Clive Anderson - AT THE DERMATOLOGIST BODY IMAGE is defined as a mental picture of the size, shape and form of our bodies coupled with our feelings about these physical characteristics. Put another way, body image is how we
perceive our body and our attitude towards it.
Most of us feel that there are things about our bodies that we would like to change and some set about changing these unloved features by diet, exercise, visits to the Dermatologist or the Plastic Surgeon.
This benign dissatisfaction with looks is common (30 to 40 per cent of us) and does not affect significantly our quality of life. It was commonly felt that these concerns were chiefly held by women but recent surveys have indicated that an increasing number of men share these views and some 17 per cent of them are now on some form of diet and an increasing number have undergone cosmetic surgery or dermatological treatment to correct a problem.
Persons who become preoccupied with perfection often view themselves as imperfect and may develop a distorted view of their own body and face. A significantly distorted perception of our body may lead to self-destructive behaviours aimed at improving our appearance (hence the bleaching syndrome). It is true that beauty is in the eye of the beholder but, also is the opposite.
Imagined ugliness syndrome or Body Dismorphic Disorder (BDD), as it is more scientifically termed, is an excessive preoccupation with a slight or imagined defect of a specific body part that results in impaired social, academic or job functioning. The preoccupation must cause significant impairment in the individual's life. The person thinks about his or her defect for at least one hour a day. Often the concern is skin imperfections wrinkles, scars, acne or hair on the face or body too much or too little, facial features misshapen nose, overall shape or size.
It is a chronic disorder that often starts in adolescence. It affects men and women equally. Persons with BDD spend hours focusing on a physical feature and engaging in repetitive time consuming behaviour. Behaviours associated with BDD are:
Frequent glancing at mirrors
or avoiding mirrors completely
Skin picking
Repeatedly measuring or palpating
the defect
Repeated requests for reassurance
about the defect
Elaborate grooming rituals
Camouflaging some aspects of
one's appearance with hand, hat or
makeup
Repeated touching of the defect
Avoiding social situations where
the defect may be seen by others
Anxiety when with other people
When persons with BDD are told that they look fine or that the defect is not noticeable, they usually don't believe this. The condition tends to be long- lasting and can lead to social isolation, school dropout, depression, unnecessary surgery and even suicide.
There are many theories as to the cause of the condition. The prevailing thought is that Body Dismorphic Disorder is associated with a chemical imbalance in the brain which may be genetic in origin. Predisposing factors are low self-esteem, overly-critical parents or other caregivers and early childhood trauma. Patients seem to be responsive to medication that increases seratonin levels in the brain adding support to the chemical imbalance theory.
Treatment is difficult as often the patient insists that the condition has a physical origin and goes from Dermatologist to Plastic Surgeon. They may undergo several unnecessary procedures and often feel the problem has become worse as a result of these procedures. Therapy involves the use of selective seratonin reuptake inhibitors to treat the chemical imbalance and psychotherapy involving cognitive behavioural therapy to help the person resist compulsive behaviour such as mirror checking or excessive grooming.
Dr. Clive Anderson is a Dermatologist and Venereologist.
