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Mirror Mirror On The Wall: Obsessing About Perfection

Updated: Jun 13, 2022

Body Dysmorphic Disorder

Imagine living perpetually in a carnival fun house and seeing yourself through a distorted mirror. That is the life of a person with body dysmorphic disorder (BDD).

Angelina had been feeling trapped in such a carnival fun house since she was sixteen. It started when her first boyfriend John teased her about the size of her nose. Knowing that she was an aspiring singer, he called it her “Barbra Streisand” nose. She was tormented by doubt about her nose. Even a few years after breaking up with John, she would spend hours every day gazing at her nose in the mirror, touching it repeatedly and asking her parents for reassurance that her nose was not too big.

By age 21, Angelina was completely overcome by obsessions about her nose. She spent so much time staring into the mirror that she started arriving late for work. She also became socially withdrawn. She no longer felt like dating or even going out with her friends. Eventually Angelina was gripped by a cold despair – she felt hopeless, worthless and ugly. In reality, she was a very attractive and likable young woman.

As her self-esteem plunged and thoughts of suicide occasionally crossed her mind, she grew increasingly desperate. Angelina’s long-term obsession with symmetry and her compulsion to arrange household objects to perfection did not help her growing distress about her nose. Convinced her nose was too big, despite numerous assurances from family and friends, she decided to undergo plastic surgery.

After her first nose job, Angelina felt somewhat relieved, but the relief was short-lived. A few weeks later, she became overcome once again by the belief that her nose was still a little too big. By the time she was 24, Angelina had received three nose jobs! She now felt satisfied with the size and shape of her nose. Sadly though, she began to ‘notice’ blemishes on her facial skin. Once again, she was spending a lot of time in front of the mirror, looking for flaws on her facial skin. She would also engage in skin-picking in an apparent attempt to blot out undesirable areas in her skin. Her parents now realized that Angelina’s beliefs about her physical appearance were not rooted in reality at all. And so, they sat down with her and convinced her to seek psychiatric help.

It was then that I first met Angelina – in my office for her first psychiatric appointment. Initially she was not very engaged in treatment but she became hopeful once she was referred to a therapist specializing in Cognitive Behavioral Therapy. She was placed on a SSRI (Selective Serotonin Re-uptake Inhibitor), a type of medication which is known to treat obsessive – compulsive disorder (OCD) and BDD. In about 10-12 weeks, Angelina began to regain control over her distressing symptoms and her life in general.

Is BDD common?

BDD is a relatively rare psychiatric illness. It may affect about 1-2% of general population.

What causes BDD?

The exact cause of BDD is unknown. However, it is believed to result from abnormalities in brain neurotransmitters especially serotonin and genetic factors.

Who is at risk for BDD?

The following factors are associated with a high risk of BDD: • History of teasing in childhood/adolescence • History of physical or sexual abuse • Family history of BDD • Poor self-esteem • Social family pressure on perfectionism • History of anxiety disorders.

‘Nip/Tuck’ Culture

As cosmetic surgeons grow in popularity, some people with BDD may go undiagnosed and untreated. Also, typically plastic surgeons are not very adept at recognizing BDD.

Which body parts are likely to be obsessed with?

These include nose, ears, skin, hair, thighs, breast size/shape, hips, lips, etc.

Co-morbid conditions

These include anxiety disorders, depression, eating disorders and OCD.

Common complications

Depression and anxiety are not only common co-morbid conditions but also may be complications of BDD. In severe cases, suicide attempts may occur.

What should you do if a loved one has symptoms of BDD?

• Understand BDD is a psychiatric illness. • Be empathic and sympathize. • Do not challenge erroneous beliefs. • Do not encourage requests for reassurance. • Help your loved one seek psychiatric treatment.

*The purpose of this article is for educational purposes only. It is not intended to diagnose or treat any medical or psychiatric issue. Dr. Rakesh Ranjan is a practicing psychiatrist and a researcher. He is a recipient of several research awards and has authored several peer reviewed journal articles and book chapters on psychiatric illnesses and their treatments. He is a national speaker for several organizations and serves on the medical advisory board for the NAMI of Greater Cleveland. If you or a loved one is experiencing any symptoms that would lead you to believe that there could be a mental imbalance, please email your questions to Dr. Ranjan at All contact info will be kept confidential.


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