Social Physique Anxiety and Its Relation with Body Dysmorphic Disorder

Abstract

1. IntroductionHaving a realistic and appropriate mental image is necessary for a healthy and satisfactory lifestyle and adaptation to the environment. If the person has a good feeling about her/his body, s/he would have a greater chance of achieving a positive body image. Sometimes, stress and anxiety, self-criticism perspectives or a low level of self-esteem in relation to a person's body can cause some people to change their appearance and body, and try beauty and treatment and cosmetic surgery (1). Social physique anxiety is a type of anxiety, which is very important due to interaction between the body and the community. According to Hart et al. (1989), social physique anxiety is the result in response to others' assessment of their physiques. A person with this type of anxiety avoids any situation in which s/he will be physically evaluated, and has the feelings of distress and concerns regarding negative evaluation of others (2, 3, 4 and 5). People who have high levels of social physique anxiety will experience more stress during fitness tests and in fitness settings, and are less inclined to participate in physical activities. Eating disorders and low self-esteem are greatly associated with this type of anxiety (6, 7). Women are more likely than men to show higher levels of social physique anxiety and its effects (6, 10). Recently, this process has increased in men as well (11, 12, and 13). People with social physique anxiety manage their stress and anxiety in different ways (14). Researchers found that some women use stress-coping strategies, such as behavioural avoidance, short-term strategies of appearance, management, social support, cognitive avoidance and acceptance, for the management of their social physique anxiety. Many of these strategies have short-term impacts, while in the long-term they may lead to worsened and chronic anxiety (15, 16).Body dysmorphic disorder is a mental preoccupation with a slight defect in appearance or, in case of presence of minor physical anomaly, the patient's anxiety is extreme and excruciating (17). The patients often attempt to perform ceremonial behaviours such as excessive cleaning, checking themselves in the mirror, excessive use of make-up or camouflaging of their appearance with clothing or jewellery. This disorder causes social, educational and occupational performance degradation (18). In the fifth edition of the Diagnostic Statistical Mental Disorders (DSM-V), doing repetitive behaviours such as checking in the mirror, over-checking the skin and comparing appearance with others, the muscle deformity has been added as a diagnostic criterion to the other criteria outlined in the DSM-IV-TR. In this edition, the insight level of patients with BDD has been considered (19). The organs of main concern in this disorder include the skin, hair and nose; however, the disorder is not limited to these organs only and involves concerns, such as the appearance as well as other physical traits, including abnormal walking, breakouts, going bald, etc. Patients with this disorder spend on average three to eight hours, and a quarter of them more than eight hours, a day thinking about their appearance defects (19). Many of these people have no insight regarding their concern or have a low level insight (21, 22), and think that others are paying special attention to their appearance defects (23). Body dysmorphic disorder usually begins during early adolescence; however, it may occur in children or in adults as well. Studies have shown that women mostly experience the mild form of the disorder, while men will experience the more severe form of the impairment (27). The prevalence of this disorder may appear equally in outpatient mental health centres in men and women (17).Epidemiologic studies have shown the following statistics about the prevalence of this disorder (24): 2.2-13% of students, 13-16% of psychiatric patients in hospitals, 14-42% of outpatient patients with major depression, 39% of patients with mental anorexia, 9-14% of patients eager to undergo treatment via skin surgery and 3% to a half of patients keen on cosmetic surgery. …