Body Dysmorphophobia: symptoms and treatment of Body Dysmorphism Disorder

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The hallmark of dysmorphophobia is the preoccupation with a defect in physical appearance

It may be totally imaginary, or, if a real small physical abnormality is present, the subject’s concern is far in excess of the normal.

Complaints are easily about mild or imaginary defects of the face or head, such as thicker or thinner hair, acne, wrinkles, scars, vascular manifestations, pallor or redness, sweating, asymmetries or disproportions of the face, or excessive hair.

Other common concerns of dysmorphic individuals relate to the shape, size, or some other appearance of the nose, eyes, eyelids, eyebrows, ears, mouth, lips, teeth, jaw, chin, cheeks, or head.

However, any other part of the body may become a cause for concern (e.g., genitals, breasts, buttocks, abdomen, arms, hands, feet, legs, hips, shoulders, spine, larger regions of the body or overall body measurements, or body build and muscle mass).

In dysmorphophobia, the preoccupation may simultaneously affect different parts of the body

This disorder is mainly observed in adolescents of both sexes and is closely related to the transformations of puberty.

If it affects adult subjects it is more complex, because with the end of adolescence the person should acquire a sense of self-confidence such that he or she can relate harmoniously with others, without being afflicted by inferiority complexes related to physical appearance, let alone by obvious symptoms such as those of dysmorphia.

Most individuals with this disorder experience severe discomfort with their supposed deformity, often describing their concerns as “intensely painful,” “tormenting,” or “devastating.”

Most find their worries difficult to control, and make little or no attempt to resist them.

As a result, dysmorphophobes often spend many hours a day thinking about their “defect” and how to remedy it (sometimes resorting to cosmetic surgery or self-manipulations that can make it worse), to the point that these thoughts can dominate their lives.

Feelings of shame about their “defect,” may lead to avoidance of work, school or social contact situations.

These people with body dysmorphism enact compulsions for the purpose of examining, improving or hiding the alleged defect

For example, they tend to check themselves in the mirror or other reflective surfaces, show excessive care for their appearance, tend to comb or wash their hair repeatedly, make constant comparisons with others’ physical appearance, seek reassurance or attempt to convince others about their defect.

Dysmorphophobia can be effectively treated with cognitive behavioral psychotherapy, borrowing many techniques from those used to treat obsessive-compulsive disorders, with which there are various similarities.

Medications are rarely effective, at least unless there is some comorbidity with major depression.

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