Дисморфофобия в практике врача-косметолога

In 1891, the Italian psychiatrist Enrico Morselli first described a patient with body dysmorphic disorder (dysmorphophobia): a deformity that could develop on her body imperceptibly.

A person is afraid of having a flattened, flattened forehead, a funny nose, crooked legs, etc., therefore he constantly peers into the mirror, feels his forehead, measures the length of his nose, examines the smallest skin defects or determines the proportions of his physique, and only after a certain period of time , being convinced that nothing has happened, is able to free himself from the state of pain and anguish that attacks him.

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how can a cosmetologist recognize the symptoms of such an actual pathology as dysmorphophobia, the cases of which are increasing every year.

The concept of «dysmorphophobia» as pathology

Appearance anxiety is recognized and accepted in most cultures as an aspect of normal human behavior. However, if these experiences are excessive, significantly suppress the person and affect the quality of his life, this may be a symptom of the development of body dysmorphic disorder.

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Patients who suffer from dysmorphophobia become regular patients of cosmetologists and plastic surgeons. Despite the fact that dysmorphophobia was described more than 100 years ago, the pathology is still underestimated, and its failure to recognize it can lead to serious consequences for patients.

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Accordingly, a review was conducted by psychiatric scientists from the UK to summarize the clinical features, prevalence, cultural aspects and treatment of body dysmorphic disorder in order to facilitate clinical decision making in daily medical practice.

External signs and behavioral reactions in case of dysmorphophobia

In The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders-5, fifth edition, body dysmorphic − is a disorder that is characterized by preoccupation with a possible defect and apparently excessive anxiety over a minor physical anomaly, and is also accompanied by significant distress and/or functional impairment.

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In the recently published International Classification of Diseases 11th Revision (ICD-11), body dysmorphic disorder − it is a persistent preoccupation with one or more likely defects or imperfections in appearance that are imperceptible or only slightly noticeable to others.

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BDD patients experience a lot of inconvenience because of the idea of ​​the attitude of others, that is, they are convinced that people pay attention, evaluate, discuss a possible defect. As a result of preoccupation with one's appearance and the presence of painful experiences, obsessive habits and thoughts arise that bring discomfort and are difficult to control, for example, looking at oneself in the mirror, excessive self-grooming, compulsive trauma to the skin and hair pulling (dermatilomania) constant search for confidence in yourself, comparing your appearance with that of others.

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All these experiences and striving for the ideal lead patients with dysmorphophobia to the office of a cosmetologist or plastic surgeon again and again.

As a result, a vicious circle is started, so the cosmetologist or related specialist solves only an external problem, which is not always the case.
And this group of patients, in connection with this and not recognizing their own pathology, does not receive proper treatment during proper treatment. This problem only gets worse over time.

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Body dysmorphophobia may be concerned about any part of the body, but they are most interested in the face, especially the condition of the skin, hair, shape of the nose and lips, size and shape of the breasts. On average, during their lifetime, patients with body dysmorphic disorder are dissatisfied with 5-7 different parts of the body. Patients who suffer from dysmorphophobia spend 3-8 hours on their appearance, and 25% of them − more than 8 hours a day.

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The preoccupation with one's body is compulsive and is associated with unpleasant emotions such as shame, disgust, anxiety and sadness, which can often be noticed by a cosmetic doctor, since patients with body dysmorphophobia can rarely discuss their appearance with other people.

Classification of dysmorphophobia

There are two types of this disorder in the ICD-11:

1)  With a critical attitude towards his condition, when in most cases a person is aware of the possibility that his beliefs associated with the disorder may be false, and he is ready to accept an alternative explanation for his actions. It is in this case that the cosmetologist can help the patient cope not only with an external defect, but also, from the point of view of a professional, convince him of the falsity of his own experiences associated with dysmorphophobia;

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2)    With a lack of criticism of one's condition, when all the time a person is sure that the beliefs that are characteristic of this disorder are true, and cannot accept an alternative explanation for their actions. When such a patient with obsessive thoughts becomes a regular client of a plastic surgeon or a cosmetologist, one cannot do without the help of a psychotherapist, psychologist or psychiatrist in this situation.

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As a result of concerns about how others might perceive them, there is almost always a disruption in one or more areas of life: social, professional, and the like. Patients who suffer from body dysmorphic disorder may avoid intimate relationships, stop attending school, work, group activities, and indeed become completely attached to the house.

Therefore, it is so important for a cosmetologist, as well as any specialist in the field of aesthetic medicine, to recognize this pathology in time in their practice in order to prevent the development of further progression of the disease.

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