A Careful Look at Morning Newspapers
Just a glance at the morning newspaper or magazine advertisements and one never fails to spot a nice ‘Cinderella fantasy’- a story supported by pictorial evidence of an ugly, obese, hairy, wrinkled or dark duckling that went to ‘X’ beauty and slimming center and overnight transformed into a ‘good-looking’ and ‘happy’ soul. These advertisements end up giving people an implicit message- ‘you should be unhappy and miserable if you are not good looking, but now please don’t worry, we are here to cleanse all ugliness out of your body and turn you into a
Normal and Abnormal Appearance Anxiety
However, the issue of anxiety and dissatisfaction with one’s appearance is complex and the media is not the only one to be blamed, though it does serve as an important catalyst in creating distress in some people. Firstly, one must differentiate between degrees of dissatisfaction with one’s appearance. Almost all human beings and even members of other species have a wish to look good as it has several advantages socially as well as reproductively. Good-looking people are liked and sought by others. Thus, we all have a wish to look physically attractive- to have clear lustrous skin, well-toned body, a good height, etc. However, for some people this wish to look good becomes the sole omnipotent purpose of their life- they remain preoccupied with a sense of ugliness and cross all limits to look physically attractive.
Consider the case of Amit (name changed), a 22-year-old man who feels that his nose is horrible-looking and thus has undergone three plastic surgeries. However, after each surgical operation he felt uglier than before. As a result Amit remains confined in his house, he rarely goes out and avoids being seen. He feels that he would be able to face the world only when he somehow improves his looks. In reality, Amit is pretty handsome and well built; his fear of ugliness is a psychological one. Amit’s fear has its roots in his childhood experience with a caregiver who gave Amit an implicit message that he is undesirable. Thus, this fear of being not desired by others haunts him till date and all his attempts to modify his body are aimed at overcoming this fear. The problem is that because this fear is a psychological one, no matter whatever physical changes Amit brings in his appearance, he would be overwhelmed by this fear of ugliness.
Amit’s case is indeed an extreme one, but it alerts us to the fact that thousands of people who have an abnormal preoccupation with their looks may have similar psychological issues, though of a lesser intensity. Plastic surgeries and beauty treatments have an important role in cases where there is an actual ugliness due to an accident, injury or some other reason. However, in cases where the ugliness is not so pronounced, there may be psychological issues, which need to be addressed rather than blindly administering surgeries and beauty treatments on normal-looking people.
Body Dysmorphic Disorder
In psychological diagnostic language, Amit suffers from Body Dysmorphic Disorder (BDD). People suffering from this condition remain excessively anxious and preoccupied with slight or imaginary defect in their appearance. This hampers their close relationships, their work and almost their entire life. They can hardly live with a sense of ease as they continuously despise and hate their looks. Most of their waking hours are full of obsessions about the way they look. They go on shopping sprees-buying clothes, endless beauty products, and tablets to somehow hide or change the disliked parts of their appearance. Some of them also indulge in frequent ‘doctor shopping’, getting various treatments done. However, all these attempts increase their frustration, as their problem is
They feel uncomfortable in all social situations. Many sufferers spend a good deal of their time looking at mirrors and trying to estimate how bad their ‘defect’ actually is. Almost any part of the body can acquire abnormal preoccupation- nose, face, breasts, genitals, etc. Levels of distress in this condition vary along a broad continuum. There are those who function relatively well, to those who function below their potential despite great efforts, to those who even consider committing suicide. This problem can affect people of all ages, regardless of the fact that whether they are males or females. One must remember that people with this disorder are not just showing vanity but they desperately wish to be accepted. They are tortured by a strong fear of rejection from others.
This disorder seems to be caused by an interaction of both socio-cultural as well as psychological factors. Individual distress or pathology gets painted on the landscape of existing social and cultural structures. Media plays an important part in individual’s evaluation of his/her appearance. The influence of media has been so pervasive that even the toys with which children play tune them towards unrealistic and harsh standards of judging their appearance. It is estimated that if the most cherished toy of the girls- the Barbie doll were the height of an actual woman, she would have only a 16-inch waist. The children, who play with Barbie, without being explicitly told, get the hidden message- ‘slim is good.’ In our present culture, immense value is being placed on the way individual looks. Being beautiful has become synonymous with being good and being not beautiful implies being bad.
As far as psychological factors are concerned, traumatic experiences like frequent teasing, child sexual abuse or lack of desire for oneself by an important other in early childhood can make an individual abnormally preoccupied with their looks. The issue of being desired is closely related to a discomfort with one’s looks. In many cases, the unconscious fear is that whether the ‘self’ that one is, as enshrined in the body is desirable for the other person or not. One of the biggest traumas which human beings face can face is that of rejection. If one feels intensely towards another person and the other person does not reciprocate that intensity back then one ends up feeling that there is something grossly wrong with one’s body and self.
Treatment
There is a need to evaluate people having appearance anxiety and seeking radical changes with regard to underlying psychological factors else results can be fatal. If the problem is in the body per se, then one can go ahead with its treatment but if the problem specifically resides in the mind, then one may like to think otherwise. People who are suffering from Body Dysmorphic Disorder (BDD) are usually very resistant to seek treatment because of their chronic feelings of embarrassment and shame. They continue to suffer in silence. However, it is important for them to realize that help is available.
In psychotherapeutic treatment of this condition gradually an insight is developed in the sufferer with regard to his/her dislike of the body and the underlying psychological processes behind it. This leads to a great relief from constant anxiety. In some cases where the distress is acute, medication can be combined with psychotherapy in the initial phase. However, as the insight develops and the sufferer feels a greater sense of control medication may be tapered off and finally terminated.
Author Note: Pulkit Sharma is Clinical Psychologist and Psychoanalytical Therapist working at Delhi, India.
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