Dysmorphophobia is the exaggerated mental preoccupation with a self-supposed physical disfigurement. It is therefore a false perception of the body. Also called disfigurement syndrome, this psychiatric disorder is characterized by a compulsive and excessive urge to perceive oneself as obnoxious or ugly. Long scientifically controversial, body dysmorphic disorder is now coming more into the focus of medical discussion.
What is dysmorphophobia?
The word dysmorphophobia is made up of three compound Greek syllables – “dys,” “morphe,” and “phobios.” It refers to the shyness, anxiety or fear of one’s own external appearance, of one’s own external shape. Today, the so-called body dysmorphic disorder is classified and recognized as an independent, psychiatric clinical picture. Therefore, if a patient is diagnosed with dysmorphophobia, he or she is entitled to adequate therapy. Due to the false perception of one’s own self-image, the mental illness often has a very negative impact on the life of the affected person and often leads to depression; cases of suicide due to dysmorphophobia have also been proven. Due to the possibilities of cosmetic plastic surgery, which has made enormous progress in recent years, this psychiatric disorder is once again coming more into focus. If one’s own self-perception is permanently disturbed, however, it is questionable whether patients can really be helped permanently with such an intervention.
Causes
It is assumed in dysmorphophobia of an unprocessed, inner-psychic conflict. Performance and quality of life decline more and more, in that the thought loops of those affected only revolve around the supposed disfigurement of the face or other body parts. Even if the affected persons are credibly assured by relatives or doctors that there is a distorted image of their own perception and reality, this is negated by the patients. In addition, it is often the case that sufferers fearfully avoid the advice of professionals, for example specialized psychiatrists. Body dysmorphic disorders are often associated with a lack of self-esteem and hypochondria. Since many affected persons avoid contact with doctors in connection with their misguided body perception, a high number of unreported cases must be assumed. Every person has certain physical features that characterize him or her and make him or her unique. Most people also cope well with this, but the concerns in this regard of patients with dysmorphophobia are always characterized by a clear exaggeration.
Symptoms, complaints and signs
No reliable data exist in the medical literature regarding the gender distribution of the disfigurement syndrome, as exact studies have been lacking to date. Expert authors assume an equal distribution in men and women, while others describe a slight predominance of the female sex. However, it is considered certain that dysmorphic behavior can already begin in childhood and adolescence. Once the excessive preoccupation with one’s own physical appearance is set in motion, the symptoms and complaints worsen with increasing age. However, the longer the complaints persist, the more difficult it is to initiate adequate psychiatric therapy. The sufferers experience themselves as supposedly ridiculous, repulsive or ugly, although objectively they look quite normal. The perception of one’s own ugliness often refers to the entire body, less frequently to individual areas. In particular, the shape, symmetry, size or position of certain body zones or extremities are questioned. Typical examples are fat pad distribution, dissatisfaction with the position of teeth, tendency to blush, or the false assumption that lips, chin, cheeks, mouth, or nose are ugly.
Diagnosis and course
Those affected suffer from a mentally self-created vicious circle of self-rejection and agonizing worry. Typically, one’s appearance is constantly questioned or checked in mirrors. In-depth psychiatric diagnosis often reveals narcissistic personality traits and profound inferiority. Due to general withdrawal tendencies and shyness, the psychosocial consequences for those affected are often considerable.In many cases, it is the general practitioner who, with his good knowledge of patients, makes a tentative diagnosis, which must then be confirmed by a psychiatrist or psychological psychotherapist. The initiation of adequate therapy should also take place at an early stage so that a tendency towards chronification can be effectively counteracted. Because the course of the disease is considered to be protracted, not infrequently affected persons remain prisoners of their pathological disfigurement fears for a lifetime.
When should one go to the doctor?
As a rule, those affected by dysmorphophobia suffer from a number of different psychological complaints. For this reason, a doctor should be consulted for this condition when there are significant inferiority complexes or decreased self-esteem. Urgent treatment is especially necessary when these complaints occur without a specific reason. Medical treatment is also advisable when teasing or bullying occurs in order to avoid further complications and discomfort. Furthermore, dysmorphophobia can also lead to suicidal thoughts. In many cases, the patient’s parents and relatives must also be aware of the complaints and contact a doctor. In severe cases, a stay in a closed clinic is advisable. This can significantly alleviate the symptoms. Most often, the diagnosis of dysmorphophobia is made by a psychologist. Treatment can also be carried out by a psychologist. The earlier the disease is diagnosed and treated, the higher the chances of complete recovery of the patient.
Treatment and therapy
A schematic psychiatric treatment for false body image is not known to date, which is why any therapy of a dysmorphic disorder must be based on a patient’s individual situation and problem of suffering. The therapist must first manage to get a patient to open up to him, to gain trust and to want to be helped in the first place. A causal therapy is not possible, because the psychological background of dysmorphophobia is still unknown. Only if depression occurs at the same time, the administration of psychotropic drugs is justified. Therapy is otherwise limited to adjunctive psychotherapeutic sessions of behavioral therapy. If patients express changing, vague or diffuse complaints, cosmetic surgery is strongly discouraged. This is because the psychological impairments hidden behind the complaints cannot be eliminated by a desired medical cosmetic surgery procedure.
Outlook and prognosis
In the case of dysmorphophobia, there is a prospect of recovery as soon as the condition is treated professionally with therapy and the diagnosis and therapy take place at an early stage. With cognitive behavioral therapy, most patients experience an improvement in health. The therapy can take place on an inpatient or outpatient basis. When used in conjunction with medication, patients experience significant symptom relief. The administration of medication without psychotherapy has been less successful. In most cases, there is a regression of symptoms as soon as the prescribed drugs are discontinued. The best chance of recovery is a combination of therapy and the administration of medications. The therapy lasts several months or years. The symptoms gradually recede until freedom from symptoms can be achieved. If left untreated, dysmorphophobia can progress into a chronic course. The prognosis deteriorates significantly. A spontaneous cure is considered very unlikely. The symptoms of the disease fluctuate in intensity during the course of the disease. At the same time, nevertheless, the symptoms become more severe the longer the disease is present. With an increase in symptoms, the patient’s risk of suicide gradually increases. To prevent a critical or life-threatening situation from occurring, timely therapy is crucial.
Prevention
Dysmorphophobia is a highly complex to sometimes bizarre condition with a persistent negative body perception. Since it must be assumed in many cases that the cause of the complaints is already laid in childhood, prevention should start here.In the case of children and adolescents with withdrawal tendencies or constant mental preoccupation with their own deficiencies, sociotherapeutic corrections should be made or talk psychology should be offered at an early stage.
Aftercare
Since dysmorphophobia is a serious and, above all, serious, psychological disorder of the affected person, he or she is usually first dependent on intensive psychological treatment by a doctor. In most cases, self-healing is not possible, so that treatment should always be carried out. Measures or possibilities of an aftercare are usually not available to the affected person in case of a dysmorphophobia. In any case, the triggers for this disease should be recognized and avoided. The earlier the disease is recognized and treated, the better is usually the further course. Dysmorphophobia is treated with the help of medication and psychological counseling. It is important to pay attention to the correct dosage and regular intake of medication to avoid further complications. The relatives and the family of the affected person must in any case understand the disease and also deal with it. Intensive discussions with the affected person are often necessary. In severe cases, the relatives should persuade the patient to undergo treatment in a closed institution to prevent further complaints. Dysmorphophobia does not reduce the life expectancy of the affected person.
This is what you can do yourself
In the case of dysmorphophobia, the possibilities of self-help in everyday life for the sufferer are very limited. Normally, the affected person is not at all able to carry out the health-promoting measures on his own initiative. The disorder is based on psychological causes and the impossibility of a real assessment of oneself. Therefore, there are only few variations of action for the affected person himself. One’s own body is not intentionally misperceived. The disorder is therefore not controllable by will. It is part of the appearance of the disorder that it is not possible for the affected person himself to see his own body in real terms and to recognize its contours. For this reason, people from the close social environment are often increasingly responsible. The patient should be approached by them for the necessary help. This requires a stable relationship of trust. In severe cases, the relatives also need advice and help from specialist staff. Information about the disease and its manifestations is necessary to learn and implement the right approach in dealing with the ill person. Patience, calmness and comprehensive information about the disease are essential for this. The affected person must not be harassed or put under pressure by everyday comments. Shame, guilt, or lecturing words should be avoided whenever possible.