A fear of mirrors that reflects anxiety, not vanity

Lily Allen's disparaging remarks about her own appearance have put the spotlight on body dysmorphic disorder, or obsession with perceived physical flaws.

The British television presenter and lifestyle coach shares her views on health and nutrition. If I had a pound for every moan that I've heard about the size and shape of tummies and wobbly bits, well, I'd be a rich woman lounging by a pool in your part of the world. It is easy to dismiss body dissatisfaction as mere vanity, a seasonal fad that tumbles into all our lives when the bikini or even Speedos are dragged out of the storage cupboard.

Recent comments by the UK singer Lily Allen made headlines around the world when she blogged about her "funny-shaped body". Her remarks are made all the more significant by the facts that she is a Chanel muse and a regular in the pages of Vogue and Elle. She says she suffers from body dysmorphic disorder (BDD), a preoccupation with a perceived defect in one's appearance. No amount of positive thinking or pep talks will convince someone with BDD that they are not ugly or disgusting. This is not the root of the problem but rather a symptom of their anxiety. The problem is not the body itself: as Allen's case proves, even a pixie-sized pop star and model can suffer with the condition. Rather, it is the anxiety and negative beliefs someone holds about her or himself that provokes the obsession with physical features.

It is easy to roll the eyes and dismiss her comments as celebrity vanity. Indeed, a recent television series, Too Ugly for Love, looked at the extremes of the disorder with heart-rending stories, yet viewer blogs still belittled many of the sufferers' problems as being solely about vanity. Ironically, it's the reverse: sufferers believe they are hideous rather than attractive. They avoid mirrors and spend hours each day worrying about being ugly. In extreme cases, they become deeply depressed and reclusive. The suicide rate for victims in the US is 45 times the national average.

And therein lies the problem. Although BDD is a serious illness it is free of physical symptoms, unlike other mental disorders such as anorexia nervosa, the result being that it can go undiagnosed and untreated for periods of approximately 15 years, according to the UK charity OCD Action, which campaigns for greater awareness of the condition. The media sometimes refer to BDD as "imagined ugliness syndrome" but for the person with BDD the ugliness is very real.

It is estimated that between one and two per cent of the world's population meet all the diagnostic criteria for BDD, but the exact cause differs from person to person. However, most experts believe it could be a combination of biological, psychological and environmental factors from the patient's past or present, with abuse and neglect being cited as possible contributing factors. One significant difference between BDD and other body-image-related problems is that it affects men and women in equal numbers. It has also been around much longer than some media would suggest. In fact, the disorder was recognised as far back as 1886, when an Italian doctor, Enrico Morselli, described what he called "dysmorphophobia". It took a further 100 years for BDD to make it into the Diagnostic and Statistical Manual of Mental Disorders.

These days, though, the solution is made more complex by the very nature of modern medicine. One problem for doctors aiming to help people with BDD is that the sufferer will often bypass the traditional support routes and head direct to the surgeon's knife. Indeed, if the funds are available, there is a real risk of a sufferer becoming addicted to cosmetic surgery. Alicia Douvall, a well-known UK model, has been under the surgeon's knife more than 100 times, even though she was diagnosed with BDD several years ago. She has said: "Every two weeks, I'll go see another doctor. Often I'll walk in not even knowing what I want doing, and say something like 'what do you think might be wrong?' or 'what do you think of my eyes?' I keep hoping I might wake up one day feeling happy with myself."