This is the age of Selfie!!

Volume 4 Issue 12 Dec 2014

This is the age of selfies, Facebook, Instagram!, the age of ‘self- centeredness’. ‘Looks’ now plays a larger part in establishing one’s social identity which can be spread across to many, across continents! Approval is instant, visible and the number of ‘likes’ quantify it! Thus vanity is galloping ahead, and Appearance is riding on it. The need to look better is pressing.

In such an environment the growth of cosmetic industry is staggering. In India this year it’s worth $ 950 million! Simultaneously there is a boom in cosmetic surgery and procedures. As a psychiatrist there is an immediate question. Are some of these consumers suffering from a psychiatric disturbance? Persons with body image and identity disturbances will be engulfed in this social change and yet their troubled psyche will continue to isolate them.

Body Dysmorphic Disorder(BDD) is one such disturbance. It is relatively common, but under recognized and underreported. The prevalence of BDD in general population is 2 to3%. However, it is found to vary from 3.2 to 53.6% in patients attending cosmetic surgery clinics (Review articles). BDD is characterized by preoccupation with minor or imaginary physical flaws. These preoccupations most often involve skin, nose, face, hair, muscularity or features related to sexuality. The individual may perform repetitive behaviors (eg, mirror checking, excessive grooming) in response to the appearance concerns. It usually starts in adolescence. BDD is highly distressing, causes great suffering and is associated with poor quality of life, impaired social or occupational functioning and suicidal attempts. The person may have insight into his problem or may be delusional and convinced that his/her BDD beliefs are true. BDD needs to be differentiated from normal concerns about appearance, narcissistic personality, Anorexia Nervosa, Social phobia, OCD, and Delusional Disorder.

Besides social pressure and expectations of beauty, a positive family history, a traumatic childhood history and poor self esteem are the other risk factors.

Patients can develop complications such as unnecessary dermatological and surgical procedures, difficulty in attending college or work, social isolation, depression, and substance abuse to avoid distress.

Almost all persons with BDD seek cosmetic treatment for their perceived physical flaws. However they are never satisfied with the treatment outcome and the continuing distress can easily be transformed to anger and even legal action against the cosmetologists or surgeons. Most of the treating doctors are not aware of this risk. Some patients, who do seem to have a satisfying outcome, will soon start having symptoms of similar kind but involving other parts of the body!

The psychiatric treatment of BDD involves vigorous psycho education, help in preventing unnecessary cosmetic treatment costs and complications, and treating the primary psychopathology through Cognitive Behavior Therapy. Pharmacological treatment involves mainly use of serotonergic drugs such as SSRIs. SSRIs are beneficial to many but are required to be continued for a long period. Impaired social functioning and a high suicide risk are part of BDD and have to part of any treatment plan.