like, well, why would someone write that if there wasn’t some basis for truth out there?”

“It was something I never wanted to say out loud because it was so painful.” Willis goes on to talk about how hearing mean comments about her face drove her to dress provocatively and lose a lot of weight, thinking she could draw the attention to her body instead. “I started starving myself,” she says. “I got down to 95 pounds.”

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This is exactly why body dysmorphic disorder (or BDD) can be so difficult to diagnose, explains Health‘s contributing psychology editor, Gail Saltz, MD. “Disordered eating can be a symptom of it, but there is no surefire sign. What body dysmorphic disorder really means is that you are so preoccupied with either a real (but slight) or imagined imperfection that you become consumed by it.”

Plenty of healthy people have a body hang-up or two that makes very little sense (mine’s my fat ankles, full disclosure), so how do you know when someone you love is really struggling? Here are four ways to recognize body dysmorphia.

quicklist: 1category: How to Spot Body Dysmorphic Disordertitle: They always need reassurance about that one thingurl:text: “Most people who have body dysmorphia are not going to talk about it openly because they feel a lot of shame,” Dr. Saltz says. “But sometimes, it’s a friend who keeps asking you repeatedly for reassurance about this one body part.” If supportive comments like “No, your arms aren’t fat, really!” or “No, your nose is beautiful” don’t seem to make them feel even a little better, that could be a red flag.

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quicklist: 2category: How to Spot Body Dysmorphic Disordertitle: They dress in a way that doesn’t make senseurl:text: Obviously, you don’t have to agree with every style choice your friends make, but think twice if she’s dressing in a way that suggests she’s trying to compensate for that one thing. “For example, she’s putting on a tent of a dress and saying it’s to hide her belly that doesn’t exist,” Dr. Saltz says. Or in the case of Tallulah Willis, she mentioned that she would wear short-shorts and push-up bras in a bid to shift attention away from her face.

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quicklist: 3category: How to Spot Body Dysmorphic Disordertitle: They go to extremesurl:text: “Dysmorphia fits in with this constellation of anxiety disorders like obsessive compulsive disorder,” explains Dr. Saltz. “It’s a compulsion that gets in the way of your life.” So in the same way that no amount of hand washing satisfies a person with OCD, no amount of “fixing” seems to help people with BDD. Some patients may even get plastic surgery, and then still think they need more work done after they’ve healed, while others try a progressively restricted diet to lose, say, an imagined double chin.

quicklist: 4category: How to Spot Body Dysmorphic Disordertitle: They’re hiding outurl:text: “The thing separating a normal insecurity from a problem with body dysmorphia is how much it affects your ability to function,” Dr. Saltz explains. If you notice that that she’s not going out as much, or she doesn’t want to date, or maybe she’s turned down a promotion because she doesn’t want to have to give presentations, those are signs her body issues are getting in the way of her life.

Amelia Harnish is an Associate Editor at Health.

This article originally appeared on Health.com.