The Broken Mirror Summary
The Broken Mirror
The Broken Mirror was written by Katherine Phillips, M D, who is Chief of outpatient services and Director of the Body Dysmorphic Disorder and Body Image Program at Butler Hospital in Providence, Rode Island. In this text, Dr. Philips explains and answers various questions about an unknown psychological disorder known as Body Dysmorphic Disorder or BDD. The text answers various questions about the disorder including: What is Body Dysmorphic Disorder? How does one know if they have BDD? How does BDD affect one’s life? And what is the treatment plan for BDD sufferers (Philips 1996)?
What is Body Dysmorphic Disorder?
Dr. Philips began this chapter by describing her first encounter with a patient who had a mild case of BDD. The patients name was Sarah, and she was a twenty four year old medical student. Sarah had recently seen a special on NBC Dateline regarding BDD. When she scheduled her appointment with Dr. Philips, she emphasized that she did not have a severe case of BDD but only mild. Dr. Philips was interested in …show more content…
meeting with her, because she had not yet worked with patients who had a mild case of BDD. Most of her patients had severe BDD with suicidal consequences. Sarah had spoken with Dr. Philips about her concerns for her appearance. When Dr. Philips met Sarah, she was confused as to why this young lady had any concerns. Sarah was a young, pretty girl with a “lovely Smile”. Although no blemishes were noticeable to the naked eye, they were still the obsession for her anxiety. And though most of Dr. Philip’s BDD patients had suffered from not being able to hold a job, Sarah had managed to control her condition while at work. Sarah had stated to Dr. Philips that she had a hard time with relationships. And due to her concern for her appearance, she isolated herself from physical contact. Two of Sarah’s largest concerns were her thighs and hair. She described her thighs as “flabby with a rippling look” and large purple varicose veins that bulge out of her legs. Although her hair looked perfect to Dr. Philips, Sarah thought otherwise. She continued to describe her hair as flat, and she also explained her constant concern for her weight. Due to these blemishes Sarah felt forced to avoid certain activities, such as the beach. Even in hot weather, she wore pants; because she was afraid people would stare at her legs and laugh. As a result, Sarah considered moving to a colder climate to avoid having to wear shorts. Since she felt her hair was extremely flat, she found herself spending hours in the mirror. At work, she avoided mirrors, because they were like a magnet for her. If she looked into one, she would have to spend hours trying to fix her hair. She also avoided shopping malls, since malls also had a great number of mirrors (Philips 1996).
Sarah’s case of BDD was considered a mild case due to her ability to control the disorder when needed, such as at work. Although a mild case of BDD interfered with a minimal extent of her living, severe cases can be much worse. Many of Dr. Philips patients who suffered from BDD were forced to stop working, isolated themselves from the outside world, stopped caring for their children, and never dated or married, due to how they viewed their outside appearance as ugly or grotesque. According to Dr. Philips, most of her extreme cases involved beautiful people who thought of themselves negatively starting at a young age. In some cases, her patient would resort to suicide to avoid having the world view what that patient saw in his or her mind. BDD sufferers not only have concern of their physical appearance, they also obsess sometimes eight to ten hours, even all day, over these so called blemishes. As a result, these obsessions have consumed everyday tasks normal people have taken for granted (Philips 1996).
How does one know if they have BDD?
In this chapter, Dr.
Philips describes BDD as not a rare disorder, but often secretive disorder. According to statistics on a study from Brown University, out of three hundred sixteen people in an outpatient setting for psychiatric treatment, 4% have BDD. Also, out of 500 people seeking psychiatric treatment in an outpatient setting, 12% have BDD. Although these numbers are high, BDD is often not diagnosed due to its close ties with other common psychiatric disorders. If a patient does not reveal the cause of their psychiatric symptoms then they may be misdiagnosed as having another related disorder. Some disorders that may result from BDD include depression, social anxiety, panic attacks, social phobia, and obsessive-compulsive disorder. Though 80% of BDD patients will have any one of these disorders, it is not often diagnosed due to the patient’s fear of revealing the cause behind such actions (Philips
1996).
There are several reasons why a patient might not reveal their cause of anxiety. Dr. Philips explains that worrying about seaming superficial is one of the reasons. Patients also fear that if they were to disclose their deformities, people will say they look fine. This causes the patient to have a feeling of being misunderstood, thus causing them to not mention it again. Another reason is the perception that once a defect is mentioned, to a friend or family member, it will become noticeable. Thus causing that friend or family member to stare and comment. This of course is untrue, since most deformities mentioned by BDD sufferers are not usually visible to another person (Philips 1996).
There are several ways to diagnose BDD. One way to Diagnose BDD is by asking a series of questions. The first half of these questions, which were developed by Dr. Philips, is in a “self-report” format. Thus the patient will answer these questions. A clinician asks the second set of questions. Another way to diagnose BDD is by evaluating the presence of certain actions such as how often a patient checks their appearance in mirrors, avoids mirrors due to how they perceive themselves, compares themselves to other and how often this comparison is done, spend excessive time grooming, pick at the skin to make it look better, cover or hide body parts, and hide parts of the body by using a certain body position (Philips 1996).
How does BDD affect one’s life?
Sufferers of BDD often experience social avoidance, problems at work, and sometimes suicide. The social consequences of BDD can interfere with many aspects of a person’s life. Some people with BDD avoid intimate relationships due to their anxiety of the blemishes they see as grotesque. Others become shut out from the world, causing them to not go outside the home for as long as six years. In some cases they even avoid family members in their own home, thus never being able to leave their room. 98% of people Dr. Philips interviewed with BDD exhibit this type of behavior. Not only does BDD affect one’s personal relationships, but also it affects other aspects of life. Three quarters of the people interviewed by Dr. Philips with BDD reported having difficulties with work and school. Since most people become preoccupied with their appearance, they often are urged to spend extended periods of time checking the mirror and grooming. This type of BDD behavior interferes with focus and concentration on other tasks. As a result, many people with BDD are late to work and find it hard to meet deadlines at work and school. Thus some are forced to drop out of school or are fired from work (Philips 1996).
What is the treatment plan for BDD sufferers?
In order for a patient to overcome BDD, they must acknowledge certain steps in treatment. Education is the first step to overcoming BDD. Since most people with BDD are misdiagnosed or referred to physicians to fix their problem, they often don’t know that it is a psychological disorder. Overcoming embarrassment and shame is the next step. Many people see mental professionals, but don’t receive the help they need, because they fail to mention their BDD symptoms. Also, BDD symptoms are often perceived as trivial. As a result, the patient avoids the subject due to embarrassment. This can lead to reluctance to try psychiatric treatment. There are many different psychiatric treatments for BDD. The most effective treatment for majority of sufferers is serotonin reuptake inhibitors or SRIs. SRIs are antidepressant medications with antiobsessional properties. When taking SRIs, a patient’s appearance related behaviors diminish or disappear. As a result, daily functioning improves. Another course of treatment is cognitive behavioral treatment. This type of treatment involves exposure and response prevention, such as facing a mirror and resisting the compulsive behaviors. Some patients who receive this treatment often notice a change in behavior. Because BDD is often an unrecognized disorder, there has been minimal research on ways to treat and diagnose. As a result, future education and research are needed to overcome this disorder (Philips 1996).
Epilogue
Throughout the book, Dr. Philips spoke of her experience with many different kinds of patients. This was very intriguing, due my reaction to many of the stories. The concept of someone becoming so engrossed in his or her own appearance was not only surprising but also disturbing. Imagine being a beautiful person on the outside, but when faced with a mirror, the blemishes frighten you. A blemish may seem minute to someone else’s perception, but to your perception it engrosses the entity of your face. This can be horrifying. As a result, you are forced to believe that others see the same, even though they don’t. Such blemishes can include a tiny pimple, the curve of the nose, the perception that hair is falling out, and a small scar. To a sufferer of BDD, these blemishes are magnified. In the eyes of this disorder, a tiny pimple may seem like huge wart overtaking the face. The curve of one’s nose may be small, but is perceived as a deformity that is seen a mile away. A person with BDD could have a full head of hair, but in the mirror see bald spots and thin hair. A small scar may be magnified in the mirror as the focal point of one’s face. This type of reaction is the basis behind Body Dysmorphic Disorder.
The intriguing reaction is not only due to how one’s self is perceived, but also the steps some people take to fix their blemishes. Some extreme steps may include getting a tan. This type of grooming is normal, but most people go to the nearest tanning salon or drugstore to get the results they need. To a BDD sufferer, that type of remedy may not be good enough. One of Dr. Philips patients was so upset over his skin, that he moved to California to get a “real” tan. The patients name was Ian. He was a college student with straight A’s. He was a young athletic good-looking male. Ian had never been a troublemaker. His problem started when he first began college. After reviewing himself in a mirror in the men’s room, he began to see himself as ugly. So ugly, that the only way he thought he would look better was by tanning. As a result, Ian broke in multiple homes, stole cash and credit cards, and went to California to get a tan. According to Ian, the only place to get a real tan was in California. Since getting a tan still did not help his perception of himself, he decided to pursue plastic surgery. In his attempts to find a plastic surgeon, Ian was turned down due to his appearance being fine. As a result of his disappointment, Ian tried suicide. He believed he was so ugly that he couldn’t live anymore. In the end, he was hospitalized and sent home to his parents (Philips 1996). Though Ian survived his suicide attempt, some do not. It is sad to think that a person perceives himself or herself as so ugly that they take their own life.
The more stories I read, the more I began to wonder if so many of the other disorders could be caused by BDD. I thought about people that I knew who exhibited certain behaviors, and wondered if they may have any underlying anxieties. I had an old friend of mine who was very insecure, hence, the reason why he is an old friend and not current friend. We will call him Bob. Bob was an interesting person. He usually stayed at home and avoided most outside contact. He often used to say that people are not to be trusted; therefore he did not desire to meet new people. Most of his time was spent at home watching TV and sleeping. When I first met Bob, he seemed confident. But as our relationship grew, I began to realize his psychoanalytic ways. For instance, when shopping at the mall, Bob would constantly compare himself to every male he saw. He would often become so upset after these comparisons that he would cry or freak out and start screaming at the nearest person. Usually that person was I. In the days after the mall event, he would avoid leaving the house. His ability to perceive himself as ugly was so prevalent that he constantly had to be reassured about his appearance. Which, in most cases, he did not believe and thus felt misunderstood. This type of behavior affected his personal relationships and work. He could not keep a steady job due to his anxiety around other people. He also lacked the ability to stay in a steady relationship, due to his anxiety over other men’s appearance compared to his. As a result, he was often depressed. As a friend of Bob’s, I tried to reassure him of his good looks and ability to be a hard worker, but that usually made matters worse. In evaluating Bob’s behavior as I was reading this book, I began to wonder whether Bob had BDD. If he did would it be a mild case or severe case? And if so, would that explain the other disorders that he exhibited so frequently, such as social anxiety, depression, and bipolar disorder? If BDD is so closely related to other well-known disorders, could it be the main cause of them in a lot of cases? In fact, could my behaviors exhibit some form of BDD?
In order to answer these questions, I looked at the research on BDD. According to Dr. Philips due to BDD not being categorized as a commonly known disorder, research has been minimal. As a result, the ability to diagnose and treat BDD has been questioned within the medical community (Philips 1996). If this is true, then more research should be done. In order for a mental professional to help a person, they must cover all aspects. Then again since BDD is not widely known, most patients are afraid to reveal their anxiety. With more research and understanding of this strange disorder, more people may be able to reveal their bodily anxieties. Thus resulting in less misdiagnosis, the feeling of being misunderstood, and suicide.
References
Philips, Katherine A. MD. (1996). The Broken Mirror: Understanding and Treating Body Dysmorphic Disorder. New York: Oxford University Press.
The Broken Mirror was written by Katherine Phillips, M D, who is Chief of outpatient services and Director of the Body Dysmorphic Disorder and Body Image Program at Butler Hospital in Providence, Rode Island. In this text, Dr. Philips explains and answers various questions about an unknown psychological disorder known as Body Dysmorphic Disorder or BDD. The text answers various questions about the disorder including: What is Body Dysmorphic Disorder? How does one know if they have BDD? How does BDD affect one’s life? And what is the treatment plan for BDD sufferers (Philips 1996)?
What is Body Dysmorphic Disorder?
Dr. Philips began this chapter by describing her first encounter with a patient who had a mild case of BDD. The patients name was Sarah, and she was a twenty four year old medical student. Sarah had recently seen a special on NBC Dateline regarding BDD. When she scheduled her appointment with Dr. Philips, she emphasized that she did not have a severe case of BDD but only mild. Dr. Philips was interested in …show more content…
meeting with her, because she had not yet worked with patients who had a mild case of BDD. Most of her patients had severe BDD with suicidal consequences. Sarah had spoken with Dr. Philips about her concerns for her appearance. When Dr. Philips met Sarah, she was confused as to why this young lady had any concerns. Sarah was a young, pretty girl with a “lovely Smile”. Although no blemishes were noticeable to the naked eye, they were still the obsession for her anxiety. And though most of Dr. Philip’s BDD patients had suffered from not being able to hold a job, Sarah had managed to control her condition while at work. Sarah had stated to Dr. Philips that she had a hard time with relationships. And due to her concern for her appearance, she isolated herself from physical contact. Two of Sarah’s largest concerns were her thighs and hair. She described her thighs as “flabby with a rippling look” and large purple varicose veins that bulge out of her legs. Although her hair looked perfect to Dr. Philips, Sarah thought otherwise. She continued to describe her hair as flat, and she also explained her constant concern for her weight. Due to these blemishes Sarah felt forced to avoid certain activities, such as the beach. Even in hot weather, she wore pants; because she was afraid people would stare at her legs and laugh. As a result, Sarah considered moving to a colder climate to avoid having to wear shorts. Since she felt her hair was extremely flat, she found herself spending hours in the mirror. At work, she avoided mirrors, because they were like a magnet for her. If she looked into one, she would have to spend hours trying to fix her hair. She also avoided shopping malls, since malls also had a great number of mirrors (Philips 1996).
Sarah’s case of BDD was considered a mild case due to her ability to control the disorder when needed, such as at work. Although a mild case of BDD interfered with a minimal extent of her living, severe cases can be much worse. Many of Dr. Philips patients who suffered from BDD were forced to stop working, isolated themselves from the outside world, stopped caring for their children, and never dated or married, due to how they viewed their outside appearance as ugly or grotesque. According to Dr. Philips, most of her extreme cases involved beautiful people who thought of themselves negatively starting at a young age. In some cases, her patient would resort to suicide to avoid having the world view what that patient saw in his or her mind. BDD sufferers not only have concern of their physical appearance, they also obsess sometimes eight to ten hours, even all day, over these so called blemishes. As a result, these obsessions have consumed everyday tasks normal people have taken for granted (Philips 1996).
How does one know if they have BDD?
In this chapter, Dr.
Philips describes BDD as not a rare disorder, but often secretive disorder. According to statistics on a study from Brown University, out of three hundred sixteen people in an outpatient setting for psychiatric treatment, 4% have BDD. Also, out of 500 people seeking psychiatric treatment in an outpatient setting, 12% have BDD. Although these numbers are high, BDD is often not diagnosed due to its close ties with other common psychiatric disorders. If a patient does not reveal the cause of their psychiatric symptoms then they may be misdiagnosed as having another related disorder. Some disorders that may result from BDD include depression, social anxiety, panic attacks, social phobia, and obsessive-compulsive disorder. Though 80% of BDD patients will have any one of these disorders, it is not often diagnosed due to the patient’s fear of revealing the cause behind such actions (Philips
1996).
There are several reasons why a patient might not reveal their cause of anxiety. Dr. Philips explains that worrying about seaming superficial is one of the reasons. Patients also fear that if they were to disclose their deformities, people will say they look fine. This causes the patient to have a feeling of being misunderstood, thus causing them to not mention it again. Another reason is the perception that once a defect is mentioned, to a friend or family member, it will become noticeable. Thus causing that friend or family member to stare and comment. This of course is untrue, since most deformities mentioned by BDD sufferers are not usually visible to another person (Philips 1996).
There are several ways to diagnose BDD. One way to Diagnose BDD is by asking a series of questions. The first half of these questions, which were developed by Dr. Philips, is in a “self-report” format. Thus the patient will answer these questions. A clinician asks the second set of questions. Another way to diagnose BDD is by evaluating the presence of certain actions such as how often a patient checks their appearance in mirrors, avoids mirrors due to how they perceive themselves, compares themselves to other and how often this comparison is done, spend excessive time grooming, pick at the skin to make it look better, cover or hide body parts, and hide parts of the body by using a certain body position (Philips 1996).
How does BDD affect one’s life?
Sufferers of BDD often experience social avoidance, problems at work, and sometimes suicide. The social consequences of BDD can interfere with many aspects of a person’s life. Some people with BDD avoid intimate relationships due to their anxiety of the blemishes they see as grotesque. Others become shut out from the world, causing them to not go outside the home for as long as six years. In some cases they even avoid family members in their own home, thus never being able to leave their room. 98% of people Dr. Philips interviewed with BDD exhibit this type of behavior. Not only does BDD affect one’s personal relationships, but also it affects other aspects of life. Three quarters of the people interviewed by Dr. Philips with BDD reported having difficulties with work and school. Since most people become preoccupied with their appearance, they often are urged to spend extended periods of time checking the mirror and grooming. This type of BDD behavior interferes with focus and concentration on other tasks. As a result, many people with BDD are late to work and find it hard to meet deadlines at work and school. Thus some are forced to drop out of school or are fired from work (Philips 1996).
What is the treatment plan for BDD sufferers?
In order for a patient to overcome BDD, they must acknowledge certain steps in treatment. Education is the first step to overcoming BDD. Since most people with BDD are misdiagnosed or referred to physicians to fix their problem, they often don’t know that it is a psychological disorder. Overcoming embarrassment and shame is the next step. Many people see mental professionals, but don’t receive the help they need, because they fail to mention their BDD symptoms. Also, BDD symptoms are often perceived as trivial. As a result, the patient avoids the subject due to embarrassment. This can lead to reluctance to try psychiatric treatment. There are many different psychiatric treatments for BDD. The most effective treatment for majority of sufferers is serotonin reuptake inhibitors or SRIs. SRIs are antidepressant medications with antiobsessional properties. When taking SRIs, a patient’s appearance related behaviors diminish or disappear. As a result, daily functioning improves. Another course of treatment is cognitive behavioral treatment. This type of treatment involves exposure and response prevention, such as facing a mirror and resisting the compulsive behaviors. Some patients who receive this treatment often notice a change in behavior. Because BDD is often an unrecognized disorder, there has been minimal research on ways to treat and diagnose. As a result, future education and research are needed to overcome this disorder (Philips 1996).
Epilogue
Throughout the book, Dr. Philips spoke of her experience with many different kinds of patients. This was very intriguing, due my reaction to many of the stories. The concept of someone becoming so engrossed in his or her own appearance was not only surprising but also disturbing. Imagine being a beautiful person on the outside, but when faced with a mirror, the blemishes frighten you. A blemish may seem minute to someone else’s perception, but to your perception it engrosses the entity of your face. This can be horrifying. As a result, you are forced to believe that others see the same, even though they don’t. Such blemishes can include a tiny pimple, the curve of the nose, the perception that hair is falling out, and a small scar. To a sufferer of BDD, these blemishes are magnified. In the eyes of this disorder, a tiny pimple may seem like huge wart overtaking the face. The curve of one’s nose may be small, but is perceived as a deformity that is seen a mile away. A person with BDD could have a full head of hair, but in the mirror see bald spots and thin hair. A small scar may be magnified in the mirror as the focal point of one’s face. This type of reaction is the basis behind Body Dysmorphic Disorder.
The intriguing reaction is not only due to how one’s self is perceived, but also the steps some people take to fix their blemishes. Some extreme steps may include getting a tan. This type of grooming is normal, but most people go to the nearest tanning salon or drugstore to get the results they need. To a BDD sufferer, that type of remedy may not be good enough. One of Dr. Philips patients was so upset over his skin, that he moved to California to get a “real” tan. The patients name was Ian. He was a college student with straight A’s. He was a young athletic good-looking male. Ian had never been a troublemaker. His problem started when he first began college. After reviewing himself in a mirror in the men’s room, he began to see himself as ugly. So ugly, that the only way he thought he would look better was by tanning. As a result, Ian broke in multiple homes, stole cash and credit cards, and went to California to get a tan. According to Ian, the only place to get a real tan was in California. Since getting a tan still did not help his perception of himself, he decided to pursue plastic surgery. In his attempts to find a plastic surgeon, Ian was turned down due to his appearance being fine. As a result of his disappointment, Ian tried suicide. He believed he was so ugly that he couldn’t live anymore. In the end, he was hospitalized and sent home to his parents (Philips 1996). Though Ian survived his suicide attempt, some do not. It is sad to think that a person perceives himself or herself as so ugly that they take their own life.
The more stories I read, the more I began to wonder if so many of the other disorders could be caused by BDD. I thought about people that I knew who exhibited certain behaviors, and wondered if they may have any underlying anxieties. I had an old friend of mine who was very insecure, hence, the reason why he is an old friend and not current friend. We will call him Bob. Bob was an interesting person. He usually stayed at home and avoided most outside contact. He often used to say that people are not to be trusted; therefore he did not desire to meet new people. Most of his time was spent at home watching TV and sleeping. When I first met Bob, he seemed confident. But as our relationship grew, I began to realize his psychoanalytic ways. For instance, when shopping at the mall, Bob would constantly compare himself to every male he saw. He would often become so upset after these comparisons that he would cry or freak out and start screaming at the nearest person. Usually that person was I. In the days after the mall event, he would avoid leaving the house. His ability to perceive himself as ugly was so prevalent that he constantly had to be reassured about his appearance. Which, in most cases, he did not believe and thus felt misunderstood. This type of behavior affected his personal relationships and work. He could not keep a steady job due to his anxiety around other people. He also lacked the ability to stay in a steady relationship, due to his anxiety over other men’s appearance compared to his. As a result, he was often depressed. As a friend of Bob’s, I tried to reassure him of his good looks and ability to be a hard worker, but that usually made matters worse. In evaluating Bob’s behavior as I was reading this book, I began to wonder whether Bob had BDD. If he did would it be a mild case or severe case? And if so, would that explain the other disorders that he exhibited so frequently, such as social anxiety, depression, and bipolar disorder? If BDD is so closely related to other well-known disorders, could it be the main cause of them in a lot of cases? In fact, could my behaviors exhibit some form of BDD?
In order to answer these questions, I looked at the research on BDD. According to Dr. Philips due to BDD not being categorized as a commonly known disorder, research has been minimal. As a result, the ability to diagnose and treat BDD has been questioned within the medical community (Philips 1996). If this is true, then more research should be done. In order for a mental professional to help a person, they must cover all aspects. Then again since BDD is not widely known, most patients are afraid to reveal their anxiety. With more research and understanding of this strange disorder, more people may be able to reveal their bodily anxieties. Thus resulting in less misdiagnosis, the feeling of being misunderstood, and suicide.
References
Philips, Katherine A. MD. (1996). The Broken Mirror: Understanding and Treating Body Dysmorphic Disorder. New York: Oxford University Press.