LOS ANGELES, CA - FEB 15: Reid Ewing at the Sony PlayStationAE UMaking the decision to reveal sexual orientation is deeply personal. Some may choose to confide in trusted friends and family before coming out to the world, others opt to keep the matter private for their entire lives and still others may live their lives in such a way that they assume it’s all obvious. Modern Family actor, Reid Ewing, recently surprised fans with a casual comment about his sexuality at a time when they were already reeling about his battle with body dysmorphia.

Plastic Surgery Addiction

In a personal essay written for Huffington Post, Ewing explained that, after moving to Los Angeles in 2008, he felt isolated and developed a deep sense of insecurity over the pressure to look a certain way. He wrote: “‘No one is allowed to be this ugly,’ I thought. ‘It’s unacceptable.’ … when I was 19-years-old, I made my first appointment to meet with a cosmetic surgeon. I genuinely believed if I had one procedure I would suddenly look like Brad Pitt.”

With “very few, if any, friends” to talk to, he would sit alone in his apartment and take pictures of himself “from every angle, analyzing every feature.” This obsession with his appearance, which, in his case, was diagnosed as body dysmorphic disorder, led him to consult with a plastic surgeon.  He admits to having had several botched procedures, including cheekbone and chin implants as well as Botox injections. By 2012, he had descended into depression and struggled with people even looking at him.

Lack of Screening

How did this happen? As Ewing explains, none of the four plastic surgeons that he saw had any mental health screenings for their patients prior to undergoing a procedure. He admitted to having suffered from depression but the discussion never went any further. His history of eating disorders and the prevalence of Obsessive Compulsive Disorder in his family never came up. As a result, his motivation for altering his appearance was never questioned and he failed to get the help he needed.

Now that he’s working on himself, he has advice for people who want to go under the knife: “Before seeking to change your face, you should question whether it is your mind that needs fixing.”

Twitter Admission

As fans praised Ewing for being honest about his body image issues, something else happened. The 27-year-old, who is known for portraying Sarah Hyland’s boyfriend on Modern Family, tweeted about how attractive a man was on Good Morning America. When a fan asked: “Did you also just out yourself?” his reply was “I was never in.”

It seems like a big moment in the life of a young man who has struggled with the confidence he needs to be comfortable being himself. It’s encouraging for other who may also be struggling with identity issues.

If you think you or someone you know may be struggling with body dysmorphic disorder, visit the Anxiety and Depression Association of America’s website or speak to your healthcare professional.