370 CHAPTER 8
Pop star Michael Jackson’s face changed repeat-
edly over time, particularly his nose, chin, and
cheeks, although he said that he only had surgery
on his nose to help his singing. Might Michael
Jackson have suffered from body dysmorphic
disorder?
Michael Ochs Archives/Getty Images Michael Ochs Archives/Getty Images Chris Walter/WireImage/Getty Images Frazer Harrison/Getty Images Michael A. Mariant-Pool/Getty ImagesPeople with body dysmorphic disorder may compulsively exercise, diet, shop
for beauty aids, pick at their skin, try to hide perceived defects, or spend hours
looking in the mirror (like Mrs. A., described in Case 8.8, who believed that she
had multiple defects). Alternatively, people with body dysmorphic disorder may try
to avoid mirrors altogether. The preoccupation with—or attempts to hide—a per-
ceived defect can be diffi cult to control and therefore devastating, consuming up to
8 hours each day (Phillips, 2001). An individual with body dysmorphic disorder
may seek reassurance (“How do I look?”), but any positive effects of reassurance
are transient; a half-hour later, the person with body dysmorphic disorder may ask
the same question—even of the same person! Unfortunately, these behaviors, which
are intended to decrease anxiety about appearance, end up increasing anxiety.CASE 8.8 • FROM THE OUTSIDE: Body Dysmorphic Disorder
Ms. A was an attractive 27-year-old single white female who presented with a chief complaint
of “I look deformed.” She had been convinced since she was a child that she was ugly, and
her mother reported that she had “constantly been in the mirror” since she was a toddler.
Ms. A was obsessed with many aspects of her appearance, including her “crooked” ears,
“ugly” eyes, “broken out” skin, “huge” nose, and “bushy” facial hair. She estimated that she
thought about her appearance for 16 hours a day and checked mirrors for 5 hours a day.
She compulsively compared herself with other people, repeatedly sought reassurance about
her appearance from her boyfriend and young son, applied and reapplied makeup for hours
a day, excessively washed her face, covered her face with her hand, and tweezed and cut her
facial hair. As a result of her appearance concerns, she had dropped out of high school and
then college. She avoided friends and most social interactions. Ms. A felt chronically suicidal
and had attempted suicide twice because, as she stated, “I’m too ugly to go on living.”
(Phillips, 2001, pp. 75–76)Individuals who have body dysmorphic disorder may feel so self-conscious
about a perceived defect that they avoid social situations (American Psychiatric
Association, 2000), which results in their having few (or no) friends nor a romantic
partner. Some try to get medical or surgical treatment for a “defect,” such as plastic
surgery, dental work, or dermatological treatment. But surgery often does not help;
in fact, the symptoms of the disorder can actually be worse after surgery (Veale,
De Haro, & Lambrou, 2003). In extreme cases, when some people with body
dysmorphic disorder can’t fi nd a doctor to perform the treatment they think they
need, they may try to do it themselves (so-called D.I.Y., or do-it-yourself, surgery).
Table 8.17 presents additional facts about body dysmorphic disorder.
Across cultures, features of body dysmorphic disorder are generally similar.
However, koro, a condition that is observed in some people in Southeast Asia and
that is somewhat similar to body dysmorphic disorder, has unique features: Those