Dysmorphophobia is a serious mental disorder. Affected people feel ugly or even disfigured, although objectively they have no obvious blemishes. They worry excessively about their appearance, focusing on certain body parts that they perceive as deformed. The disorder is a significant burden for those affected. Many withdraw for fear of being rejected by social life. Read all important information about dysmorphophobia here.
In people with a dysmorphophobia, also called body dysmorphic disorder, the thoughts constantly revolve around their appearance. They feel disfigured, although there is no objective reason. Even if a body part does not correspond to the usual ideal of beauty, the affected people perceive this much worse than it really is. The reason for the postponed reality view is a body image disorder. Most of the time they fix themselves on a certain part of the body that seems unaesthetic to them. Women often complain about their face, chest, legs or hips, while men tend to feel disfigured by too few muscles, unsightly genitals or too much body hair.
Dysmorphophobia has far-reaching consequences for social and professional life. Those affected withdraw from friends and family because they are ashamed of their looks. They neglect their work. More than half of those affected have suicidal thoughts. Thus, there is an increased risk of suicide in dysmorphophobia.
Body Dysmorphic Disorder (BDD) is one of the compulsive spectrum disorders in the new version of the Diagnostic and Statistical Manual of Mental Disorders. Because people with a dysmorphophobia have behaviors similar to those with OCD.
How many are affected by dysmorphophobia?
About 0.7 to 2.4 percent of the population suffer from dysmorphophobia. Women are slightly more affected than men. In many cases, the disorder begins in adolescence. In addition to the distorted body perception, at least half of those affected also suffer from depressive symptoms. The social phobia and obsessive-compulsive disorder occur equally frequently at the same time.
A special variant of dysmorphophobia is muscle dysmophobia, which affects mostly men. They feel their body as too little muscular or feel too small. Even if her body already resembles that of a professional athlete, he displeases them. Some, therefore, begin to exercise excessively. Muscle addiction is also referred to as Adonis Complex or inverse anorexia (reverse anorexia). Much like an anorexic, the men perceive their bodies distorted. Instead of avoiding calories, however, they focus on taking high-protein foods. Some, in desperation, also use anabolic steroids to gain muscle mass as quickly as possible.
How many people are affected by muscle dysmorphia is unclear. Bodybuilders are about ten percent. Experts believe that the number of those affected will continue to increase. The reason is that now men are under the pressure of a beauty ideal.
People with body dysmorphic disorder are constantly dealing with their stigma. Those affected have no control over their self-deprecating thoughts that significantly affect their quality of life. People with dysmorphophobia tend to have so-called safety behaviors, which are also typical of constraints. Some have to check their supposed flaws again and again in the mirror, although they feel bad. Others shy their eyes in the mirror and do not dare to public. As a rule, people with dysmorphophobia try to hide their imaginary blemish. Some are treated regularly by the plastic surgeon or try to change their appearance themselves. But none of this solves the problem – they are still ashamed of their appearance. Often depressive symptoms such as depression and hopelessness accompany the dysmorphophobia.
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), the following symptoms must be considered for the diagnosis of dysmorphophobia:
- Those concerned are overly concerned with supposed blemishes that are unrecognizable or marginal to others.
- The supposed blemish repeatedly drives those affected to certain behaviors or mental actions. For example, they check their appearance in the mirror, operate exaggerated personal hygiene, have to be constantly confirmed by others that they are not ugly (reinsurance behavior) or constantly compare themselves with other people.
- Sufferers suffer from the excessive preoccupation of their outward appearance or affect them in social, occupational or other important areas of life.
- Excessive attention to appearance is not based on an eating disorder.
Dysmorphophobia can also occur in combination with delusions. The affected person is then completely sure that his perception of his own body corresponds to reality. Other sufferers, on the other hand, realize that their self-perception is inconsistent with reality.
Dysmorphophobia: causes and risk factors
The cause of dysmorphophobia is attributed by experts to the interplay of biological and psychosocial factors. The values conveyed in our society also have an important influence. Beauty has a high priority. The media reinforces the sense of appearance by giving the impression that beauty makes you happy.
There is evidence that childhood experiences play a crucial role. Abuse experiences and neglect in childhood are risk factors for the development of dysmorphophobia. Children who are overprotected and whose parents avoid conflicts are also at risk.
People with body dysmorphic disorder have always paid great attention to their appearance since childhood. Parents often get affection for their looks, not for their personality. The appearance thus becomes the source of affirmation and recognition. Teasing and bullying can seriously damage self-esteem and help those affected question their appearance more and more. Particularly vulnerable are people who have a low self-esteem and are more timid and timid.
Experts believe that biological factors also influence the development. They suspect a disorder in the household of the neurotransmitter serotonin. This assumption is strengthened by the fact that treatment with selective serotonin reuptake inhibitors (SSRIs) can help with dysmorphophobia.
Certain thoughts and behaviors maintain the symptoms of dysmorphophobia. Those affected often have a perfectionist and unattainable claim to their appearance. They focus their attention strongly on the exterior and therefore perceive changes or deviations from their ideal increasingly. Their appearance always seems unattractive to them compared to their intended ideal. The social retreat and the constant look in the mirror reinforce the feeling of being ugly yet. This safety behavior encourages the person in their belief that there is a good reason not to show themselves in public.
Dysmorphophobia: examinations and diagnosis
The body dysmorphic disorder is often not recognized. First, the disorder is often masked by depressive symptoms. Second, many sufferers are unaware that worry about their looks is a psychological issue. There are some self-tests on the internet that allow a first assessment of dysmorphophobia. However, such a self-conducted dysmorphophobia test does not replace the diagnosis of a psychiatrist or psychologist.
To diagnose dysmorphophobia, the psychiatrist or psychologist conducts a detailed anamnesis interview. On the basis of questions that are based on the diagnostic criteria, the experts try to get a comprehensive picture of the symptoms.
The following questions could ask the psychiatrist or psychologist to diagnose dysmorphophobia:
- Do you feel disfigured by your appearance?
- How much time a day are you dealing with external blemish?
- Do you spend a lot of time in the day looking in the mirror?
- Do you avoid contact with other people because you are ashamed of their appearance?
- Do you feel burdened by thoughts about her appearance?
After the discussion, treatment options and the further procedure will be discussed.
People with dysmorphophobia rarely seek psychotherapeutic treatment. Often, however, they seek out cosmetic surgeons or dermatologists to correct the perceived blemishes. However, this rarely contributes to an improvement in the symptoms, since the desired ideal is unattainable. Experts recommend cognitive-behavioral therapy and medications for successful treatment. The therapy can be performed both outpatient and inpatient.
The cognitive behavioral therapy
Cognitive behavioral therapy begins with the distorted thoughts and safety behavior. At the beginning of the therapy, the therapist first clarifies the patients in detail about the causes, symptoms and the treatment of the dysmorphophobia. The better the sufferer is familiar with the disorder, the easier it is for them to discover the symptoms. An important part of the therapy is also to identify possible causes of the disorder. When the causes surface, many patients realize that concern for appearance is only an expression of a deeper problem.
In therapy, those affected learn to recognize and change stressful thoughts. The perfectionist claims realistic and achievable claims are opposed. In addition to thoughts, concrete behaviors also play an important role in the treatment. Many do not dare to go public because they are afraid of being judged by others. When people with a body dysmorphic disorder go into people, then with a lot of make-up or clothing that hides the hated body parts. In order to reduce shame and anxiety in terms of appearance, sufferers should not hide the supposed flaws, but show open. In the confrontation with their fears sufferers experience that their fears do not apply. The experience that other people do not perceive their flaws changes thoughts. With repeated confrontations with the feared situation the uncertainty gives way and the fears decrease.
For inpatient treatment, patients are prepared for possible relapses before discharge. Because in the usual environment many sufferers fall back into old patterns of behavior. Ultimately, the goal of therapy is for patients to be able to use the learned techniques without outside help.
For the treatment of dysmorphophobia, only antidepressants have proven successful as drugs. In combination with psychotherapeutic treatment, selective serotonin reuptake inhibitors (SSRIs) may be added in some cases. They increase the level of mood-enhancing serotonin in the brain and can contribute to an improvement of the symptoms. SSRIs are not addictive, but they can cause nausea, restlessness, and sexual dysfunction.
Dysmorphophobia: disease course and prognosis
Body dysmorphic disorder is a serious mental illness. Without treatment, dysmorphophobia is chronic in many cases. The intensity of the symptoms varies. At the beginning, the prevailing feeling is the fear of being ugly. Over time, about half of those affected form a firm conviction of their stigma and develop a delusion. With the duration and intensity of dysmorphophobia, the risk of attempting suicide also increases. An early detection and treatment of dysmorphophobia therefore also increases the chances of a successful therapy.