Body dysmorphia: the tyranny of thin

It's a sign of the times when even a TV cartoon recognises that women with obvious signs of anorexia nervosa have become normalised. A recent episode of South Park had the fat boy telling the little scrawny girl: "I think you might have an eating disorder" - to which she squeaks: "Oh, gee, thanks". There is now concern among experts that the current media obsession with ultra-skinny celebrities could be pushing our natural tendency to be self-critical towards diagnosable neurotic disorder.

Body dysmorphic disorder (BDD) is a disabling psychiatric condition that causes an estimated one in 100 of the population to obsess about an imagined or minor defect in their appearance. "The large majority of people with severe BDD are preoccupied with aspects of their face," says BDD expert Dr David Veale, consultant psychiatrist at the Priory Hospital, north London. But it can relate to body shape and size and is linked to eating disorders, obsessive compulsive disorder (OCD) or addiction to cosmetic surgery.

Yet there's growing recognition, he says, that severe BDD is one end of a spectrum. A mild version of the disorder is now becoming accepted as normal behaviour, especially in women and adolescents.

"Women's perfectionist streaks are encouraged, as far as their bodies are concerned, so that they can only see their fat tummy in the mirror," says Judy Price, a therapist who runs Happyweight courses in Hastings. "Many women deliberately foster this negative approach, believing it's the best way to motivate themselves to change."

Susan Sharpe was devastated when she put on weight in her forties, going from a size 10 to a size 14. "I hated my body so much I even cancelled holidays," says the mother of two. "I never looked at myself in a full-length mirror and didn't let my husband Rob see me naked for five years. He kept telling me I wasn't that big but I didn't believe him."

The current fascination with young female celebs, who make size 4 clothes (the ultra-desirable size 00 in America) look baggy, hardly helps matters. It's currently difficult to avoid cover girls Nicole Richie (5ft 1in, 6st 1lb, according to Now magazine) or Keira Knightley (5ft 7in and 6st 10lb, ditto). The queen of celebs, Victoria Beckham, has already "consumed her own biceps and leg muscles and you have to wonder if she is now consuming her own heart muscle", says eating disorders specialist Dr Dee Dawson (in August's Grazia).

And though the magazine cover stories routinely warn of the severe health penalties, from loss of periods to premature death, that face women who "starve themselves to silly weights", the pictures are sufficiently glamorous to send out the message: skeletal is sexy.

Health experts urged the organisers of this week's London Fashion Week to ban any models whose bodies fell below the Body Mass Index figure of 18 (a BMI of 18.5 or below is classed as underweight by the World Health Organisation). This, they said, was to protect the health not just of the models themselves but of women everywhere. Madrid Fashion Week actually went ahead with a ban.

Starving is expensive. To lose periods and be at risk of premature death, Hollywood's fat-free women are dependent on weight-loss centres, spas and cosmetic surgeons. Is there any chance we can turn the tide in Britain and enjoy being a healthy, even a strapping figure of femininity?

One solution being mooted by a range of therapists is Body Aspect, a 3D-scanning device that provides an accurate picture of the female form, which can also create the imagined outline of the body that exists inside the mind.

Developed by Marks & Spencer to make properly fitting bras, the scanner was first used in healthcare by cosmetic surgeons in Yorkshire. "We were looking for an objective measure of large breasts to decide whether women should be allowed NHS breast reduction surgery to prevent backache and degenerative spinal damage leading to physical disability," says Mark Henley, senior consultant plastic surgeon at Nottingham University Hospitals. "It's not cup size that counts. It's the degree of disproportion of the breast to the rest of the body. And surgeons are not good at making that assessment.

"The Body Aspect scanner is consistent and fair. Sometimes, when women are told they are a normal size, they find this reassurance is enough to enable them to enjoy their fuller forms."

The scanner was used in exactly this way in the recent Channel 4 series How To Look Good Naked as part of a "makeover" to help women be happier with their bodies. Susan Sharpe, one of the participants, stood in a capsule where an all-round camera produced an initially distorted image of her body. "I had to say whether to add or subtract from different parts of my body: boobs, hips, arms, legs. I found out that I saw myself as over 20 per cent bigger than I actually am," she says. "It was a real shock that has changed my life. I feel so much better about myself and love dressing up and looking great."

Dr Helen O'Connor, a clinical psychologist treating eating disorders at Leigh House Hospital, an adolescent inpatient unit in Winchester, says the scanner could be beneficial. "Many of the young women I see have a distorted view of their bodies, that, when combined with other problems including low self-esteem, contribute to the eating disorder. It's very difficult to change this view and the scanner could potentially make a huge difference."

Judy Price is also keen to refer clients for a Body Aspect scan. "I have to make do with persuading women to strip off and look at themselves objectively in the mirror. It can be almost impossible to persuade women to focus on their good points."

Her most successful strategy is to ask women to recall their thoughts about their latest photos of themselves in a bikini. "Most women admit to hiding them at the back of the drawer. Then I ask them to dig out old holiday snaps and remember their reactions at the time. So many women remember being equally horrified by pictures of their bodies five, 10 or even 20 years ago - when they clearly can now see what a fine figure they presented."

When she asks them to write a list of things they like about themselves, women almost always begin with how they relate to others, she says: "It's always: I'm a good mother or a caring friend. It's very difficult to persuade them to appreciate themselves physically. And yet, it's far easier to lose weight and get healthy if you feel good about your body."

So instead of burying your holiday snaps, place them centre stage and repeat after me: "I am drop-dead gorgeous. So eat your heart out, Posh Spice."

Are you dysmorphic?

True body dysmorphia affects around one in 100 people and usually involves a perceived problem with the facial features. But in these body-conscious times, milder forms abound. Look for these signs:

* Feeling you are disgusting.

* Forever checking your appearance and frequently comparing a part of your body with other people's.

* Avoiding being seen in bright light or from certain angles.

* Attempting to camouflage the perceived defect with clothing, make-up or posture.

* Constantly grooming in order to disguise the perceived defect.

* Seriously considering surgery to correct a defect, when other people think you look normal.

For more information: BDD Foundation www.thebddfoundation.org.