Mirror Image

“I’m gonna make a change For once in my life It’s gonna feel real good Gonna make a difference Gonna make it right” Man in the Mirror, – Michael Jackson

Sadly, the late and terrifically talented Michael Jackson is often said to have suffered from a complex psychiatric disorder known as body dysmorphic disorder, or BDD.

The repeated surgical alterations of Jackson’s nose, chin, facial structure and bleaching of his skin suggest that when he looked in the mirror he was profoundly unhappy with what he saw. In typical BDD fashion, his dissatisfaction grew with each alteration.

BDD’s exact cause is unknown, but increasing evidence suggests a genetic link. The disorder’s essential feature is the individual’s excessive preoccupation with an imagined or slight defect in appearance.

People affected by BDD may spend hours each day thinking about the perceived failing. These tortured souls either overly check their appearance in the mirror or avoid mirrors altogether by sometimes covering or removing them.

Persons with BDD often avoid social situations because they fear people will point out their imagined defect. Some skip work or school repeatedly or become housebound. Consequently, their relationships suffer.

The prevalence of the disorder is unknown. It is frequently under -diagnosed because patients are too ashamed to report it. Moreover, because of common coexisting conditions – including anxiety, depression, hypochondriasis, low self-esteem – the diagnosis is often overlooked.

Initially, these patients visit physicians or plastic surgeons because of their dissatisfaction with their skin ( acne, wrinkles, spots), hair ( thinning, balding) or nose ( size, shape). However, some may also be concerned with the size of their teeth, penis, muscles, breasts or buttocks. Many are preoccupied with more than one body part.

As a psychotherapist I’ve done my share of counseling for BDD. The prevalence in my practice has been about 1 to 2 percent of patients. However, according to the Diagnostic and Statistical Manual of Mental Disorders, a mental-health standard, rates range from 6 to 15 percent in settings involved with cosmetic surgery and dermatology.

If you or someone you care about has or is at risk for BDD, consider the following: Do you avoid social situations because of your bodily concern? Do you feel this defect is causing problems at work or school? Does it lead to distress? How much time do you spend concealing your defect? Does it prevent you from developing a sexual relationship?

Parents should be aware that the onset of BDD usually occurs in adolescence and young adulthood, although it may also develop in older adults overly concerned with impact of aging on appearance.

If BDD is suspected, a clinical psychologist or psychiatrist must do an evaluation. Treatment includes SSRI antidepressants, in conjunction with psychotherapy because these patients demonstrate severe issues with self-esteem and have poor insight into their problem.

While we may never know Michael Jackson’s full story, I for one am left speechless at what appears to be the gross exploitation by surgical scalpel of a psychiatric illness.