In detail

Body Dysmorphic Disorder: imaginary ugliness

Body Dysmorphic Disorder: imaginary ugliness

Satisfaction for body image It is an important objective in today's society, and this concern for the physical aspect becomes pathological when it reaches irrational limits. The media promote the ideal perfect body. These messages influence the development of the identity of the adolescent, who perceives a distorted image of his own body.

Content

  • 1 What is Body Dysmorphic Disorder
  • 2 History of Body Dysmorphic Disorder
  • 3 Symptoms of TDC
  • 4 More common in women
  • 5 Age of onset, course and evolution of the TDC
  • 6 The other scene of dysmorphia
  • 7 Treatment of TDC

What is Body Dysmorphic Disorder

People with CDD have an excessive concern for their body image, due to some minimal body defect or body defects that are only in the mind of those who imagine them. And in case any imperfection exists, the feelings it generates are extremely exaggerated or unfounded. These obsessive ideas refer to body parts that are assigned a special aesthetic or communicative function.

Those who suffer from this disorder have a series of overrated ideas about your body or some trait, which do not reach delusional proportions because at some point they recognize that these obsessions are irrational or excessive, that is, they retain the reality judgment.

Many of these people experience severe discomfort in relation to the defect and describe their concerns as "very painful, torturing or devastating." They cannot control and dominate their concerns but at the same time they do little or nothing to overcome them.

They usually spend hours thinking about the defect to the point that these thoughts dominate their lives almost completely. Therefore, in many cases there is a significant deterioration in many areas of the subject's life.

The idea of ​​having an unsightly, unpleasant or repulsive aspect focuses almost exclusively on certain parts of the body and only in exceptional cases does it cover the entire body.

The most frequent concerns relate to facial and sexual features

According to our experience, the TDC is becoming more significant today because many people who go in search of plastic surgery, for example. to get a mammoplasty or rhinoplasty imagine that they have a deformity. However, no operation may modify the attitude of these subjects to their alleged unsightly appearance.

Body dysmorphic disorder (CDD), as well as anorexia nervosa, depersonalization (body sensation of being separated from oneself) and hypochondriasis, are encompassed in a type of conditions associated with obsessive-compulsive spectrum (EOC) and that are characterized by "concern for the body and appearance" and today it is known that many of the methods used to combat obsessive compulsive disorder (OCD) They are also very useful for these diseases.

In contexts where cosmetic activities are usually carried out, it usually goes unnoticed.

It affects between 2.5 and 5% of the population with a predominance in women.

History of Body Dysmorphic Disorder

The term dysmorphophobia was coined by the Italian psychiatrist Enrique Morselli at the end of the 19th century. (1886). He denominated with him a type of psychic condition that consisted of the "awareness of the idea of ​​the deformity itself: the individual fears to be deformed or become one" and how "A subjective feeling of ugliness or physical defect that the patient believes is evident to others, although its appearance is within the limits of normalcy". He observed that condition in patients who came from his private practice, however, that type of complaint was unusual among asylum patients for mentally ill people of the time.

TDC symptoms

  1. They refer to imaginary or minor defects in the face, or head such as acne, wrinkles, scars, vascular spots, paleness or redness of the skin, excessive hair, asymmetries, facial disproportion, thinness of hair; swelling These people may also worry about the shape, size or other aspects of the nose, eyelids, eyebrows, ears, mouth lips, teeth, jaw, chin, cheeks, etc. Any part of the body can also be of concern: genitals, breasts, buttocks, abdomen, arms, hands, legs, hips, shoulders, spine, spine, large areas of the body and even the entire body. Sometimes worry usually expands to several parts of the body at the same time. Although most complaints are usually specific (“crooked” lips or prominent or “hooked” nose) they are sometimes very vague: “crooked face”, “slightly open” eyes, etc.).
  2. They usually limit themselves to talking about "their ugliness" without going into details.
  3. They spend several hours (more than 1 hour / day) checking (checkers) for the defect in the mirror or reflective surfaces (compulsive behaviors).
  4. Sometimes they use magnifying glasses to see it better.
  5. They resort to excessive cleaning (cleaners) or ritualized makeup to reduce anxiety, with little result.
  6. They have both avoidance (covering the mirrors) and verification behaviors.
  7. They ask for opinions to calm down momentarily.
  8. They compare with each other.
  9. They believe that people observe, criticize or make fun of them (reference ideas).
  10. They hide the ugly part (they wear a beard, a hat, fill in the underpants by looking like a bigger penis).
  11. They have ideas of malfunction or fragility of the ugly part.
  12. They isolate themselves socially out of shame to be seen and in many cases they leave only at night.
  13. Some seek aesthetic or corrective treatments (surgeries, dental treatments, etc.).

More common in women

According to the psychiatrist Dr. J. Moizesowicz certain disorders of the EOC such as: compulsive shopping, kleptomania and dysmorphophobia are more common among women, while pathological gambling or ludopathy, pyromania and hypochondriasis (the constant fear of having a serious illness, even though doctors have told him that it is not), they are more frequent among men. It is difficult to determine whether this difference is due to endocrine, neuroanatomic, psychological or socio-cultural factors.

Age of onset, course and evolution of the TDC

TDC begins in adolescence but usually goes unnoticed for the concealment of symptoms that these people do and because it is confused with the normal concerns about the physical aspect typical of this evolutionary stage. Its appearance can be both gradual and abrupt and its course is usually continuous. With respect to the part of the body on which the concerns are focused, it may vary over time.

Most of these patients resort to cosmetic, reconstructive or dental surgery to correct the defect, although they are not satisfied and repeat these procedures several times since the disorder is mental and the surgeries do not correct the obsessions. They get to abandon studies, work and friendships. Sometimes they require hospitalization for suicidal thoughts. TDC is often associated with other serious disorders such as major depressive disorder, delusional disorder, social phobia and Obsessive Compulsive Disorder.

The other scene of dysmorphia

In all dysmorphobias, that is to say in all body image disturbances in which the patient subjectively perceives a deformity that does not really exist, there are aggressive impulses that have become unconscious by repression. Paraphrasing the well-known metaphor of S. Freud that alludes that in situations of grief "the shadow of the object falls on the self" in the identifications also falls on the body image the shadow of the objects that have been renounced. In this case, the aggressive fight in which the opponent (the object) is inflicted with a real or imaginary injury falls on the body image of the individual who is partially placed in the position of the other.

TDC treatment

Given the plurality of causes that determine the TDC, the treatment must be generally psychotherapeutic and psychopharmacological, the latter depending on the intensity of the symptoms.

In our experience with these patients, it is often noted that the shameful anguish of this class of patients is so intense that only at a later stage of therapy do they discover the preconscious origin of the conflicts linked to their alleged defects.

With the passage of time, the component of anguish present in the belief that one has a partial deformity usually gives way to a less agonizing, hypochondriacal or compulsive concern for the deformity and its correction and improves the quality of life.

References

Conrado LA, Hounie AG, Diniz JB, Fossaluza V, Torres AR, Miguel EC, et al. Body dysmorphic disorder in dermatological patients: prevalence and clinical characteristics. J Am Acad Dermtol. 2010

Phillips KA, Díaz SF. Gender differences in body dysmorphic disorder. J Nerv Ment Dis. 1997

Feusner JD, Hembacher E, Moller H, Moody TD. Abnormalities in the visual processing of objects in body dysmorphic disorder. Psychol Med. 2011

Veale D, Boocock A, Gournay K, Dryden W, Shah F, Willson R, et al. Body dysmorphic disorder. A survey of fifty cases. Br J Psychiatry. nineteen ninety six

//www.ncbi.nlm.nih.gov/pmc/articles/PMC2716131/

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