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Systemic approach and hypnosis

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Dysmorphophobia or body dysmorphic disorder (BDD)

A modern fear of our own image

Padraic Gibson, PhD

Padraic Gibson is a psychologist, family therapist and supervisor. He works in Ireland, Italy, France and Malta. He is a Senior Research Associate and Lecturer at LACT, Dublin City University and Clinical Director of La Clinique des TOC / The OCD Clinic®.


Dysmorphophobia, what is it?

The image we have of ourselves is linked to how we feel and how we look. This image relates to everyone at one time or another, given the nature of human evolution and our social processes, and we all have a perspective on how we are perceived as social objects. Our normal aversions influence our feelings but rarely block us in our daily lives. Social media, television, movies, and advertisements all play a role in how we compare to those around us. All of these aspects of social life have an impact on how we feel about our body image. We currently live in a culture that places great importance on image, diet and fitness. People are expected to go to the gym regularly, and not always for the health benefits.  

Dysmorphophobia in numbers

Body dysmorphic disorder seems to be relatively common. According to some studies , between 0.7% and 2.4% of the general population is affected. This obsessive-compulsive disorder tends to be more common in people with schizophrenia or anorexia, although some studies of people with no diagnosed illness have shown that around 2-13% of them have it. Body dysmorphic disorder is commonly encountered in clinical settings and dermatology departments show that between 3% and 53% of patients suffer from it. In cosmetic surgery departments, 8-37% of patients suffer from it, but people with obsessive-compulsive disorder (OCD) also show dysmorphic tendencies, although in 11-13% of cases social phobia is a contributing factor major.

Dysmorphophobia, what is it?

Society and dysmorphophobia

When patients come to our clinic, we have observed that this disorder exhibits an interactive pattern very similar to many other phobic and obsessive disorders (Gibson, 2021). With the increasing options for procedures and the seemingly endless advances in cosmetic surgery, those who have longed to alter their appearance can now do so. Although the belief that it would make them more attractive, has little evidence to prove it (except in the case of physical damage from particular birth defects). In Western societies, both men and women resort to plastic surgery. However, if it has proven to be an indispensable science in reconstruction situations, if used excessively and often inappropriately, the worst effects can be seen in any gossip magazine. Like any medicine, surgery becomes toxic if taken at the wrong dose. Patients who are obsessed with a specific aspect of their body refuse to accept themselves as they are, their attention being obsessively focused on their perceived "imperfection". When they feel trapped in this perception, they live their lives like hell, tormented throughout the day by their own image. It should also be noted that this obsession tends to turn into panic, even at the sight of their own image in a mirror or in a photograph. Tragically, someone suffering in this way places incredible trust in cosmetic surgery, which is rarely performed.

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Signs and symptoms of dysmorphophobia

Signs and symptoms of dysmorphophobia

  • Extreme preoccupation with a perceived defect in appearance that to others cannot be seen or appears minor.
  • The strong belief that you have a flaw in your appearance that makes you look ugly or deformed.
  • Belief that others look down on your appearance or make fun of you.
  • Engaging in behaviors aimed at correcting or hiding the perceived defect that are difficult to resist or control, such as frequent looking in the mirror, grooming, or scratching the skin.
  • Attempt to conceal perceived flaws through styling, makeup, or clothing.
  • Constantly comparing their appearance to that of others
  • Frequently seek reassurance from others about their appearance
  • Have perfectionist tendencies
  • Resorting to cosmetic procedures without much satisfaction
  • Avoid social situations

Dysmorphophobia in the systemic approach

Systemicist Dr. Padraic Gibson sheds light on the treatment of dysorphophobia with brief systemic therapy. Padraic Gibson is a family therapist and supervisor. He works in Ireland, Italy and Malta. He is a Senior Research Associate and Lecturer at Dublin City University and co-founder of the OCD and Anxiety Disorders Clinic ( OCD Clinic® ).

It is important to point out that, in most cases, the perceived "imperfection" is in fact non-existent or insignificant. The pathogenic conviction of having an unacceptable aesthetic deformity has become a mental fixation for the person. It should also be noted that these flaws are often “discovered" by patients in response to social or relationship issues. In our clinic, we see patients who have a deep sense of insecurity use this explanation to make sense of their social issues. Their mind obsessively clings to this "defect" as a means of explaining the foundations of their social problems. The tragedy is that they suffer from the illusion that once the defect is removed or changed, everything will miraculously return to normal. place, but we rarely see that happen. The corrective chain reaction that begins usually involves a series of corrective surgeries, with ever-increasing dissatisfaction image and a growing sense of social isolation or self-loathing. Humans can always find something more to work with, as the mind contemplates the illusion of perfection. The illusion of mastering his problem and the belief that surgery is his only escape plan traps the patient in an endless game and the process spins out of control.

The Dysfunctional Functioning of Dysmorphophobia

As in the case of obsessive-compulsive disorder, the solution that patients apply in the context of dysmorphophobia turns into a new problem, which ends up requiring another "new solution", which in turn creates another problem, and so right now. This endless escalation leads to real and tragic concrete effects, for example real distortions, destroying the natural harmony that existed in the unique image of the person. The effects are often devastating in these cases and we see patients suffer periods of intense social isolation, often to avoid panic attacks triggered by their fear of social criticism and potential judgment and rejection by others. At this stage, family and loved ones become more involved and tend to accompany the sick in many situations where they fear panicking. Even if relatives clearly understand that the patient's problem is psychological and not physical, they eventually accept the need for further surgery. It is also important to note that conversations with loved ones and attempts to reassure the person about their natural beauty lead the patient to become increasingly paranoid and skeptical about how they and others perceive them. He even begins to believe that others are lying to him. All of the above makes this problem difficult to treat, and patients often only go to therapy long after having undergone numerous surgeries or procedures, which is an unfortunate and tragic reality. During therapy, the clinician should not attempt to rationally persuade the person to interrupt their current course with surgery, as this will only increase their resistance to a therapeutic solution. The clinician must slowly help him see that what seems to have given him a way to control his problem is now creating an even bigger problem, which he unfortunately can no longer control.

Key points about body dysmorphia

Body dysmorphic disorder has real and serious consequences: 

  • It makes people so preoccupied with their image that it interferes with their ability to function normally.
  • Cosmetic surgery becomes a compulsive obsession to correct perceived flaws.
  • Social isolation is a real consequence of these surgeries and their growing lack of confidence. 
  • Body dysmorphic phobia can be treated, but the clinician must have effective ways to persuade the person to come out of their dysfunctional perception and progressive surgical procedures.

LACT trainings to treat phobias with the systemic approach

The treatment of phobias by the systemic approach is taught in the third year of the LACT course of the Clinician of the Relationship and in the clinical master of Giorgio Nardone .

Key points about body dysmorphia

Content covered in the training on the treatment of phobias

  •  Monophobias, specific phobias and generalized phobias
  • Diagnostic criteria for monophobias or specific phobias (DSM-5).
  • List of the most common forms of monophobia.
  • Dysfunctional solution attempts related monophobias, specific phobias and generalized phobia.
  • The treatment of monophobias or specific phobias in brief strategic therapy (strategy, communication and therapeutic relationship).
  • Explanation of the therapeutic maneuver "study your enemy".
  • Explanation of the therapeutic maneuver "logbook".
 phobia treatment training

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