Case history
Case history #1
A 22-year-old single, female student has been obsessed since age 12 with her 'horrible-looking' skin, which she believes is covered by blemishes and acne scars that are clearly visible to others. At age 15 years, she also became preoccupied with her 'huge and crooked nose'. In reality, the woman has clear skin, with only a few minor blemishes, and a normal-looking nose. She estimates that she obsesses about her perceived physical flaws for 3-5 hours a day. Her appearance concerns cause significant emotional distress, including depressed mood, anxiety, self-consciousness, and intermittent suicidal ideation. She has become irritable and angry because she thinks it isn’t fair that she looks so bad. She has also become increasingly socially withdrawn because she believes that other people agree that she is very ugly and stare at her because she looks so bad. She has stopped seeing most of her friends and is no longer dating. She has also started to miss classes because she feels so self-conscious around others, and her grades have dropped. She has difficulty concentrating on schoolwork because she is distracted by thoughts that she is ugly, and spends so much time doing BDD-related repetitive behaviours. These repetitive behaviours include frequently checking her appearance in mirrors and other reflecting surfaces (such as windows), taking selfies to check her appearance, comparing her appearance with that of celebrities and her friends, picking her skin with needles to try to make it look better, and researching skin procedures and rhinoplasty online. Even though other people tell her that she is attractive and that they cannot perceive the flaws that she sees, she remains convinced that the flaws are real and very noticeable to others. Topical antibiotics and isotretinoin have not improved her appearance concerns.
Case history #2
A 33-year-old single man who works as a waiter presents wearing six layers of T-shirts plus a large overcoat indoors, even though it’s summer. He is preoccupied with the belief that he looks 'skinny and scrawny'. He is actually very muscular because he excessively lifts weights and uses anabolic-androgenic steroids to build muscle. He estimates that he obsesses about his body build and muscularity for at least 8 hours a day. His appearance concerns make him 'very depressed, even suicidal', and anabolic steroids have triggered aggressive behaviour towards others, such as throwing a brick at his girlfriend’s head ('roid rage'). He meticulously attends to his diet, insisting on eating six precisely timed, high-protein, low-fat meals a day to try to get more muscular and leaner (which he refers to as 'force feeding'). He belongs to five gyms and works out for at least 3 hours a day. In addition, he compulsively lifts heavy objects throughout the day, whenever he can, including his furniture at home and huge stacks of dishes at work, in a desperate attempt to become more muscular. He also performs typical BDD repetitive behaviours, such as mirror checking and comparing himself with others, especially when working out at the gym. He hides his body whenever possible, by wearing baggy gym clothes and huge jackets, so he doesn't look 'weak and tiny'. In addition to injecting himself with anabolic steroids, which have caused dyslipidaemia, he uses a wide array of prescription medication (obtained online without a prescription) and supplements to build muscle and burn fat. These include human growth hormone, insulin, diuretics, thyroid hormone, amfetamines, and multiple protein supplements.
Use of this content is subject to our disclaimer