Why do I always feel like I don’t look good

  ”Doctor, look at this young lady, she looks so good-looking, but she was hospitalized because she felt that she was not beautiful enough.” As soon as she entered the ward on Monday morning, Qi Qi, the patient in charge of me, pulled another girl in her twenties. come before me.
  This girl is about 1.7 meters tall, with big almond-like eyes, thick eyelashes that flicker, a straight nose bridge and a pointy chin that are almost perfect, somewhat similar to a popular female star, although there are traces of “processing” , The expression is also quite melancholy, but it is really good-looking.
  Later, this beautiful young lady became my supervisor’s patient. Her name is Xiaoxuan. She is a college student, but she took a year off from school because she was in a bad mood. From her parents’ point of view, Xiaoxuan’s mood was often gloomy after she reached puberty. Originally lively, cheerful and lively, she became inferior and silent, always feeling that she was ugly. The parents thought that the whole body would restore Xiaoxuan’s original temperament, but after several surgeries, she still could not regain her confidence and optimism. She didn’t even participate in social activities until she didn’t go to school. She was lying in bed almost all day, not even wanting to eat, and even claimed that she had no hope, no future, and no longer wanted to live.
Why is she a beautiful young lady in the eyes of others, but she feels ugly to herself?

  The family realizes that there may be something wrong with Xiaoxuan’s psychology. So, after several turns, Xiaoxuan was admitted to the psychiatric ward. After our examination, Xiaoxuan met the diagnostic criteria for a depressive episode, including three core symptoms, namely low mood, loss of interest and pleasure, easy fatigue, and seven additional symptoms: decreased attention, decreased self-evaluation and self-confidence, and sense of worthlessness. , Pessimism about the future, suicidal behavior, sleep disturbance, loss of appetite.
  The diagnosis of depression is clear, but after antidepressant treatment, will Xiaoxuan be able to live her own life like other girls of the same age?
  I’m not so sure. Because at the same time, Xiao Xuan’s attention to appearance is also unusual, which is different from ordinary depression patients.
  According to her family, Xiaoxuan is not very beautiful, but her appearance is middle and upper class among her peers. She has studied dance and cello since she was a child, and her body and temperament are also very prominent. Xiaoxuan here is the deduction item. They really couldn’t understand why Xiaoxuan thought she was ugly and had low self-esteem.
  In the conversation with Xiaoxuan, she mentioned that a few years ago, the video of the school’s theatrical performance was put on the Internet, one of which was Xiaoxuan dancing solo. Several netizens commented that “the dance can be done, but it’s a pity that she looks a bit unworthy of the audience”, and openly discussed Xiaoxuan’s small eyes and a slumped nose. Xiaoxuan was deeply stabbed. After that, she began to spend a long time looking in the mirror every day, staring at her eyes, nose and chin all the time, and the more she looked, the more ugly she felt. Even ashamed of her previous ignorance, she was very distressed and began to avoid gatherings with classmates and friends. In order to hide these “defects”, she also deliberately blocked her face with her hair, put on makeup before going out, put on big sunglasses and a mask, and refused all performances.
  Xiaoxuan was inspired by a classmate who cut her double eyelids. She thought that she could also use cosmetic surgery to change the “defects” of her appearance. After soft grinding and hard foaming, the family agreed and took Xiaoxuan to the plastic surgery hospital for canthoplasty and double eyelid surgery. But she felt that the operation did not achieve the expected results, and her eyes were still ugly, even uglier than before the operation! I couldn’t even stop crying. Seeing the unhappy Xiaoxuan, the family was also very anxious, so they coaxed Xiaoxuan to say that if they are not satisfied, we will go to surgery.
  As a result, Xiaoxuan began to enter and leave the plastic surgery hospital frequently. From the beginning of cutting double eyelids, opening the corners of the eyes, adding eyelashes, to rhinoplasty, chin padding, and then to the appearance of a female star. But with more and more “moving” places, Xiaoxuan was not as satisfied as expected. She always felt that the operation was not ideal and did not achieve the expected results. She thought she was ugly and couldn’t even get plastic surgery to help her, and she felt hopeless because of it.
Based on these circumstances, another disease surfaced – body dysmorphic disorder

  Patients with body dysmorphic disorder often pay too much attention to the face and body, and the pursuit of beauty requires perfection. Normal-appearing people perceive their appearance as flawed, or are overly concerned about minor physical problems, which cause significant personal distress or interfere with socio-professional functioning. Its diagnostic criteria are as follows:
  Preoccupation with one or more perceived or perceived minor or unobservable physical defects or imperfections.
  During certain periods of time in the course of the disorder, individuals exhibit repetitive behaviors (eg, looking in the mirror, excessive grooming, skin scratching, seeking affirmation) or mental activities (eg, comparing their own and others’ appearance).
  This preoccupation causes clinically significant distress, leading to impairment of social, occupational, or other important functions.
  Appearance preoccupation is not better explained by other diseases.
  Body dysmorphic disorder mostly begins in adolescence or early adulthood, with a prevalence of 1.7%-2.4% in the general population, but due to low recognition rates, it can take a decade or more to diagnose and receive appropriate treatment. Nowadays, more and more people are pursuing cosmetic surgery, and there are many patients with body dysmorphic disorder in this army of cosmetic surgery. A survey has found that the incidence of body dysmorphic disorder can reach 3.2%-53.6% in plastic surgery people, and the results of plastic surgery for such people are often unsatisfactory, just like Xiaoxuan.
So, how is body dysmorphic disorder formed?

  It is currently believed that body dysmorphic disorder has biological, psychological and environmental factors.
1 Biological factors

  Body dysmorphic disorder and obsessive-compulsive disorder share a common genetic basis, with 65% of related phenotypes explained by common genetic factors, and the prevalence of obsessive-compulsive disorder in first-degree relatives of patients is higher than in the general population.
2 psychological factors

  The cognitive-behavioral model hypothesis states that looking in a mirror or a thought about one’s own appearance activates a mental image of one’s own ugly appearance, and then selectively focuses and magnifies the part of the appearance flaw or defect, and believes that this is also how oneself looks in the eyes of others , which ultimately led to a distorted assessment of appearance. The more Xiaoxuan looks in the mirror, the more ugly she feels, which is related to this. Behavioural theory holds that adverse experiences related to an individual’s appearance are unconditioned stimuli that elicit unconditioned negative emotional responses, and when associated with certain parts of the body, evaluations about those body parts also become negative. sex. Netizens’ evaluation of Xiaoxuan’s appearance can also be regarded as an unconditioned stimulus, making it ugly.
3 Environmental factors

  Including childhood trauma and adverse life events may interfere with an individual’s normal psychological development, leading to negative attitudes toward certain parts of the body later in life. Some physical traumas can also lead to unnecessarily excessive attention to appearance.
  All in all, for Xiaoxuan, drug treatment and psychological treatment are necessary, and long-term continuous treatment is also necessary to reduce recurrence.