Body dysmorphia is the state in which we do not believe that our body looks like what it actually does look like. We may see ourselves as fat when in fact we are thin - or vice versa - or we may believe that we have a particular blemish or major defect when other people would hardly notice it, if at all.

Body dysmorphia is a state of mind, a perception deficit and, as such, is exceedingly difficult to treat. A basic feature of any addictive or compulsive behaviour is the psychopathology of denial: the sufferer does not believe that he or she has the problem in the first place and therefore sees absolutely no reason why it should be treated. This is as true of eating disorders as it is of alcoholism or drug addiction or any other addictive or compulsive behaviour. Patients with eating disorders commonly also have body dysmorphic symptoms: they do not see themselves as others see them and a feature that totally obsesses them is heard with total incredulity by other people. Thus, for people suffering from eating disorders, there is commonly the dual difficulty of being told that one has something that one does not believe one has, and also believing that one has got something when other people say one has not. One way or another, other people's viewpoints come to be totally distrusted.

Perhaps we all have body dysmorphia to some slight degree. To be totally happy with one's shape and appearance, warts and all, is probably quite rare and is a sign of considerable maturity. To be just a bit uncomfortable - perhaps about the shape of the nose, or the straightness or thinning of the hair, or the presence of a paunch or of big buttocks or of bags under the eyes, or "poor" posture - is perfectly normal. It is only when it becomes an obsession - so that the attention given to it takes away from the natural easy enjoyment of life - that it becomes true body dysmorphia.