We rarely see ourselves as others see us - there are things we like about our bodies, and some we don't. Even our icons - the airbrushed movie stars and models who smile perfect smiles from magazine racks at checkout counters - often report disliking their noses or the shape of their knees. But if this insecurity about body image becomes an obsession, the consequences for the sufferer can be tragic.

The body image obsession known as BDD or body dysmorphic disorder affects as many as one person in fifty and typically begins in young people. If left untreated it can lead to impairment of functioning and even suicide, according to a study conducted at Brown University in the United States.

People with BDD not only dislike some aspect of how they look, they are preoccupied with it to the point where it is very difficult to sit down and relax with friends, or go to school or work and talk to others without thinking negative thoughts about their supposed flaws. These obsessive thoughts soon overtake the person's mind and become all he or she can think about.

Dr Katherine A Phillips, who conducted the large-scale study at Brown University, found that the disorder afflicts the sexes to a similar degree, although men and women obsess about different parts of the body. Phillips study also confirmed that most sufferers started experiencing BDD symptoms during adolescence, although in many cases the disorder remained undiagnosed until becoming more severe.

Symptoms

Young people today already have to struggle against media stereotypes of stick-thin models and men with rippled chests and bulging biceps. And for BDD sufferers, who constantly compare their appearance to others, this is a very painful and disturbing experience.

In the case of someone with BDD the dissatisfaction with their own physique may lead to serious eating disorders like bulimia and anorexia, but it can also extend to different body parts. The BBC recently reported a case in a Scottish hospital where a surgeon agreed to remove healthy limbs from patients suffering with BDD.

Studies show that people with BDD check their appearance in mirrors and shop windows constantly and regularly seek confirmation of the supposed flaw from friends and family. Clothing and make-up are used to "cover-up", and in more severe cases the sufferer will avoid social situations where the perceived flaw could be exposed.

In many cases the flaw doesn't even exist or is blown right out of proportion, and yet those with BDD will feel like absolute failures for their perceived physical defects.

Treatment

Many sufferers go to see a plastic surgeon or dermatologist rather than a mental health expert, even though the treatments will not be helpful. And in the case of doctors, it is reported that until recently BDD was often mis-diagnosed because doctors were not always familiar with the condition.

Young people especially feel so ashamed and worthless they play down the problem and parents tend to view it as just a "phase" which makes diagnosis and treatment even more difficult.

A 1998 study presented at the 106th Annual Convention of the American Psychological Association suggested that teasing also has a major impact on a young girl's body satisfaction. The researcher, Dr Gowen, proved that girls start worrying about body image at about 10 years old, much younger than previously thought. "Ten to thirteen-year-old girls who are being picked on may question what is wrong with themselves," says Dr Gowan, "and accordingly believe that if they were pretty or skinnier their peers would not tease them."

Psychiatric treatment, including medication and cognitive-behavioural therapy can be effective in decreasing BDD symptoms and the suffering they cause. The medications, including selective serotonin reuptake inhibitors (SSRIs) and fluoxetine (Prozac) can relieve obsession, decrease distress and depression, allowing the patient to function normally.

Most importantly, remember that current treatment for BDD is successful, so seek help for yourself or a friend if you feel that your behaviour or your friend's is being altered by distorted body image.

References: Dr Katherine A. Phillips, Director of Body Dysmorphic Disorder and Body Image Program at Butler Hospital, Rhode Island. Dr Gowan: Social Victimisation, Teasing and Weight Concerns in Young Adolescents. APA San Fransisco.