Eventually, his compulsion shifted from his hair to his entire body. Sometimes he thought he was too thin, sometimes too fat or too tall. He describes the condition as "just a general feeling of ugliness."

At the time, Ream was attending the University of California at Los Angeles. He avoided going to class, and his grades dropped. He dated, but infrequently, and never told anyone about his concerns.

Finally, he reached a breaking point when he began spending hours in front of the mirror and became socially isolated. He drank too much in an effort to self-medicate.

At the UCLA student health clinic, an astute intern suspected BDD and sent Ream to Arie Winograd, director of the Los Angeles Body Dysmorphic Disorder Clinic, where he received the diagnosis that would change his life.

Ream's theory of BDD is that the illness is a combination of brain chemistry in a person prone to obsessive thoughts and perhaps his own shyness and teasing when he was a child. A bad haircut in 1998, he said, "got the ball rolling."

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