Dysmorphophobia: description, signs of the disease and how to eliminate them

The appearance of each of us can not be perfect, there will definitely be something that does not meet the standards (with perfectly flat legs there can be a crooked tooth, and with an angelic face - those extra pounds on the thighs). Most people are philosophical about this, accepting themselves as they were born. But there are people who are ready at any cost to correct the natural body defects, and the result never fully satisfies them. These are dysmorphophobes. Dysmorphophobia is often called the “new plague of the 21st century”.

The name dysmorphophobia received from the merger of the ancient Greek words "δυσ" (negative prefix), "μορφ?" (Appearance, appearance) and "φ? βος "(fear, fear). This is a mental disorder in which the patient is excessively worried about her appearance, or rather, about her minor defects. It seems to him that a crooked tooth or the uneven line of the upper lip must be seen by everyone around him, which causes literally panic in a dysmorphophobe. The defect itself is not always as such. Sometimes we are talking about nothing more than an individual peculiarity of appearance - a birthmark on the face, wide wings of the nose, a particular eye section.

The disorder develops gradually, and usually bodily dysmorphophobia starts for the first time during adolescence. Teenagers are known to be more attentive to the characteristics of their own body. Both women and men are equally affected. At whatever age dysmorphophobia manifests itself in a person it is considered the most dangerous of phobias for the reason that more often than other disorders it pushes a person because of his dissatisfaction with his appearance of suicide.

It is difficult to find a person who would be completely satisfied with his appearance, who could honestly say - yes, I am handsome and standard (this is another story, which in psychiatry is called delusions of grandeur!), But usually our shortcomings (moles, breast forms or ears) do not greatly affect the performance, school, ordinary everyday life.

The International Classification of Diseases (ICD-10) does not consider dysmorphophobia a separate disorder, relating it to the hypochondriac syndrome. But the ICD-11, which will soon be replaced by the tenth version of the International Classification of Diseases, contains a reference to dysmorphophobia as a separate mental disorder of obsessive-compulsive type.

The term itself was proposed by Italian doctors in 1886. Thus, the psychiatrist Enrico Morselli described several cases in which pretty, attractive women considered themselves so ugly that they refused to get married, appear in public, because they were afraid that everyone would laugh at them.

Quite often, classical dysmorphophobes are perceived as eccentric representatives of the human race, who, in the unanimous opinion of the majority of people around them, tend to stand out, “show off”. This is actually not the case. Dysmorphophobia is motivated by other motives - he is pathologically afraid that he will be a laughing stock, because in his understanding his flaws in appearance are so big and serious that they make him a real freak.

For a person with this disorder, obsessions (obsessive thoughts) and compulsions (obsessive actions) are characteristic. Thoughts that do not give to live in peace pushes a person to certain actions that temporarily bring relief from thoughts. So, A dysmorphophobic person may look at himself in the mirror for a long time or, on the contrary, be afraid of mirrors and his own reflection in them., avoid any places where there may be mirrors. If a person has an obsessive idea that his skin is uneven, he can rub scrubs and peels into it for hours (this will be a compulsion action), while his own skin will suffer and bleed.

In severe cases, the patient admits that he is a complete freak and refuses to go out and communicate with anyone. This is how the severe form of social phobia sometimes develops with the complete restriction of any social contacts.

German psychiatrists estimate that approximately 2% of the population has a disorder in varying degrees (usually in moderate form). These people are very critical of themselves, they may not like, hate some parts of their bodies (nose, ears, legs, eye shape). In 15% of cases, patients with this disorder resort to suicide attempts. Among dysmorphophobia, which voluntarily subjected themselves to a huge number of plastic surgeries, the number of suicide attempts is about 25%, and in case of violation of sexual identity (when a person is not satisfied with not only his appearance, but also the sex, which nature has endowed him), the suicide rate increases to 30%.

It should be noted that the diagnosis of dysmorphophobia is not an easy task, even for practicing clinical specialists, therefore, the disorder often goes unnoticed. It cleverly "masked" by other mental ills. Therefore, dysmorphophobia is often diagnosed as “clinical depression”, “social phobia”, “obsessive-compulsive disorder”. Women with dysmorphophobia can experience significant eating disorders, leading to anorexia nervosa or bulimia nervosa. In men, muscular dysmorphism is often encountered, and in this condition, the representatives of the stronger sex experience excessive anxiety about their muscles, which, in their opinion, are undeveloped.

Nevertheless, there are certain criteria that allow to speak about the presence of dysmorphophobia in a particular patient:

• the person is absolutely convinced that he has deformities, bodily anomalies for at least six months;
• his own appearance and her “shortcomings” worry him much more than all other possible problems, anxiety about this is growing, progressing, obsessive thoughts are not controlled by the patient himself, he cannot get rid of them;
• a person stubbornly looks for ways to overcome his bodily deficiencies, often by plastic surgeries, while he goes beyond all permissible limits;
• the assurances of others and the conviction of doctors that the patient does not have gross defects of appearance that need correction, do not have a result — he is not convinced by this;
• concern about the appearance prevents a person from leading a normal life, impairs his social communications, his quality of life.

It is difficult to answer unequivocally how to recognize dysmorphophobia - the variety of symptoms is too great, but in most cases they are united by one thing - the magnitude and significance of the defect, even if it is in appearance, are exaggerated. Experts have identified several common symptoms and signs characteristic of people with dysmorphophobia.

• Sign of the mirror - the obsessive need to constantly look in the mirror or any other reflective surface, while the person is trying to find an angle at which it will look as attractive as possible, at which its disadvantage will be invisible to others.
• Sign photos and selfies - a person categorically refuses to be photographed, and even tries not to take pictures of himself (does not take a selfie), because he is sure that in the photographs his flaws will become obvious, noticeable to everyone and, above all, to himself. Dysmorphophob will find several dozens of reasons to justify their unwillingness to pose for the photographer. Such patients usually try to avoid mirror surfaces - to contemplate their own reflection is unpleasant.
• Sign of scoptophobia - a person is pathologically afraid to be ridiculed, to become the object of a joke or tease.
• Sign of disguise - a person begins to do everything to hide a flaw that seems insurmountable to him - he unreasonably uses cosmetics, wears weird baggy clothes to hide a figure, does plastic surgery to correct flaws.
• Sign of over-care - self-care becomes an overvalued idea. A person can shave for a long time several times a day, brush her hair, pluck her eyebrows, change clothes, diet, etc.
• Defective concern - several times in an hour a person can touch a part of the body that is considered inferior, if, of course, it allows its anatomical location. For loved ones, a person is often interested in their opinion of a lack, leading others to a nervous breakdown with their questions.

In adolescents, the onset of the disorder is usually often accompanied by a refusal to leave the house during the daytime, it seems to them that, in the light of the day, their shortcomings will be visible to everyone and become public knowledge. Academic performance suffers, success in studies, work, and extracurricular activity decreases.

Often, people with long-standing and neglected dysmorphophobia try to alleviate their thoughts and condition by taking alcohol and drugs. They suffer from increased anxiety, they can have panic attacks, especially if someone finds them "unprepared", not ready to meet or communicate - without makeup, a wig, the usual "masking clothes", etc.

Dysphophobic low self-esteem, often they have increased suicidal idealization. It is difficult for them to focus on work or study tasks for the reason that all thoughts are almost always occupied by a lack of physicality. Often, people with this disorder compare their appearance with the appearance of their idol and these comparisons are always not in favor of the patient.

At the same time, people with dysmorphophobia are very inquisitive in all that concerns methods of eliminating their possible “defect” - they are up to date with the latest news of plastic surgery, they read special medical and near-scientific literature, they are looking for popular advice on how to cope with a defect. It must be said that even a series of plastic surgeries, made to bring appearance to ideal representations, do not bring long-lasting and lasting relief - it again begins to seem that something is wrong, and you have to do a new operation.

It should be noted that not all apply to the doctors for the correction of "deficiencies". Sometimes, without physical ability, financial resources, dysmorphobes try to put implants themselves, almost at home, to do tattoos to remove the defect on their own. Needless to say, such attempts often end in a very pitiable manner - blood poisoning, sepsis, death or disability.

What do people with dysmorphophobia most often complain about? Plastic surgeons and psychiatrists have calculated and concluded that there are separate parts of the body that do not suit dysmorphophobia most often:

• about 72% of patients are dissatisfied with the skin condition;
• hair does not like 56% of people with this disorder;
• nose does not suit 37% of dysmorphophobes;
• in 20% of cases (plus or minus percentage), patients express extreme rejection of their own weight, abdomen, chest, eyes and thighs.

Complaints about the shape of the jaw (found in about 6% of patients), the shape of the shoulders and knees (3% of patients), as well as the appearance of the toes and ankles (2% each) can be considered the rarest. Delusional confidence that the appearance is flawed, often accompanied by a feeling of imperfection of several parts of the body.

It is believed that the main cause of the disorder is a hypertrophied attitude to his appearance in adolescence. Gradually, guesses become confidence, a person is convinced that his attitude to his external data is fully consistent with reality. However, psychology describes the mechanisms of development of adolescent suspicion about the appearance, but not all adolescents develop dysmorphophobia. Experts believe that the following factors affect the probability of illness:

• genetic endocrine disorders (reduced serotonin levels);
• the presence of obsessive compulsive disorder;
• generalized type anxiety disorder;
• hereditary causes (every fifth dysmorphophobe has at least one relative with mental illness);
• damage to individual parts of the brain, their pathological activity.

It is believed that psychological factors can affect the likelihood of dysmorphophobia. If a teenager is teased or criticized among his peers, this can be the starting mechanism that triggers mental disorder. This is indicated by up to 65% of patients.

Becoming a root cause can and education, or rather its particular style. Some mothers and fathers themselves attach great importance to the little things in the appearance of the child, require him to pay close attention to the aesthetics of the appearance. If a child has the above biological (hereditary) factors, then it is this model of upbringing that can raise a real dysmorphophobe from an ordinary child. The root cause can be any psychological traumatic situation, including failures in personal life, sexual fiasco.

Separately, it is necessary to say about the influence of television, the Internet, which contribute to the development of disorder, demonstrating some standards of beauty - models, actresses with flawless or almost flawless appearance, men with powerful biceps, presenting them as the first handsome or sex symbols.

More susceptible to dysmorphophobia are individuals suffering from perfectionism, shy men and women who are unsure of themselves, are prone to avoid something that frightens them or upsets them.

Today, cognitive-behavioral psychotherapy is considered the most effective way to treat dysmorphophobia, this method helps to get rid of obsessive thoughts and form new ideas about their appearance in about 77% of cases.

Antidepressants may be recommended to fight the disorder more effectively. - this group of drugs helps to eliminate the depressive component of the state by normalizing the level of serotonin.

Treatment usually takes place on an outpatient basis. In psychiatry, it is also customary to pay great attention to rehabilitation and follow-up - the ailment is prone to relapse.