Body Dysmorphic Disorder, Social Media Use, Borderline and Narcissistic Pathologies

Body dysmorphic disorder (BDD) presents a significant challenge in dermatology and aesthetic care, and the rise of social media has further intensified these difficulties [1]. Mariam Trichas and colleagues offer a current overview of BDD in their article. In addition to discussing the challenges of the 21st century, they also explore the history of the disorder: the term “dysmorphophobia” originates from Morselli, and a case study by Sigmund Freud is already noted [2, 3]. When it comes to aging, the literature refers to Dorian Gray syndrome, named after the protagonist of Oscar Wilde's novel, who longs for eternal beauty and youth. The classification of dysmorphophobia has evolved over time, with Eric Hollander positioning it within the obsessive-compulsive spectrum. The Diagnostic and Statistical Manual of Mental Disorders (DSM)-III and DSM-IV classifications of psychiatric disorders categorize it among the somatoform disorders, while the DSM-5 recognizes BDD as a distinct category within obsessive-compulsive and related disorders [1, 4]. The article also highlights the alarming suicide rate, which makes the issue particularly serious. There is a limited understanding of the disorder as well. The roots of the condition must be traced back to childhood and adolescence, as this period is crucial for the development of a healthy body image [1, 2, 4]. The effects of social media, comparisons with others, and dissatisfaction with one's appearance may all contribute to BDD. In recent years, the COVID-19 pandemic and the restrictions on online social platforms have further exacerbated the problem. The use of filters not only damages self-esteem but also impacts reality testing. The authors also note that several new terms have emerged related to online platforms (e.g., webcam usage) [2]. Individuals affected by dysmorphophobia may exhibit high levels of perfectionism [4]. Individuals with skin conditions are especially vulnerable to body dysmorphic disorder (BDD) because their lesions cannot be concealed, making attractiveness and the judgments of others critically important. Additionally, social interactions can be hindered because of stigmatization. These factors lead to a situation where thoughts and focus center on skin lesions and appearance. Self-monitoring, often referred to as mirror-checking, constitutes one of the most significant forms of dysmorphophobic compulsions. Behaviors, such as doctor-shopping, which involve visiting multiple medical specialists, may also emerge [1, 4]. In addition to substance abuse, anxiety, and affective disorders, personality structure can also be impaired in patients with BDD. When the personality is significantly distorted and does not conform to societal norms, we refer to it as a personality disorder. Borderline personality disorder is marked by impulsivity, unstable relationships, and self-harm, and may be linked with eating disorders, substance abuse, risky sexual behavior, and body dysmorphophobia. The self-harm associated with borderline personality disorder can also express itself through frequent aesthetic interventions [1, 5]. Narcissistic personality disorder is also discussed in relation to BDD. It encompasses a wide range of characteristics, and contrary to popular belief, can also be found in withdrawn individuals. Narcissistic traits and personality disorders are currently the focus of lively debate, as this issue is becoming increasingly prevalent with the rise of social media. Others argue that we often attribute narcissistic traits to a person more frequently than is warranted. A common feature of narcissistic pathologies is low self-esteem, which is often compensated for by seeking positive feedback. The individual's attention is primarily centered on themselves. This forms a vicious cycle, where aesthetic interventions are reinforced by sharing results online and may also prompt others to pursue body modifications [5]. Recognizing BDD and its psychiatric comorbidities can be crucial, as their consequences can significantly impact the social interactions of the affected person, increasing the risk of suicide. The article by Mariam Trichas et al. highlights the important role of the dermatologist in this process: a lack of recognition and empathy, poor communication, and unnecessary aesthetic interventions can exacerbate the issue. The authors declare no conflicts of interest.