Dysmorphophobia and dysmorphomania

This form of mental disorders is characteristic of adolescence and adolescence, an average of 13 to 20 years, and is expressed by dissatisfaction with their appearance, individual features or figures. It can occur sporadically (after appropriate comments from peers or adults), and can be relatively constant (if, for example, teased at school, in the courtyard, etc.)
In other cases, painful thoughts arise about the presence of some imaginary or overestimated physical defect. Most often this concerns the visible parts of the body: the shape or size of the nose, ears, forehead, lips, leg structure. Somewhat less often - the size of the chest, waist, abdomen, thighs
- for girls and girls, the size and shape of the genitals - for boys and boys.
There are also painful thoughts about the spread of unpleasant odors (intestinal gases, urine, sweat, smells from the mouth) to patients. This pathology is known as "dysmorphophobia", which in Greek literally means obsessive fear of bodily deformity. This fear, concerning the allegedly incorrect or ugly structure of one or another part of the body, is usually accompanied by a critical attitude toward one's experiences, although the patient can not overcome it.
Dysmorphomania is a disorder of a deeper, psychotic level, when a painful conviction of having an imaginary physical defect acquires an overvalued or delirious character, i.e. Is not amenable to correction and is accompanied by a lack of criticism from the patient.
Dysmorphomania is accompanied by a depressed mood, careful disguise of their experiences and "defects" and the desire to correct their "flaw" in any way. Therefore, such patients to disguise "ugly" ears come up with a special hairstyle or do not take off the headdress - with "ugliness" of the head. They turn to doctors, most often surgeons and cosmetologists, asking them to "fix" their ears, nose, lips, skin transplant, remove fat from the abdomen, hips, remove all teeth and insert new ones, change the shape of the jaw, remove all birthmarks, etc. .
Seeking medical intervention, most often a plastic surgery, patients show such activity and ingenuity that in a number of cases they manage to convince doctors and parents in their rightness. However, even the most successful operation does not bring peace to the patient, he discovers new defects and suffers as before. Patients often try to correct their own shortcomings by their own methods. For example, stubbornly refuse to eat or adhere to a special diet, come up with a special set of debilitating exercises, pruning their noses, filing teeth, and so on. In case of unsuccessful attempts to correct (or self-correct) their "shortcomings", suicide may be committed.
For the timely detection of the described mental disorder use two objective indicators: "symptom of the mirror" and "symptom of photography." "The symptom of the mirror" is expressed in the constant desire to view in the mirror its image with the aim, first, "to find the most successful pose," the facial expression, the gait, to hide from its surrounding its apparent flaw, or at least make it less noticeable. Secondly, in order to "understand themselves," what kind of correction is required and how to better implement it. Patients view themselves in the mirror at a time when, in their opinion, no one is looking at them.
"The symptom of photography" is that patients categorically refuse to be photographed, even for very important documents, the true motive of such behavior is the belief that the photograph "perpetuates ugliness", "in a static form, the defect is more visible."
The syndrome of dysmorphomania (dysmorphophobia) can be observed both in patients with borderline disorders (with a special character store, after exposure to a psychogenic factor), and in schizophrenia. In the second case, the prognosis is less favorable because of the low effectiveness of existing methods of treatment. An unfavorable forecast in the event of an idea of ​​a physical defect in relation to the most correct and beautiful part of the body. On the contrary, the prognosis is favorable when there is a certain "soil" for the development of the idea or the fear of physical inferiority (for example, a really not very nice nose, but also an inordinate one, so that it can be fixed on it so strongly).
Treatment of patients with the described syndrome should avoid surgical intervention at the request of patients, because this leads, as a rule, to an even greater weighting of the disease. It is also advisable to seek help from a psychiatrist as soon as possible. The effectiveness of treatment is inversely proportional to the duration of the syndrome. In the process of treatment, both medication (antipsychotics, antidepressants) and various methods of psychotherapeutic treatment and social rehabilitation are used.
Of particular importance in the prevention of dysmorphomanic and especially dysmorphophobic disorders is proper education from childhood to avoid the formation of low self-esteem, an inferiority complex.
Do not make offensive remarks about the child, his appearance (for example, "what kind of a lop-eater are you", "well, you're fat," "who do you have such a long nose for," etc.). If the child has any shortcomings in appearance (excessive fullness, youthful acne), you need to help him get rid of it, rather than sharpen his focus on it. It is necessary to observe a certain measure from teachers, school doctors and nurses. Particular attention is required by children with actual physical defects - in these cases it is necessary to eliminate the physical defect as soon as possible, if necessary even surgically, until it causes mental disturbances in the adolescent.