Along with 20,000 others, I attended the Michael Jackson Memorial at the Staples Center in Los Angeles in 2009. Much has been written about the memorial already, and you can find volumes of fact, opinion, and rumor about the man himself. He was, controversy notwithstanding, a rarity. An extreme talent. Some would argue that he was “one of a kind.”

But there was something about Michael Jackson that was not as unusual as many people assumed. In fact, as many as 9 million people in the United States share this feature in common with Mr. Jackson: He was tormented by his appearance.

By all accounts, Michael Jackson suffered from an illness known as body dysmorphic disorder (BDD), a condition that often paralyzes its sufferers with shame, embarrassment, and even disgust. So much so that more than 75% of those with BDD seek out either plastic surgery or dermatological treatments in order to change their appearance.

Michael Jackson was not the only one. He was just perhaps the best known one to struggle with this form of body hatred. Only someone with BDD would be able to understand the depth of discomfort that he may have experienced when he looked in the mirror.

BDD is defined by the American Psychiatric Association as “a preoccupation in some imagined defect in personal appearance, or an excessive concern with a minor physical irregularity. The preoccupation causes significant distress or impairment.” And it doesn’t matter whether the perceived defect is real or imagined. Either is possible with BDD. Whether it is the texture or color of one’s skin, the texture or color of one’s hair, the shape or length of one’s nose, the shape or color of one’s eyes, or even a complaint about one’s stomach, thighs, or buttocks, the distress from BDD can be so severe that early three-quarters of people with the condition feel like dying and nearly one-quarter actually try to kill themselves.

The casual observer may not notice the acne, or the scar, or the wrinkle, the facial asymmetry, or the skin discoloration. But to the person with BDD, it may be all they think about. Experts have found that BDD patients spend anywhere from three to eight hours a day thinking about the aspect of their appearance that plagues them. To try and compensate for their perceived ”defect,” people with BDD may try a number of different routes: pick at their skin until it bleeds, try to camouflage their imperfections with make-up, check the mirror frequently, seek reassurance excessively, wear disguises, skip-out on social events, and the like.

Not every case of BDD is severe. In fact in many cases, you would never know if a person had BDD. Certainly few cases of BDD gain the notoriety that Michael Jackson’s did. Nevertheless, BDD is a very real condition. It is a recognized illness, and it inflicts a great deal of personal and interpersonal pain.

Not that BDD explains all of the eccentricities that we all observed with Michael Jackson. It probably doesn’t even come close. But understanding even this much about the famous “Man in the Mirror,” an oft-changed face that was recognizable in perhaps nearly every country of the world, may at least shed some more light on the complexity of the one who would be called The King of Pop.

You can learn more about BDD in my book 100 Questions and Answers about Anorexia Nervosa or from the resource entitled The Broken Mirror by Katherine Phillips.