觉得自己丑？你只是得了“体象障碍症”
在给大家解释“体象障碍”到底是什么之前，先给大家讲这样一个故事。
一个来自英国的叫做Alanah的女孩，她觉得自己很丑、巨丑无比：
"I thought it was cruel for other people to have to see my face, that it really is disgusting," says 20-year-old Alanah.
“我认为让其他人看到我的脸是很可怕的一件事，因为它真的是太恶心了，”20岁的阿莲娜说。
好多姑娘照镜子可能是在臭美，而她却从自己的脸上看到的全是缺点：
"I see marks all over my face, which my mum has told me that she does not see. I see my skin is just bumpy and blemished. I see my nose is way too big and crooked and sticks out too much. My eyes are too small."
“我的脸上全是色斑，但我妈妈说她看不到。我看到我的皮肤皱巴巴的而且都是斑点。我看我的鼻子不仅大而且还不直，它还那么明显。我的眼睛太小了。”
（阿莲娜）
她为了掩饰自己的那些“缺陷”，每天花四个小时化妆，可即便是这样，她出门还是会感到焦虑：
"My routine at the time was four or five layers of foundation and concealer. Eye make-up always had to be done as well, very heavy eye make-up, and it would just be constant," says Alanah. "So every little imperfection I'd have to keep touching up and keep going over and doing the same thing again and again."
“我通常会涂四层或五层的粉底和遮瑕膏。眼妆我也要化很多次，而且很浓，“阿莲娜说。”所以每一个小的缺陷我都不会放过，我会不断得涂抹，不断地化，一次又一次做同样的事情。”
现在我们再来看一下什么是体象障碍，在英文中它被称为Body Dysmorphic Disorder (BDD)，即身体畸形恐惧症，又称为体象障碍、体象畸形症，在国外有人称其为丑形幻想症、畸形恐惧症、美丽强迫症等。体象障碍是指：个体在客观上躯体外表并不存在缺陷，或者有极其轻微的缺陷，但其主观想象具有奇特的丑陋而产生的极为痛苦的心理疾病。
国外有关网站上的介绍是这样的——
Body dysmorphic disorder (BDD) is an anxiety disorder that causes a person to have a distorted view of how they look and to spend a lot of time worrying about their appearance.
For example, they may be convinced that a barely visible scar is a major flaw that everyone is staring at, or that their nose looks abnormal.
Having BDD does not mean the person is vain or self-obsessed.
请注意最后一句，患有BDD并不是虚荣或是过度自恋。
患有体象障碍——或者说BDD的人，通常最在意的外表缺陷主要体现在以下方面：
Skin（皮肤）
Face（脸）
Nose（鼻子）
Mouth（嘴巴）
Hair（头发）
Eyelids（眼睑）
Wrinkles（皱纹）
Excessive greasiness（多脂油腻）
Acne（痤疮痘痘）
Excessive facial hair（脸上汗毛过多）
Nasal size and shape（鼻子的大小跟形状）
Teeth（牙齿）
Jaw（下巴）
Breasts（胸部）
Genitals（生殖器）
Buttocks（臀部）
Lips（唇）
BDD可以严重影响患者的生活、工作和感情，可是普通人对自己的一些缺陷有时也会格外在意，那怎么区分你是正常阈值内的在意还是是BDD呢？
普特君在网络上搜到了一些BDD的症状，大家仅做参考：
constantly compare their looks to other people's
一直拿自己的外貌和别人作对比
spend a long time in front of a mirror, but at other times avoid mirrors altogether
在镜子前花很长的时间，但在其他时间内却排斥照镜子
spend a long time concealing what they believe is a defect
花很长的时间去隐藏他们自以为的那些缺陷
become distressed by a particular area of their body (most commonly their face)
对他们身体的某一部位极其不满（大多数情况下是脸）
feel anxious when around other people and avoid social situations
有人在周围时会感到很不安，会尽量避免社交场合
be very secretive and reluctant to seek help, because they believe others will see them as vain or self-obsessed
特别抵抗去寻求别人的帮助，因为怕别人觉得自己是虚荣和自恋
seek medical treatment for the perceived defect – for example, they may have cosmetic surgery, which is unlikely to relieve their distress
对那些自以为的缺陷他们会寻求医学治疗，比如，有些人会做整形手术，而这并不能缓解他们的痛苦
xcessively diet and exercise
过分的节食和锻炼
BDD大多发生在青春期，文章开头故事中的阿莲娜也是如此，当她还是一个14岁的女孩时，她是很乐意跟家人一起拍照的，但不知从什么时候，事情开始发生了变化：
"I didn't notice [the signs] at the time but looking back now I know that they're symptoms of BDD. For example, I'd be in school and I'd be very aware of my surroundings. I'd be looking around to see who was looking at me, to see who was laughing, to see who was talking," she says.
“我当时没有注意到这些迹象，但是现在回想起来我知道它们是BDD的症状。例如，我在学校的时候我会非常关注我周围的环境。我要四处看看是谁在看我，看谁在笑、谁在说话，”她说。
（小时候的阿莲娜）
"There were big windows in my school. I'd be looking in the windows to check the way I look. I'd go to the bathroom a lot more often, to mirror check."
“我的学校里有一扇大窗户。我会通过看窗户玻璃来检查自己的样子。我会经常去卫生间，对着镜子检查。”
在她15岁的时候，她开始拒绝去学校。阿莲娜的母亲开车把她送去学校，但她却不肯下车——或者说不是不肯，而是不能——这样的往返学校，有时候一天就能重复8次。
阿莲娜变得越来越孤僻，而母亲也对她的变化感到心痛：
"For the first two or three years we just didn't know what it was," says Scarlett.
“前两三年，我们还不知道这是什么，”斯嘉丽说
"From being a high-achiever, very confident, she just imploded really, couldn't get out. I had to bath her, I had to get her drinks. She was just in bed all day long.
“一个优秀、自信的孩子彻底崩溃了，可她还走不出那样的困境。我必须给她洗澡，给她拿喝的。她整天躺在床上。
"It's heartbreaking because I know every mum thinks their children are beautiful, but there is literally nothing wrong with Alanah and I think everyone can see it," says Scarlett.
“这太令人伤心了，每一个母亲都认为自己的孩子是美丽的，但事实上阿莲娜又做错什么了呢？我想大家都能明白，”斯嘉丽说。
（女人眼中的自己）
可斯嘉丽却对女儿的疾病无能为力：
"It's so frustrating, and actually now I know not to fight if she says she's ugly, I just have to not keep going on about it. It's what she sees and that's it, and I have to leave it and try to focus on other things.
“这让我感到绝望，现在我知道当她说自己是丑的时候我不要去回答，我只能跳过这个话题。她看到的就是这样的‘事实’，而我能做的就是不要理这些问题，去关注一些其他事情。
"The worse thing is that, as a mum, you're meant to protect your children and help them and I just felt totally helpless not being able to do anything for her."
“更糟糕的是，作为一个母亲，你必须要保护你的孩子，帮助他们，但我觉得自己特别无助，不能为她做任何事情。”
阿莲娜和她的妈妈花费了很长时间才诊断出原来自己是得了BDD。阿莲娜多次被误诊为青少年焦虑症和社交焦虑症，直到最后她才被伦敦南部莫兹利诊所确诊。
由此可以看出，得了这个病最可怕的是自己都不知道自己得了什么病，有些患者连自己都会疑问“也许真的是我太自恋太注重外表了？”
在国外有关BDD研究的网站上，有这样一个测试，看你是不是真的患了BDD，当然，也是仅供参考：
Asking the following 4 questions may be helpful:
1. Are you worried about how you look? (Yes/No); if you are, do you think about your appearance problems a lot and wish you could think about them less? (Yes/No)
2. How much time per day, on average, do you spend thinking about how you look? - (a) Less than 1 hour a day; (b) 1-3 hours a day; (c) more than 3 hours a day
3. Is your main concern with how you look that you aren’t thin enough or that you might become too fat? (Yes/No)
4. How has this problem with how you look affected your life? - (a) Has it often upset you a lot? (Yes/No); (b) has it often gotten in the way of doing things with friends, your family, or dating? (Yes/No); (c) has it caused you any problems with school or work? (Yes/No); (d) are there things you avoid because of how you look? (Yes/No)
Patients are likely to have BDD if they give the following answers:
Question 1 - Answer of “yes” to both parts of the question
Question 2 - Answer of (b) or (c)
Question 3 - Whereas an answer of “yes” answer may indicate that BDD is present, it is possible that an eating disorder is a more accurate diagnosis
Question 4 - Answer of “yes” to any of the 4 parts of the question
BDD为患者带来了很大的痛苦，故事中的阿莲娜根本都不知道为什么会变成这样子，据BDD基金会的主席Rob Willson所说，导致BBD 可能有以下几个原因：
Being adolescence and can sometimes be a response to bullying and teasing in teens
在青少年时期被孤立会被欺凌嘲笑
Feel different in thier teens
在青少年时期感觉自己跟被人不一样
Genetic factors
基因因素
Social factors
社会因素
Early-life experiences
早期的生活经验
Personality variables
个性因素
此外，据Wilson说，社交网络的高度发达也加重了BDD患者的病情，因为他们会忍不住去网络上拿自己跟同龄人比较，人们po在网络上的照片都经过各种ps变得“完美无缺”，从而使患者更加体会到自己的“不完美”：
"We all end up worrying quite a lot more about how we look in our teens, but specifically BDD separates itself out from everyday concerns [in that] the person would have to be preoccupied with their appearance for at least an hour a day," he says.
“我们总会都会担心自己在同龄人的眼中是怎么样的，但特殊的是，BDD会把这种担心从从每日的寻常担心中分离出来，每天花至少一个小时的时间关注自己的外貌，”他说。
（阿莲娜）
"It has to cause significant levels of distress - such as high levels of anxiety, high levels of shame or depression - and it also has to be bad enough to interfere with the person's functioning."
“它必然会给患者带来过分的苦恼——严重的焦虑、严重的羞耻感或抑郁症——而且它也足够糟糕，以至于干扰到人的正常机能。”
可怕的是，BBD除了会带来无尽的痛苦还会对患者的生命造成危险：
"It's one of the highest-risk problems of all psychiatric disorders," says Willson. "With one of the most extreme high risks of suicide, functional impairment and distress."
“这是所有精神疾病中的风险最高的一种问题，“Willson说。“伴随着极高的自杀风险，功能性缺陷和痛苦。”
整形成瘾也是这些患者的另一个体现，他们永远永远不满意自己的外表，即使达到了“阶段性目标”，他们也不会从此就开心起来，而是开始对自己身体有了新一轮的不满，处于无休止的低自尊和焦虑之中。
（韩国“风扇大妈”韩美玉，从下图一直整成了上图）
不过，在我们今天所讲的这个故事中，故事的主人公阿莲娜却通过治疗，正在慢慢的接受自己的“不完美”。
由BBC第四频道出品的一档新节目《人无完人》请来了摄影师Pankin为阿莲娜拍照，目的是提高大家对BDD的认知，并帮助他人认识到与自己相类似的症状。
在拍摄照片的那一天阿莲娜的母亲还表示她怕女儿挺不过这一关：
"I knew that she was going to tell Rankin that she doesn't like photos," says Scarlett, "but it wasn't the photos, it was herself in the photos she didn't like."
“我知道她会告诉Rankin，她不喜欢照片，”斯嘉丽说，“但不是照片的问题，她是不喜欢照片中的自己。”
对BDD患者来说最怕让别人为自己拍照，因为这“完全脱离自己的掌控”，不过即使他们自拍也不会开心，阿莲娜就曾每天自拍200多张，拍完后又一张张的删掉。
但她还是克服了内心的艰难，让别人给自己化妆，别人给自己弄头发，别人给自己拍照。
相信大家都很想知道阿莲娜对这些照片的看法是什么样的呢？
"My eyes are crossed, my hands and my arms look really big and chunky. My nose looks crooked, my face is out of proportion. I don't necessarily know if I can see myself very positively yet."
在“人无完人”中，在镜头的拍摄不久后她说：“我的眼睛是斜的，我的手和手臂看起来真的又粗又壮。我的鼻子看起来歪了，我的脸不对称。我不知道自己还能不能用积极的态度看待自己。”
（Rankin镜头下的阿莲娜）
她还是对自己不满意，然而可喜的是，随着时间的推移，她逐渐能够接受照片的自己，她把照片放在了客厅中——要知道，她以前可不是从来不允许母亲在客厅中放任何有关她的照片。
现在的阿莲娜恢复得很好，她现在在大学里学习心理学，希望读博继续攻读BDD。她还希望成为一个认知行为治疗师帮助更多患此病的人。
事实上，无论我们是不是得了BDD，都要知道人无完人，要学会拥抱自己的不完美，即使自己没有那么好，也要更努力的爱自己。
希望你每天从镜子中看到的自己都是健康的、自信的。
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