Dysmorphophobia

   or body dysmorphic disorder (from 1891). Uneasiness about one’s looks is probably as old as the human condition. The French poet Baudelaire described in the late 1850s in "Scattered thoughts" ("Pensées éparses"): "The man who believes himself ugly, or who sees in himself an imaginary deformity . . . Obsession." In 1891, Italian psychiatrist Enrico Morselli (1852–1929) attached a medical term to the phenomenon, coining dysmorphophobia in an article in the Bulletin of the Royal Medical Society of Genoa (Bolletino della Reale Accademia Medica di Genova); by it he meant unrealistic fear of personal ugliness, an omnibus concept to which some authorities today now reckon anorexia nervosa. (See Body Image: Disturbances of.) He wrote in 1891, "The dysmorphophobic patient is, in fact, truly tortured: in the midst of his daily routines, of speeches, while reading, during lunch, thus anywhere and at any time of day, he is struck by the suspicion of a deformity that might have appeared on his body and without his knowledge: he fears that he has or might have his forehead pressed in and flattened [depressa e schiacciata], his nose ridiculous, his legs crooked" (p. 111).

   Morselli’s diagnosis started to receive international currency when Emil Kraepelin tucked it into the eighth edition of his textbook, the volume published in 1915. Making it part of obsessive-compulsive neuroses, Kraepelin said, "Some patients cannot rid themselves of the thought of having something conspicuous or ridiculous on their bodies, arousing the attention or ridicule of passers-by with the strangely shaped nose, crooked legs or a repellent odor" (Psychiatrie, 8th ed., IV, p. 1861). Kraepelin used Morselli’s term but did not mention Morselli himself.

   Dysmorphophobia came into DSM-III-R in 1987 as "body dysmorphic disorder (dysmorphophobia)" in the "somatoform disorders" section, "a preoccupation with some imagined defect in appearance in a normal-appearing person." The drafters did not like the "-phobia" part because the suffix suggested "phobic avoidance," which was not the case here (the patients are glued to the mirror rather than avoiding it). If the misbelief was of psychotic intensity, "delusional disorder" would be a better diagnosis, it was noted in the Manual.