Dysmorphophobia: How the compulsion to look good makes you sick

Is your mood right in the basement when your hair isn't lying down in the morning? Would you like to call in sick at work so that nobody sees you? Then you could have a serious problem. Dysmorphophobia or also body dysmorphic disorder (new name) is the name of this disease phenomenon, which particularly affects young women.

Affected people concern themselves too much with their reflection in the mirror. At first glance, this disorder sounds quite harmless. But it is not. It can even be pretty dangerous.

Studies have shown that over three quarters of those affected have suicidal ideation.

"Depending on the study, between three and 27 percent also attempted suicide," says graduate psychotherapist Stefan Brunhoeber in an interview with BRIGITTE.de. The expert has specialized in the treatment of body dysmorphic disorders in his practice in Bonn.

Dysmorphophobia and the compulsion to be beautiful

In this country, dysmorphophobia is still little known, but the number of those affected is increasing. Around one million people – around 1.8 percent of the German population – suffer from a body dysmorphic disorder, according to Brunhoeber. A shockingly high number.

But what exactly characterizes this disorder, what do patients see when they look in the mirror and is cosmetic surgery the last resort? Stefan Brunhoeber clarifies these and other questions for us in an interview.

BRIGITTE: What is Body Dysmorphic Disorder?
Stefan Brunhoeber: That is a form of Body acceptance disorderwhich is mainly triggered at puberty. Affected people deal with their external appearance for more than an hour a day and suffer from it at the same time. They think that their body the way it looks is not enough, that is, it is not beautiful enough. By increasing preoccupation with the outside, an attempt is made to get the problem under control – but this only makes things worse.

At some point your entire life revolves around your own appearance?
In extreme cases, yes.

For some, it can even get to the point that they spend every free minute – even in their dreams – occupied with their appearance.

How do those affected perceive their reflection in the mirror?
It is estimated that 95 percent of patients have a body schema disorder. You perceive yourself as distorted.

How do I know if I have body dysmorphic disorder?
Thinking about how you look for more than an hour a day. Healthy people also concern themselves with their appearance in the bathroom in the morning, but their thoughts quickly move on to the rest of the day. The thoughts of those affected revolve more intensively about their own appearance. Further Symptoms are:

Can cosmetic surgery help?
The current consensus is no. My clinical experience is also that such an operation cannot help because it does not eliminate the triggers and causes that lead to a body dysmorphic disorder.

Body Dysmorphic Disorder: Teasing and Social Media Triggers

What causes the disease?
Over 60 percent say teasing or stupid comments about their appearance triggered the condition. Comparison with socially successful people can lead to the hope that looking good will make you similarly successful. Positive learning experiences can also be triggers.

For example, if you start to put on make-up or lose weight and others compliment you, this can make the disease more likely. Those affected often think that they did not look good before and that they now have to work and change their appearance even more. All of these triggers are based on cracked self-esteem.

Do Social Media and Instagram Beauty Ideals Enhance Body Dysmorphic Disorder?
Many of my patients often come into contact with social media at work. This stresses them incredibly, because they constantly have to compare themselves to other – often seemingly perfect-looking people – and always have the feeling that they are doing worse. So yes, social media can be another trigger for body dysmorphic disorder.

How can one imagine the course of the disease?
Imagine you have two men in the same car. One takes his car to the car wash every two months, the other spends several hours a day looking after the car. For the second man, it is much worse if the car is scratched because he has invested a lot more in his car. It has become an increasingly important part of his identity.

Sufferers become more vulnerable and have to do more to look good in order to feel safe. Appearance becomes identity. You start to let social contacts and other activities slip. Those affected need professional help, otherwise the disease will be chronic.

What are the consequences?
Some resort to alcohol and drugs to feel more secure.

Some are withdrawing more and more socially and have hardly left the house for years because they are so ashamed.

Partnership or sexual problems arise because those affected feel unattractive and think that the partner is about to leave them. Many also have frequent absences from school or work because they do not dare to show themselves on site.

How is the disease treated?
After taking a common anamnesis and researching the cause, an individual disorder is developed (psycho-education) so that those affected better understand their illness. Patients have to learn that the problem is not their appearance, but their thinking and acting. Further therapy steps are:

Besides, it has tospecially trained safety and avoidance behavior is reduced so that those affected have the corrective experience that others don't think so badly about their appearance. To do this, I often go into town with the patients and do surveys about how others perceive their appearance. Affected must also learn to deal with negative statements and to defend oneself in this regard.

Sources used: own expert interview

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