How can I accept being ugly


Which nose corresponds to the ideal measurements, and which smile stands up to Hollywood criteria? Everyone has small optical quirks (see also the bdw cover story “The Natural Law of Beauty”). But for people with dysmorphophobia - the fear of being disfigured - they become a big problem: They feel ugly and hardly dare to go outside. Current studies assume that around one to five percent of all men and women in Germany suffer from the agonizing disorder. "The disease usually begins during puberty, but it takes an average of 15 years to correctly diagnose it," says child and adolescent psychiatrist Claudia Mehler-Wex from the Ulm University Hospital.

Until then, the supposedly ugly people will populate the practices of dermatologists, orthodontists and cosmetic surgeons. But they can hardly help them. Because if a crooked tooth is straightened, a small skin wrinkle bothers shortly afterwards - something is always there. In addition to their faces, the women affected are mainly dissatisfied with their bosoms and legs, while the men are dissatisfied with their genitals, hair or their height. The nose or hairline is examined in the mirror for hours. Other patients cover all mirrors in the home because they cannot stand the sight of themselves. Almost all of them avoid contact with other people because they then feel observed and insecure. Claudia Mehler-Wex: "About 75 percent of patients suffer from depression at the same time, 30 percent even have suicidal thoughts." Parents and doctors in particular are called upon to recognize dysmorphophobia in good time - in the 18-year-old who is stimulated through questionable TV role models, wishes to have a breast operation for high school graduation, as well as with the boy who no longer dares to venture into people because of a few pimples.

A disorder in the serotonin balance could be to blame for the wrong body image. This assumption is supported by parallels to LSD: The drug changes the effect of serotonin and is usually associated with hallucinations in which parts of the body appear bizarrely changed. This thesis is also supported by the fact that most dysmorphophobia patients react well to psychotropic drugs that increase serotonin levels. For Claudia Mehler-Wex, however, they are just a crutch in treatment. “The focus is always on psychotherapy.” The doctor wants to help the patient to see himself differently. “For those affected, there is only black or white. Their bodies appear to them either perfectly or ugly. They hide nuances in between. In psychotherapeutic discussions, behavior training or group therapy, we give them the opportunity to build up a new sense of self-worth and reduce social anxiety. ”Such therapy usually lasts six to twelve months. Some have to relearn the most everyday things that they can no longer cope with for fear of others: shopping, driving the bus or going to the authorities. What is important for people is the experience that, despite their (imagined) ugliness, they are accepted and treated with respect. Dr. Ulrich Fricke

medinfo in July: urinary incontinence



Prof. Claudia Mehler-Wex Ulm University Clinic and Polyclinic for Child and Adolescent Psychiatry / Psychotherapy Steinhövelstrasse 5 89075 Ulm Tel. 0731 / 500-61604


Information from the Humboldt University: www.koerperdysmorphe


Ulrich Stangier SKIN DISEASES AND BODY DYSMORPHIC DISORDERS Hogrefe Verlag 2002, € 19.95

July 15, 2008