A Distorted Image

For more than a decade, Tim Costello has been obsessed with having the perfect washboard stomach. The 42-year-old mail carrier from Long Island, N.Y., who still lives with his parents, has only one goal. "I want perfection. I don't want to settle for less," said Costello.

48 Hours Correspondent Troy Roberts reports.

"This has destroyed my life," he said. "As embarrassing as it is, I haven't had a date in 15 years. Thank goodness to my religious convictions, I'm still alive. I would have killed myself."

Costello is one of an estimated 5 million Americans who suffer from body dysmorphic disorder, or BDD. Those who suffer from BDD are obsessed with an imagined physical defect. When a person with BDD looks in the mirror, he or she sees a distorted image.

For Costello, his stomach was his obsession. He was so sensitive to being touched there, he couldn't tolerate a pair of normally fitting pants and wore a too-large size 38. Today, even when he hugs his mother, there is no stomach contact.

Although he was diagnosed in 1997, Costello waited two years to get treatment.

"As men and women have gained economic equality, men's handsomeness has become more important in society," said Dr. Fugen Neziroglu, who first diagnosed Costello.

After two weeks, Costello made progress. He was forbidden from wearing the size 38 pants and submitted to a more reasonable size 34.

On doctor's orders, everything around Costello's waist was made tight. Over and over, Costello's trainer touched his stomach. "I don't like that at all. I actually just want to hit them, but these guys are too big," Costello said at the time.

After three weeks, the therapy seemed to be working.

he said. "And for a while I was just waiting for a train to come down and run me over."

David Balfour has also struggled with BDD for decades. Balfour's case is so extreme he can't hold a job. Balfour's obsession with his nose began when he was a teen-ager. "To me, the bump on my nose made my nose look as big as my whole head," said Balfour, now 32.

Balfour couldn't pass a mirror without looking at himself. "I would spend between seven and eight hours a day (at) the mirror, every day," he said.

He begged his parents to pay for plastic surgery, but they refused. So a decade ago, when he was 21, Balfour did something drastic to get the nose he wanted. "I took my glasses off, and I actually smashed my nose, right here, to get rid of the bump," he said.

He had emergency surgery on his nose, but he was still unsatisfied. So Balfour had another rhinoplasty.

Dr. Eric Hollander, of New York's Mt. Sinai Hospital, had treated David for two years. "He's a very ill individual, and he's been ill for some time," explained Dr. Hollander. "There seems to be a chemical imbalance in the brain. A disturbance of the chemical messenger called serotonin that seems to be involved in patients getting stuck on things."

And Dr. Hollander has extensively studied the effects of drugs in treating the disorder. "Most patients with body dysmorphic disorder are initially treated effectively with medicines that work on the serotonin system," Dr. Hollander said. Both Balfour and Costello are taking this medication.

Seventy percent of the patients in Dr. Hollander's most recent study, who received both therapy and drugs, are improving.

For seven weeks last year, Costello tried to undo the damage from the mysterious disorder that has controlled him for two decades. "I just feel like I'm a worthless slob. And you know, I never think about anything but the body," says Costello. "I saw my stomach in the mirror, and I went berserk."

Dr. Mulcahy made Costello wear padding to show him his stomach isn't as big as he thinks it is. Costello is learning that people will still accept him even if he isn't perfect.

"I'm actually getting out of bed now, putting on pants and a shirt, actually just trying to be more sociable, going out and being with people, doing different things. I'm out of my room. I guess I'm out there with the normal people," he said.

Balfour wants to get better, too. "If I had one wish, I would just wish for peace in my brain. I would wish for the BDD to go away. I would wish for just happiness and just peace," Balfour said.

Since 1999, Balfour has tried several courses of therapy, and none have worked. He is now taking Ultran, an opiate-based drug. He says it takes the edge off his anxiety but does nothing for his BDD. He has yet to try some experimenal treatments that may help him. Dr. Hollander, however, believes that the drug is having a more positive effect than Balfour admits.