Yeo Esther says she must stay pretty 'until the day she dies' — can appearance anxiety fuel depression?

Physician and broadcaster Yeo Esther has opened up about years of hurtful online comments targeting her looks and a childhood appearance complex she has carried ever since. Experts say repeated negative judgments about a person's appearance can go beyond momentary hurt, affecting self-esteem, body image and mood.

Yeo appeared on the YouTube channel "A-List Jang Young-ran" on Wednesday and said that among the many criticisms directed at her, comments about her looks sting the most. She cited specific remarks she has received — "ugly," "that's going too far," and "why did Hong Hye-geol marry someone like her" — and said appearance-related words tend to stay with her the longest.

She also recalled growing up as the third of five daughters and being subjected to comparisons about looks, including a memory from elementary school when a sibling was mocked as "a monkey-faced older sister." Explaining why she pays close attention to her appearance, Yeo said: "Even if I die tomorrow, I have to be young and pretty until today."

Concerns about appearance are universal. The problem arises when dissatisfaction with one's looks grows severe enough to disrupt daily functioning and mental health. When a person fixates persistently on a disliked feature of their face or body — repeatedly checking mirrors, comparing themselves to others, or avoiding situations because of their appearance — what begins as a simple complex can develop into a body image disorder.

Body image refers to how a person perceives and evaluates their own body and appearance. Repeated negative experiences related to looks can cause someone to see themselves in a distorted way, independent of how they actually appear, or to magnify perceived flaws in specific areas. Recurring appearance-based judgments — comparisons from family or peers, teasing, or hostile online comments — can leave lasting impressions that shape how a person evaluates themselves long afterward.

When such concerns intensify, it becomes important to distinguish them from body dysmorphic disorder. Body dysmorphic disorder is a condition in which a person becomes excessively preoccupied with a perceived flaw in their appearance that is either absent or barely noticeable to others, causing significant distress and interference with daily life. The Mayo Clinic, a nonprofit academic medical center in the United States, explains that the disorder drives repetitive behaviors such as mirror-checking, excessive grooming and comparing oneself to others.

Having an appearance complex, however, does not mean a person has body dysmorphic disorder. The key factors are the intensity and duration of the concern and the degree to which it affects daily life. Anyone who fears social interactions because of their appearance, avoids being photographed or participating in social activities, or spends most of the day preoccupied with how they look should consider seeking professional help.

Appearance-related stress can also be linked to depression. Depression is not simply a matter of feeling down. It can involve a sustained loss of interest and motivation, changes in sleep and appetite, fatigue, difficulty concentrating, feelings of guilt and recurring thoughts of death. The National Institute of Mental Health says depression is diagnosed by evaluating a range of persistent symptoms beyond low mood, and that treatment can help even when symptoms are fewer in number.

South Korea's National Mental Health Information Portal also notes that psychotherapy and medication are central to treating depression, and that non-pharmacological treatments may be recommended in some cases. Depression can be a condition requiring treatment rather than a matter of willpower, and anyone whose symptoms persist or impair daily functioning is encouraged to seek psychiatric care.

Yeo also spoke about why she chose not to hide her own experience with depression. She said she had undergone various medication treatments and wanted to help dispel misconceptions about electroconvulsive therapy. In practice, counseling and medication form the foundation of depression treatment, but brain stimulation therapies are sometimes used when a patient does not respond adequately to those approaches or when symptoms are severe.

The National Institute of Mental Health says brain stimulation therapies are used less frequently than medication or psychotherapy but can play an important role in depression that does not respond to other treatments. Electroconvulsive therapy and repetitive transcranial magnetic stimulation are among the most commonly used options.

More recently, esketamine has been used in some cases of treatment-resistant depression and major depressive disorder accompanied by acute suicidal ideation. The US Food and Drug Administration says esketamine nasal spray can be used alongside oral antidepressants to treat depressive symptoms in adults with treatment-resistant depression and in those with major depressive disorder accompanied by acute suicidal ideation or behavior. This treatment requires rigorous evaluation and monitoring at a specialized medical facility.

Hostile online comments are not a trivial matter either. Repeated appearance-based judgments and comparisons online can worsen body dissatisfaction and depressive symptoms. The American Psychological Association says social media use that involves excessive attention to appearance comparisons and feedback on photos can be associated with poor body image, disordered eating and depressive symptoms.

Reducing appearance-related harm begins with managing exposure to environments where such judgments are frequent. Habitually revisiting malicious comments or following accounts that invite constant self-comparison can heighten anxiety. When needed, setting digital boundaries — blocking comments, limiting notifications, hiding accounts or reducing overall social media use — can help.

Caring for one's appearance is not inherently problematic. Tending to skin, hair, body shape and personal style can be a form of healthy self-care. The distinction worth making, however, is whether the motivation is "to feel comfortable and healthy" or whether it stems from pressure to "keep fixing things to avoid being criticized." When the latter drives the behavior, procedures, dieting and cosmetics spending may temporarily ease anxiety without leading to genuine satisfaction.

When an appearance complex is rooted in long-standing emotional wounds, resolving it through personal effort alone can be difficult. Cognitive behavioral therapy can help by examining distorted thoughts about appearance and repetitive behaviors, and by rebuilding a more realistic self-assessment. The Mayo Clinic notes that cognitive behavioral therapy and medication can be used together in treating body dysmorphic disorder.

The attitudes of those around a person also matter. Telling someone to "stop being so sensitive" or "not to worry about it" may do little to ease the pain. When someone opens up about appearance-related distress, it is more helpful to listen to how long those words have hurt rather than to evaluate or compare their looks — and, if necessary, to encourage them to seek professional support.

Anyone who experiences prolonged low mood or recurring thoughts of death should seek help immediately. The Suicide Prevention Hotline at 109 is a national safety net providing 24-hour emergency counseling to people in crisis. Those who find it difficult to cope alone can reach out through 109, a nearby emergency room or a community mental health center.

What stands out in Yeo's account is not simply the desire to look attractive, but how deeply old wounds about appearance can affect mental health. Caring for one's looks can be a healthy form of self-care — but when appearance-based judgments shake the very foundation of a person's life, emotional recovery deserves equal attention.

If you're thinking about self-harm or suicide, dial the Suicide Prevention Hotline at 109, available 24 hours a day, seven days a week. Please request a translator for English-language services.