Dysmorphophobia or body dysmorphic disorder (BDD)

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.

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.

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.

•  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".