Body Dysmorphic Syndrome- Unhappy With Looks!

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A teenager attempted suicide as he felt ugly. He gets a diagnosis of body dysmorphic syndrome.

The family of a 19-year old male brought him to the hospital after he attempted suicide. The boy had a severe obsessive preoccupation with his facial appearance, which was the reason behind his suicide attempt. The doctors initially diagnosed him with depression, but after the complete history and examination, they concluded that he suffering from body dysmorphic syndrome.

His family members revealed that he wanted a skin graft for his face as he is unsatisfied with his facial appearance.

The boy had developed acne at the age of 17 years, i.e., two years earlier than the presentation. Since then, he is suffering from sleep disturbances and has become increasingly preoccupied with the appearance of his face. The patient was depressed regarding his acne. He would say:

 “If I squeeze my pimples today, they will grow back tomorrow. I cannot deal with my acne.”

Thereafter, he believed that his face is ugly and he has enlarged skin pores so he should have skin grafts. He spent 4 to 6 hours per day checking his face and also washed his face multiple times a day with a belief that washing his face would shrink his pores. He visited multiple plastic surgeons; they reassured him that his face is fine and doesn’t need any treatment.

Despite reassurance from multiple plastic surgeons and related professionals, he firmly believed his pores and facial skin made him look ugly.

Moreover, he started researching on the internet. Online resources reinforced his idea of getting a skin graft.

Eventually, the patient became socially withdrawn. Moreover, he feared interacting with people as he thought they would make fun of this face and skin pores. He felt restless in crowds.

The patient had no history of psychiatric illness in the family. Neither the patient had a history of mania, substance abuse, or any mental illness

Examination:

On examination, the patient was healthy, well-dressed, and clean. His skin had a normal color, texture, and elasticity. He spoke little but softly and slowly. Multiple times during the conversation, he hid his face with his hands.

His physical examination was normal and so was his mental status examination.

The patient poured out his thoughts, saying that the size of his facial pores is similar to toothpicks. He expressed feeling scared of looking in the mirror and interacting with people. Additionally, the boy admitted feeling hopeless and worthless, so he attempted to cut his wrist to end his life. He said:

 “I feel very bad. There is no meaning to my life. I would rather die.”

Investigations:

The patient underwent multiple tests to rule out somatic disease. He had normal serological investigations, electrocardiogram (ECG), electroencephalogram (EEG), and a cranial computerised tomography (CT) scan.

Eventually, the patient gets diagnosed with body dysmorphic disorder (BDD).

Treatment of Body dysmorphic syndrome:

The physicians started him on 20 mg/day fluoxetine and cognitive behavioral therapy (CBT).

After 1 week, the dose of fluoxetine was increased to 40 mg/d. After two weeks of treatment with antidepressant and CBT, the patient’s mood improved, and he didn’t feel worthless anymore. Eventually, after 6 weeks of inpatient treatment, he realized his preoccupations about his facial pores were irrational. However, he was still unstable so his doctors didn’t discharge him.

His treatment continued, and by the eighth week of treatment, he improved substantially, so he was discharged.

At the 2-month follow-up, he was doing well. He had started re-engaging in his studies and social life.

References:

Zhang Y, Ma H, Wang Y. Case report of body dysmorphic disorder in a suicidal patient. Shanghai Arch Psychiatry. 2016;28(1):48-51. doi:10.3969/j.issn.1002-0829.215112

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Dr. Arsia Hanif has been a meritorious Healthcare professional with a proven track record throughout her academic life securing first position in her MCAT examination and then, in 2017, she successfully completed her Bachelors of Medicine and Surgery from Dow University of Health Sciences. She has had the opportunity to apply her theoretical knowledge to the real-life scenarios, as a House Officer (HO) serving at Civil Hospital. Whilst working at the Civil Hospital, she discovered that nothing satisfies her more than helping other humans in need and since then has made a commitment to implement her expertise in the field of medicine to cure the sick and regain the state of health and well-being. Being a Doctor is exactly what you’d think it’s like. She is the colleague at work that everyone wants to know but nobody wants to be. If you want to get something done, you approach her – everyone knows that! She is currently studying with Medical Council of Canada and aspires to be a leading Neurologist someday. Alongside, she has taken up medical writing to exercise her skills of delivering comprehensible version of the otherwise difficult medical literature. Her breaks comprise either of swimming, volunteering services at a Medical Camp or spending time with family.

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