The Picture of Dorian Gray: A Plastic Surgeon’s View

The psychic-dynamic factors underlying the hypochondriac disorder involving an obsessive preoccupation with physical attractiveness (dysmorphophobia) and the treatment possibilities for some manifestations of this syndrome have been examined. This psychosomatic illness frequently leads to the taking of finasteride, a medication that halts the balding process in cases of androgenetic alopecia or even stimulates renewed hair growth. The nosological demarcation of the disorder requires the differential diagnosis of depressive, hypochondriac and delusionary disorders. The psychodynamics involved, as deduced from 2 case studies, takes the form of an expansion of the patients' reductionist perspective, characterized by an emphasis on external types extending to a psychogenetic attitude with regression into narcissistic fixation. The authors seek eternal youth which is a "leitmotif' of the disorder, and they apply the term "Dorian Gray Syndrome" after Oscar Wilde's novel. The treatment recommended is a course of intensive psychotherapy; often the topic of "life-style medication" must be introduced before the specific narcissistic conflicts behind the current symptoms can be treated. Show more