Body Dysmorphic Disorder: My Disease.

Body image is an internal view of one's own appearance. It is, in effect, how we see ourselves. However, it is multifaceted and consists of several components. For instance, there is the issue of accuracy of body perception - Do you see what others see? Overestimating the size of certain body sites (such as waist and hip size) when compared to objective measurements has often been noted as a sign of body image disturbance. However, more often the perception is not truly distorted, but rather, some aspect of appearance is disliked, disparaged, or seen as unacceptable.

Indications of this subjective distress can be assessed with a wide variety of questionnaires or figural rating scales. These measures may indicate high levels of body dissatisfaction, negative thoughts, or cognitions associated with certain body parts, or even high levels of social avoidance due to negative feelings about the body.

Body image may be seen as "disturbed" when one's self-evaluation of appearance is at such a level that it interferes with social and/or occupational functioning, or causes elevated levels of anxiety and depression in the individual.

The primary feature is a person's extreme disparagement of some aspect of his/her appearance. Importantly, the individual's rating of the body feature does not fit with that of an objective observer, who may not see anything unattractive or unusual about the feature, or who may note some minimal problem (i.e., the nose or ears may be a bit larger than "average"). What is perhaps most important from a clinical viewpoint is that the individual is obsessively focused on the disliked body feature, and this obsession severely interferes with that person's existence.

BDD may lead a person to engage in extreme avoidance behaviors, such as isolation from acquaintances and even loved ones. Suicidal behavior is not uncommon, and clinical depression may also eventuate. In some cases, multiple surgeries and body modification efforts (such as compulsive weightlifting) fail to improve the person's view of the appearance "defect."