OCD or Body Dysmorphic Disorder

“Why wasn’t I born pretty like some people?”

“What’ve I done in my past life to be born this ugly?”

“How am I going to live with this face?”

“I’m growing older and going to be even uglier. How do I live till then? Can I just kill myself?”

“Why can those people cope with their ugly look and live like nothing happens, but not me?”

This is a defaulted case who now follow up with General Hospital due to financial constraint.

She is in her late 40s, married with two teenage sons, having long standing mood disorder, very preoccupied and worried with her look, thinking about cosmetic surgery. She thinks she’s very, very ugly, and ugly people should kill themselves.

From the outsiders’, she’s actually quite tall and has a reasonably pretty face.

When she walks on the streets and see some women who’re less attractive, she’d be thinking, “how do they live with that look? Why didn’t they just kill themselves?”

She said people teased her. Telling her not to speak to them since she’s so ugly. She can’t bear people’s remarks about her look and appearance.

Her husband and two sons are very supportive, always trying to comfort her. So are her siblings. But she couldn’t get rid of this obsession from her mind. Whether she’s doing something or not, her mind consistently reminds her that she’s ugly. She also tries to do some meditation, but that doesn’t calm her down and release her stress at all.

In a conversation with her for about 30 minutes, she asked over 10 times of “Can ugly people live? Are you sure? Really? They can live till old being so ugly? They don’t have to kill themselves? They must be suffering isn’t it? Why do they bother to live?”

Then few minutes later, she’d be asking all of these questions over again. This suggests some level of OCD, but her obsessional is to do with her look. She also appears to see things very negatively, which may indicate her dysthymic mood, if not depression. In fact when I asked her a few questions, I realized she is almost completely incapable to see things positively, optimistically, and be grateful.

This was when I gave her a task – to write down a list of 30 items “Anything I have that others MAY be jealous with”, I easily gave her over 10 examples (you have healthy limbs; your husband loves you; your sons listen to you; you’re tall; you can see; you get to arrange your time; you can taste food; there’s electricity supply at home; I’m able to pay the bills etc etc).

When she started to ask those “ugly persons should kill themselves” kind of question, I reminded her about the task, and she told me, “there’s nothing anyone will be jealous about me”, couldn’t recall any of the examples I gave her few minutes ago.

So this is a severe obsession with her own definition of “ugly look” and some degree of depression. Before we help her, what  could be the diagnosis?

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