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Millions of people have a secret obsession. They’re obsessed with how they look, with a perceived flaw in their appearance. They worry that their nose is too big, their breasts are too small, their skin is blemished, their hair is thinning, their body build is too small—any body part can be the focus of this obsession. It’s easy for us to discount these concerns. How can she worry so much about her looks when she’s so pretty? Why is he so upset about his hair—it looks fine! But people with these body obsessions suffer greatly, some are severely tormented, some consider suicide.
Most of us care about how we look—we think about our appearance and try to improve it. A recent survey of 30,000 people in the U.S. found that 93% of women and 82% of men care about their appearance and work to improve it. And other surveys have shown that many of us are dissatisfied with some aspect of how we look. We’re not pretty enough or sufficiently handsome. Who wouldn’t like a leaner body, smoother skin, more attractive eyes, a flatter stomach? If we could look better, most of us would. Indeed, most of us try. We wear makeup, buy flattering clothes, check our reflection in mirrors, carefully shave, and curl or straighten our hair, hoping to look okay. But when do normal concerns become an obsession?
The concerns of body dysmorphic disorder (BDD) echo these normal concerns but are more extreme. People who have BDD not only dislike some aspect of how they look, they’re preoccupied with it. They worry too much. They’d like to worry less, but they can’t. Many say they’re obsessed.
They also suffer. Their worries about their looks cause them emotional pain and interfere with their life. Some BDD sufferers function fairly well despite their distress—no one would ever know how unhappy they are. Carrie, who worried about slight facial blemishes and her “small” breasts, was sometimes late for work because she got stuck in the mirror checking her face. And she missed parties because she thought she looked so bad she didn’t want people to see her. Yet she had many friends and did her job well. Because of his supposedly thinning hair, David had problems concentrating on his school work and missed the prom, but he still got good grades.
But when BDD is severe, friendships, intimate relationships, and work dis integrate. Jane was so tormented by her “huge” nose, “crooked” lip, “big” jaw, “fat and round” buttocks, and “tiny” breasts that she dropped out of school and couldn’t keep a job. She stopped dating and seeing her friends. Because she thought she looked so monstrously ugly, she locked herself up in her house for five years, finally even trying to kill herself.
What’s so intriguing about BDD is that people who have it focus on defects that others don’t see or consider minimal. Ironically, Jane was actually an attractive woman who had none of the defects she abhorred. David’s hair looked fine, and Carrie’s breasts were somewhat small, but not noticeably so. But to the BDD sufferer, the problem looks hideous and repulsive, magnified by the mind’s eye.
BDD concerns don’t make sense to others. How can she worry so much about her hair when it’s so nice? How could he be so upset about a few pimples? He should just stop thinking about it. “I’m always telling my wife she looks fine,” a high school teacher told me. “Why can’t she just stop worrying? Wrinkles aren’t that important! I tell her this all the time, but it doesn’t seem to help.” BDD is a problem because these people can’t stop worrying; reassurance doesn’t put an end to their concern.

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