María Dolors Mas: "Self-esteem is formed by five self-concepts"

The concept of the "I", the own identity, is a psychological element that, by its own definition, seems to be something intimate and non-transferable: the idea that nobody knows us as much as we ourselves is very intuitive, and has a lot of truth. However, we cannot forget that the way we perceive the world around us and how others interact with us also greatly influences how we see ourselves.

Psychopathologies such as body dysmorphic disorder are an example of the extent to which our perception of ourselves can get out of hand, to the point of damaging us. Luckily, from psychotherapy it is possible to overcome this psychological alteration and other similar ones, such as and as the person we interviewed today, the psychologist María Dolors Mas, knows first-hand Delblanch.

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Interview with María Dolors Mas Delblanch: body dysmorphic disorder and its relationship with advertising, aesthetics and social networks

María Dolors Mas Delblanch is a General Health Psychologist with many years of experience in therapeutic resources such as the techniques of the cognitive-behavioral model, contextual therapies, and Virtual Reality and applied to psychology. This professional works from child and adolescent therapy and for adults in her practice in Badalona, ​​and in this interview she talks to us about the particularities of body dysmorphic disorder and about the psychological alterations linked to this.

How would you summarize what body dysmorphic disorder is, and what differentiates it from other similar psychopathologies?

Dysmorphic disorder or dysmorphophobia is excessive preoccupation with non-observable defects or blemishes on the face and the head, although it also tends to occur very frequently in other parts such as the thighs, hips, abdomen or arms.

Despite this, the imperfections that cause a greater aversion for patients are all those areas related to the acne such as the forehead, nose or chin, hair loss (especially in women and young men), marks, scars ...

At the same time, compulsions such as constantly looking in the mirror, grooming for a long time and excessively before going out to the house, often appear. street and, in some cases, paradoxical as it may seem, some patients even self-injure (abrasions, scratches) as a form of social avoidance and, in some cases of minors, as a way of obtaining parental authorization for an aesthetic intervention that, otherwise, would not would have.

All of this obviously causes clinically significant discomfort and clearly interferes with both personal, family, social and academic or work life.

It can be differentiated from other similar disorders such as muscle dysmorphia produced in eating disorders or obsessive-compulsive spectrum disorders such as trichotillomania or dermatilomania. However, it seems quite clear that, for example, in the case of muscle dysmorphia the profile is closer to that of ED patients in terms of perfectionism, anhedonia, obsessions related to eating and / or physical exercise intense. In addition, in this case, it occurs mainly in men, while dysmorphic disorder occurs, above all, in women.

Is there a profile of a person especially predisposed to developing this disorder?

Body dysmorphic disorder (BDD) constitutes between 1.7 and 2.5% of diagnoses in the general population, although it usually be underdiagnosed because they are patients who go to a cosmetic surgeon earlier than to a cosmetic surgeon. psychologist.

Those who have lived in a dysfunctional environment in parental figures, with little family support, have a higher risk of BDD and / or social, who have lived traumatic experiences such as sexual abuse or who present, in a premorbid way, dermatological problems or doctors.

Likewise, the patients most predisposed to suffering from BDD are those with certain personality characteristics such as neuroticism, perfectionism, hypersensitivity to criticism, fear of rejection, low self-esteem and assertiveness, hopelessness and hypochondria.

On the other hand, there are socially predisposing factors such as high family expectations that lead to high perfectionism in order to avoid disappointing the figures parental. In the same way, the current patterns of beauty and their diffusion are predisposing sociocultural factors. constant through advertising, social networks and the media as symbols of success and money.

How does the world of social networks and the constant praise of beauty canons on the Internet and in the media influence the appearance of body dysmorphic disorder?

As I said, both advertising, social media and the media provide a social representation of an ideal body basing all its content on very slim, tall, young female models, who, therefore, are already presupposed money and success in life.

For this reason, patients with BDD and, especially, young adolescent girls, establish a pattern of social comparison with these images with the negative consequences, at all levels, that it supposed.

In addition, said social representation of an ideal image of some models has a direct impact on the perception of one's own. body that patients have and, even more, of those aesthetic problems that, in most cases, would not be objectifiable.

Obviously, there is a lack of critical sense in the face of images that, possibly, have been photographically retouched, but because previously they have not This critical capacity existed in those who have the responsibility to allow the publication of images in advertising, the media or RRSS as well as a lack of reflection on the part of parents and teachers, at a stage in which it is very important to affirm the personality of the teenagers.

In body dysmorphic disorder, is self-esteem damaged in all aspects, or only in relation to the image of one's own body?

As we know, self-esteem is made up of five self-concepts: academic / work, family, social, emotional and physical. Although, obviously, the most damaged self-concept is the physical one in terms of the image we have about our own body and care Of the same, the fact that we have intrusive thoughts about possible asymmetries, corrections or imperfections, causes us a deterioration of the emotional self-concept since we are not able to respond to situations in the same way as if we had control over our emotions.

At the same time, compulsions take a long time, which can lead to decreased academic / work performance and therefore affect academic / work self-concept.

In the same way, many times, family and friends do not fully understand a disorder that, in most cases, they "do not see" and, For this reason, the family and social self-concept is affected since the patient does not just feel integrated neither in his social group nor family

What are some of the strategies and techniques used in psychotherapy to help patients with this disorder?

Above all, the patient must go to psychotherapy because this is the most crucial and complicated point. Generally, many patients go first to the plastic surgeon and cases of body dysmorphic disorder are not always detected there. In cases where the surgeon does understand psychopathology, he usually makes the referral but, even so, the will of the patient must be counted on, who, other Many times, you may decide to go to another surgeon and to those who are needed until you find the one who will intervene without talking about therapy, if that is the case. find.

It is also essential to establish a good therapeutic alliance with the patient and, in the case of being a minor, it is necessary to choose the co-therapist appropriately for the Exposure sessions with response prevention (ERP) Generally, it is sought within the family environment and is usually one of the parents, if there is a sufficient level of trust solid. Even so, the existence of educational discrepancy can be an interference and, therefore, it will be necessary to have a quality social network.

In some sessions it will be necessary to relax, for which instead of using the classic techniques, which, in the end, they do not give us enough information about the true anxiety state of the patient, it can be used Mindfulness through Virtual Reality.

Likewise, Virtual Reality can be used to distort the body image. Thus, we have environments such as the changing room or the restaurant that serve us, the first one, so that the patient has correct information about her own distorted dimensions.

In this sense, this third-generation technique (which we have used in our Cabinet for 10 years) is a perfect substitute for gradual exposure to avoided situations, as this saves the patient all the inconveniences since the patient is located in a warm, empathetic and, above all, safe environment, in which to expose herself, in a way very close to the real one, to her fears.

From what you have seen throughout your experience, how is the process of recovery and improvement of these people taking place, once they have sought professional help?

In general, if the two elements that I mentioned above are met: introspection by the patient that her problem is psychological and non-aesthetic plus a good therapeutic alliance and following the protocol of a cognitive-behavioral treatment which has been added third-generation therapies such as Virtual Reality or ACT, most patients have a good evolution with remission of the symptomatology.

However, an important point continues to be that patients become aware of the need for periodic follow-ups after discharge. Although the last two sessions are dedicated to relapse prevention, it is important to carry out this follow-up to check if the results are maintained in the medium and long term, to carry out an assessment of the treatment carried out as well as the maintenance of the behaviors that were established during the same.