A controlled look in the mirror, quickly plucking your hair: Dealing with your appearance is one of the rituals of everyday life. For people with body dysmorphic disorder, it becomes a painful compulsion.
The knowledge that the eyes of the beholder take on a deadly new meaning for people with body dysmorphic disorder (KDS): They cannot exist before their own eyes. They feel ugly and are convinced that their nose, their physique, their skin is making them worse. The more they concern themselves with their appearance, the more they focus on obvious flaws, the stronger their impression of their own unattractiveness.
Fiction and reality separate from each other
“Affected people are often very attractive. Their self-evaluation differs greatly from their true nature,” says psychologist Victoria Ritter, who researches the causes and treatment options for body dysmorphic disorders at the University of Frankfurt/Main. Among other things, she found that people with this disorder are on average sensitive to aesthetic proportions and already register minimal deviations. But because everyone asks, “Am I beautiful?” The needs of those affected are often recognized too late.
KDS often starts during puberty
When Wilhelm Steffen’s daughter locked herself in the bathroom for a long time, the parents initially thought of a teenage whims. The Darmstadt resident, who is involved in a self-help group for relatives, says the doctors, whom they later visited, were also initially at a loss.
Furthermore, the affected people do not consider themselves ill but are convinced that it is a physical defect that forces them to look in the mirror again and again. They go to the dermatologist to get closer to their aesthetic ideal, some even to the plastic surgeon – however, remains inaccessible due to the distorted body perception.
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 work. Taking care of your appearance becomes a strategy for handling uncertainty.
withdrawal from everyday life
“If someone spends more than an hour a day on control rituals, checking their presence in the mirror, window panes, mobile phone displays or constantly asking others about their presence, they should be alerted. Must stay,” Ritter says. Another warning sign: Affected people withdraw, no longer see friends, don’t go to school or work for fear of attracting attention because of their perceived flaws.
Triggers for KDS can be bullying or teasing. The beauty ideals stated in the media also play a part: there, the attractive are usually successful too. However, body dysmorphic disorder is not a phenomenon of the media age. 100 years ago the disease was described under the term “fear of deformity” (dysmorphophobia).
The causes are often in childhood. The home of an overly protective parent, for example, may play a role, but may also experience rejection or perpetual criticism. Often those affected lack self-esteem and the ability to tolerate and resolve conflicts.
Psychotherapy works better than medicine
For example, treatments focus on practicing such skills. Another important component is the so-called exposure. Patients approach other people with a list of questions about their appearance – this can be very public even in a pedestrian area – and find out how they really look. A new therapeutic approach at the University of Frankfurt is attempting to use, among other things, video feedback to replace and overwrite distorted images. “The latter are often related to negative autobiographical experiences,” explains Ritter.
Some antidepressants, so-called selective serotonin reuptake inhibitors, also help some KDS patients. According to Braunhober, however, psychotherapy is a more effective long-term approach to reconciling oneself with one’s mirror image.
There is hardly any self help group. When his daughter fell ill, Wilhelm Steffen found support with a group for parents of children with eating disorders in Darmstadt. The two diseases are often associated. To be able to talk to other parents who have experienced similar things was a huge relief, he recalls. It is also helpful “because it gives us the opportunity to understand the views of those affected”.
More information about KDS is available here http://dysmorphophobia.de/
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