Body dysmorphic disorder (BDD) is a serious psychiatric condition found in approximately 2.4% of the population, with more women than men affected. The hallmark is severe anxiety linked to an imagined or highly exaggerated defect in one’s appearance. The average age of onset is in the late teenage years, but patients can take several years before seeing a mental health specialist, preferring, instead, to seek care in dermatology, plastic surgery or orthodontic clinics, in order to fix what they think is unsightly ugliness. If and when they decide to see a psychiatrist, patients may benefit from various medication and therapy interventions. Over the years, I have treated patients with a whole range of BDD symptoms, including the thick-haired woman who believed she was bald, the student with the perfectly symmetrical face who worried her left eyebrow was one inch higher than the right one, and the muscular young man who felt his biceps were gradually shrinking and would soon completely disappear. None of these cases, however, prepared me for the challenge of diagnosing “Dana”.
Dana was referred to me for a psychiatric evaluation, not by her dermatologist, plastic surgeon or dentist as is often the case, but by her daughter’s pediatrician. A forty-seven-year-old interior designer, she had had a successful career creating beautiful spaces for her clients to enjoy. About two years ago, following a lengthy divorce battle that resulted in her winning full custody of her five-year-old daughter “Kaetlin”, Dana was looking forward to a less stressful new chapter. Instead of finding relaxation, however, she started struggling with a new source of worry: For no reason she could identify, Dana started worrying about her daughter’s face. Specifically, she became very concerned that her daughter had very pointy “Vulcan ears”, similar to Mr. Spock’s, the Vulcan science officer in Star Trek. She imagined students making fun of her in class and on the bus, and wondered about her future professional and relationship prospects. She made her grow out her hair so it could cover her ears.