Dysmorphophobia – body defects that do not exist. How to cure an obsession with appearance? WE EXPLAIN

Proven content

The canons of beauty encourage you to strive for the ideal and pay attention to your appearance. This increases the awareness of all shortcomings of our body. We can accept them or try to change them whenever possible. Body image, however, can distort dysmorphophobia. What do exaggerating bodily defects, delusions related to appearance, and belief in the ugliness of one’s own body lead to?

When you only see imperfections – obsession with appearance

The human body is not perfect, and the canons of beauty take into account and emphasize only some features of appearance. Additionally, these patterns change over the centuries, as does fashion. Even people who meet the specific requirements of a given period in human history fit into this pattern only for a short section of their lives. This is the specificity of the body and organic matter – they change and are not perfect, and we have a limited influence on them.

For years, there has been talk of social pressure over appearance that makes people, especially young people, into complexes. This is a complex problem, but the pursuit of perfect looks also has a lesser-known face. It is about body dysmorphic disorder (BDD), that is, an obsession with appearance that is a mental disorder. This obsessive-compulsive disorder is also known as dysmorphophobia. This is not ordinary or even a bit over-grooming. He is also far from simply wanting to cure specific dermatological problems or to normalize an incorrect weight.

A person with dysmorphophobia tends to exaggerate minor imperfections that other people may not pay attention to at all – it may be a wrinkle, scar, unsatisfactory hair appearance, shape of the nose or mouth. Such a disorder is non-neurotic dysmorphophobia, which is a hypochondriacal disorder. It happens that a person convinced of their ugliness notices flaws in appearance that are not there. We are then dealing with a delusional dysmorphophobia.

In the case of BDD, the patient is overly focused on the defect, devotes a lot of time to it, tries to get rid of it many times, but cannot achieve the desired effect. Even if he decides he has dealt with one flaw, he quickly finds another. Fixation on a flaw of the body leads to compulsive behavior, social phobias and avoidance of contact with people.

Dysmorphophobia belongs to the group of psychodermatological disorders, i.e. related to skin diseases. Dermatological problems can have a significant impact on the psyche of those affected, but in people with BDD there is also a lack of acceptance of the body structure, its mass or muscles.

Dysmorphic disorders can affect virtually any part of the body, and quite often even several areas. With time a person with BDD may look for further defects in his body. This is quite common when a beauty treatment is performed. The disease makes the patient feel unhappy, and the fear of unattractive appearance comes to the fore again. Most often, the obsession with appearance focuses on the skin, hair, body weight, as well as various parts of the face (including the nose, eyes, mouth). Concerns about body composition and the appearance of genitals and breasts are also common.

How to recognize dysmorphophobia?

Taking care of your appearance, which may seem excessive to some, is not a sign of a dysmorphic disorder. Also, complexes or low self-esteem are not enough to say that we are dealing with this disease. When does preoccupation with appearance turn into a dangerous obsession?

The fear of ugliness is primarily characterized by seeing defects in oneself where there are none. Sometimes these are minor deviations from the ideal, i.e. a scar, wrinkles, the shape of the face, nose or mouth, other times the patient perceives non-existent imperfections, i.e. physical features that do not deviate from the norm in any way. One of the main problems is that the person with dysmorphic disorder believes that these imaginary defects are serious. He even treats them as deformities. It causes embarrassment, anxiety, as well as other negative emotions and compulsive behavior.

Behavior characteristic of dysmorphophobia have:

1. fixation on one’s appearance, usually a specific defect or several defects;
2. greatly exaggerating the problem, treating a minor or non-existent imperfection as something unattractive or even disgusting;
3. intrusive thoughts related to the appearance of their body that make it impossible to function normally in social situations, e.g. at school, university, at work – sick people think about their flaws for up to three to eight hours a day;
4. morbid focusing on the defect, browsing through mirrors and glass surfaces;
5. hiding the defect and diverting attention from it;
6. the constant feeling that everyone around sees and talks about an imaginary body defect;
7. avoiding friendships and relationships;
8. attempts to eliminate unwanted features of the external appearance – visits to aesthetic medicine offices, forcing treatments for which there are no indications, as well as the desire to perform plastic surgery on other parts of the body;
9. in the case of dysmorphophobia focusing on weight, the patient can exercise intensively and follow different diets, but also seek help from specialists.

In practice diagnosis of dysmorphophobia may not be simple. The sick person has a disturbed body image and usually does not allow himself to think that it is the result of an illness. The shame associated with the belief in ugliness may also be an obstacle. The chance that she will seek help herself is further reduced if depressive symptoms, social phobias, personality disorders (e.g., paranoid or avoidant personality disorder), or suicidal thoughts are present. It should be noted that these symptoms often accompany people with BDD. They can further make it difficult for the doctor to make a proper diagnosis.

Other problems accompanying dysmorphophobia include bipolar disorder and self-mutilation, and even apotenophilia, i.e. persistent, even obsessive, limb amputation.

How common is dysmorphophobia?

Dysmorphophobia is diagnosed in about 1-2% of population, it occurs with a similar frequency in men and women. This ailment is still little known and there is no detailed research on it, especially in Poland. As during the “Polish Woman in Europe” Conference, Dr. hab. n. med. Irena Walecka, Head of the Dermatology Clinic of the Postgraduate Medical Center, dysmorphophobia occurs much more often than is commonly believed. The lack of precise statistics results from the fact that patients are ashamed of their symptoms and do not receive psychiatric care. Instead, they report to dermatologists, aesthetic medicine doctors and plastic surgeons. The further course of treatment depends on how doctors from these groups approach the patient’s problem and whether they recognize the symptoms of BDD. Patients visit a psychiatrist even after 10 years of treatment by other specialists.

What causes dysmorphophobia?

It is difficult to clearly define what causes dysmorphic disorders. In each individual case, such development of the psyche is influenced by a different set of experiences and inclinations. Here you should list:

1. biological factors. These include neurological disorders, specifically problems with neurotransmitters (serotonin and dopamine), which affect cognitive ability. The probability of the disease manifestation is influenced by genetic predisposition, especially the manifestation of obsessive-compulsive behavior in the immediate family.
2. cultural factors. The tendency to this type of disorder can turn into an obsession with appearance under the influence of social and cultural conditions. The influence of the media and the commonly accepted canon of beauty are not without significance here. The vision of an unattainable ideal deepens the obsessive focus on the shortcomings of one’s own body.
3. psychological factors. Dysmorphophobia often appears in adolescents and young adults as a result of childhood experiences that have disturbed emotional development. The closest environment, family and peers often contribute to low self-esteem and fear of rejection.

Read also about skin conditions that can negatively affect your mental state, lead to depression and suicidal ideation:

1. Acne – causes, methods to get rid of acne
2. Psoriasis
3. Atopic dermatitis (AD) – causes, symptoms, treatment

Can a dysmorphophobia be cured?

Normal functioning in society is much more difficult for people with dysmorphophobia. As their ailments worsen and isolation, they become more and more dependent on their loved ones. This is why it is so important treatment of dysmorphic disorders as early as possible. At some stage, you may refuse to go out because of a phobia, anxiety or depression.

The mainstay of treatment is various forms of therapy, such as cognitive behavioral psychotherapy, relaxation techniques, and work on anxiety and phobic responses through gradual exposure to specific social situations. In the course of treatment, if necessary, pharmaceuticals are used, including antidepressants or anti-anxiety preparations. You can also consult other doctors at the same time. Usually, however, dermatological or surgical treatment leads to nowhere – after dealing with one defect (e.g. acne), the patient finds another defect, and the dysmorphic problem continues.

The effectiveness of treatment depends, as in the case of other mental disorders, on the form and intensity of symptoms, proper diagnosis, and the support of relatives. The therapy is slightly different in the case of a neurotic disease than in the case of delusions belonging to psychotic symptoms. Both these forms of ailment may coexist in dysmorphophobia.

Comprehensive help and a holistic approach to the patient gives a great chance to improve the patient’s condition, significantly minimize symptoms and improve the overall quality of life.

Dysmorphophobia and eating disorders

Body image disorders very often focus on the appearance of the skin, but there are also preoccupation with body weight and the amount of body fat. If the dysmorphophobia affects the general body structure or areas such as the abdomen or thighs, there is a risk of developing an eating disorder. The desire to “fix” your body leads to obsessive reading about diets and methods of getting the perfect body. The next step is to modify your diet, and the possible consequences are anorexia or bulimia. Identifying the cause of an eating disorder is not easy. They do not always coexist with dysmorphophobia, and may be caused by other mental disorders.

Skin diseases and psyche

Psychodermatology deals with dermatological problems and their influence on the mental state of a person. Specialists examine:

1. the impact of skin changes on the mental state – decreased self-esteem, shame and depression caused by appearance;
2. the influence of negative emotions on the actual condition of the skin – acne, eczema, alopecia, itching and other symptoms caused by stress and other emotional factors.

Both of the above-mentioned states can drive each other, which creates the risk of a vicious circle effect. Dermatological diseases cause depression and stress, and these emotional states contribute to skin changes. This correlation proves that some patients struggling with dermatological problems require the help of a dermatologist, psychologist or psychiatrist.

Psychodermatology also takes into account a mental disorder such as dysmorphophobia, which is manifested by obsessions and delusions related to skin lesions. Other primary disorders of this type include:

1. parasitic insanity (formerly tactile hallucinosis) – the patient experiences sensations, which he describes as movements of parasites on the skin or under its surface; he may also be delusional and see alleged parasites;
2. trichotillomania – obsessive, also uncontrolled hair pulling, can affect the scalp, but also eyebrows, eyelashes or pubic area;
3. nail biting (onychophagy);
4. dermatillomania – pathological skin picking.

If we observe disturbing symptoms in ourselves or a loved one that are related to appearance, complexes, skin diseases or obsessions, it is very important to react appropriately and see a doctor. Breaking down the embarrassment and embarrassment of your ailments is the first step to getting professional help and improving your quality of life.