Body dysmorphia: types and symptoms of this disorder

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

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

From this impossible aspiration arises explicit rejection of physical variables as diverse as body hair, eye color / shape, hair density or even teeth alignment. Ultimately, the repudiation of the 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 involves a distortion in the process of self-perception , which magnifies a small defect (negligible 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 about physical defects that are invaluable to others

The person with body dysmorphia refers to discomfort around a specific area of ​​his body, this being a physical attribute to which he associates a negative emotional nuance. In this way, when she observes or thinks about herself, she perceives overflowing feelings that lead her to deep and persistent dissatisfaction . His rejection produces a great sense of shame and inadequacy.

The complained regions are usually located on the face , especially highlighting the nose (because of its size or shape), eyes (color, inclination and eyelid) and skin (especially when acne traces persist during adolescence or the first wrinkles glimpse bordering the corner of the mouth). Additionally, the hair is susceptible to repudiation (due to its density or brightness), 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 breast or the curve of the waist. In this sense it is common for breasts to be judged as very large or small, with asymmetric shape or undesirable characteristics (irregular areolas or with a color too light / dark), or excessively droopy (following some discrete ptosis). Finally, also the genitals, in men and women, can 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 repudiable , 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, so that a massive self-awareness of the body itself and an over-dimension of the irregularities that occur in normality occur.

Concerns about physical imperfection take up a lot of daily time, so that a quarter of those affected report that thoughts on the subject are prolonged for eight hours or more a day. That is why they tend to live them as invasive ideas, which come to mind without the will and that end up precipitating a significant unease (sadness, fear of being rejected, anguish, frustration, etc.).

Studies on the disorder suggest that the age of onset is located in adolescence , a period of life in which there is an accentuated need to be accepted by the environment. Criticism of the group of membership can be a clear trigger for the problem, which is supported from concealment and is only revealed to those considered to be of absolute confidence. 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 the aspect itself, a series of strategies aimed at minimizing the anguish associated with it are usually developed. In this sense, mental behaviors and acts are distinguished, which cause momentary relief but which, as time goes by, tend to increase difficult emotions linked to intrusive thinking.

Among the checking behaviors, the use of full-length or hand-held mirrors is especially noteworthy, as well as the search for reflective surfaces in public or passing areas, with which to inadvertently explore the silhouette (the abdomen, the legs or the back). Excessive grooming can also be carried out, in which an arsenal of cosmetic products is used to conceal the details of the face on which the negative assessment is projected.

With regard to mental acts, it is common for the affected person to be constantly compared to others , stopping at the body parts of others that he rejects in himself. Thus, you can repair especially those who have the traits you would like, which represent isolated or exceptional cases, so the behavior ends up exacerbating your pain and increasing the feeling of strangeness or deformity (“why can’t I be like this? “).

All these behaviors are difficult to resist or stop , when they arise automatically together with the concern about imperfection. Thus, a relationship of a functional nature is established between them: thought causes discomfort, and the reaction (behavioral or mental) unsuccessfully pursues the purpose 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.

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3. Deterioration of everyday life

Body dysmorphic disorder usually has a significant impact on the development of the daily life of those who suffer from it, extending to dimensions such as relationships or relationships, as well as academic and work areas. It is not uncommon for the negative assessment of specific aspects of the body to have its resonance on the subjective ability to display a satisfactory sexual life , which would result in difficulties in establishing loving bonds of physical intimacy.

In severe cases, the problem (currently considered a disorder of somatic symptoms in the DSM-5) causes a significant deterioration of the social sphere as a whole, with persistent sensations that it is being observed or that people “give themselves” account “of the body nuance that the person describes as inappropriate. This fear of the judgment of others tends to deteriorate the academic and working life , since it would sponsor isolation and shyness by the anticipation of eventual mockery or contempt by others.

Many studies underscore a dramatic increase in suicidal ideation in people suffering from this mental health problem, with a relative risk that quadruples that observed for the general population. This tremendous finding is eloquent regarding the suffering that may accompany the disorder, which is usually chronicled if an adequate therapeutic plan is not articulated.

Finally, there is ample evidence of the comorbidities that this disorder can have with mental health problems such as major depression (due to the substantive erosion of a basic dimension for self-image), social phobia (accentuated fear of being rejected or ridiculous before others) and drug abuse (with special emphasis on alcohol, which would act as a social lubricant).

4. Muscular dysmorphia

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

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

This perception extends to the whole body , but it is not an obstacle so that there are also specific parts that can be judged as unpleasant (face, head, etc.).

5. Capacity for introspection regarding 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 vision of the “I” is excessive and does not fit reality precisely. 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 feel dissatisfied with some physical / aesthetic attribute that has been lucky to have. It is a common fact, and not at all pathological.

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


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