A 2007 study published in Primary Psychiatry found that about 80 percent of people suffering from body dysmorphic disorder “experience lifetime suicidal ideation and 24% to 28% have attempted suicide.” 
 
 While various experts, including plastic surgeons and psychologists, have cautioned against Snapchat dysmorphia, Vashi said it is unlikely that people will change their behavior in the near future. People who have BDD tend to obsess over their appearance and body image, often checking the mirror, grooming or seeking reassurance for many hours a day, the clinic said. For example, in studies that used the 36-Item Short Form Health Survey, mental health-related quality of life was markedly poorer than for the general population, and even poorer than for patients with diabetes, a recent myocardial infarction, or clinical depression.18 
 
 SUICIDALITY IN BODY DYSMORPHIC DISORDER Suicidal Ideation and Suicide Attempts in Body Dysmorphic Disorder Over the past century, patients with BDD have been described as being so distressed over their “ugliness” that they thought about, attempted, or committed suicide.13,19–22 For example, one young woman who obsessed about perceived lines under her eyes said, “I am constantly thinking about them, about my face and how I have changed. Life is not worth living.”19 Like this woman and other patients described in earlier reports, a patient seen by the author of this article was so distressed by her supposedly “large” nose, “ugly” hair, and “small” breasts that she considered suicide. 24 The Italian study contained a clinical outpatient sample,15 and the study from England consisted of clinician referrals and self-referrals in response to media articles on BDD.11 The German study was a nationwide survey with participants representative of the general population; 42 individuals were diagnosed with BDD.2 The two US studies found a high rate of lifetime suicidal ideation (81% and 78%) even though the mean age of subjects was only in the early 30s. TABLE 1 Suicidality Variable Non-Epidemiologic Samples Epidemiologic Sample US (n=307) US (n=200) Italy (n=58) England (n=50) Germany (n=42)† Suicidal ideation 81% 78% – – – Suicidal ideation due to BDD‡ 68% 55% 45% – 19% Attempted suicide 24% 28% – 24% – Attempted suicide due to BDD‡ 15% 13% – – 7% Number of suicide attempts§ 2.1±1.4 3.2±4.1 – – – Number of suicide attempts due to BDD‡,§ 1.2±1.4 1.2±3.0 – – – Open in a separate window Studies have found that 24% to 28% of individuals with BDD have attempted suicide ( ). Two Cases of Completed Suicide The two cases described here were participants in the previously noted prospective BDD interview study.24 Both individuals were receiving treatment at the time of their death. TABLE 3 “Are you very worried about your appearance in any way?” or, “Are you unhappy with how you look?” If the patient replies affirmatively, proceed as you would with any other illness, asking the patient to tell you about his or her concern, eg, “What don’t you like about how you look?” or, “What is your concern?” Ask if there are other body areas they do not like, eg, “Are you unhappy with any other aspects of your appearance? Are these or any other body areas a concern for you?” Next, determine whether the patient is preoccupied with the perceived appearance flaws by asking, “How much time would you estimate that you spend each day thinking about your appearance, if you add up all the time you spend during the entire day?” or, “Do these concerns preoccupy you?” Thinking about the perceived flaws for a total of at least 1 hour per day is consistent with the diagnosis of BDD. CBT for BDD usually includes cognitive restructuring to identify cognitive errors and develop more accurate and helpful BDD-related thoughts and beliefs, as well as advanced cognitive techniques which focus on core beliefs; behavioral experiments to test the accuracy of BDD beliefs; exposure to avoided situations such as social situations; and response prevention to decrease compulsive behaviors such as mirror checking (S Wilhelm, PhD, unpublished data, 2007).3,62 Daily CBT homework should be assigned.
– Think you look better in your latest selfie than in real life? Then beware of "Snapchat dysmorphia," a newly dubbed term for people seeking plastic surgery to mimic their appearance in filtered selfies, the San Francisco Chronicle reports. "Sometimes I have patients who say, 'I want every single spot gone, and I want it gone by this week or I want it gone tomorrow,' because that's what this filtered photograph gave them," dermatologist Neelam Vashi tells the Washington Post. "They check off one thing, and it's gone. That's not realistic. I can't do that." Researchers say the fixation may be a new version of body dysmorphic disorder (or BDD), a mental ailment that makes people obsess over any perceived flaw in their appearance. A 2017 survey of plastic surgeons first spotted the trend, which is fueled by photo-filtering and editing technology once available only to celebrities. "This is an alarming trend because those filtered selfies often present an unattainable look and are blurring the line of reality and fantasy for these patients," according to an article in the JAMA medical journal co-written by Vashi. What's more, BDD is a serious mental disorder that can require cognitive behavioral therapy and medication—and lead to suicidal thoughts in 80% of sufferers, per a 2007 study. Just seeing an unfiltered image of oneself "can bring feelings of sadness" for some people, says Vashi, "and then if one really develops this disorder, that sadness clearly progresses to something that can be dangerous and alarming."