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For some, a distorted image of themselves is a serious illness

At 20, Sarah was shy but lived a normal life. Then, when her marriage broke up a year later, she suddenly became convinced she was hideously ugly. "Sometimes I'd lie in bed all day because I couldn't face the mirrors in the bathroom," she says. "If I did go out, I'd cover my hand. If I saw myself in a mirror, I'd burst into tears and run home."

After spending $35,000 in three years on cosmetic surgery, Sarah saw a television programme about body dysmorphic disorder (BDD) and recognised the symptoms. She saw Dr David Veale, an expert in BDD, and had two months in hospital and two months of daily therapy. Today, she is coping with her condition.

BDD is an illness characterized by distorted body image - sufferers become obsessed by slight or imagined defects in their appearance.  "It's still underdiagnosed," says  Veale. "That's dangerous as there's  a high rate of suicide with it."

The condition affects one in 100  people and some experts believe the  number of sufferers is growing fast, thanks to the increasing emphasis on physical perfection in society and the media. It often starts in adolescence and can be triggered by stress, extreme teasing or sexual abuse.

It affects as many men as women, particularly those who are sensitive, perfectionist or work in an artistic field. It can take the form of a general feeling of ugliness or can revolve around a particular body part, most commonly the face. Sufferers may go to great lengths to hide their "flaw" and can develop obsessive rituals such as checking their appearance, adjusting their hair or measuring the hated body part. They can become addicted to cosmetic surgery or weightlifting.

Once established, BDD causes a change in the brain chemistry, particularly of the neurotransmitter serotonin, which regulates happiness and satisfaction. The most effective treatment seems to be a combination of cognitive therapy and a selective serotonin reuptake inhibitor drug, such as Prozac.