Generality
Dysmorphophobia is a mental pathology, characterized by an obsessive and often groundless concern that a particular part of the body (eg the nose) carries an imperfection so evident that it must be hidden in any case.
Those suffering from dysmorphophobia adopt very specific behaviors, such as: hiding the alleged body defect with every possible strategy, feeling anxious among other people for the fear that the latter may notice the alleged physical defect, contact the cosmetic surgeon to plan a possible intervention to correct the alleged imperfection, etc.
The diagnosis of dysmorphophobia is based on medical and psychological assessments, on the clinical history and on the comparison between the framework of the presumed patient compartments and the diagnostic criteria reported by the DSM-5, in the chapter dedicated to dysmorphophobia.
In general, the treatment consists of cognitive-behavioral psychotherapy, associated with the administration of serotonin-reuptake inhibitor drugs.
What is dysmorphophobia?
Dysmorphophobia, or dysmorphic body disorder, is a mental illness characterized by the preoccupation - obsessive and often unfounded - that one or more aspects of the body are markedly imperfect and need to be hidden or modified with every countermeasure, even the most extreme.
In other words, those who suffer from dysmorphophobia believe they have a serious physical defect and, following this, develop an obsession that leads them to resort to any remedy to hide the supposed imperfection of the body.
CLASSIFICATION ACCORDING TO DSM-5
Introduction: the Diagnostic and Statistical Manual of Mental Disorders ( DSM ) is a collection of all the peculiar characteristics of known mental and mental illnesses, including the respective criteria required for diagnosis.
According to the DSM-5 (latest edition), dysmorphophobia is a mental illness that is fully part of obsessive-compulsive disorder . In fact, as a classic obsessive-compulsive disorder, it induces the patient to continually repeat certain gestures, as if they were rituals which it is impossible to renounce.
Epidemiology
Dysmorphophobia is a fairly common mental illness, affecting more people than those estimated (ie 2.4% of the general population).
Both men and women suffer equally from dysmorphophobia; very often, this condition arises as early as adolescence.
Dysmorphophobia is widespread among people with a history of depression or social phobia, among those with obsessive compulsive disorder or generalized anxiety disorder and among people suffering from anorexia nervosa or bulimia ( eating disorders ).
Causes
Psychiatrists and psychologists believe that, like many mental illnesses, dysmorphophobia also occurs as a result of a combination of factors of different nature, including: genetic factors, psychological factors, social factors, cultural factors and factors related to development.
According to some interesting research, dysmorphophobia would be more common in the presence of:
- Introversion;
- Tendency to perfectionism;
- Negative vision of one's aesthetic image;
- Increased aesthetic sensitivity;
- Abuses and / or episodes of abandonment during childhood.
Symptoms, signs and complications
The symptoms of dysmorphophobia consist of very particular abnormal behaviors.
The list of typical behaviors of an individual with dysmorphophobia includes:
- Constantly compare your physical appearance with that of other people;
- Observe yourself in the mirror for many hours a day or avoid the mirrors categorically;
- Spend a lot of time during the day - especially when you are in the company of other people - to hide what you think is a physical defect;
- Feeling anxious among other people, for the fear that the latter may notice the alleged physical defect;
- Avoid crowded places, participation in social situations or events etc .;
- Appeal to cosmetic surgery, to remedy that anatomical aspect that is a source of discomfort and concern. Many times, the appeal to the aesthetic surgeon is useless, in the sense that even after the "retouching" the obsessive preoccupation remains;
- Feel a strong sense of discomfort, when an individual makes observations about the anatomical tract considered imperfect;
- Undergo restrictive diets and practice physical activity incessantly.
Dysmorphophobia is a source of obsessive torments, often without foundation, which seriously compromise the quality of daily life, work, interpersonal relationships and the sociality of the affected individual.
WHICH DEEDS OF THE BODY ARE GIVING MORE CONCERNS?
In patients with dysmorphophobia, the perception of the anatomical defect may relate to any point in the human body. However, some anatomical sites, such as the nose, abdomen, thighs, skin and hair, tend to worry more often than others.
Curiosity: muscular dysmorphy or vigoressia, a particular subtype of dysmorphophobia
There are several subtypes of dysmorphophobia; one of these subtypes is reported, because it is particularly well known: vigoressia or muscular dysmorphy .
Vigorexia is a mental illness characterized by the continuous and obsessive concern for muscle mass ; concern that affects the health of the person concerned (eg: use of anabolic steroids for muscle growth) and his social life (eg, isolation).
* NB: the vigoressia is also known with the terms: bigorexia and anorexia pours .
COMPLICATIONS
In the absence of adequate therapies where, instead, it would be necessary to intervene, dysmorphophobia can be responsible for serious consequences, including: depression, self-harm and suicidal thoughts .
Diagnosis
To reach a diagnosis of dysmorphophobia, the following are fundamental:
- A medical evaluation ( physical examination ), which excludes the presence of physical health problems;
- A psychological evaluation, aimed at evaluating the behaviors, thoughts and self-image of the alleged patient;
- The medical history, family history, personal history and the social history of the alleged patient;
- Comparison of symptoms reported by the presumed patient with the diagnostic criteria present in DSM-5, in the chapter dedicated to dysmorphophobia.
DIAGNOSTIC CRITERIA ACCORDING TO DSM-5
According to the Diagnostic and Statistical Manual of Mental Disorders fifth edition, an individual suffers from dysmorphophobia if:
- It presents concern with one or more negligible physical defects or not objectively detectable by other people;
- Adopt repetitive or ritual behaviors (eg looking in the mirror, touching the defective part, seeking reassurance, etc.), in response to the discomfort with the alleged physical defect;
- It exhibits particular mental attitudes (eg obsessive thoughts, constant confrontation with others, conviction of being observed and judged etc.), in response to the discomfort of the physical defect;
- Develops, due to the persistent concern for the alleged physical defects, severe stress, anxiety, lowered mood, problems in the workplace and / or difficulties in social relations;
- He is concerned about a physical appearance not attributable to another mental illness. For example, the only concern for body weight or fat mass level is typical of a eating behavior disorder such as anorexia nervosa and for this reason, its presence, in the absence of other obsessions, excludes that the person concerned suffers from dysmorphophobia;
- Despite the awareness of complaining about a minimal or non-existent defect, he still has obsessive thoughts / behavior during daily life.
PROBLEMS OF DIAGNOSIS
The diagnosis of dysmorphophobia is quite complex, as affected individuals tend to hide their problems. This typical attitude on the part of patients represents the main reason why dysmorphophobia is underdiagnosed.
Therapy
In general, the treatment of dysmorphophobia consists of the combination of a particular psychological therapy, known as cognitive-behavioral psychotherapy, and a medical-pharmacological therapy based on selective serotonin reuptake inhibitors .
COGNITIVE-BEHAVIORAL PSYCHOTHERAPY
Cognitive-behavioral psychotherapy aims to teach the patient with dysmorphophobia how to identify, dominate and prevent problematic behaviors (in specialized jargon, "inactive behavior" or "distorted thoughts"), which characterize the obsessive concern for an alleged defect physical.
Moreover, it is of enormous help in providing a method for identifying the so-called "symptomatology triggers", ie the factors that trigger pathological behaviors.
Cognitive-behavioral psychotherapy includes a part "in the studio", with the psychotherapist, and a part "at home", reserved for the exercise and improvement of the techniques of domination and prevention.
PHARMACOLOGICAL THERAPY
Premise: the FDA - that is the US government agency for the regulation of food and pharmaceutical products - has not specifically approved any drug for the treatment of dysmorphophobia.
Some experts in the field of mental illness believe that dysmorphophobia also depends on the malfunctioning of certain neurotransmitters in the brain, including serotonin . For this reason and despite the FDA's position, I am of the opinion that a treatment based on selective serotonin reuptake inhibitors may be a valid help for patients with dysmorphophobia, provided it is associated with psychotherapy.
HOME REMEDIES AND OTHER TIPS
To get better results from the above treatments, psychiatrists and psychologists advise patients with dysmorphophobia to:
- Follow the advice of the attending physician and the proposed therapies. For example, it is a serious mistake not to give continuity to psychotherapy sessions or to believe that you can overcome your own problems on your own;
- Learn about your mental illness. According to the medical-scientific community, a person who knows in detail the mental illness from which he suffers is more likely to recover or, at least, alleviate the symptoms in order to lead a normal life;
- Practicing at home with domain techniques, learned with cognitive-behavioral psychotherapy;
- Keep active. Physical activity helps overcome moments of depression, anxiety attacks, stress due to obsession with the alleged defect, etc .;
- Avoid consumption of alcohol and drugs. Medical investigations have confirmed that alcohol and drugs worsen the symptoms and can interact with the drugs in use, giving rise to serious side effects.
To the above-mentioned advice, it is worth adding other good and useful remedies, such as:
- Attend support groups for people suffering from the same mental illness;
- Avoid social isolation in any way;
- Write a diary, in which to record what triggers the moments of concern and what, on the contrary, attenuates them;
- Learn from an expert some relaxation techniques, which help manage stress and the most difficult moments of the disease.
Prognosis
The prognosis in case of dysmorphophobia is variable and depends, to a large extent, on the willingness of patients to want to heal and on their tenacity in sticking to the therapeutic plan.
At psychiatrists and psychologists, it is widely believed that an early diagnosis of dysmorphophobia is more frequently associated with healing and successful treatment.
Prevention
Currently, there is no method of preventing dysmorphophobia. In this sense, a turning point could derive from the discovery of the precise triggering causes.
