Wednesday, May 26, 2010

Not everybody's good looking

I don't know whether to laugh or cry. Jeff's underbite is now an abbreviation: B.D.D. Jeff needs an orthodontist, not a pychiatrist. (Note that Dr. Phillips thinks her judgement about Jeff is better than Jeff's judgement about Jeff.)

Obsessing About an Underbite

Katharine A. Phillips, M.D. Can concern about an ordinary body flaw like misaligned teeth be a sign of a serious psychiatric disorder? That’s the question explored by Dr. Katharine A. Phillips, a professor of psychiatry at Brown Medical School. Dr. Phillips recently joined the Consults blog to answer readers’ questions about body dysmorphic disorder, a troublesome condition in which people become so obsessed with perceived body defects that they refuse to leave the house or socialize.

Q.I have underbite. I do not have the insurance to correct it and it is a battle to walk out the door every day. I feel like people can see it from two blocks away. It has had a massively negative impact on my life and I feel like I don’t even want to try to achieve anything anymore, because why bother? I will still look like this. I’m not even looking for an answer here, I just wanted to get this off my chest. I wouldn’t wish this upon my worst enemy.

Jeff, Iowa

A.Dr. Phillips responds:

Jeff, you highlight some important points about body dysmorphic disorder, or B.D.D., although without meeting with you I can’t be sure that you have the condition. People with B.D.D. are preoccupied with slight or nonexistent defects or flaws in their appearance, and the preoccupation causes significant distress and can interfere with school, work, relationships or socializing.

Just as you feel that people can see your underbite from two blocks away, many people with B.D.D. have the distressing experience of thinking that other people take special notice of them in a negative way because of how they look — for example, by staring at them, laughing at them or making fun of them. This is an emotionally painful experience that can cause people with B.D.D. to isolate themselves from other people. It can be a clue that a person has body dysmorphic disorder.

You imply that you would like to get surgery — indeed, a majority of people with B.D.D. get cosmetic surgery or dermatologic treatments for their bodily concerns. This is problematic, because research studies indicate that cosmetic treatments usually don’t improve B.D.D. –- and can even make it worse. And people with B.D.D. tend to be dissatisfied with the results of such treatment. In contrast, people who don’t have B.D.D. are typically satisfied with the results of cosmetic treatment.

It makes sense that cosmetic treatment wouldn’t help B.D.D., because the problem in those with the condition isn’t with actual appearance -– rather, it’s a problem of distorted body image. Changing a surface physical feature doesn’t fix the person’s tendency to worry, obsess and over-focus on minor details and imperfections and to see themselves in a distorted way, differently from how other people see them.

Your comments also convey the huge impact that B.D.D. often has on people’s lives. As he says, just walking out the door every day can be a battle. Level of functioning and quality of life vary for people with B.D.D. but on average are very poor.

The good news is that there are treatments that can help. The scientific research that’s been done indicates that serotonin reuptake inhibitor medications (for example, escitalopram, fluoxetine or fluvoxamine) and cognitive behavioral therapy are helpful for a majority of people with B.D.D. More research is needed on these treatments and on other types of therapy, but this is good news for people who suffer from this distressing, impairing and sometimes disabling disorder.

To learn more about B.D.D., see Personal Health columnist Jane Brody’s story “When Your Looks Take Over Your Life.” And please join the discussion below.


  1. "The good news is that there are treatments that can help. The scientific research that’s been done indicates that serotonin reuptake inhibitor medications (for example, escitalopram, fluoxetine or fluvoxamine) and cognitive behavioral therapy are helpful for a majority of people with B.D.D."

    SSRIs... By now, Jeff from Iowa maybe already is on his way to his doctor (if he got out of the house, that is...): "I think, an SSRI might be right for me." Hallelujah! (And if the SSRI doesn't do the job, there's always the possibility to add on an antipsychotic, which might very well solve Jeff's problem, in time, as his teeth rot away... )

  2. If my car is running poorly, and I think it's the transmission, and I take it to AJAX Transmissions: Guess what? The mechanic, more often than not, will tell me the problem is with the transmission.

    The same would be true if I took it to an engine specialist--the problem would be with the engine or the carburetor.

    I'm told that, after working on the job for years, police tend to divide the world into two groups: The bad guys, and the good guys.

    Either because of greed, or an overspecialized view of the world, people allow that lens to color whatever impinges on their senses, to force answers to fit that view, rather that seek solutions without preconceived notions, or from other perspectives.

    That's why a multidisciplinary approach to problem solving is catching on.

    In this particular case, the obvious answer, an orthodontist, redirects the solution into the hands of another specialist, bypassing the psychiatrist who, of course, has the only "real" solution.

  3. One should be sceptical about the calibre of psychiatrists on the faculty of Brown University. There's Katherine A. Phillips, MD and then there's the guy who wrote Listening to Prozac.

    Thanks for the comments.

  4. One should be skeptical about the calibre of all psychiatrists practicing today.

    The only consolation I suppose is the absurdity with which psychiatrists are applying their wares in the interest of peddling psychiatric drugs is clearly becoming far more pronounced. This is a great example; you need psychiatric drugs because you have a poor self image related to your underbite. Wow!

    As psychiatry attempts to push the boundaries of its influence outward, sooner or later, society will question the validity of the entire establishment. I am encouraged by people like Katherine Phillips because she and others like her are unwittingly contributing to the awakening of a spellbound society.

  5. Yes, bring her on and others like her. The article reads like an infomercial and "Jeff" seems like an obvious fake. The troubling thing is that if you look at her picture, she hasn't been around the block much, and she may be the public face of a newer generation brought up on this crap. I'd better get busy and finish today's post which is a rambling look at this trend.


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