Body dysmorphia: types and symptoms of this disorder

We live in times where we are constantly bombarded with images of perfect bodies. When walking through the streets of any big city, it is difficult to prevent our eyes from ending up resting on one of those giant advertisements that project the image of models or actors with vertiginous silhouettes and smiles without taint.

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

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

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.

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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 supposes a distortion in the process of self-perception, that magnifies a small defect (unnoticeable in the eyes of others) or that directly identifies it where it is not. Hereinafter we will explore each of its fundamental symptoms.

1. Concern for physical defects unnoticeable to others

The person with body dysmorphia reports discomfort around a specific area of ​​their body, this being a physical attribute to which they associate a negative emotional nuance. In this way, when she observes or thinks about herself, perceives overwhelming feelings that lead to dissatisfaction deep and persistent. His rejection gives you a great sense of shame and inadequacy.

The regions that are the object of complaint are usually located on the face, especially emphasizing the nose (because of its size or its shape), the eyes (the color, inclination and palpebral fall) and the skin (especially when traces of acne persist during adolescence or the first wrinkles are glimpsed bordering the corner lip). Additionally, the hair is susceptible to repudiation (due to its density or its shine), as well as the shape or size of the head.

Also the perception of the body can be compromised, with a special emphasis on the female chest or the curve of the waist. In this sense, it is common for breasts to be judged as very large or small, with an asymmetrical shape or characteristic undesirable (irregular areolas or with too light/dark color), or excessively droopy (due to some discrete ptosis). Finally, the genitals, in men and women, can also be perceived in an aversive way (in very different parameters).

Subjects with body dysmorphia they report that at least two parts of their body are widely repugnant to them, although these tend to fluctuate over time, moving to different and distant regions (up to seven or eight on average throughout life). It is necessary to remember that these are minimal or non-existent imperfections, which is why a massive self-awareness of one's own body and an oversizing of the irregularities that occur in it in a situation of normal.

Worries about physical imperfection take up a lot of time every day, so that a quarter of of those affected report that thoughts about the subject last for eight hours or more a day. That is why they tend to experience them as invasive ideas, which come to mind without the will and that end up precipitating notable discomfort (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 an accentuated need to be accepted by the environment. Criticism from the belonging group can be a clear trigger for the problem, which is supported from concealment and is only revealed to those who are considered to be absolutely trustworthy. That is why its diagnosis and treatment can take many years.

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2. Behaviors of concern for one's appearance

As a consequence of these concerns about one's appearance, a series of strategies are usually developed aimed at minimizing the anguish associated with it. In this sense, behaviors and mental acts are distinguished, which cause momentary relief but which With the passing of time, difficult emotions linked to thinking tend to increase. intruder.

Among the verification behaviors, the use of full-length or hand mirrors stands out, as well as the search for reflective surfaces in public or transit areas, with which to inadvertently explore the silhouette (the abdomen, legs or the rear). Excessive grooming can also be carried out, in which an arsenal of products is used cosmetics aimed at concealing the details of the face on which the assessment is projected negative.

As regards mental acts, the common thing is that the affected person constantly compares himself with others, stopping at the parts of the body of others that she rejects in herself. Thus, you can pay special attention to those who have the traits you would like, who represent isolated or exceptional cases, so that the behavior ends up exacerbating their pain and increasing the feeling of strangeness or deformity ("why can't I be So?").

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

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

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3. impairment of everyday life

Body dysmorphic disorder usually has a notable impact on the development of the daily life of the person who suffers from it. suffers, extending to dimensions such as relationships or friendships, as well as academic and labor. It is not uncommon for negative assessments of specific aspects of the body to have resonance with the subjective capacity to display a satisfying sexual life, which would translate into difficulties in establishing loving bonds of physical intimacy.

In severe cases, the problem (currently considered a Somatic Symptom Disorder in DSM-5) causes significant impairment of the social sphere in their together, with persistent feelings that one is being watched or that people "notice" the body nuance that the person dismisses as inappropriate. This fear of the judgment of others tends to deteriorate academic and professional life., since it would foster isolation and shyness due to the anticipation of eventual ridicule or contempt from others.

Many studies underline a dramatic increase in suicidal ideation in people who suffer from this mental health problem, with a relative risk that is four times that observed for the general population. This tremendous finding is eloquent regarding 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 can have with problems of mental health such as major depression (due to the substantive erosion of a basic dimension for the self-image), the social phobia (accentuated fear of being rejected or ridiculed in front of others) and drug abuse (with special emphasis on alcohol, which would act as a social lubricant).

4. muscle dysmorphia

Muscular dysmorphia is relatively common in the context of the disorder, accompanying the rest of the symptoms that have been previously described. Occurs more in men than in women, since it alludes to the physical stereotype that society tends to attribute to this group, and supposes a very important obstacle to maintaining a relationship in which contact is implicit physical.

Consists in the perception that the body is scrawny or lacking in muscle tissue, or that its size is excessively small. It implies an alteration in the perception of the general musculoskeletal structure (thin arms, weak legs, etc.), even though anthropometry is within normal values.

This perception extends to the whole body, but this does not prevent the existence of specific parts that can be judged unpleasant (face, head, etc.).

5. Introspection capacity regarding ideas about the body

When one inquires into the degree of credibility that people with this disorder attribute to the perception of their own body, most of them recognize that this vision of the "I" is excessive and does not conform to reality with precision. 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, having documented cases in which such assessments would reach a delusional entity.

Is this situation always pathological?

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

The problem arises when the assessment supposes a distortion with respect to objective reality, or damage is generated to the quality of life or other areas of daily functioning, and especially when the person does not recognize that they could be wrong. In the latter case, it is necessary to seek the help of a mental health professional, since there are currently treatments that have widely demonstrated their effectiveness.

Bibliographic references:

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