Body
Dysmorphic DisorderIn this disorder the patient is preoccupied with a
defect in appearance. This can be a real defect or an imagined defect. When it
is real it usually is a slight variation of the normal or a slight physical anomaly.
However, the important part is that the patient's concern is markedly
excessive. This preoccupation with this problem causes the
patient marked distress and affects the social, occupational and other functioning
in every day activities. In the case of dissatisfaction regarding body shape and
preoccupation with weight loss the patient would better be classified as "anorexia
nervosa", which is dealt with under "eating disorders". Symptoms
of body dysmorphic disorder: Common concerns are: preoccupation with the size or shape
of the nose, the eyes, the mouth or the eyebrows. The breasts may be too large
or too small, the hips may be too prominent, the buttocks may be too pronounced.
However, when the patient asks a relative or friend about their opinion, the patient
does not accept the advice and starts the preoccupation again. Hours every
day are literally spend looking at a mirror or researching opinions of others,
who do not take long to avoid the patient or get angered by this behavior. Although
initially the frequent checking of the "defect" might have been reducing
the anxiety about it, as time goes on, it becomes clear that the more the patient
checks the "defect", the more anxious he or she becomes. Some patients
are convinced that the "ugly body part" is very fragile or could be
damaged any time. Patients may want to hide as they do not want to get
caught checking themselves all the time, but as time goes on find it more and
more difficult to suppress the checking. Eventually it affects their social functioning
and leads to social isolation as they do not participate fully at work, at home or
with friends. They may find it difficult to keep jobs or they work in
jobs that are well below their capabilities. They may get into marital problems
or find themselves faced with a divorce. Not infrequently they may develop a major
depression with suicidal ideation or attempting suicide. At this time the family
might learn for the first time about the underlying disorder as the patient was
hiding it successfully from them up to that crisis. Course of body
dysmorphic disorder: Reliable statistics regarding body dysmorphic
disorder do not exist, as patients cover up very often. However, it may be more
common than thought of in the past. Men and women are affected with this disorder
about equally. It begins usually in adolescence, but it may not be detected for
several years because of the reluctance to share this. The preoccupation with
a body part can wax and wane, but it tends to be chronic in nature. Differential
diagnosis: This disorder must be differentiated from normal concerns
about appearance. In the body dysmorphic disorder excessive time is spent constantly
checking, while with a normal concern about appearance this is dealt with very
quickly and does not interfere with other life functions.There might be other
mental disorders present that have similar symptoms such as obsessive-compulsive
disorder. In delusional disorder, somatic type,
an imagined defect( that in reality is not there) can be so vividly imagined that
the patient actually believes the delusions. Major depressive
disorder was mentioned above. If this gets superimposed, the
important symptoms to watch for are suicidal thoughts. Other mental disorders
are anorexia nervosa, avoidant personality
disorder , social phobia
and gender identity disorder. Treatment
of body dysmorphic disorder: It may take years before the patient
is ready to volunteer that there are these symptoms. It may therefore take years
before the disorder is diagnosed. Unfortunately, the longer the patient
waits to seek treatment, the more difficult it is to treat as the thought patterns
and habits that have been formed over the years are much deeper entrenched. The
patient should be referred to a psychiatrist for proper diagnosis. Associated
depressive illness needs to be treated with an SSRI antidepressant. Clomipramine
(brand name: Anafranil) and fluoxetine( brand name: Prozac) have been used with
a certain amount of success. Other useful therapeutic measures are self help support
groups, supportive counseling and groups that focus on building up self-esteem. Here
is more
info on body dysmorphic disorder.
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