Mirror mirror

Most of us are probably unhappy with some aspect of our appearance - for me, it's the bump in my nose and the ridiculously narrow shoulders that mean clothes don't sit properly and I'm forever hitching up handbag and bra straps. The majority only think about such 'flaws' occasionally, though; any discontent is transient and has no significant impact on day-to-day life.

For those with Body Dysmorphic Disorder (BDD), however, concern about their looks may be so great that it prevents any kind of normal functioning. 

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BDD is an OCD related condition in which sufferers are preoccupied with one or more elements of their appearance. This preoccupation is usually with a non-existent 'issue' that others wouldn't notice - though it can also be with something normal, like male pattern baldness - but which makes the sufferer feel ugly or unattractive.

As a result, they engage in rituals, such as repeatedly checking themselves in the mirror, or take measures to conceal the perceived defect - wearing shapeless or heavy clothes, or applying thick make-up. Some even resort to unnecessary cosmetic or dermatological procedures. They may also restrict their activities, to avoid being seen, possibly to the point of becoming housebound.

For a diagnosis of BDD, this preoccupation needs to occupy at least an hour a day and to cause significant distress and/or interfere with ordinary living. It's not a question of vanity; sufferers genuinely believe they are ugly or somehow defective. The problem can be so serious that some are driven to suicide.

About 10% of people diagnosed with OCD also have BDD, but research is still needed to identify its causes. It's unclear, therefore, how much cultural influences may contribute to its development.

Recent editions of the Channel 4 documentary series Bodyshockers have made me wonder, though, whether as a society we aren't steering whole generations onto a path that might lead to this condition.

The programme follows people who have had their bodies modified by tattoos, piercings or cosmetic surgery. Those who regret these modifications, and want to reverse them, are introduced to others who are contemplating similar work.

One show involved a girl in her early 20s who was obsessed with the size of her breasts. The fact that they were - in her eyes - too small was all she could think about and she was determined to have augmentation surgery. Her mother was devastated at the prospect - and uncomprehending, as she had tried to bring her daughter up to understand that there were more important things in life than looks. Unfortunately, all of the girl's closest friends had undergone the same procedure, making it the norm and her the odd one out.

In another show, an 18-year-old girl obsessed with taking selfies had filler in her face to make her eyes less baggy. Yes, at 18. I would have laughed, if I hadn't felt so much like crying.

Our increasing obsession with looks is leading more and more people to have unnecessary procedures and surgeries, and it's hard to imagine how we might ever turn the clock back on this disturbing trend, which has already caused so much mental and physical damage.

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You can find out more about BDD from the Body Dysmorphic Disorder Foundation.