Mirror, Mirror on the Wall, I Hate You and the Way I Look!

Remember that children’s story about Snow White and the Seven Dwarfs and the Evil Queen? What did the queen constantly ask her mirror? Of course, it was “Mirror, mirror on the wall, who is the fairest of them all?” Unfortunately, although it had always said she was the fairest, one day it declares Snow White is the fairest, and therein begins the tale of the queen’s murderous rage.

Mirrors can play a destructive role in a psychiatric disorder, too. Known as body dysmorphic disorder (BDD) it affects how people view their own bodies and appearance. We sometimes refer to it as a somatoform disorder, which is a subtype of OCD. When someone has BDD, they focus too much on what they think are flaws in their appearance. This can have a negative effect on their lives and overall mental and physical health.

In samples that aren’t from a clinical setting, the rate of BDD is between 0.7% and 13%. It is called an obsessive-compulsive anxiety-linked condition and 1.7% of the general population has it at some point in their lives. Regardless of age, gender, or race, BDD can affect anyone.

An obsessive focus on a particular bodily part or feature, like the skin, hair, or nose, characterizes BDD symptoms. We’ve seen people become “addicted” to plastic surgery, hoping they will find that perfect body that eludes them. People with BDD can spend hours every day watching themselves, grooming themselves, or comparing themselves to others. They might avoid social situations, have trouble with anxiety or sadness, and do things like pick at their skin or groom themselves too much.

A mix of treatments and medications is frequently used to treat BDD. Cognitive-behavioral therapy (CBT) is the most effective way to treat BDD. The goal of CBT is to lessen the obsession with physical appearance and improve overall functioning. Exposure and Response Prevention (ERP) is another type of therapy that teaches the person how to control their urges while gradually exposing them to their fears. The most frequently given drug for BDD is an SSRI because research has shown that it is useful in easing the symptoms of anxiety and depression. But there’s an even greater risk these individuals may face.

People with body dysmorphic disorder (BDD) run a serious risk of suicide. Several studies have found that people with BDD are significantly more likely to consider suicide. One in four or more people with BDD report having tried suicide, and over 80% of individuals with BDD report having had suicidal thoughts. We know nothing about why BDD patients are more likely to commit suicide, although we know of its link to higher suicidality. In emergency psychiatric care, there’s evidence that BDD can contribute to a patient’s condition deteriorating.

Suicidality should be thoroughly evaluated and tracked in people with BDD as it is a major worry in this community and affects how people perceive and feel about their own bodies and looks. This makes people think and feel disturbing thoughts, which can seriously disrupt their lives and put their emotional and physical health at risk. It is also important, as mentioned above, to keep in mind that people with BDD may also have comorbid disorders, such as eating disorders, which can worsen suicidal thoughts and actions.

And remember one other thing. Not all mirrors are created equal. Quality mirrors give a more accurate reflection, but people with BDD will always see a distorted image of themselves in their minds, no matter how good the mirror is.