The Broken Mirror: Understanding and Treating Body Dysmorphic Disorder

Jane is an attractive woman in her mid-thirties, tall, thin, and stately. She believes she is breathtakingly ugly. Tormented by what she sees as her huge nose, crooked lip, big jaw, fat buttocks, and tiny breasts, she has not left her house in six years. Though she lives in the same house as her mother, she once went two years without seeing her. When relatives come over, she avoids them, staying up on the third floor of the house, even on Thanksgiving. The one time she left the house--forced to see a doctor--she covered her face with bandages. Eventually, she attempted suicide. "I can't imagine any suffering greater than this. If I had a choice, I'd rather be blind or have my arms cut off. I'd be happy to have cancer."
Jane has body dysmorphic disorder, or BDD. In The Broken Mirror, Dr. Katharine Phillips draws on years of clinical practice and detailed interviews with over 200 patients to bring readers the first book on this debilitating disease, in which sufferers are obsessed by perceived flaws in their appearance. Phillips describes severe cases, such as Jane's, but also a multitude of milder cases, such as Carl, a successful lawyer who uses his work to distract him from his supposedly thinning hair, yet says that he thinks about it constantly. Many sufferers are able to function very well in society, but remain secretly obsessed by their "hideous acne" or "horrible nose," sneaking constant peeks at a pocket mirror, or spend hours at a time redoing makeup. According to Phillips' research, BDD afflicts approximately 2% of the population, or nearly 5 million people. It is not an uncommon disorder, simply a hidden one, since sufferers are often embarrassed to tell even their closest friends about their concerns: one woman, after fifty years of marriage, still felt too uncomfortable to reveal her preoccupation to her husband.
Besides the fascinating story of the disease itself, The Broken Mirror is also a literally lifesaving handbook for sufferers, their families, and their doctors. Left untreated, the torment of BDD can lead to psychiatric hospitalization and sometimes suicide. With treatment, many sufferers are able to lead normal lives. Phillips provides a quick self-assessment questionnaire, helping readers distinguish between normal concern with appearance and the obsession of BDD to determine whether they or someone they know have BDD. She includes warning signs for dermatologists and plastic surgeons, since they are the medical professionals who see BDD sufferers most often as they continually seek to "fix" their looks. Other chapters outline effective treatments for BDD using drugs and cognitive-behavioral therapy, answering often-asked questions about treatments. Finally, Phillips includes a chapter aimed at the friends and families of BDD sufferers. Profoundly affected by the disease themselves, since sufferers often refuse to attend weddings and other family events, or constantly ask loved ones for reassurance about their looks, those who care about someone with BDD will find both helpful advice and reassurance in this indispensable book.
The Broken Mirror--the first book on this underrecognized disorder--is essential reading for the psychiatrists, mental health professionals, and other physicians who see these often undiagnosed patients; for the friends and family concerned and upset by a loved one who won't believe their reassurances; and for the millions who suffer from BDD in silence and secrecy.

Katharine A. Phillips, M.D., is Chief of Outpatient Services and Director of the Body Dysmorphic Disorder and Body Image Program at Butler Hospital in Providence, Rhode Island, and Associate Professor of Psychiatry and Human Behavior at Brown University School of Medicine. She is internationally known for her pioneering work on BDD.