Body dysmorphia: types and symptoms of this disorder.

A form of psychological disorder that affects the way we perceive ourselves.

We live in times when we are constantly bombarded with images of perfect bodies. As we walk through the streets of any big city, it is difficult to avoid our eyes falling on one of those giant advertisements that project the image of models or actors with dizzying silhouettes and unblemished smiles.

Although this aesthetic ideal is unattainable this aesthetic ideal is unattainable for most people, there are many who choose it.Many people choose it as a benchmark to aspire to, which ends up crashing against a very different and more mundane reality: all bodies are imperfect (even those of the aforementioned celebrities, adorned with the "paint and bodywork" of computer retouching).

From this impossible aspiration arises the explicit rejection of physical variables as diverse as body hair, eye color/shape, hair density or even the alignment of the teeth. It arises, in short, the repudiation of one's own body and its naturalness.

In this article we will talk about body dysmorphia (and its subclinical forms), which is a common problem (especially in industrialized countries) related to the erosion of self-esteem.

What is body dysmorphia?

Body dysmorphia (also known as dysmorphophobia or body dysmorphic disorder) is expressed, in general terms, as the explicit rejection of a specific attribute (or several) of the body.

It involves a distortion in the process of self-perception.The symptoms of the disease are those that magnify a small defect (inappreciable to the eyes of others) or that directly identify it where it is not. In the following we will explore each of its fundamental symptoms.

1. Preoccupation with physical defects unnoticeable to others

The person with body dysmorphia refers discomfort around a specific area of his or her body, this being a physical attribute to which he or she associates a negative emotional nuance. Thus, when they observe or think about themselves, she perceives overflowing feelings that lead to a deep and persistent dissatisfaction. and persistent dissatisfaction. Her rejection produces in her a great sense of shame and inadequacy.

The regions of complaint are usually located on the face.The nose (for its size or shape), the eyes (color, slant and drooping eyelids) and the skin (especially when traces of acne persist during adolescence or the first wrinkles are visible around the corner of the mouth). In addition, the hair is susceptible to repudiation (because of its density or its shine), as well as the shape or size of the head.

Body perception may also be compromisedThe perception of the body can also be compromised, with a special emphasis on the female breast or the curve of the waist. In this sense it is frequent that the breasts are judged as too large or small, with asymmetrical shape or undesirable characteristics (irregular areolas or with a too light/dark color), or excessively sagging (as a result of some discrete ptosis). Finally, the genitalia, in men and women, can also be perceived in an aversive way (in very different parameters).

Subjects with body dysmorphia report that at least two parts of their body are widely disliked, although these tend to fluctuate over time, moving to different and distant regions (up to seven or eight on average over a lifetime).The body parts tend to fluctuate over time, moving to different and distant regions (up to seven or eight on average over the course of a lifetime). It is necessary to remember that these are minimal or non-existent imperfections, so that a massive self-consciousness of one's own body and an overdimension of the irregularities that occur in it in a normal situation are objectified.

Worries about physical imperfection take up a lot of time every day, so that a quarter of those affected report that thoughts on the subject last for eight hours or more a day. This is why they tend to experience them as invasive ideas, which come to mind unwillingly and end up precipitating considerable distress (sadness, fear of being rejected, anguish, frustration, etc.).

Studies on the disorder suggest that the age of onset is in adolescence, a period of life in which there is a strong need to be accepted by the environment.This is a period of life in which there is an accentuated need to be accepted by the environment. The criticisms of the group of belonging can be a clear trigger of the problem, which is supported from the concealment and is only revealed to those who are considered of absolute confidence. That is why its diagnosis and treatment can take many years.

2. Behavior of preoccupation with one's own appearance

As a consequence of these worries about one's own appearance, a series of strategies tend to be developed aimed at minimizing the anguish associated with it. In this sense, behaviors and mental acts are distinguished, which provoke a momentary relief but with the passing of time tend to increase the difficult emotions linked to the intrusive thought.

Among the checking behaviors, the use of full-length or hand-held mirrors stands out, as well as the search for reflective surfaces in public or transit areas, with which to inadvertently explore the silhouette (abdomen, legs or buttocks). Excessive grooming may also take place, involving the use of an arsenal of cosmetic products aimed at concealing the details of the face on which the negative assessment is projected.

As far as mental acts are concerned, the affected person often constantly compares him/herself with others, focusing on the parts of the bodyThe affected person may constantly compare him/herself with others, focusing on the parts of the body of others that he/she rejects in him/herself. Thus, he/she may especially notice those who have the features he/she would like, who represent isolated or exceptional cases, so that the behavior ends up exacerbating his/her Pain and increasing the feeling of strangeness or deformity ("why can't I be like that?").

All of these behaviors are difficult to resist or stop.They arise automatically together with the concern about imperfection. Thus, a relationship of a functional nature is established between the two: the thought provokes discomfort, and the reaction (behavioral or mental) pursues unsuccessfully the aim of stopping or alleviating it.

In this relationship lies the basic mechanism for the maintenance of the problem, since the strategies used to remove the suffering only work in the short term, but in the medium and long term they aggravate it.

3. Impairment of daily life

Body dysmorphic disorder usually has a significant impact on the development of the sufferer's daily life, extending to dimensions such as relationships with a partner or friendship, as well as academic and work areas. It is not uncommon for negative appraisals of specific aspects of the body to have a resonance on the subjective ability to the subjective capacity to develop a satisfactory sexual life, which would translate into difficulties in establishingThis would translate into difficulties in establishing loving bonds of physical intimacy.

In severe cases, the problem (currently considered as a somatic symptom disorder in the DSM-5) causes significant impairment of the social sphere as a whole, with persistent feelings that one is being watched or that people "notice" the bodily nuance that the person labels as inappropriate. This fear of the judgment of others tends to impair academic and work life, as it would foster isolation and isolation.This fear of others' judgment tends to deteriorate academic and work life, as it may lead to isolation and shyness due to the anticipation of being mocked or scorned by others.

Many studies underline a dramatic increase in suicidal ideation. in people suffering from this mental health problem, with a relative risk that is quadruple that observed for the general population. This tremendous finding is eloquent with respect to the suffering that can accompany the disorder, which tends to become chronic if an adequate therapeutic plan is not articulated.

Finally, there is ample evidence of the comorbidities that this disorder may have with mental health problems such as major depression (due to the substantial erosion of a basic dimension of self-image), social phobia (accentuated fear of being rejected or of making a fool of oneself in front of others) and drug abuse (with special emphasis on alcohol, which acts as a social lubricant).

4. Muscular dysmorphia

Muscle dysmorphia is relatively common in the context of the disorder, accompanying the rest of the symptoms described above. It occurs more in males than in females.This is because it alludes to the physical stereotype that society tends to attribute to this group, and is a very important obstacle to the maintenance of a relationship in which physical contact is implicit.

It consists of the perception that the body is thin or that it lacks muscular tissue, or that its size is excessive.or that its size is excessively small. It involves an alteration in the perception of the general musculoskeletal structure (thin arms, puny legs, etc.), although the anthropometry is within normal values.

This perception extends to the whole bodyThis perception extends to the whole body, but does not preclude the existence of specific parts that may be judged as unpleasant (face, head, etc.).

5. Capacity for introspection with respect to ideas about the body

When inquiring into the degree of credibility that people with this disorder attribute to the perception of their own body, most of them recognize that this view of the "I" is excessive and does not accurately match reality. accurately. However, the ability to "realize" is not a solution to their problem, over which they perceive a total loss of control.

On other occasions, there is no self-awareness of the way in which the assessment of the body is disfigured, and cases have been documented in which such assessments reach a delusional entity.

Is this situation always pathological?

Most people harbor insecurities about their appearance, or feel dissatisfied with their appearance.Most people harbor insecurities about their appearance, or feel dissatisfied with some physical/aesthetic attribute that they have been fortunate enough to have. This is a common occurrence, and not at all pathological.

The problem arises when the assessment is a distortion of the objective reality.In the latter case, it is necessary to seek the help of a mental health professional, as treatments are now widely available and proven to be effective. In the latter case, it is necessary to seek the help of a mental health professional, since treatments are currently available that have amply demonstrated their efficacy.

Bibliographical references:

• Rajyaluxmi, A. and Veale, D. (2019). Understanding and Treating Body Dysmorphic Disorder. Indian Journal of Psychiatry, 61(1), 131-135.
• Veale, D. (2004). Body Dysmorphic Disorder. Postgraduate Medical Journal, 80(940), 67-71.