Dysmorphophobia
The content of the article:
- Causes and risk factors
- Forms of the disease
- Symptoms
- Diagnostics
- Treatment
- Possible complications and consequences
- Forecast
- Prevention
Dysmorphophobia (from ancient Greek δυσ - a prefix with a negative value, μορφή - "appearance", "appearance", φόβος - "fear") is a mental pathology, which is based on a panic fear of physical imperfection in the absence of objective reasons or existing substantially overestimated minor defects.
Panic fear of physical imperfection is a sign of body dysmorphophobia
Pathology was first described at the end of the 19th century by the Italian psychiatrist E. Morselli as an obsession with bodily deformation ("fear of being changed").
Patients suffering from body dysmorphic disorder are prone to excessive dramatization of the slightest defects in appearance or features of the body's functioning (such as bad breath, a peculiar body odor, etc.), accompanied by disorders of the depressive spectrum, limited contacts. Sometimes - even with classic facial features and proportional build - patients try to completely exclude interaction with the environment for fear of being ridiculed.
The results of different studies demonstrate a characteristic trend: if, on average, among the population, the frequency of occurrence of this mental disorder does not exceed 1-2%, then among patients who systematically seek help from aesthetic medicine institutions, their number varies from 7 to 15%.
Both females and males are equally susceptible to the disease, the debut often falls on the period of adolescence. A distinctive feature of dysmorphophobic syndrome is a high frequency of suicides: compared to other mental pathologies, it is 2-3 times and almost 50% more than the average in the population.
Painful ideas about their own imperfection and the presence of any defects more often arise in adolescents aged 13–19 years, although they can manifest themselves in adulthood.
Close to the concept of "dysmorphophobia" is the term "dysmorphomania". If in the first case the patient experiences an obsessive fear about a real, but exaggerated or imaginary defect, then in the second, the fear develops into a persistent belief that cannot be corrected.
Synonyms (outdated): paranoia of ugliness, delirium (or complex) of an ugly appearance, delusional ideas of ugliness, asymmetry and deformation of the body, dysmorphic anxiety.
Causes and risk factors
There are 2 voluminous groups of reasons that can provoke the development of dysmorphophobia: psychogenic and biological.
The psychogenic triggering factor of the disease is most often psychotrauma, which is the result of:
- bad joke;
- inappropriate (sometimes unfounded) criticism;
- acute stressful effects, when the patient was rudely indicated an explicit or fictitious defect;
- comparing yourself to more successful people with “correct” facial features and physique in a situation of personal or professional failure;
- authoritarian parenting style; etc.
Dysmorphophobia is most often formed under the influence of psychotrauma
For biological reasons, when there is no connection with psychogenia, the following can be attributed:
- violation of the metabolism of neurotransmitters (neurotransmitters);
- obsessive-compulsive disorder (obsessive-compulsive syndrome);
- schizophrenia;
- anxiety disorder;
- genetic predisposition;
- anomalies in the structure of the structures of the brain.
Risk factors for the development of dysmorphophobia are personal accentuations or some character traits, the carriers of which are more susceptible to external provoking psychogenic influences:
- The pursuit of excellence;
- shyness and shyness in communicating with others;
- introversion (focus of interests on their own inner world);
- sensitivity to critical remarks, impressionability, sentimentality;
- tendency to self-reflection, excessive self-criticism;
- a tendency to limit contacts.
Forms of the disease
The main types of painful conditions:
- paranoid delirium, when the patient perceives an anatomically and physiologically unchanged part of the body, a facial feature as something disgusting, attracting everyone's attention and causing unhealthy interest, subject to ridicule;
- an overvalued (hyperquantivalent) idea of a disfiguring physical disability in the case of a minor anatomical or physiological feature (for example, a small mole on the face is considered a disfiguring spot that cannot be shown to others).
Symptoms
Dysmorphophobia is characterized by a specific triad of disorders:
- the obsession with physical imperfection, ugliness ("fat belly", "legs like matches", "ears like an elephant", "potato nose");
- delusional attitude (“they point the finger on the street,” “everyone laughs behind their backs,” “they look on the sly,” “it's unpleasant to stand next to me”);
- decreased mood up to depressive personality disorder, sometimes with suicidal thoughts.
Delusional delusion with body dysmorphophobia is a feeling when everyone laughs and points a finger
The disease can have a gradual, slow onset or occur simultaneously, like "insight", when the patient suddenly decides that he has ugly features. The spectrum of painful manifestations of dysmorphophobia is very diverse:
- a mirror symptom (observed in almost 80% of patients), characterized by an obsessive desire to look in mirrors or other reflective surfaces in an attempt to find a favorable angle, correct an existing deficiency (protrude lips, pull in cheeks, mask ears with strands of hair, etc.);
- a symptom of photography, which is expressed in a categorical refusal to photograph even with the necessary documents in order not to capture the existing "ugliness". Patients are convinced that it is on static images that their defects are most pronounced. If photographing is inevitable, they try to hide behind someone, to achieve blurriness of the picture with sharp movements; if there is a photo, they retouch, glue or cut out the “problem” part of the body;
- the desire to constantly be alone, intolerance of crowds;
- disguise of imaginary defects (excessive amounts of decorative cosmetics, glasses, wigs, hats with wide brim, baggy clothes, bandages, plasters, attempts to hide the face behind a newspaper, umbrella, raised collar, etc.);
- persistent desire to convince loved ones of their “ugliness” and to get their approval for corrective intervention;
- desire for correction, manifested by persistent appeals for medical help (cosmetic procedures, plastic surgery), up to suicide blackmail in case of refusal to correct the "deformity". Sometimes this desire is manifested exclusively by reflections and exaggeration of the topic of correcting a defect in conversations with close people;
- attempts to eliminate defects in appearance without professional help (refusal to eat, development of "special" complexes of exercises and diets, taking various medications, in severe cases - self-removal of moles, abrasion of the skin with abrasives, filing teeth, etc.);
- tendency to consciously concealment, concealment of feelings - when talking with relatives and medical personnel, patients pretend that they fully agree with the arguments presented and have realized the groundlessness of their fears, “parted with delusions”;
- in severe cases, some patients demonstrate a desire to commit “merciful murder” in relation to relatives and strangers with similar “defects” in appearance (“so as not to suffer,” “to get rid of suffering”);
- anxiety disorders;
- apathetic depression.
People with body dysmorphic disorder often try to correct the "flaws" of their appearance with the help of plastic surgery
In most cases, patients with dysmorphomania are socially maladjusted, they cannot concentrate on work or school life, and experience difficulties in building personal relationships.
Diagnostics
Diagnosis of the disease is not difficult in the case when the patient does not try to distort the manifestations of the existing painful symptoms with the help of purposeful concealment.
For an objective assessment of the condition, a number of diagnostic criteria are used to establish the correct diagnosis:
- persistent concern about the presence of a disfiguring defect;
- concentration of attention on 1-2 organs, several facial features, while the actual defects (scars, scars, post-traumatic disfigurement of soft tissues and skin) are perceived by the patient as insignificant, trifling;
- striving to correct the "disfiguring" feature;
- social and labor maladjustment.
Treatment
There is no cure that can completely eliminate the disease. Patients are shown symptomatic pharmacotherapy:
- anxiolytics;
- antipsychotics;
- antidepressants;
- behavior correctors;
- sedatives.
In addition to drug treatment, rational psychotherapy is used, individual in each case. Its main component is patient reorientation.
With dysmorphophobia, drug and psychotherapeutic treatment is used
Attempts to persuade the patient, to prove to him the falseness of ideas about the defect in the overwhelming majority of cases are untenable. Also, cosmetic operations are not categorically shown, since they lead to an aggravation of the condition, without bringing the expected relief.
Possible complications and consequences
The disease can lead to the following:
- Infection, sepsis, disfigurement as the result of independent attempts to correct external defects.
- Suicide.
- Exhaustion on refusal to eat.
Forecast
The prognosis for complete recovery is poor. The disease is characterized by a wavy chronic course with periods of remission and exacerbation. With the help of a combination of psychotherapeutic influence and rational pharmacotherapy, in most cases, it is possible to achieve stable remission, labor and social adaptation of patients.
In the absence of treatment, traumatic effects or persistent psycho-emotional stress, the symptoms intensify.
Prevention
The fundamental place in the prevention of the possible development of dysmorphophobia is the correct interaction within the family with the child, and later with the adolescent.
The following measures of influence are inadmissible:
- criticism of appearance ("what are your protruding ears", "legs are thick, like an elephant");
- insults (“who are you so scary at?”, “you can't leave the house with such pimples”);
- attempts to influence the child's behavior through condemnation of eating habits or the prevailing regime ("and so all the dresses are small, if you eat so many sweets, you will become like an elephant", "already the fattest in the classroom, you will sleep until lunch, and not play sports, you will the fattest in school ").
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Olesya Smolnyakova Therapy, clinical pharmacology and pharmacotherapy About the author
Education: higher, 2004 (GOU VPO "Kursk State Medical University"), specialty "General Medicine", qualification "Doctor". 2008-2012 - Postgraduate student of the Department of Clinical Pharmacology, KSMU, Candidate of Medical Sciences (2013, specialty "Pharmacology, Clinical Pharmacology"). 2014-2015 - professional retraining, specialty "Management in education", FSBEI HPE "KSU".
The information is generalized and provided for informational purposes only. At the first sign of illness, see your doctor. Self-medication is hazardous to health!
