The Nose – a Case Report of Body Dysmorphic Disorder and a Literature Review

Abstract

Introduction

Body Dysmophic Disorder (BDD) is relatively common disorder. Patients with delusional beliefs seem to show greater morbidity (more suicidal attempts and drug abuse or dependence) and less likelihood of receiving treatment.

Objectives and aims

In this study, we intended to report a case of BDD followed in psychiatric consultation from 2 years ago, and to make a review of the literature, namely presentation, treatment and prognosis of BDD.

Methods

We conducted a description of a BDD case and a research using “Body Dysmorphic Disorder” keywords on Pubmed.

Results

J.F., 45 years old, unemployed, living with his father, referred to the Psychiatric consultation by his GP. The disorder started in the adolescence with an excessive preoccupation with hair loss and nose length, but in early adulthood these concerns became more important. Around 30 years old he was followed in Psychiatry but abandoned. Years later he underwent nose plastic surgery. He tried underwent other nose surgeries, but was refused. He was advised to look for psychiatric care. From the initial observation I highlight the appearance (thin, with a wig, adhesive tape connecting the tip of the nose to the forehead pulling up the nose), delusional ideas regarding the appearance of the nose, overvalued hypochondriac ideas, and no insight for the disease. The patient was reluctant in taking psychotropic drugs. He was referred to day hospital, which he attended with great irregularity.

Conclusions

BDD is a disorder with poor prognosis, especially when delusional variant is present, probably in relation to the lack of insight.

Disclosure of interest

The authors have not supplied their declaration of competing interest.