The majority of patients with this disorder experience extreme distress for their supposed deformity, often describing their preoccupations as "intensely painful", "excruciating", or "devastating." Most find their preoccupations difficult to control, and make little or no attempt to resist. As a result, they often spend many hours a day to think about their "defect" and how to remedy them (sometimes resorting to cosmetic surgery or self-manipulation that can worsen the situation), so that these thoughts may dominate their lives. This phobia is seen mostly in adolescents of both sexes and is closely linked to changes in the age of puberty. If these phobias affect adults it is more serious, because by the end of adolescence, the person should acquire a sense of confidence in itself would allow it the opportunity to relate harmoniously with others, without being afflicted by inferiority complexes bound physical appearance. Hence the inability to weave balanced social and sexual relations, resulting in social isolation, aggressive drives and dystonia related to sexuality. The phobia interferes with the individual's normal routine, occupational functioning, or with school or with social activities and relationships. The discomfort becomes increasingly limiting. The person may develop obsessive behaviors harmful to their health, as, in severe cases, anorexia nervosa or bulimia, self-mutilating behavior (using razor blades, needles, scissors, etc.).