Through  Katharine A. Phillips  , MD, Weill Cornell Medical College

OCD and somatoform disorders

In dysmorphophobia, concern for one or more non-existent or mild physical appearance defects results in significant suffering or affects behavior.

• People typically spend several hours a day worrying about the faults they perceive that can affect any part of their body.

• Doctors diagnose this disorder when concern about its appearance causes significant suffering or disrupts behavior.

• Certain antidepressants (selective serotonin reuptake inhibitors or clomipramine) and behavioral and cognitive therapy are often helpful.

People with dysmorphophobia think they have one or more cosmetic defects, which are actually non-existent or mild. They do certain things repeatedly (like staring at themselves in the mirror, grooming excessively, or comparing themselves to others) out of disproportionate concern for their appearance.

Dysmorphophobia usually begins during the teenage years and may be a little more common in women. The disorder affects approximately 2 to 3% of the population.

Symptoms of dysmorphophobia

Symptoms of dysmorphophobia can develop gradually or suddenly, vary in intensity and tend to persist without proper treatment. The concerns are usually on the face or head, but may involve any part or parts of the body and move from one part of the body to another. For example, a person may be worried about what they perceive to be the onset of baldness, acne, wrinkles, the color of their skin, or excessive facial or body hair. A person may also focus their attention on the shape or size of a part of their body, such as the nose, eyes, ears, mouth, breasts or buttocks. Some men, who have a normal physique, even athletic, feel puny and try by all means to increase their weight and improve their musculature; this is called muscle dysmorphia. People with Alzheimer's disease can describe parts of the body they don't like by calling them ugly, unattractive, misshapen, hideous, or monstrous.

Most people with dysmorphophobia are unaware that they actually look normal.

They usually find it difficult to control their concerns and worry for hours on end about the flaws they perceive. They sometimes think that other people are staring at them or laughing at them because of their looks. Most often examine themselves in front of a mirror, others avoid looking at themselves and still others oscillate between these two behaviors.

Many people obsessively and excessively groom themselves, groom their skin (to remove or repair perceived skin blemishes), seeking reassurance about perceived blemishes. They often change their clothes to try to cover up or camouflage their nonexistent or slight defect or to try to improve their appearance in some other way. For example, men can grow beards to cover up perceived scars or wear a hat to cover slightly thinning hair. Many people have recourse to cosmetic (most often dermatological), dental or surgical medical treatment, sometimes repeatedly, in order to correct the defect they perceive. This type of treatment is usually unsuccessful and may intensify their concern. Some men with muscle dysmorphia take anabolic steroids (such as testosterone), which can be dangerous.

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Did you know ?

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Some people worry so much about their seemingly nonexistent or slight blemish that they avoid going out in public.

Because people with dysmorphophobia are embarrassed about their appearance, they sometimes avoid appearing in public, including going to work, school, and attending social events. Some, with severe symptoms, only leave their homes at night, and others not at all. This disorder therefore often results in social isolation. The suffering and dysfunctions induced by this disease sometimes lead to depression, repeated hospitalizations, suicidal behavior, and suicide.

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Diagnosis of dysmorphophobia

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Clinical examination, based on specific diagnostic criteria

The disorder can go undiagnosed for years because people with dysmorphophobia are too embarrassed and ashamed to reveal their symptoms or because they genuinely believe they are ugly. It is distinguished from normal concerns related to the physical aspect or vanity in that the worry is time consuming and causes significant suffering or disrupts the functioning of the person.

The doctor diagnoses dysmorphophobia when the person does the following:

• She is concerned about one or more flaws in the appearance that other people consider insignificant or do not notice

• She does or thinks certain things repeatedly (such as staring at herself in the mirror, grooming excessively, or comparing herself to others) out of concern for her appearance

• She feels deeply anxious or has difficulty functioning (at work, with her family, or with her friends) due to her extreme worry about what she perceives to be flaws in appearance

Treatment of dysmorphophobia

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• Certain antidepressants

• Behavioral and cognitive therapy

Treatment with certain antidepressants, specifically selective serotonin reuptake inhibitors or clomipramine (a tricyclic antidepressant) is often effective in people with dysmorphophobia.

Behavioral and cognitive therapy that focuses specifically on this disorder may also be effective. With this therapy, healthcare professionals help people develop useful and more reality-oriented beliefs about their physical appearance. They also help them stop repetitive excessive behaviors, such as examining themselves in a mirror and pummeling their skin. They also help them participate and feel more comfortable in social situations.

The habit reversal technique is used to alleviate the repetitive skin crushing or hair removal that people with dysmorphophobia go through in an attempt to minimize or eliminate what they perceive to be skin blemishes (such as only imperfections) or hairiness (such as excess hair on the face).

Because many people with this disorder don't recognize that they have a problem, doctors may need to use motivational techniques to get people to participate in treatment.

Many specialists believe that the combination of drug treatment and behavioral and cognitive therapy is the best option for severe cases.

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Hypochondria

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Hypochondria is a chronic fear of having serious illness.

This disorder takes on certain characteristics of OCD such as:
• the presence of a haunting idea (fear of illness)
• the resulting anxiety
• and the behavior of checks which consist of repeated medical consultations. However, these behaviors are not compulsions.

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Note : Hypochondria is less often associated with OCD compared to dysmorphophobia.