Body Dysmorphic Disorder; "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)

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Body Dysmorphic Disorder; "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)


Byline: Dr. Jose Pujalte Jr.

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 wherein 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's been noted that patients with BDD are overly concerned with the following areas: Imperfections of the skin - scars, blemishes, wrinkles, even acne; parts of the face, generally the nose; and hair - too little on the head or too much in 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 - 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. …

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Body Dysmorphic Disorder; "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)
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