“Beauty is all very well at first sight;   but who ever looks at it when it has been in the house three days?” — George Bernard Shaw (1856-1950), Anglo-Irish playwright, critic Man and Superman, Act 4 (1903)

MANILA, Philippines — Very few are pleased with what they have physically.

Some wish for a sharper nose, smaller feet, a slimmer waist – name it. Mostly it’s a thought now and then, a passing “if only I were __________” (taller, thinner, wider, etc.). The question is when does the obsession with looks and features turn for the worse and become a psychiatric concern? When does “vanity” if you can call it that, become a sickness?

Body Dysmorphic Disorder. The Mayo Clinic defines body dysmorphic disorder (BDD) as an “excessive preoccupation with a real or imagined defect in one’s own appearance.” The extreme anxiety (and distress) impairs activities of work or school. One effect is that the person’s social life suffers.

Causes. Researchers and psychiatrists have not pinpointed the exact cause of BDD. However, as in many mental conditions, an organic or physical cause can be unearthed. A chemical imbalance (insufficient amount) specifically of the neurotransmitter serotonin is one cause. Apparently, BDD runs in families of higher socio-economic status where the person is expected to look and behave (unrealistically) in a certain way. In addition, BDD can also form part of a generalized anxiety disorder, an eating disorder like anorexia nervosa or bulimia, or an obsessive-compulsive disorder.

Signs and symptoms.  It has been noted that patients with BDD are overly concerned with the following areas: Imperfections of the skin such as scars, blemishes, wrinkles, even acne; parts of the face, generally the nose; and hair – too little on the head or too much on the body. Sometimes the concern is over the size or shape of the penis, breasts, buttocks, or muscles in general. The Cleveland Clinic lists warning signs in possible BDD patients:

* Engaging in repetitive, time-consuming behaviors such as constant mirror checking, pricking the skin, touching, covering, or hiding the perceived imperfection.

* Inability to stop focusing on the perceived defect.

* Constantly seeking reassurance that the defect is not obvious, visible, or abnormal.

* Feeling anxious around people who might notice the imperfection.

* Feeling self-conscious and not wanting to be seen in public.

* Always consulting dermatologists or plastic surgeons about ways to remove the “problem.”

Screening and diagnosis. It’s difficult to have personal insight in this condition because we are all, to a certain degree, vain. But here is where caring friends and loving relatives can help. They can schedule a visit to a psychologist or psychiatrist. The mental health professional administers a questionnaire that evaluates areas such as:

* Preoccupation with appearance.

* Degree of self-consciousness.

* Tendency to overvalue appearance in determining over-all self worth.

* Avoidance of social situations and physical contact with others.

* Excessive altering of appearance through grooming, cosmetics, or clothing.

* Tendency to frequently check on appearance and seek reassurance from others.

Treatment. The goal of psychotherapy is to expose and correct the false beliefs leading to a distorted image of the patient’s body. This requires a change of thinking (cognitive therapy) and an adjustment in behavior (behavioral therapy). Sometimes, medications, usually antidepressants,  are prescribed. Finally, the family can be recruited to share the responsibility of treatment.

Indeed, there seems to be no bottom when it comes to mental self-torture. But for victims of body dysmorphic disorder, it’s especially worse for they are trapped in superficiality and somewhat unhinged at that. No cosmetic or plastic procedure will ever be enough.

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