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For some people body dysmorphic symptoms become so severe that they are utterly crippling. These people are absolutely convinced that a particular defect not only exists - when in other people's view it might not - but that it is such a terrible defect that it absolutely must be changed at all costs. They may try to hide it behind cosmetics or wear clothes to cover it or have plastic surgery to change it, but even then they may fail to be satisfied because the problem is actually in the mind, not in the body.

For precisely this reason, treatment has to be directed at the mind rather than at the body. Surgical treatment is a disaster. It can never achieve the change in perception that the patient needs. All it can change is the surgeon's view of the body, not the patient's. The result of surgery will always be a disappointment to these patients: it can never be exactly right. Even "before and after" photographs will be unconvincing to the patient. The problem will remain in the mind, regardless of what happened to the body. This principle is obvious and yet still physicians and surgeons, with the approval of psychiatrists, sometimes do extraordinarily inappropriate things to the body without understanding that these cannot change the mind. Pharmaceutical drugs such as anti-depressants are often prescribed in the hope that the patient will be better able to resolve emotional

issues. In the short term the patient may indeed feel better, but the solution to the underlying problem will become even more elusive, now with the added complication of the patient's belief that there will be a pill for every ill.

In the longer term the patient becomes dependent upon the medication; antidepressants are addictive even though they are slow to act and slow to produce

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