By Professor Kevin Gournay

Dysmorphophobia, which has been re-named Body Dysmorphic Disorder is one whereby there is a preoccupation with one’s appearance and this leads to considerable distress. I am currently engaged in some research on the nature and treatment of this condition but it is a common accompaniment of phobic and obsessional states. People who suffer from this condition may often develop a concern about their appearance and specifically worry about the size of their nose, other facial features or, indeed, virtually any part of their body. The preoccupation is usually so severe that sufferers may spend several hours each day thinking about their perceived defect and engaging in a whole range of checking and avoidance behaviour. It is not uncommon to find that people who appear to have social phobia or agoraphobia in fact suffer from this condition because they are concerned about how other people may judge their physical appearance.

One of the commonest ways that this condition shows is in association with an eating disorder (most commonly Anorexia Nervosa where people commonly perceive themselves as fat, whereas the truth is that they are indeed very slim. In general, patients with this problem can intellectually accept that their appearance is within normal limits but, at another “emotional” level, they are concerned with their body and perceive it to be abnormal, disgusting or both.  Sometimes, patients go to tremendous lengths to cover up their perceived defects, for example, patients may use sunglasses, makeup or clothing to hide the parts of their body which they feel are abnormal.

Doctor David Veale, myself and some other colleagues are currently researching this condition and we have just conducted a large scale survey and a preliminary trial to treatment. Very often patients with this condition have a more than moderate degree of depression, have a phobia of social situations and roughly one-third of them have Obsessive/Compulsive Disorder. The preoccupation is such that around 40% of the people we have seen have attempted suicide. Many patients we have seen have sought help from plastic surgeons and dermatologists and, indeed, some of the people have had repeated attempts to surgically correct their perceived difficulty but still remain dissatisfied.

In the treatment trial we have carried out, we have used cognitive/behaviour therapy to help people deal with their problems. In particular, we have used exposure-based treatments to help them break their pattern of avoidance behaviour and face up to the situations they commonly avoid. In addition, we have attempted to help them defeat the negative automatic pattern of thinking which tends to build as more avoidance takes place. Preliminary results show that patients can achieve quite good results from this form of treatment although, we have to accept that some patients remain in a depressed condition. This may therefore be one of those states whereby treatment with cognitive/behaviour therapy needs to be augmented by the use of antidepressant medication. We are currently considering the possibility of researching the effectiveness of treatment with combined cognitive/behaviour therapy and one of the newer antidepressants.

Professor Kevin Gournay is an Emeritus Professor at the Institute of Psychiatry. He has more than 35 years of experience and is the author of more than 130 articles and books. He is based in Cheshunt Hertfordshire.

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