Many of us go to the beauty parlor in the hope of looking more attractive. A good number of us work out at the gym, hoping to tease our bodies into a more attractive shape. However, when these normal concerns become a major preoccupation with a person, it becomes a disease.

Consider this: Sandhya*, 15, cannot bear to look at the mirror. She feels the shape of her nose makes her face wholly unattractive, and is trying to convince her father to get her a nose job (plastic surgery). Sumitra, 17, is obsessive about her weight and examines herself in the mirror for at least an hour everyday. In spite of repeated assurances by her family that she is, in fact, underweight, Sumitra insists on dieting and excessive exercising. These young women are undergoing treatment for Body Dysmorphic Disorder (BDD).

People suffering from BDD are not merely preoccupied with beauty or body image; the obsession actually interferes with their social, academic and daily life functions.

BDD is a chronic condition and may lead a person to engage in extreme avoidance behaviours and might even lead to clinical depression and suicidal behaviour. BDD usually begins in adolescence - a time when people are generally most sensitive about their appearance. Although Chib is unwilling to disclose hospital data, she maintains that there has been a dramatic increase in the number of patients, especially teenagers.

While it is known to afflict both men and women, the latter are believed to be more susceptible to it since they are more under pressure to conform to prevailing beauty images and constructs.

"My daughter is obsessed with her complexion. She insists on getting facials regularly and uses a ridiculous number of creams and lotions on her face. She was a bright student but this obsession is affecting her grades. Even a slight blemish on her skin means that she will avoid meeting her friends," says Sarita Chadha, 45, mother of 17-year-old Sneha Chadha.

Psychologists believe that responding with reassurance, in fact, heightens the concern. Parents are also advised to discourage visits to dermatologists or plastic surgeons. The reasoning here is that the patient's problem does not actually lie in the body, but is the result of his/her body image. Commenting on the perceived defect - even frequent reassurance - has been observed to heighten the patient's concern.

Over the last couple of years, doctors have noticed an upswing in the number of BDD patients, especially in the teenage bracket. "This increase could be the result of increased awareness. People now know that they can change the shape of their nose if they don't like it. BDD is fuelled by the social idea of beauty as portrayed by the media and the fashion industry," says Chib.

"My son is so obsessive about his hair that he spends over an hour everyday in front of the mirror. He is always late for outings with friends because he spends so much time examining himself in the mirror. And he is hardly involved in any sport thanks to this obsession," says New Delhi-based media executive Meenal Bannerjee about her 16-year-old son.

The increasing number of reported BDD patients is essentially a reflection of society's preoccupation with appearance. In a 2000 poll by People magazine in the US, 80 per cent of women of the women sampled reported that the images of women on TV, movies, fashion magazines and advertising make them feel insecure about their looks. The poll also indicated that women feel so insecure that they are willing to try diets that pose health risks (34 per cent) or use surgery (34 per cent). A whopping 93 per cent indicated that they made various and repeated attempts to lose weight to measure up to the images.

While there is no definitive survey to show whether the Indian situation is similar, there is no doubt that the distorted - often unattainable - body images in the media do cause anxiety and insecurity among women and, indeed, men about their looks and bodies. Feminist groups across the world have been protesting against this skewed portrayal of women in media and the fashion industry. "Many mammals groom, and every culture uses adornment. 'Natural' and 'unnatural' are not the terms in question. The actual struggle is between pain and pleasure, freedom and compulsion...," wrote Naomi Wolf in her book, 'The Beauty Myth'.

Psychologists believe that a negative body image is related to low self-esteem. "To a certain extent, BDD is a fallout of low self-esteem. It is also a reflection of loss of control in some part of the patient's life. He or she usually requires counseling and, in severe cases, might require medication as well," says Chib.
It is now over a decade-and-a-half since Wolf first published 'The Beauty Myth' - making the connection between media images and the use of 'beauty' as both a demand on and a judgement of women. "The beauty myth is always actually prescribing behavior and not appearance," she wrote. Today, more than ever, her warning rings true.