In the field of body therapy, and particularly in massage therapy, professionals may be confronted with clients for whom the body is a source of concern and suffering. Dysmorphophobia, or body dysmorphic disorder (BDD), is a complex body image disorder that influences self-perception and social relationships. Understanding this disorder is essential if we are to better support those affected in a caring environment.
| Contents Symptomatology: The signs of dysmorphophobia Diagnosis of dysmorphophobia Psychosocial consequences Recommended treatments The importance of a caring approach |
Symptomatology: Signs of dysmorphophobia
People suffering from dysmorphophobia develop an obsession with perceived physical defects that are generally invisible or even non-existent to others. These preoccupations often concern the face (acne, wrinkles, hairiness, etc.), but can involve any other part of the body (chest, legs, nose…). In men, we sometimes observe a specific form called muscular dysmorphia, characterized by an obsession with muscle mass perceived as insufficient.
Associated behaviors include repetitive checking in front of the mirror, excessive grooming rituals, frequent comparisons with other people, or attempts to camouflage imagined defects. These compulsive behaviors can occupy several hours a day, significantly disrupting daily life and social interactions.
Diagnosis of dysmorphophobia
The diagnosis of dysmorphophobia is based on a set of criteria, including :
- Intense preoccupation with little-seen or imagined defects in body appearance.
- Repetition of verification or camouflage behaviors.
- Marked distress that interferes with social or professional functioning.
It’s important to differentiate this disorder from other similar conditions. For example, if the preoccupation is solely with body shape in relation to eating, an eating disorder could be diagnosed instead. Dysmorphophobia, on the other hand, is characterized by a focus on specific body details, often with an irrational logic.
Psychosocial consequences
Dysmorphophobia can have a major impact on people’s lives. Social and professional activities are often disrupted by incessant preoccupation with appearance. Some people avoid social interaction altogether, and it’s not uncommon for them to prefer to go out only at night, or to withdraw from social life altogether. Isolation can go hand in hand with severe depression, increasing the risk of suicidal thoughts. Studies show that up to 80% of people with dysmorphophobia develop suicidal thoughts, and almost 30% put them into action.
Recommended treatments
For many people with dysmorphophobia (BDD), cosmetic surgery fails to alleviate their symptoms, as their perception of their appearance is not grounded in reality. It is recommended that cosmetic surgeons and psychiatrists work together to screen patients before surgery for possible BDD, as the results of surgery could be harmful to them (Bowyer et al., 2016).
Treatment for dysmorphophobia often combines a pharmacological approach with cognitive-behavioural therapy (CBT). Antidepressants such as selective serotonin reuptake inhibitors (SSRIs) are often prescribed to reduce obsessional symptoms, while CBT helps patients work through irrational thoughts and reduce repetitive behaviors.
CBT includes gradual exposure and ritual prevention techniques (such as limiting time spent in front of the mirror), as well as cognitive reconstruction exercises. For more severe cases, a combination of medication and therapy is often more effective.
The importance of a caring approach
In the context of massage therapy, it is essential that the therapist is aware of the implications of dysmorphophobia. Practitioners can play a key role by providing a space of trust and avoiding remarks about clients’ physical appearance. If they suspect dysmorphophobia, encouraging the client to consult a mental health professional can be beneficial. Massage can bring relaxation and a better connection to the body, but complete management requires a multidisciplinary approach.
By learning about body image disorders such as dysmorphophobia, massage therapists can offer respectful and appropriate support, helping their clients to rediscover a peaceful relationship with their bodies.
To remember:
- People with dysmorphophobia develop an obsession with imagined or inconspicuous body defects, leading to repetitive behaviors (such as checking their appearance) that disrupt their daily lives.
- Dysmorphophobia is characterized by an irrational focus on certain physical details, and must be distinguished from eating disorders or gender dysphoria.
- It can lead to social isolation, depression and an increased risk of suicidal thoughts, requiring serious treatment.
- The combination of cognitive-behavioral therapy and antidepressants is often effective, and massage can provide a relaxing and caring environment, although specialized support is often required for complete treatment.
Sources :
- American Psychiatric Association (2022). Diagnostic and Statistical Manual of Mental Disorders: DSM-5-TR.
- The MSD Manual. Dysmorphophobia. Website: msdmanuals.com; 2023
- Bowyer, Laura; Krebs, Georgina; Mataix-Cols, David; Veale, David; Monzani, Benedetta (December 2016). “A critical review of cosmetic treatment outcomes in body dysmorphic disorder”. Body Image. 19: 1-8. doi:10.1016/j.bodyim.2016.07.001. PMID 27517118. S2CID 4553598.
