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Self image - girl looking in mirror
Ever find yourself brooding over a scar, blemish, bulge or other so-called physical flaw on your person? It’s common, but with some folks, like Karen, it’s more than a minor irritant or pet peeve. It takes an ominous turn. When I asked this 30-something woman complaining of depression what was causing her distress, she replied, “It’s my face.”
“What about your face?” I asked, seeing nothing askew.
Without making eye contact, she pointed to her nose. To me, it seemed fine—not out of proportion to her other facial features, straight and without scars.
“Tell me what you see when you look in the mirror,” I requested.
Avoiding my gaze, she muttered one word. “Ugly.”
Imagined Defect?
Karen was suffering from a psychological condition called body dysmorphic disorder, or BDD. Those who have it—between two and three percent of the populace—are obsessed with an imagined or barely detectable defect in their appearance. BDD is more common in teens, women and those with mental health challenges related to self-esteem. While less prevalent in men, guys don’t lag far behind females in this regard. Folks with a history of childhood bullying or, by nature, a perfectionistic personality are at greater risk. The physical characteristics that those with BDD regard as ugly or repulsive about themselves, most of us would consider nothing of the kind, or only a minor, inconsequential flaw.
Studies show that, when viewed by others, those with BDD are judged roughly as good-looking as the general population. Some even qualify as knockouts. Consequently, this condition is, in part, a perceptual disorder, a distortion of what the vast majority view as reality. Now, lots of us harbor a bit of BDD, although not to a degree that constitutes a psychological problem. Many adolescents go through a phase when they obsess about their appearance, and most adults dislike some aspect of their looks. Just consider the billions we Americans spend annually on cosmetics, so-called beauty aids, weight loss nostrums, body toning exercise routines and flattering attire. However, this disquiet doesn’t rise to the level of an obsession, one substantially interfering with one’s well-being.
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In contrast, with folks like Karen, there’s plenty of interference. The majority of those with BDD are depressed, some avoid routine social situations, and a few become suicidal. Many spend much of their day mentally fixated on their imagined defects, repeatedly studying themselves in mirrors and worrying obsessively about how to correct whatever they consider imperfect.
As you might expect, quite a few of these folks undergo multiple cosmetic surgeries (they constitute up to 15% of this patient group). Nonetheless, rarely are they satisfied with their new-me appearance, often resulting in multiple attempts to fix their “defects.” However, the defect in question is not physical. It’s psychological.
Low Self-Esteem?
Predictably, the causes of BDD are uncertain, ranging from low self-esteem to childhood trauma (intense teasing about one’s appearance) to, surprisingly, a misfire in visual processing in the brain, one that causes them to actually see differently than most people. Which is a long-winded way of saying there are often multiple causative factors.
Many with BDD go years before knowing what ails them, usually because they just think they’re ugly rather than suffering from a perceptual distortion. Like Karen, they present with other complaints (depression, social anxiety, worry, extreme self-consciousness, etc.) that mask their true malady. Fortunately, once someone is diagnosed, there are effective treatments.
Research shows cognitive-behavioral therapy often helps, as can somatic treatments like Brainspotting, EMDR and Neurofeedback. However, the effectiveness of these approaches is too often blunted by the relentless onslaught of media messages promoting an absurdly narrow and, for most, unattainable cultural standard for what constitutes good looks.
As we often say, beauty is in the eyes of the beholder. However, if you have BDD, so is ugliness.
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