Being afraid of one’s own image

Dr Manish Jain

 In today’s world when appearances have begun to rule our lives, there is some aspect of our overall looks that most of us may not like — uneven teeth, a big nose or small eyes. While we may not be happy with the way we look, these imperfections, real or perceived, don’t interfere with our daily lives. 

However, individuals, who suffer from body dysmorphic disorder (BDD), have negative, and sometimes biased, views about their real or perceived flaws. These people are excessively preoccupied with some 'imagined' or 'slight' defect in their body to the extent that it starts affecting their mental health. 

Symptoms and traits

This disorder is characterised by persistent and intrusive negative thoughts about imagined or slight flaws that these people can't control. They refuse to believe others about their appearance. Their thoughts and behaviour may cause severe emotional stress and interfere with their daily functioning. They may miss work or school, avoid social gatherings and withdraw from family and friends because of their fear that others will notice their flaws.

Symptoms and behavioural traits include excessive preoccupation with grooming rituals, hiding their bodies under various clothes, makeup, comparing their body parts to others', checking or avoiding mirror, seeking corrective surgery, etc. BDD patients always worry about their nose, eyes, hair, chin, skin or lips, etc. Even a slight flaw seems prominent to them.

These kind of obsessions and behaviour cause emotional distress and impact their abilities to perform day to day activities. People with severe BDD may even have suicidal thoughts.

Causes and factors

The causes of this disorder are unknown, though biological and environmental factors, including genetics, neurobiological factors like malfunctioning of serotonin in the brain may be responsible for its development.

Other factors may include bullying and/or abuse during childhood/adolescence, low self-esteem. Such patients may get dependent on alcohol and develop poor eating habits.

BDD is thought to affect around one to two per cent of the population, and it affects men and women equally. It often starts during adolescence. However, most people who are diagnosed with this problem do not get diagnosed until 10 to 15 years after their symptoms usually begin. This may be due to a feeling of shame often associated with mental problems, which prevents people from seeking help.

People affected with BDD may also suffer from other disorders such as anxiety or social anxiety disorder, depression, eating disorders, or obsessive-compulsive disorder (OCD). BDD patients can also be misdiagnosed as they share similar symptoms with other mental disorders.

BDD is treatable and can be treated with the help of trained mental health professionals like a psychiatrist or a clinical psychologist who can use a combination of medication and psychotherapy or cognitive behavioural therapy (CBT).

With effective and tailor-made treatments, BDD can be overcome and patients can live full, productive lives.

 — The writer is consultant, psychiatry, BLK Super Specialty Hospital, New Delhi