Commentary: It is not vanity when you are obsessed about how you look

SINGAPORE: With the ceaseless bombardment of what’s magnificence – from pores and skin, hair, garments and weight – it’s no surprise that the worldwide magnificence business is price US$532 billion (S$706 billion). 

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However what’s an appropriate quest to feel and appear good and when does it spill over into one thing that turns into a critical psychological well being problem?

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This may be illustrated with the kind of shoppers I see.

I first met with Joseph*, a soft-spoken younger man with good-looking options similar to a Korean movie star, when he was dropped at our hospital’s emergency providers after an try to finish his life.

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He had undergone a number of beauty surgical procedure procedures abroad however but can be caught in entrance of a mirror for a number of hours watching the “monster” within the reflection.

Joseph believed that his look was so marred by his ugliness that he was unable to work together with different individuals, and would put his palms over his face to cover. “Unless my parents allow me to go for the cosmetic surgery, there is no meaning to my life,” he had mentioned. 


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Physique Dysmorphic Dysfunction (BDD) is a disabling psychological well being situation characterised by obsessive concepts that one’s personal look is severely flawed. Individuals with BDD are sometimes perceived by others as being infatuated with self-importance or discontented with their bodily look.

It causes people to interact in repetitive or time-consuming behaviours to verify, cover, or repair their look in order to alleviate misery.

In brief, like Joseph, nothing is ever adequate and there are fixed emotions of inadequacies.

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One in seven individuals in Singapore can be experiencing a psychological well being situation of their lifetimes. (File picture: TODAY/Nuria Ling)

It’s unlucky that people with this situation are believed to be desperately attempting to impress others – they search validation and hope for flattering feedback about their very own bodily enchantment. This lack of expertise of the situation could create emotions of disgrace on the a part of BDD victims about disclosing their signs to different individuals or in search of assist.

READ: IN FOCUS: The challenges younger individuals face in in search of psychological well being assist

BDD is estimated to have an effect on about 2 per cent of adolescents and adults worldwide, and this determine could also be underreported. At current, there was no full-scale research of the dysfunction in Singapore, however a preliminary research by the Nationwide College of Singapore suggests an identical proportion right here.

It ought to be famous, nonetheless, that not everybody who seeks beauty surgical procedure suffers from BDD.

Though the precise causes of BDD are debatable, research counsel a mixture of various components, together with environmental and organic causes.

The situation appears to develop in people who find themselves extraordinarily self-conscious and self-focused, who could have been teased or bullied of their childhood or adolescent years and who had been unable to beat it then.

Sociocultural components such because the emphasis on wanting engaging and presumably sure character traits – for instance,  perfectionism – might also play a job, with neuroscience analysis pointing to variations in mind perform referring to the processing of visible and perceptual data in them.

To place it merely, individuals with BDD are inclined to over-focus on particulars, however are usually not capable of course of visible data in a holistic method or to see the large image. 


Usually, the onset of the dysfunction begins in adolescence, earlier than the age of 18. BDD can have an effect on each women and men, though about 40 per cent of victims are males and 60 per cent girls.

Ladies are inclined to report extra extreme signs, and normally have extra areas of concern, equivalent to pores and skin imperfections and hair or facial options. Males are sometimes extra preoccupied with their construct or muscle tone. 

Nevertheless, few individuals with BDD in Singapore search assist as a result of many are unaware of the dysfunction and most victims are inclined to have restricted perception into their situation, and consider it as a bodily drawback.

READ: Commentary: Will you rent and retain individuals with psychological well being situations?

Due to the idea that their points are bodily in nature, it’s unlucky that most individuals are inclined to seek the advice of aesthetic practitioners somewhat than psychological well being professionals.

With out remedy, BDD may cause substantial impairment in psychosocial functioning, and its affect can go away those that have the situation in extreme emotional misery. Proof from world research has discovered that 70 per cent of individuals with BDD endure from co-morbid melancholy.

Turning continuously to beauty surgical procedure to discover a fast repair resolution to their drawback, BDD victims both camouflage a perceived defect or attempt to obtain an unrealistic excellent. Many nonetheless really feel dissatisfied after a number of beauty interventions and this will result in their social isolation.

READ: Commentary: It is going to be a waste if mother and father don’t preserve versatile work preparations

All these components could intensify anxieties, exacerbating the signs of their BDD, together with emotions of anger, despair and hopelessness. Many find yourself loathing themselves for being so useless and self-obsessed.

Greater than 60 per cent have reported having suicidal ideas, and round 24 per cent to twenty-eight per cent of circumstances have tried suicide.

Close-up of a woman's eye with make-up on

(Photograph: Unsplash/Linh Ha)

Within the case of Tammie*, she hated how her eyebrows appeared and would spend hours on her eyebrows every day – drawing, then wiping them off and redrawing them once more. When they didn’t look symmetrical or the appropriate form, she would burst into tears of frustration and proceed her try and “perfect” the form of her eyebrows. 

As she felt ugly, hideous and alienated, she didn’t need to go away her room or be seen by anybody, even her circle of relatives. On account of this, she had bother going to lessons and stopped hanging out along with her pals. She turned socially remoted and depressed.

BDD impacts not simply the particular person, however their household or pals as effectively. Households who’ve family members with BDD could discover themselves burdened financially and psychologically when caring for them.

READ: Commentary: There may be not often a proper time to speak about your psychological well being while you’re relationship – however do it anyway

They might find yourself paying for his or her beauty procedures, really feel paralysed to assist as their family members refuse psychological remedy, and even change their household’s approach of doing issues in order to accommodate the particular person’s worries.  

It may be excruciating for relations to witness their family members affected by this situation. Members of the family could expertise feelings starting from worry, to anger, to disappointment and profound frustration.

Some households might also should take care of their family members’ continuously aggressive behaviour, fuelled by an incapacity to repair their perceived defects or, as they think about, the sense of rejection by their pals or different individuals.


The help and understanding of relations and pals, and the willingness of the particular person to hunt assist as early as doable, are each crucial for higher outcomes.

One of many evidence-based therapies for BDD is cognitive-behavioural remedy (CBT) – a type of remedy that challenges sufferers to reframe their unhelpful, unfavourable ideas about their look. 

It additionally teaches them to chorus from repetitive compulsive behaviours, and encourages them to face their feared conditions in a gradual method.

By way of the usage of mirrors, sufferers are additionally skilled to see their total physique somewhat than simply specializing in the disliked particulars, and to explain themselves in non-judgemental methods.

Household training and involvement is very helpful, not just for the affected person’s restoration but in addition for the household’s functioning as an entire.

Tammie’s household was capable of specific their issues to her and provides her their help in encouraging her to hunt assist, after they noticed a unfavourable change in behaviour at dwelling and in class.

Apart from receiving help and encouragement within the restoration course of, the particular person’s motivation to vary is equally necessary too. BDD is unlikely to go away by itself. Nevertheless, with remedy and the appropriate help, the situation will be managed and even enhance. 

* Pseudonyms have been used to guard the identities of individuals talked about on this commentary.

Dr Jackki Yim is a Senior Medical Psychologist on the Division of Psychology within the Institute of Psychological Well being.

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