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Face It, I Am Ugly

Body Dysmorphic Disorder (BDD) is a psychological condition where a person has an abnormal obsession wit a perceived physical flaw. He/she has a desperate need to mask it or go for multiple plastic surgery procedures. BDD can strike at any age, but the onset is usually during a person's teenager years or early adulthood when there is a peer pressure to look good.

Although sufferers can be unhappy about any body part, the chief dissatisfaction often lies with their face, which typically is the first thing people notice. The illness is different from bulimia or anorexia, where people think they are fat. People with BDD have more extreme reactions to their facial features, opting for surgical corrections, while anorexic people hate their body and usually starve themselves to slim down.

Plastic surgeons are usually the first people BDD suffers turn to, to address a perceived flaw such as a "too-big" or "too-small" nose, eyes or breasts. They may still seek other medical opinions despite getting assurances from their plastic surgeons that surgery has been a success. It is difficult to spot a BDD case because more sufferers appear to be normal.

The problem becomes apparent only when a person repeatedly requests for the same surgical process. The treatment for BDD includes medication for and counseling, but sufferers are often in a state of denial and refuse to believe that they have a problem. The illness often leads to problems like depression and social isolations. But because BDD is not a well-studied illness and patients are difficult to monitor, it is not know if it is a life-long ailment.

What is certain is that sufferers find it difficult to form meaningful relationships. Some are afraid to go on their first dates because they think that their noses are too big, there is something wrong with their eyes or their breasts are small. However with counseling, patient can come to term with the perception of their bodies and learn to lead a more normal life. People who have Body Dysmorphic Disorder often think they don't look good enough.

They Get So Upset They Cannot Function Normally

BDD sufferers usually obsess over one particular feature. Most commonly, the hair, face, skin, body build, breasts or private parts. They become so distressed over the imagined defect that this affects their daily life and ability to work or socialise with others. Said Dr Lionel, a consultant psychiatrist: "'Boo is a condition that affects a person's whole perception and thinking.


"There's an unshakable belief in the person's mind, that the 'defect' is something so big and serious, no matter what is said to them, they won't be able to change their mind." This could lead to depression, anxiety, obsessive behavior, and even suicidal thoughts. Said psychologist Daniel: "Most people are concerned about how they look. But when they spend too much time on this, or become obsessive and are distressed by their looks, it crosses the line from normal to problem."

BDD can be caused by a chemical imbalance in the brain, or by childhood issues or unresolved conflicts. Those who are easily stressed, are perfectionists or suffer from low self-esteem are also more prone to ODD. Some common signs of BDD include frequent glancing in mirrors or shiny objects to look at themselves, sometimes for hours, and constant measuring, touching, and talking about the "defect".

BDD sufferers may try to camouflage the "defect" with makeup or clothing, like with a hat or scarf. Many would visit several doctors asking them to fix the "defect". Or they visit specialists like plastic surgeons and dermatologists. If the disorder becomes chronic and severe, sufferers could also become depressed and even attempt suicide. Dr Andrew, a psychiatrist in private practice cited a US study of 30 BDD patients which revealed that almost one out of every three had attempted suicide at least once.

That's why it is important to seek early intervention for BDD, he said. With medication and counselling, BDD sufferers can make a full recovery. But this is easier said than done. Said Mr Andrew. "BDD can be quite hard to detect, because the patient usually carries out his (obsessive) behavior in secret or in private." Even if the illness is spotted, the healing process could be difficult.

Added Dr Andrew: "This is a very difficult group of patients to manage because they don't see themselves as having a mental problem. So we as psychiatrists... work long and hard to get them to accept this treatment." Dr Andrew feels this is not because BDD is uncommon, but because the cases remain undiagnosed. He urged doctors to recognise and refer cases early because this increases a patient's chances of recovery.


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