When your thoughts turn to torment

Controlling look in the mirror, plucking your hair quickly: Dealing with your appearance is one of the daily rituals of life. For people with body dysmorphic disorder, it becomes a painful compulsion.

The wisdom that beauty is in the eye of the beholder takes on a deadly new meaning for people with body dysmorphic disorder (KDS): they cannot exist before their very eyes. They feel ugly and are convinced that their noses, body, and skin are disfiguring them. The more attention they pay to their appearance, the more they focus on visible impurities, the more they feel unattractive.

Fiction and reality are different from each other

“Often these sufferers are very attractive,” says psychologist Victoria Ritter, who researches the causes and treatment options for body dysmorphic disorders at the University of Frankfurt/Main. “Their self-assessment is very different from their actual appearance.” Among other things, I found that people with this disorder are above average sensitive to aesthetic proportions and actually score minimal deviations. But because everyone is asking “Am I pretty?” Often the needs of those affected are recognized too late.

KDS often begins during puberty

When Wilhelm Stephen’s daughter locked herself in the bathroom longer and longer, the parents initially thought about the whim of a preteen teen. Doctors, who later turned to them, were also at a loss, says a resident of Darmstadt, who participates in a self-help group for relatives.

In addition, sufferers do not consider themselves sick, but are convinced that a physical defect forces them to look in front of the mirror again and again. They go to the dermatologist, and some also to the plastic surgeon, in order to get closer to their beauty model – which, however, remains inaccessible due to distorted body perception.

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Body dysmorphic disorder first occurs during puberty in more than 80 percent of cases. This is the time when a person has to do most of the developmental tasks. Paying attention to a person’s appearance becomes a strategy for resolving uncertainty.

Withdrawing from everyday life

“If someone spends more than an hour a day in ritual control, checking their appearance in the mirror, in window panes, on a mobile phone screen, or constantly asking others about their appearance, they should be vigilant,” Ritter says. Another warning sign: Affected people withdraw, no longer meet their friends, no longer go to school or work for fear of attracting attention there for their supposed flaws.

KDS triggers can be bullying or harassment. The ideas of beauty conveyed in the media also play a role: there, the attractive is usually also successful. However, body dysmorphic disorder is not a phenomenon in the age of media. The disease was already described under the term “dysmorphophobia” 100 years ago.

The causes often lie in childhood. An overprotective parental home, for example, can play a role, but it can also experience always being rejected or criticized. Those affected often lack self-esteem and the ability to tolerate and resolve conflicts.

Psychotherapy works better than medication

So treatments focus on practicing such skills, for example. Another important component is the so-called exposure. Patients engage with other people through a catalog of questions about their appearance – this can also be very general in the pedestrian zone – and find out how they actually look. In a new therapeutic approach at the University of Frankfurt, attempts are being made to use video comments, among other things, to alter and write on distorted images. “The latter is often associated with negative autobiographical experiences,” Ritter explains.

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Some antidepressants, called selective serotonin reuptake inhibitors, also help some KDS patients. However, according to Brunhuber, psychotherapy is the most effective long-term approach to coming to terms with the mirror image.

There are hardly any self-help groups. When his daughter fell ill, Wilhelm Steffen found support in Darmstadt with a group for parents of children with eating disorders. Often the two diseases are associated. He remembers that being able to talk to other parents who have gone through similar things was a huge relief. It is also useful “because it gives us the opportunity to understand the thoughts of those affected.”

More information about KDS is available at http://dysmorphophobie.de/

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