Holly Madison Developed 'Body Dysmorphia' While Living in Playboy Mansion Under Hugh Hefner's Judgment (Exclusive)

"It definitely took me a couple years to kind of get deprogrammed and get out of the Playboy fog," Madison tells PEOPLE exclusively of processing her trauma

For Holly Madison, residing in the Playboy Mansion for nearly a decade had lasting effects on her mental health.

Madison, who was only 21 when she moved into the Holmby Hills home, was Hugh Hefner's girlfriend from 2001 to 2008 — and that title meant conforming to specific and restrictive beauty standards.

“I would definitely say that living in the mansion created a body dysmorphia for me because I was always kind of wondering what's wrong with me," Madison, now 43, tells PEOPLE exclusively. "[Hugh] had a way of making me feel like I wasn't pretty enough, and I would look around to everybody else and constantly be wondering, what's so different about them and why are they so much better?”

According to Johns Hopkins Medicine, body dysmorphic disorder (BDD) is considered a mental health disorder that manifests as “worry about the way your body looks” to the point where “it interferes with your ability to function normally.”

Undertaking “extreme measures” such as “repeated cosmetic surgical procedures to correct the perceived flaw” is also a hallmark sign, according to JHM.

Understandably, Madison consistently felt “self-conscious" about every aspect of her appearance.

Related: Holly Madison Recalls 'Traumatic' First Night with Ex Hugh Hefner: He Was 'Pushed on Top of Me'

“It was constantly like, what can I do? What can I do? What can I change? How can I look better?” recalls Madison, who has been open in the past about having a nose job and a breast augmentation.

“When I look at what the typical Playboy bunny looks like with the blonde hair and big boobs, I always wanted to look like that. That was just something I would see and it would resonate with me, and it wasn't to impress any certain person,” Madison explains of her decision to have plastic surgery. “I just wanted to look like that, and that's what attracted me to the Playboy brand in the first place.”

While she chose to undergo plastic surgery "for myself" at first, Madison says living in the mansion with Hefner had a negative impact on her self-confidence.

“I could be looking like a plastic surgery nightmare right now!” reflects Madison. “Because it was just constantly me wondering, what's wrong with me? What's wrong with me?”

Related: Holly Madison Says Hugh Hefner 'Flipped Out' When She Cut Her Hair: He 'Said It Made Me Look Old'

After she first left the mansion, Madison was in “survival” mode and felt “traumatized” by her experiences while trying to create a new life for herself away from Hefner.

“I was just in this fight or flight state for about four months, just trying to get my feet off the ground because I knew I had to. It was like, build a career for yourself right now before people forget you were on a show," she says. "So I did that, and then I was just working my ass off for three years straight.”

Madison says she finally found some stability when she decided to get married and have children, which was also when she gave herself a chance to process all that she’d been through. (She and Pasquale Rotella — who share children Rainbow Aurora, 10, and Forest Leonardo, 7 — finalized their divorce in early 2019.)

“I remember I was looking through this Girl's Next Door coffee table book that we put out when the show was still on because I was looking for a certain outfit I wore for a throwback photo on Instagram, and I was looking at pictures of myself and I was like, 'Holy s---, I'm fake smiling in all these pictures,'" she says. "Nobody else would be able to tell that. They'd just be like, 'Oh, you're smiling.' But I know myself, and I'm like, 'Oh, my God, I was so miserable.' I remembered how miserable I was every day, and then that just all came crashing down.”

Today, Madison has made her peace with the past. She's busy with season 2 of her Girls Next Level podcast, which she co-hosts with former Playboy Bunny Bridget Marquardt, and she loves the work she's doing on true crime shows for ID network.

“I feel like I'm on the other side of it,” Madison says of healing from her trauma. “It definitely took me a couple years to kind of get deprogrammed and get out of the Playboy fog and realize what that relationship was really all about and quit trying to glorify it or justify it to other people.”

She adds: "I'm kind of hyper independent now, but I've been in a relationship for four years on and off. I'm happy."

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