Millions of Americans — women and men — have a secret obsession. They're obsessed with how they look, with a perceived flaw in their appearance. They worry that their nose is too big, their breasts are too small, their skin is blemished, their hair is thinning, their body build is too small — any body part can become the focus of this obsession. It's easy for us to discount these concerns. How can she worry so much about her looks when she's so pretty? Why is he so upset about his hair — it looks fine! But people with these bodily obsessions suffer greatly; some are severely tormented, some are suicidal.
Quite obviously, most of us care about how we look. A recent survey of 30,000 people found that 93 percent of women and 82 percent of men care about their appearance and work to improve it. Other surveys have shown that many of us are dissatisfied with some aspect of how we look. We're not pretty enough or sufficiently handsome. Who wouldn't like smoother skin, more attractive eyes, a flatter stomach? If we could look better, most of us would. Indeed, most of us try. But when do normal concerns become an obsession?
While the concerns of Body Dysmorphic Disorder (BDD) echo these normal concerns, they're more extreme. People who have BDD not only dislike some aspect of how they look, they're preoccupied with it. They worry too much. They'd like to worry less, but they can't. Many say they're obsessed. They also suffer. Their worries about their looks cause them significant emotional distress and can interfere with their life.
Some BDD sufferers function well despite their distress — no one would ever know how unhappy they are. Sarah, who worried about slight facial blemishes and her 'big' nose, was sometimes late for work because she got stuck at the mirror checking her face. And she missed parties because she thought she looked so bad she didn't want people to see her. Yet she had many friends and did her job well.
But when BDD is severe, friendships, intimate relationships, and work disintegrate. Michelle was so tormented by her 'ugliness;' that she dropped out of school and couldn't keep a job. She stopped dating and seeing her friends. Because she thought she looked so monstrously ugly, she locked herself up in her house for 4 years.
What's so intriguing about BDD is that people who have it focus on defects others don't see or consider minimal. How can she worry about her hair when it's so nice? How can he be so upset about a few pimples? But to the BDD sufferer, the problem looks hideous and repulsive, magnified by the mind's eye.
BDD isn't rare. Secrecy and shame are part of the reason BDD is underrecognized and underdiagnosed. Preliminary estimates suggest that it may affect as many as two percent of the U.S. population, which translates into more than five million people in this country alone. It affects people of all socioeconomic strata and from all walks of life. BDD also occurs around the world — in Japan, South America, Europe, and other countries.
The following links contain more information on this subject.
(The written literature on this page was excerpted from The Broken Mirror: Understanding and Treating Body Dysmorphic Disorder by Dr. Katharine A. Phillips)
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