Jane Brody reports today on body dysmorphic disorder.

A pioneering researcher, Dr. Jamie D. Feusner, and his colleagues at the David Geffen School of Medicine at the University of California, Los Angeles, recently found patterns of brain activity in people with B.D.D. that appeared to differ from those of others. The differences showed up in areas involved in visual processing. The more severe the symptoms, the more the person’s brain activity on imaging scans differed, on average, from normal levels, the researchers reported in the February issue of The Archives of General Psychiatry.

Winona Ryder, in Girl Interrupted, says “Crazy isn’t about being broken, or swallowing a dark secret. It’s you, or me, amplified…”  This is one of the difficult things about mental illness.  Symptoms range across of a broad continuum from mild to extreme, and it is easy to read an article like this and dismiss it by thinking everyone does that, or everyone feels this way.

In an interview, Dr. Phillips described how crippling the disorder can become for those who spend hours in front of a mirror trying to “fix” their “ugly hair” or disguise a facial blemish only they can see.

But when you re-check and re-lock your front door ten times on your way out of your house, or when your depression persists for two weeks, or when, as in this example, you spend hours in front of a mirror looking at your face, then the behavior is impacting your day to to day life and you should consider asking for help.  Crazy is about more … compulsion, rumination, obsession … “it’s you, or  me, amplified.”

Also today, Dr. Richard Friedman, muses on self-defeating behavior.

What was striking about this intelligent and articulate young man was his view that he was a hapless victim of bad luck, in the guise of unfaithful women and a capricious boss; there was no sense that he might have had a hand in his own misfortune.

I decided to push him. “Do you ever wonder why so many disappointing things happen to you?” I asked. “Is it just chance, or might you have something to do with it?”

His reply was a resentful question: “You think it’s all my fault, don’t you?”

Now I got it. He was about to turn our first meeting into yet another encounter in which he was mistreated. It seemed he rarely missed an opportunity to feel wronged.

Perhaps there is a hidden psychological reward.

The American Psychiatric Association found itself in this position when it included a category for self-defeating patients in an earlier version of its Diagnostic and Statistical Manual of Mental Disorders.

Partly in response to social and political pressure, the notion of masochistic character has disappeared from the manual altogether, even though the behavior is a source of considerable suffering and a legitimate target for treatment.