Melanie similarly described the difference between her appearance concerns and those of other people. “My concern is totally obsessive—it’s on my mind for hours a day—and it makes me miserable. Other peoples’ appearance concerns don’t make them so depressed, stop them from walking out the door, or make them unable to laugh at a joke. My concerns take all of my concentration, and they take over my life.”
Kathleen’s and Melanie’s BDD concerns echoed normal concerns echoed normal concerns, but they were more intense and severe. They worried too much, and they suffered. Many people with BDD have some additional normal concerns about their appearance, which they can usually easily differentiate from their BDD concerns.
Thus, BDD appears to differ quantitatively—by a matter of degree—from normal appearance concerns, lying at the severe end of a continuum or dimension of appearance preoccupation and dissatisfaction. But does BDD also differ from normal concerns in a more substantial and fundamental way? Is it also qualitatively different from normal appearance concerns? In other words, is there a point of rarity or discontinuity that suggests a natural cutoff point between BDD and health?
The answer to this question is probably yes. BDD does seem to differ from normal appearance concerns in ways other than its severity. One difference is that BDD appears to affect an approximately equal number of men and women, whereas studies of the general population indicate that more women than men are unhappy with how they look. In addition, surveys of the general population have generally found that people usually dislike their weight or weight-related aspects of appearance, such as the size of their abdomen, hips, or thighs. For example, in a 1972 Psychology Today survey, 48% of women were dissatisfied with their weight, 50% with their abdomen, and 49% with their hips and upper thighs. Only 11% were dissatisfied with their face. And in the 1997 Psychology Today survey I previously mentioned, 44% of women said that looking at their stomach in the mirror was very upsetting, whereas only 16% said this about their face. Among people with BDD, however, facial concerns are most common.
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