Preoccupation with an imagined physical deformity may be determined by cultural concerns about physical appearance and the importance of physical self-presentation (DSM-IV, 1994, p. 467; Castillo, 1997). For example, among some Hispanics "thinner" is associated with being "sick," whereas "hefty" is perceived as "healthy." Among many Anglo-Americans, the opposite is the accepted belief. In this context, a Hispanic client confronting these two conflictive beliefs in the North America culture would be very concerned with a "defect" involving his or her physical appearance in public. This concern, however, might be culturally appropriate in the sense that this client would be responding to racial discrimination and humiliation directed toward an individual's appearance, which differs from those expected in the North American culture.
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