Dysmorphophobia

from Wikipedia, the free encyclopedia
Classification according to ICD-10
F22.8 Other persistent delusional disorders
Delusional dysmorphophobia
F45.2 Hypochondriac Disorder
Dysmorphophobia (not delusional)
ICD-10 online (WHO version 2019)

The body dysmorphic disorder or body dysmorphic disorder , also known as Entstellungssyndrom , is a disorder of perception of one's own body . The normal psychological basis of body schema disorder is the concept of body schema .

Etymology and synonyms

The expression is a Graecism , formed from the ancient Greek dys 'bad' (here in the sense of 'miss-') and morphé 'form' (here in the sense of 'designed') as well as phóbos 'fear'. It was first used in 1886 by the Turin neurologist Enrico Morselli (1852-1929). The ICD-10 has adopted this expression.

Synonyms are deformity fear , body dysmorphic disorder or English Body Dysmorphic Disorder (according to DSM-IV -TR), body image disorder or Body Image Disturbance or Thersites complex .

Another clinical disorder is " muscle dysmorphic disorder," which is often seen as a sub-form of body dysmorphic disorder. However, it is also often associated with eating disorders, as many cognitive and behavioral mechanisms appear to be similar. These symptoms are often referred to as the Adonis complex . The expressions body dysmorphic or body dysmorphia or muscle dysmorphia or muscle dysmorphia find for the male form to this day use. It differs from body dysmorphic disorder in that muscle dysmorphism does not perceive individual body parts as being disfigured, but rather the perceived flaw relates to the entire musculature : those affected assume that they are too small and skinny. This is the difference to the classic eating disorder, in which those affected think they are too fat and want to reduce body mass instead of increasing it.

Definitions

Morselli defined a group of three symptoms (triad) -

  • delusional belief in having a physical defect
  • Shame towards fellow human beings and
  • sexual inhibition

- as pathognomonic for the disease.

The book Nursing Diagnoses and Measures describes dysmorphophobia as "a patient-defined stressful condition that shows that the body no longer supports a person's self-esteem and is disruptive to the person by limiting their social relationships."

Price (1999) defines: "A changed body image exists when individual and social coping strategies for changing body reality, the body ideal and body representation are ineffective or overwhelmed by injury, illness or disability or social stigmatization ."

causes

The exact causes of the development of the body dysmorphic disorder are unknown. It is now believed that both biological and sociocultural factors could play a role here. Especially in the Anglo-Saxon scientific community, the body dysmorphic disorder as well as u. a. Hypochondriasis , trichotillomania and anorexia nervosa to the OC spectrum disorders (Obsessive Compulsive Spectrum Disorders) counted. The causes are therefore similar to those of obsessive-compulsive disorder .

Symptoms

Those affected perceive their body or individual body parts as ugly or disfigured. Most often the face and head are perceived this way, e.g. B. as a result of acne, scars, a nose or ears perceived as too big, or asymmetrical facial features. Feet or genitals are perceived a little less often.

Because of this assessment of their appearance, people often experience obsessive-compulsive thoughts that can last for up to several hours a day. Furthermore, they often show so-called ritualized behaviors: checking the appearance in mirrors or other reflective surfaces, comparing one's own appearance with that of other people, applying makeup or other cosmetic items.

Many of those affected have little or no insight into the disease, but are firmly convinced that they are enormously unattractive .

The doping researcher Luitpold Kistler pointed out that the disease also occurs in bodybuilders who, despite objectively enormous muscle mass, would find alleged deficits in themselves:

“These people have a disturbed self-image. If a 140 kilogram, muscular man who has lost ten kilograms no longer leaves the house because he thinks he is too thin - then he is sick. "

Also, self-injury (SIA) is common symptom of disorders in the perception regarding their own body.

Social consequences

The external perception of one's own body in dysmorphophobia shows great to extreme differences to self-perception . Those affected often feel that others are staring at them in public and fear that the alleged disfigurement gives others cause for rejection, contempt or other negative evaluations. Due to the feared ugliness of their own body, it is often difficult or even impossible for those affected to talk to people who are perceived as attractive and to have a love relationship.

Dysmorphophobia can result in withdrawal from social life and, in extreme cases, complete social isolation . The comorbidity with the social phobia is very high. A 1997 study found that in individuals suffering from both body dysmorphic disorder and social phobia, the onset of social phobia was in all cases prior to the onset of body dysmorphic disorder.

Another consequence can be the desire for cosmetic correction of the alleged deficits.

treatment

Sufferers often do not seek treatment or do so very late, mostly out of shame or ignorance that they are suffering from an illness that can be treated psychiatrically or psychotherapeutically.

A meta-analysis of the cognitive-behavioral psychotherapy results from eight case series and two controlled studies showed that cognitive-behavioral therapy is effective in patients with dysmorphophobia or body dysmorphic disorder. Serotonin reuptake inhibitors have also been shown to be effective. Fluoxetine in particular shows a good response in monotherapy . Two studies that looked at the possible additive effects of antipsychotics in combination with SSRIs could not show any or only questionable effects. Recent work also shows the effectiveness of escitalopram in this disorder.

See also

literature

  • Stefan Brunhoeber ,: Cognitive behavior therapy for body dysmorphic disorder . A therapy manual [with CD-ROM]. Hogrefe, Göttingen / Bern / Stockholm / Vienna / Paris / Oxford / Prague / Toronto / Cambridge, MA / Amsterdam / Copenhagen 2009, ISBN 978-3-8017-2213-5 .
  • Marilynn E. Doenges, Mary Frances Moorhouse, Alice C. Geissler-Murr: Nursing diagnoses and measures . Ed .: Chris Abderhalden, Regula Ricka. 3rd, completely revised and expanded edition. Hans Huber, Bern / Göttingen / Toronto / Seattle 2002, ISBN 3-456-82960-4 (Original title: Nurse's Pocket Guide . Translated by Annina Hänny).
  • Harrison G. Pope, Katherine A. Phillips, Roberto Olivardia: The Adonis Complex . Beauty mania and body cult in men. dtv (paperback 24249), Munich 2001, ISBN 3-423-24249-3 .
  • Lissy Scharf: Adonis Complex . Body awareness and body awareness disorders in men. Bernburg 2005 (diploma thesis at the Anhalt University of Applied Sciences ).

Web links

Individual evidence

  1. ↑ Enrico Morselli: Sulla dismorfofobia e sulla tafefobia. Volume VI. Bollettino Accademia delle Scienze, Mediche di Genova 1886. pp. 110-119.
  2. ↑ R. Olivardia, HG Pope Jr., JI Hudson: Muscle Dysmorphia in Male Weightlifters: A Case-Control Study . In: American Journal of Psychiatry , 157, 2000, pp. 1291-1296.
  3. ↑ SB Murray, E. Rieger, SW Touyz, Y. De la Garza Garcia: Muscle Dysmorphia amd the DSM-V Conundrum: Where Does it belong? A review paper. In: International Journal of Eating Disorders , 43 (6), 2010, pp. 483-491.
  4. ^ Harrison G. Pope, Katherine A. Phillips, Roberto Olivardia: The Adonis Complex. Beauty mania and body cult in men. dtv, Munich 2001, ISBN 3-423-24249-3 .
  5. ↑ CG Pope, HG Pope, W. Menard, C. Fay, R. Olivardia, KA Phillips: Clinical features of muscle dysmorphia among males with body dysmorphic. In: Body Image. Volume 2, 2005, pp. 395-400.
  6. ↑ G. Kanayama, S. Barry, JI Hudson, HG Pope Jr .: Body image and attitudes toward male roles in anabolic-androgenic steroid users. In: American Journal of Psychiatry. Volume 163, 2006, pp. 697-703.
  7. ↑ R. Olivardia: Mirror, Mirror on the Wall, Who's the Largest of Them All? The Features and Phenomenology of Muscle Dysmorphia . In: Havard Rev Psychiatry , 9 (5), 2001, pp. 254-259
  8. ↑ CG Pope, HG Pope, W. Menard, C. Fay, R. Olivardia, KA Phillips: Clinical Features of muscle dysmorphia among males with body dysmorphic disorder . In: Body Image , 2, 2005, pp. 395-400.
  9. ^ Marilynn Doenges, Mary Frances Moorhouse, Alice C. Geissler-Murr: nursing diagnoses and measures . 3. Edition. Publisher Hans Huber, 2002
  10. ↑ Michele Fornaro, Filippo Gabrielli, Claudio Albano et al .: Obsessive-compulsive disorder and related disorders: a comprehensive survey. In: Annals of General Psychiatry , 2009, 8, p. 13.
  11. ↑ Frieder Pfeiffer: At some point it just booms . Spiegel Online , January 20, 2007. Interview with anabolic steroids researcher Luitpold Kistler; Retrieved February 4, 2009.
  12. ^ Sabine Wilhelm et al .: Prevalence of body dysmorphic disorder in patients with anxiety disorders. In: Journal of Anxiety Disorders. Volume 11, No. 5, 1997, pp. 499-502, doi: 10.1016 / S0887-6185 (97) 00026-1
  13. ^ Theo K. Bouman et al .: Cosmetic Professionals Awareness of Body Dysmorphic Disorder. In: Plastic & Reconstructive Surgery. Volume 139, No. 2, 2017, pp. 336–342, doi: 10.1097 / PRS.0000000000002962 , full text
  14. ↑ J. Williams, T. Hadjistavropoulos, D. Sharpe: A meta-analysis of psychological and pharmacological treatments for body dysmorphic disorder. In: Behavior Res. Therapy. Volume 44, 2006, pp. 99-111.
  15. ^ E. Hollander, MR Leibowitz, R. Winchel et al .: Treatment of body-dysmorphic disorder with serotonin uptake blockers. In: American Journal of Psychiatry. Volume 146, 1989, pp. 768-770.
  16. ^ KA Phillips, RS Albertini, JM Siniscalchi, A. Khan, M. Robinson: Effectiveness of pharmacotherapy for body dysmorphic disorder: a chart-review study. In: Journal of Clinical Psychiatry. Vol. 62, 2001, pp. 721-727.
  17. ^ KA Phillips, RS Albertini, SA Rasmussen: A randomized placebo-controlled trial of fluoxetine in body dysmorphic disorder . In: Arch Gen Psychiatry , 59, 2002, pp. 381-388.
  18. ^ KA Phillips: Olanzapine augmentation of fluoxetine in body dysmorphic disorder . In: Am J Psychiatry , 162, 2005, pp. 1022-1023.
  19. ^ KA Phillips: Placebo-controlled study of pimozide augmentation of fluoxetine in body dysmorphic disorder . In: Am J Psychiatry . 2005 Feb; 162 (2), 2005, pp. 377-379.
  20. ^ KA Phillips: An open-label study of escitalopram in body dysmorphic disorder. In: International Clinical Psychopharmacology . Volume 21, 2006, pp. 177-179.