Professor leads way in recognizing, treating body dysmorphic disorder
With her long strawberry-blond hair, large green eyes and beautiful complexion, 22-year-old Jennifer would be considered attractive by any standards.
She reminded Katharine A. Phillips of the captain of a high school cheerleading squad, but there had been no crisp fall afternoons on the sidelines of the football field for Jennifer: She had dropped out of high school, and was steadily dropping out of public life.
"I'm too scared to go out - everyone will see how ugly I am," Jennifer told Phillips, the assistant professor of psychiatry who diagnosed the young woman with body dysmorphic disorder (BDD).
Phillips, director of the Body Dysmorphic Disorder and Body Image Program at Butler Hospital, is one of the nation's foremost experts of BDD, in which sufferers are obsessed with perceived flaws in their appearance to the extent that it disrupts their life, and at its extreme can lead to thoughts of suicide.
Jennifer purchased clothes through catalogs, went to the food store during the middle of the night, and rarely ventured out of her parents' home during the day because she believed her skin was pimpled and scarred, Phillips wrote in her book on the disorder, "The Broken Mirror."
Once Jennifer tried to go to the store during the day, but got stuck in a traffic jam. Panicking that the other drivers were staring at her, she abandoned the car and ran to the seclusion of a telephone booth to call her mother.
"Their suffering can be so intense," said Phillips." It is clear that it is not under their control ... you just can't will yourself to stop."
In Jennifer's words: "I try not to think about it, but I have to. I think about it for most of the day. It's the first thing I think of when I wake up."
Men as well as women are diagnosed with BDD, said Phillips. Most are in their 30s and worry about their appearance up to three hours a day. Their most common obsessions concern their skin, hair and nose.
Phillips began seeing patients with symptoms of BDD as a resident at the McLane Hospital in Belmont, Mass., but she had barely any knowledge on the disorder. There were never any lectures on BDD in either medical school or residency, she said.
"I just listened to my patients. Some people came in and were extremely distraught," said Phillips. "I thought it was astounding, yet it was generally unknown ... somehow it had fallen through the cracks of our knowledge."
Once Phillips began researching the disorder, she discovered case descriptions from well-known psychiatrists going back 100 years that were remarkably consistent with the patients she was treating.
An estimated 2 percent of the population is afflicted with BDD, and Phillips said she has seen some 300 patients with the disorder. They include some as young as a 6-year-old boy who believed his teeth were yellow, his stomach was "fat," and his hair looked wrong. None of his "defects" were discernible to others.
He would brush his hair for nearly an hour each morning, and if he could not get it to look "right" he would dunk his head in water and restart his grooming routine, often causing him to be late for school, according to Phillips.
When the boy first arrived in a psychiatrist's office at Butler, he crouched to look at his reflection in the chrome on the chair, she said.
That boy, as well as some other patients, have responded well to treatment with a number of antidepressants, said Phillips. Cognitive behavioral therapy also has been a successful treatment, she said.
However, cautioned Phillips, "It is new territory - we are still very early in the research on BDD."
BDD sufferers may eventually find relief through treatment that makes Phillips' research crucial, said former colleague David Guevremont.
"It's extremely valuable," said Guevremont, of the Blackstone Valley Psychological Institute in North Smithfield. "It's clear that people who have this disorder suffer greatly and may be reluctant to seek help."
As word about the disorder spreads, the potential to identify and treat patients with the symptoms increases, said Guevremont.
Phillips is applying for a grant from the National Institute of Mental Health (NIMH) to study the effectiveness of treating adolescents' BDD with the antidepressant Prozac. Another NIMH grant already funds the same study on an adult population, a project that began in April 1995.
Doctors are also now showing increasing interest in BDD, as evidenced by the growing number of published reports on the disorder in psychiatric literature over the past few years, said Phillips.
Numerous people claiming to have BDD have contacted Phillips since her book was first published in 1996 and word of her research spread. Letters pile up on her office desk and the telephone rings with callers from as far away as England and India, relaying experiences and asking for help.
Phillips hopes that her research will ultimately "give a message of hope" to people like Jennifer, who had seen at least 15 dermatologists - most of whom had refused her treatment - before turning to Phillips.
"There are a lot of people out there suffering with this," said Phillips. "I'm sitting on mountains of data, and I want to write it up and get it out."