Body dysmorphia is a feeling that something with one’s body is not right. This process focuses on a feeling of one’s nose being too large or too short, one being too fat or too skinny, one’s legs not feeling the right length or right width, or, perhaps, feeling that one’s penis is not large enough or that one’s breasts are too small. These self-perceptions can, when contrasted with the overvalued ideals of our culture, drive much of America’s obsession with cosmetic surgery. The problem, of course, is that the real issue is not the body itself, but the mind’s perception of the body. This symptom—viewing something about one’s body as defective—serves as a reservoir to house other feelings of defectiveness that one has about oneself or one’s sense of security in the world. For example, the woman who sees fat and her own perceived fat as disgusting often feels, consciously or unconsciously, that she is disgusting.
Patients with body dysmorphia harbor the illusion that if they can only fix their perceived defect, then they will feel fixed in their personality. But once the nose is repaired in a surgical intervention, patients with body dysmorphia often discover a new defective feature of their body on which to focus. This pattern of obsession keeps the experience of criticism alive; it reinforces the patient’s negative self-worth. In a most common scenario, a woman looking at herself in a mirror simply cannot tell if she is skinny or fat. Her need to use a scale to measure her weight parallels her kind of emotional numbness. As she cannot tell whether she is skinny or fat, she also cannot tell whether she is happy, sad, anxious, blue, or excited. This obsession provides an externalized avenue through which to contain, to think about, and to connect with feelings of badness and defectiveness about oneself. Hence, the abusive cycle repeats itself.