Dysmorphophobia, also called Body Dysmorphic Disorder (BDD), is the abnormal and irrational fear of physical deformity. The phobia terminology is now less commonly used and Body Dysmorphic Disorder is generally used instead. According to a Wiki entry, BDD is “A fairly common mental disorder, estimated to affect up to 2.4% of the population.” The entry also says “BDD usually starts during adolescence, and affects men and women roughly equally”.
This disorder relates to one’s own body image and does not generally relate to a fear of deformity in others. It was first described by Italian psychiatrist Enrico Morselli as “dysmorphophobia”, in 1891, in relation to patients who had exhibited these symptoms. He wrote:
“But, when one of these ideas occupies someone’s attention repeatedly on the same day, and aggressively and persistently returns to monopolise his attention, refusing to remit by any conscious effort; and when in particular the emotion accompanying it becomes one of fear, distress, anxiety, and anguish, compelling the individual to modify his behaviour and to act in a pre-determined and fixed way, then the psychological phenomena has gone beyond the bounds of normal, and may validly be considered to have entered the realm of psychopathology.”
Society holds images of beauty and acceptable appearance to high standards, which may cause anxiety for those who are unhappy about their appearance, even if no severe physical flaws are present. This was recognized early in the history of psychoanalysis, when French psychiatrist Pierre Janet described a dysmorphophobic female patient who believed that she had a mustache, when in fact it was not present – but the fear caused her to isolate herself from the public for many years.
The sufferer will generally fixate on a single such “flaw”, whether present or not.
The phobic will often engage in excessive grooming and may constantly touch or seek to hide the “flaw” they believe is present. Phobics will avoid having their photo taken and will frequently compare their appearance to others or continually seek mirrors to check their appearance. Repeated medical visits may be seen even when doctors declare there is no cause for concern.
- extreme anxiety, dread
- shortness of breath
- rapid breathing
- heart palpitation
- excessive sweating
- dry mouth
- confusion / inability to articulate clearly
- lack of focus
- feelings of powerlessness
- obsession with the subject of the phobia
- fear or feelings of losing control
- avoidance behavior
Eating disorders can lead to BDD, and obsessive-compulsive disorder (OCD) can be a contributing factor. (BDD is classed in the OCD spectrum.)
Though twin studies into BDD are few, one estimated its heritability at 43%, although BDD's causation may involve introversion, negative body image, perfectionism, heightened aesthetic sensitivity, and childhood abuse and neglect.
Pre-existing medical issues such as moles, scars, slightly unusual features, etc., can be direct underlying roots of BDD.
Dysmorphophobia is a specific (or “isolated”) phobia, centered on non-social key factors. Isolated phobias tend to have some previous trauma (often in childhood and often physically injurious) as a root cause; a fear of bees may stem from an injury in childhood, for instance.
Upbringing can also play a role, such as parental warnings about a direct threat (such as “snakes can bite and kill you”) which is especially notable in cases where a threat is more imminent. (An allergy to bees or peanut butter, for instance, would naturally reinforce a real medical concern.)
It is thought that genetics and hereditary factors may play a role in specific phobias, especially those related to a danger of injury. (A primal “fight or flight” reflex may be more easily triggered in those with a genetic predisposition, for instance.)
By contrast, social phobias (like a fear of body odor or touch) are less well understood, are driven by social anxiety and are broadly labeled as “social anxiety disorder”.
In all kinds of phobias, external experiences and / or reports can further reinforce or develop the fear, such as seeing a family member or friend who is affected. In extreme cases, indirect exposures can be as remote as overhearing a reference in conversation or seeing something on the news or on TV and movies.
Dysmorphophobia, like most phobias, stems from a subconscious overprotection mechanism, and as with many phobias can also be rooted in an unresolved emotional conflict.
- Cognitive behavior therapy (CBT)
- Habit strategies to relax
- Cognitive therapy (CT)
- In vivo exposure
- Response prevention
- Group therapy
- Energy Psychology
The list of books below are hand picked by the staff at Massive Phobia. It's a mixture of Cognitive Behavioral Therapy, Habit Strategies, Trauma Healing, Mindfulness, Meditation, Buddhist Knowledge and Somatic Study. We hope you enjoy them as much as we did.