Dysmorphophobia: description, signs of the disease and methods for eliminating them

The appearance of each of us cannot be perfect, there is certainly something that does not meet the standards (with perfectly straight legs, there can be a crooked tooth, and with an angelic face - extra pounds on the hips). Most people take this philosophically, accepting themselves as they were born. But there are people who are ready at all costs to correct natural bodily imperfections, while the result never satisfies them completely. These are dysmorphophobes. Dysmorphophobia is often called the "new plague of the 21st century."

Dysmorphophobia got its name 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 his appearance, or rather, about its minor defects. It seems to him that a crooked tooth or an uneven line of the upper lip must be seen by everyone around him, which causes a dysmorphophobe to literally panic horror. The defect itself is not always such in essence. Sometimes we are talking about nothing more than an individual characteristic of appearance - a mole on the face, wide wings of the nose, a special section of the eyes.

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

It is difficult to find a person who would be completely satisfied with his external data, who could honestly say - yes, I am a handsome man and a standard (this is another story that is called delirium of greatness in psychiatry!), But usually our shortcomings (moles, chest shape or ears) do not greatly affect performance, study, normal everyday life.

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

The term itself was proposed by Italian doctors in 1886. So, the psychiatrist Enrico Morselli described several cases where pretty, attractive women considered themselves so ugly that they refused to marry, 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, which, according to the joint opinion of most of the people around them, tend to stand out, "show off." This is actually not the case. Dysmorphophobe is driven by other motives - he is pathologically afraid that he will become a laughing stock, because in his understanding his appearance flaws are so big and serious that they make him a real freak.

Obsessions (obsessive thoughts) and compulsions (obsessive actions) are characteristic of a person with such a disorder. Thoughts that do not allow you to live calmly, push a person to certain actions that temporarily bring relief from thoughts. So, a dysmorphophobe may consider itself for a long time in a mirror or, conversely, be afraid of mirrors and its own reflection in themAvoid any places where mirrors may be. If a person has an obsessive idea that he has uneven skin, he can rub scrubs and peels into it for hours (this will be an action-compulsion), while his own skin will suffer and bleed.

In severe cases, the patient recognizes himself as a complete freak and generally refuses to go out on the street to communicate with someone. That is how a severe form of sociophobia sometimes develops with the complete restriction of any social contacts.

German psychiatrists estimate that approximately 2% of the population has some degree of disorder (usually mild). These people are very critical of themselves, they may not love, hate any separate parts of their body (nose, ears, legs, eye shape). In 15% of cases, patients with this disorder resort to suicide attempts. Among dysmorphophobes who 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 identification (when a person is not satisfied not only with his appearance, but also with the gender that nature has endowed him with), the probability of suicide increases to 30%.

It should be noted that the diagnosis of dysmorphophobia is not an easy task even for practicing clinical specialists, therefore, often the disorder goes unnoticed. It is cleverly “disguised” as other mental illnesses.That is why often dysmorphophobia is diagnosed with “clinical depression”, “social phobia”, “obsessive-compulsive disorder”. In women with dysmorphophobia, significant eating disorders can occur, leading to anorexia nervosa or bulimia nervosa. Men often have muscular dysmorphia, 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 us to talk about the presence of dysmorphophobia in a particular patient:

• a person is absolutely convinced that he has deformities, bodily anomalies for at least six months;
• his own appearance and its “shortcomings" bother him much more than all other possible problems, his anxiety grows and progresses, obsessive thoughts are not controlled by the patient himself, he cannot get rid of them;
• a person stubbornly searches for ways to overcome his bodily imperfections, often through plastic surgeries, while he goes beyond all permissible boundaries;
• the assurances of others and the beliefs of doctors that the patient does not have gross appearance defects that need correction, have no result - this does not convince him;
• concern for appearance prevents a person from leading a normal life, worsens his social communications, and the quality of his life.

It is difficult to clearly answer how to recognize a dysmorphophobe - 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, is exaggerated. Specialists identified several common symptoms and signs characteristic of people with dysmorphophobia.

• Sign of a mirror - an obsessive need to constantly look in a mirror or any other reflective surface, while a person is trying to find a view in which he will look as attractive as possible, in which his lack will be invisible to others.
• Photo tag and selfie - a person categorically refuses to be photographed, and even tries not to take pictures of himself (does not take a selfie), because I’m sure that in the pictures his shortcomings will become obvious, noticeable to everyone, and especially for himself. Dismorphophobe will find several dozen reasons to justify its unwillingness to pose for the photographer. Such patients usually try to avoid mirror surfaces - contemplating their own reflection is unpleasant.
• Sign of scoptophobia - a person is pathologically afraid of being ridiculed, becoming the object of a joke or teaser.
• Sign of disguise - a person begins to do everything to hide a flaw that seems insurmountable to him - he uses cosmetics unjustifiably, wears strange baggy clothes to hide his figure, and does plastic surgery to correct the flaws.
• Sign of excess care - Self-care becomes an overvalued idea. A person can shave for several times a day, comb his hair, pluck his eyebrows, change clothes, diet, etc.
• Defect Concern - several times per hour, a person can touch a part of the body that is considered inferior, unless, of course, this allows its anatomical location. In close ones, a person is often interested in their opinion regarding a lack, bringing others around them to a nervous breakdown.

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

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

Dysphrophophobia understates self-esteem, often they have increased suicidal idealization. It is difficult for them to focus on work or an educational task for the reason that all thoughts are almost constantly occupied by a lack of body. Often people with such a 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 curious in everything regarding the methods of eliminating their possible “defect” - they are up to date with the latest news on plastic surgery, they read special medical and pseudoscientific literature, and seek folk advice on how to deal with the defect. It must be said that even a series of plastic surgeries made to bring the appearance closer to ideal representations do not bring long-lasting and lasting relief - again it begins to seem that something is wrong and a new operation has to be done.

It should be noted that not everyone is contacting doctors for the correction of “deficiencies”. Sometimes, having no physical ability, financial resources, dysmorphophobes themselves try to install implants, almost at home, to get tattoos to remove the defect on their own. Needless to say, such attempts often end in very bad shape - blood poisoning, sepsis, death or disability.

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

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

Complaints regarding the shape of the jaw (found in about 6% of patients), the shape of the shoulders and knees (3% of patients), and also the appearance of the toes and ankles (2% each) can be considered the rarest. The delusional belief that the appearance is flawed is often accompanied by a feeling of imperfection of several parts of the body at once.

It is believed that the main cause of the disorder is a hypertrophic attitude to their appearance in adolescence. Guesses gradually 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 teenage suspiciousness regarding appearance, but not all adolescents develop dysmorphophobia. Experts believe that the following factors affect the likelihood of a disease:

• genetic endocrine disorders (decreased serotonin level);
• the presence of obsessive-compulsive disorder;
• generalized type anxiety disorder;
• hereditary causes (every fifth dysmorphophobe reveals at least one relative with mental illness);
• lesions of individual parts of the brain, their pathological activity.

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

Education can also become the root cause, or rather, its special style. Some mothers and fathers themselves attach great importance to trifles in the appearance of the child, require him to closely monitor the aesthetics of the appearance.If a child has the above biological (hereditary) factors, then such a model of education can grow a real dysmorphophobe out of an ordinary child. The root cause can be any psychological traumatic situation, including failure in his personal life, sexual debacle.

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

To a greater extent subject to dysmorphophobia, individuals suffering from perfectionism, shy men and women, unsure of themselves, inclined to avoid something that scares or upsets them.

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

Antidepressants may be recommended to combat the disorder more effectively. - This group of drugs helps to eliminate the depressive component of the condition due to the normalization of serotonin levels.

Treatment usually proceeds on an outpatient basis. In psychiatry, it is also customary to pay great attention to rehabilitation and clinical supervision - the disease is prone to relapse.