Beauty is in the eye of the beholder: New insights in imagined ugliness

Patients with body dysmorphic disorder (BDD) are intensely distressed by an imagined or slight flaw in their physical appearance, and are preoccupied by the perceived flaw and its significance. Thus, BDD is highly debilitating; it often results in severe impairment in social and occupational functioning, as well as in high rates of suicidal ideation and attempts. A typical BDD patient can present as an attractive and intelligent individual with clear, logical thought processes about everything that is not related to his or her delusion of ugliness. The patient's belief in his or her ugliness and the various distorted perceptions and beliefs that follow from that mistaken conviction are in striking contrast to the patient's general rationality. Thus, clinicians, friends, and family members often find BDD patients puzzling and frustrating. However, these patients are also fascinating and often compelling because of their attractiveness and other strengths. Only this focused, seemingly inexplicable craziness seems to stand between them and a happy, fulfilling life.