How does dysmorphophobia differ from ordinary dissatisfaction with appearance?
Many people feel dissatisfaction with some aspect of their appearance, and this is normal: a thought arises, causes slight annoyance, and goes away. With dysmorphophobia, everything is different - attention is focused on the “defect” for hours, anxiety does not decrease, and behavior adapts to it. Rituals appear: checking reflections, taking photographs, comparing with other people, asking loved ones. The key sign is real losses: damaged relationships, absences from school and work, refusal of photographs and meetings. It is the scale of suffering and disruption of life that distinguishes the disorder from the usual complex.
- Thoughts occupy more than an hour a day
- Anxiety is not reduced by over-conviction
- Repeated checks and rituals
- Avoidance of communication, photos, mirrors
- Study, work, relationships are disrupted
How it manifests itself
The most common concerns are the skin and its imperfections, the nose, hair, chin, facial symmetry, and in men it is often lack of muscularity. A person studies himself for a long time in certain lighting, chooses angles for photos, wears clothes that hide the “defect,” and uses heavy makeup. Many people look for confirmation from others, but calm lasts minutes. Anxiety, depressed mood, and social isolation are often associated. A significant portion of people turn not to a psychotherapist, but to a cosmetologist or plastic surgeon, and the result of the intervention almost never brings relief.
- Hours of thinking about appearance
- Checking reflections or avoiding mirrors entirely
- Disguise with cosmetics, clothing, hairstyle
- Constant comparisons with others
- Seeking confirmation from loved ones
- Avoiding photographs and crowded places
Causes and risk factors
The disorder is formed by a combination of biological predisposition and external influences. Features of visual information processing are important, when the brain fixates on details instead of a holistic image, as well as character traits - perfectionism, increased sensitivity to evaluation. Often there is a history of bullying due to appearance, criticism in the family, bullying at school. An additional factor is an environment where edited images are accepted as the norm. The onset usually occurs in adolescence, when self-esteem is especially dependent on the opinions of peers.
- Adolescence and young adulthood
- Bullying and criticism of appearance
- Perfectionism and high anxiety
- Family history of anxiety and obsessive-compulsive disorders
- Social networks and processed images
How to make a diagnosis
The diagnosis is clinical: the doctor asks in detail how much time thoughts about appearance take, what rituals are performed, how much it interferes with life, whether there is avoidance and thoughts of self-harm. Special questionnaires and scales are used. It is important to distinguish body dysmorphic disorder from eating disorders, in which anxiety concerns weight and body shape, from obsessive-compulsive disorder, and from the delusional variant, when the conviction of ugliness is absolute. The choice of treatment depends on this, so the assessment is carried out by a specialist, not an online test.
- Detailed clinical conversation
- Questionnaires for assessing body dysmorphic disorder
- Assessing anxiety, mood and risk of self-harm
- Clarification of the number of cosmetic interventions
- Differentiation from eating disorders
Treatment
The main method is cognitive behavioral therapy with work on beliefs about appearance and a gradual abandonment of rituals and avoidance. A person learns to tolerate anxiety without reflection checks and questioning, and restores social activity. If symptoms are severe, the doctor may prescribe drugs from the group of selective serotonin reuptake inhibitors; The course is long, the effect is assessed after several weeks. Cosmetic and surgical interventions for dysmorphophobia do not solve the problem: dissatisfaction usually moves to another part of the body, so consultation with a specialist is necessary before surgery.
- Cognitive behavioral therapy is the first choice method
- Gradual abandonment of checks and disguises
- Medicines prescribed by a doctor for severe forms
- Working with self-esteem and social skills
- Limiting photo processing and time on social networks
- Caution with cosmetic interventions