Being seen or being watched? A psychoanalytic perspective on body dysmorphia

The focus of this paper is on individuals who present as excessively preoccupied with their body, perceiving some aspect(s) to be 'ugly' such that they feel compelled to alter and/or conceal this 'ugly' body part. These difficulties are understood as symptoms of an underlying narcissistic disturbance. The author suggests that the relative pervasiveness of an identification with a 'super'-ego accounts for the degree of severity of the disturbance (increasing the compulsion to alter and/or conceal the hated body part) and that it has implications for the patient's accessibility in analytic treatment. Understanding the vicissitudes of the development of the body-self in the context of the earliest relationship with the 'object of desire' is core to helping these patients because of the quality of the identifications that ensue and that are then enacted the transference.