Body dysmorphic disorder is a psychiatric condition that leads people to adopt extremely distorted negative beliefs about their appearances: seeing themselves to be ugly, malformed, misshapen or hideous. Such beliefs do not reflect the reality of how they appear to others. The degree of concern and distress they may feel about their appearance is vastly out of proportion to any actual physical “defect”. Sufferers of body dysmorphic disorder may typically become obsessed with one aspect of their appearance, for example, believing that their nose is too large or that they are covered with warts. The obsession takes on a central role in their existence, dictating ever more of their behaviour to the point of isolating them socially or precipitating repeated unnecessary surgery. The tragedy is that cosmetic procedures – by definition – do not solve the underlying psychological problem. They leave a majority of sufferers worse off: they pay for the procedure and suffer the pain and inconvenience of it, yet “see” the resulting cosmetic outcome as unsatisfactory, even if objectively the result is excellent.
The mirror is a major problem for people with body dysmorphic disorder. Some sufferers become fixated with mirror checking, with hours of their day absorbed in inspecting their appearance. Mostly this checking is counter-productive, making them feel worse and increasing their distress. Other people with the condition may avoid mirrors altogether. Some can even have catastrophic reactions should they happen to glance at themselves in a reflective surface such as a shop window. Lots of sufferers conceal themselves under hats, scarves, wigs, dark glasses or excessive layers of makeup or concealing clothing in an attempt to hide their supposed defects.
A small minority of the population is believed to experience the condition. One study found about 2.3% of participants had the condition.
The highest rates of body dysmorphic disorder are found among people using cosmetic services like plastic surgeons, cosmetic dermatologists and cosmetic dentists. One study found up to 70% of people with body dysmorphic disorder had sought cosmetic procedures, and half had received such interventions.
One of the contributors to the obsession is Western advertisements featuring teenagers for selling clothes to women. Girls have been encouraged to form unrealistically thin body ideals by the mass media. A similar message about sculpted male bodies is taking its toll on boys, making them more susceptible to being overly concerned about weight.
Body dysmorphic disorder should not simply be dismissed as an expression of extreme vanity or insecurity about looks. This condition often leads to substantial distress and social and occupational impairment. Rates of depression are high, while suicide is not an uncommon outcome for those who do not receive appropriate treatment. Many avoid social situations for fear of others judging them negatively because of how they look.
Screening should be mandated for people seeking any cosmetic procedure that might be seen as “enduring”; this includes surgical procedures.