Body dysmorphophobia: treatment, how to get rid of the syndrome

Body dysmorphic disorder is a mental disorder in which the subject is extremely concerned about minor defects or certain features of his own body. This disorder usually begins in adolescence. All people are susceptible to dysmorphophobia, regardless of gender. The main danger of dysmorphophobia is suicide attempts.

Body dysmorphophobia is a pathological belief and belief in the presence of any physical defects or diseases, which is based on somatic sensations leading to hypochondria. It includes three main components: the belief in the presence of a physical “deformity” (disadvantage), which can be real or exist only in the patient’s imagination, ideas of attitude, and depressive states.

What is dysmorphophobia

Body dysmorphic disorder is a mental disorder in which a person attaches great importance to his appearance. He is haunted by an obsessive desire to change any part of the body or eliminate an obvious or far-fetched defect. The term “dysmorphophobia” (also known as dysmorphomania) appeared in 1886. It was introduced by the Italian psychiatrist, Professor Enrico Morselli.

Bodysmorphophobia syndrome develops in those who are too critical of themselves. Probably, many of us have ever wanted to change something about ourselves. Those who suffer from this disease simply dream of such changes. They often look quite attractive, but, considering themselves extremely ugly, they avoid contact with society and are ready to do anything to become different. Such people are reluctant to even ask for help. They think they will be laughed at or judged. Sometimes this happens because others do not consider the syndrome to be a serious problem. They think it's a desire to attract attention or stupidity.

According to psychologists, dysmorphophobia combines manifestations of obsessive-compulsive syndrome, namely obsessive thoughts and the same actions. A person can sit in front of a mirror for several hours, looking for flaws in himself. Or he goes to the other extreme - he avoids mirrors. He spends at least 1 hour a day thinking about his appearance. At some point, he decides to become a hermit, not wanting to show himself to people with his shortcomings.

According to studies conducted in Germany, signs of body dysmorphic disorder are observed in approximately 2% of residents. These people suffer from low self-esteem, as well as an overly critical attitude towards their appearance. Interestingly, the disorder is equally common among men and women.

Similar studies were conducted in the USA. They found that among those who suffered from body dysmorphic disorder, the suicide rate was 2 times higher than in depression and bipolar affective disorder.

Interesting! Those who disagree with their gender develop dysmorphophobia more often than others. These people also have an increased risk of suicide.

Generally speaking, about 1% of the population of our planet faces this mental disorder. But many doctors believe that the figure is underestimated and there are many more patients. In their opinion, in most cases body dysmorphic disorder develops among representatives of the middle and rich class. Most of the patients have a good education, a high stable income, and a position in society.

“I want to be like Sofia Rotaru”

We conducted a survey among cosmetologists and plastic surgeons and asked our audience to send in the most unusual question that a patient asked them at an appointment. Within a few days we received more than 150 responses. Below are the brightest of them.

Ninel Mikhailovna Beketova , Clinical psychologist, Director of the Institute of Doctor-Patient Relationships

“If a patient with a diagnosis of dysmorphophobia comes to an appointment, then first of all it is very important for the attending physician (whether a cosmetologist or a psychotherapist) to establish communication with such a patient. After all, all questions and requests from patients are aimed specifically at establishing contact with the doctor, no matter how strange it may sound at first glance. And it is in an effort to establish a trusting relationship that the patient asks the doctor questions - he needs to establish a trusting relationship.

However, the doctor can often be hostile to such a desire of the patient, and this can also be the norm, since the doctor may, at the time of the question, see the world completely differently from the patient. The contradictions that arise between the world of the doctor and the world of the patient come into conflict during communication, which becomes complicated and difficult, which is characterized by the inability to achieve mutual understanding.

For example, a patient makes the demand: “I want to be like Sophia Loren and I have the right to dream about it. What can modern medicine offer me? And my doctor in particular?”

The patient has the right to ask the doctor about what he wants, and how the doctor sees the desired transformation and what available methods he can offer. And here the doctor must ask - after all, until the necessary questions are asked, it is impossible to understand the boundaries of the patient’s awareness of reality, since there can be many options for meaning among different people. Just like doctors. The faster the doctor makes a conclusion about the meaning of the patient’s question, the greater the likelihood that he will not make a mistake, and the patient will not experience the mistake as a misunderstanding on the part of the doctor. So the most important thing is to reach an early understanding. And here a lot depends on the ability to understand oneself and one’s boundaries, as well as to hear the other person.”

Symptoms of the disease

Bodysmorphophobia has a number of characteristic symptoms:

1. An attempt to hide non-existent flaws.
2. A lot of time is devoted to caring for one's appearance.
3. Constantly touching the skin at the site of an imaginary defect.
4. Frequently asked questions regarding appearance.
5. Passion for diets and sports.
6. Low self-esteem.
7. A person does not want to go outside or does it only in the dark. So he tries to hide apparent deformities from others.
8. Bodysmorphophobia in adolescents leads to decreased academic performance and problems communicating with peers.
9. Excessive consumption of alcoholic beverages.
10. Independent drug treatment, the purpose of which is to get rid of defects.
11. Depression, thoughts of suicide.
12. Decreased performance due to the inability to concentrate on anything other than appearance.
13. Constant suspicion that others are discussing and mocking the patient.

A person suffering from dysmorphophobia tries to disguise shortcomings with the help of an extravagant appearance. He also has thoughts of resorting to plastic surgery. But even several operations do not bring the desired satisfaction.

Relevance of DFF at present

Researchers note that appearance is one of the objects of cyberbullying - bullying on social networks. Not only are modern children addicted to the approval of their photos in the virtual space, they easily make fun of their peers - with less caution than in the real world.

Among teenagers, body volume (for girls) and muscle development (for boys) are most often criticized. Constantly making offensive comments in front of a wide audience can create a negative attitude towards the body. In addition, social networks are often filled with low-quality discriminatory content. As a result, those whose parameters are far from ideal fall under a wave of negativity and acquire DFF.

Causes

So, what is body dysmorphic disorder? This is an excessive preoccupation with appearance. Most often, it develops in adolescence, since during this period physical disabilities (real or imagined) are perceived most acutely.

It is impossible to say unequivocally what causes the development of the disease. Rather, it can be called multifactorial.

Conventionally, in psychology, the causes of dysmorphophobia are divided into 4 types.

Psychological

First of all, this is criticism and mockery. They tease a lot of people. And most of them let the offensive words fall on deaf ears. But if a person has a predisposition to developing a disease, words spoken at the wrong time will only be an impetus for its development or exacerbation.

Diagnostics

A psychiatrist or psychotherapist can make an accurate diagnosis. Therefore, it is worth contacting these specialists. Diagnosis is not easy, since many patients are embarrassed to talk about their shortcomings. It is also important to see the difference between the normal desire to look good and take care of oneself and the obsession with changing one’s appearance or eliminating imaginary defects.

So, what does the doctor pay attention to:

• obsession, anxiety regarding appearance, looking at oneself in the mirror for many hours;
• the presence of a seeming lack of appearance;
• decreased quality of life, lack of personal life, friends and communication in general;
• reluctance to be photographed;
• suspiciousness, fear of being humiliated and ridiculed.

The specialist assesses the severity of each of the listed symptoms, as well as their dynamics. With dysmorphophobia, these indicators increase over time.

Treatment methods

How to get rid of dysmorphophobia? The main difficulty in treatment is the patient’s reluctance to admit that there is a problem. He explains his excessive enthusiasm for appearance by the banal desire to look good. This is why such people rarely seek help. And if they do, they don’t fully follow the doctor’s orders. As a result, it is only possible to reduce the severity of symptoms, but not to cure the disease.

Ignoring medical prescriptions leads to serious consequences, such as depression or even suicide attempts.

So how to treat body dysmorphic disorder? First of all, this is drug therapy. Typically, the patient is prescribed antidepressants of the serotonin reuptake inhibitor class. To obtain sustainable results, they must be taken for at least six months. During this time, you will be able to get rid of depression, anxiety, obsessive thoughts and desires.

At the initial stages of dysmorphophobia, a short course of treatment with benzodiazepine tranquilizers is carried out. In more severe cases, antipsychotics are indicated.

Psychotherapeutic measures play an important role in the treatment of the syndrome. Most often this is cognitive behavioral therapy. It helps a person stop being so critical of appearance. But this is not the main thing. It is important that a person sees what condition he is in, how dangerous it is for his health and life in general.

Experts advise practicing both individually and as part of a group. This therapy has a number of advantages:

1. You can look at the problem from the outside.
2. There is support for people who are struggling with the same disease.
3. Here is an example of those who have successfully dealt with body dysmorphic disorder.
4. The person receives additional psychological and emotional help.

Without a doubt

The causes of dysmorphophobia can be divided into two large groups.

The first is psychological trauma. For example, during a divorce, a husband told his wife: “I’m leaving you because you are a fat cow.” And a woman, who in fact is not even overweight, begins to worry about this. She develops dysmorphophobia, which can result in bulimia. Another example: someone once made an unsuccessful joke about the shape of a young man’s nose, this was combined with some kind of stress, and as a result, we have the Cyrano de Bergerac complex in all its glory.

Even watching TV can be a traumatic factor. Nowadays there are many programs about plastic surgeries, based on the principle: Vasya (Tanya, Ivan Ivanovich) had a physical disability, he had an operation, he became beautiful, successful and happy, which would never have happened if he had remained “ugly”. For a person who feels like a failure, has recently suffered a collapse in a personal relationship, or is simply quite impressionable, such a transfer can become a trigger that sets off the mechanism of body dysmorphic disorder.

The second possible cause of dysmorphophobia is a serious mental illness. Usually we are talking about an anxiety disorder that leads to obsessive thoughts. Even if we convince such a person that his profile resembles a Greek god (and not at all like Pinocchio, as he previously believed), this will not help him much. After all, anxiety disorder has not gone away! Instead of the old obsession, he immediately develops a new one.

He will not be satisfied with the shape of his ears, eyes or kneecaps - it doesn’t matter, there will always be an object for dissatisfaction

Also, dysmorphophobia may be associated with schizophrenia or psychopathy of the schizoid circle. In this case, it is simply part of a delusional concept. It is useless to treat such dysmorphophobia in itself, because it is based on a more serious disease that needs to be dealt with first, and dissatisfaction with appearance is just a symptom.

Prevention

All people with body dysmorphic disorder have low self-esteem. Like other psychological problems, it comes from childhood. Perhaps the parents pointed out to the child some features of his appearance or inconsistency. As a result, already in adulthood he was faced with self-doubt.

There are 3 ways to prevent the development of dysmorphophobia or reduce the severity of its symptoms:

1. Learn to look at yourself objectively. Look in the mirror. Find all the advantages of your appearance, what makes you stand out among others. Focus specifically on these moments.
2. Develop a sense of humor. Take examples from famous people, such as movie stars, with flaws in their appearance. Look how confident they are in themselves and their beauty, how easily they treat some defects.
3. Consider your distinctive features as a gift from your ancestors. Typically, appearance features are passed on from generation to generation. Isn't being similar to your great-grandparents a reason to be proud?

Remember that you are a unique individual. Treat yourself the same way you would treat your child. Appreciate yourself, despite your shortcomings and idiosyncrasies.

Example from life

As a teenager, I had a friend who was simply obsessed with her appearance. She did not have any defects or shortcomings, she was very pretty. But still she always didn’t like something about herself.

At first, my friend wanted to lose weight. She reduced the amount of food to a minimum and tortured herself with daily training. She stopped only when her parents began to sound the alarm, seeing her daughter’s painful thinness.

Self-care has turned into some kind of ritual. It was difficult to count how many different products and cosmetics were in her room. It’s probably not worth talking about makeup. Because already at the age of 15-16 she applied it according to all the rules, using not only decorative cosmetics, but also foundation, powder, etc. At that age it looked a little ridiculous.

Fortunately, as I grew older, my obsessive desire for perfection lessened a bit.

How to recognize a person with dysmorphophobia at an appointment?

ICD-10 provides the following parameters for assessing the patient’s condition:

• Persistent concern about the possibility or presence of a severe, progressive physical illness or deformity.
• Normal sensations are interpreted by the patient as signs of disease.
• Attention is usually concentrated on one or two organs.
• Attempts to manipulate in the family or other social spheres using declared disorders.
• The desire to overcome the disease through the selection of health-improving measures, a gentle regime and self-medication.

The DSM-IV (Diagnostic and Statistical Manual of mental disorders IV) also gives similar criteria:

• Preoccupation with a perceived defect in appearance and internal state. If a slight physical anomaly is present, it is given undue attention.
• The concern involves significant distress or difficulty in social, professional, or other important communication areas.
• The preoccupation cannot be explained by another mental disorder.