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Just face it

An obsession with looks Can drive people to extremes

An obsession with looks Can drive people to extremes   | Photo Credit: Michael A. Mariant

Is there a part of you that you hate to look at and perhaps try to hide from others? Do you glance at your image in distress whenever you pass a reflective surface?

Many of us are embarrassed by or dissatisfied with some body part or other. But what if such self-consciousness about a perceived facial or body defect becomes all consuming, an obsession or paranoia that keeps the person from focusing on school or work, pursuing normal social activities, even leaving the house to shop or see a doctor? What if it leads to attempted suicide?

Such are the challenges facing tens of thousands of Americans who suffer from body dysmorphic disorder, or BDD, a syndrome known for more than a century but recognised only recently by the official psychiatric diagnostic manual. Even more recently, effective treatments have been developed for the disorder, and its emotional and neurological underpinnings have begun to yield to research.

Overactive brains

A pioneering researcher, Dr. Jamie D. Feusner, and his colleagues at the David Geffen School of Medicine at the University of California, recently found patterns of brain activity in people with BDD that appeared to differ from those of others, specially in visual processing. The more severe the symptoms, the more the person's brain activity on imaging scans differed, on average, from normal levels, the researchers reported in the February issue of The Archives of General Psychiatry.

These brain changes may help explain how people can become overly focused on a perceived defect of their face, hair, skin or facial or body shape that others may not notice — indeed, that may not even exist. Some turn to alcohol and drugs to try to cope with the extreme distress. Others seek cosmetic surgery — which fails to relieve anxiety and can even make the problem worse, leaving scars where nothing was apparent before.

Dr. Katharine A. Phillips is a professor of psychiatry at Brown Medical School, and the author, most recently, of “Understanding Body Dysmorphic Disorder: An Essential Guide”. She described how crippling the disorder can become for those who spend hours in front of a mirror trying to “fix” their “ugly hair” or disguise a facial blemish only they can see. Some pick at an unnoticeable mark on their skin until they do indeed have a visible lesion. Some won't leave the house unless they can totally cover their face and hair. Those who do go out without masking the area of concern sometimes suddenly flee and hide when they think someone has noticed it or is staring at them.

Many trace their problem to a childhood emotional trauma, like being teased about their looks, parental neglect, distress over parents' divorce, or emotional, sexual or physical abuse. The disorder seems to have a combination of genetic, emotional and neurobiological underpinnings.

One presumed factor — societal emphasis on looks — is far less important than one might think. The incidence of BDD is nearly the same all over the world, regardless of cultural influences. Unlike eating disorders, which mainly affect women seeking supermodel thinness, nearly as many men as women have body dysmorphic disorder.

The two most effective approaches are cognitive behavioural therapy and treatment with serotonin-enhancing drugs, either alone or in combination. In cognitive therapy, patients gradually learn to reorder their thinking, expose their “defect” to others and view themselves more realistically. However, there is still controversy about how many people achieve long-lasting benefits from the serotonin drugs.

What does not work is plastic surgery and other cosmetic treatments. Even if the treatments modify one presumed defect, the person is likely to find another, and another, and another, leading to a vicious cycle of costly and often deforming as well as ineffective remedies.

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Printable version | Sep 23, 2020 9:40:35 PM | https://www.thehindu.com/features/metroplus/Just-face-it/article16634478.ece

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