Monday, March 16, 2009

Surgeon Shopping

A 30 year old man makes an appointment in your surgery clinic asking you to fix his nose. He's seen five surgeons already including plastic surgeons, dermatologists, and ENTs, but they refuse to operate on him. He feels that his nose makes him look ugly, and that no one takes him seriously because of it. It's been this way for his entire life, and it's made him depressed and anxious. He can't stop thinking about it; at night, he can't sleep because of it. He says he has no past medical history, but he's been hospitalized several times for suicidal ideation. He takes fluoxetine and alprazolam. He lives alone and says that he cannot go outside in public because people keep looking at him and his nose. He's currently unemployed and gets money from his parents. They don't like his nose either. It's shown above.

What's your diagnosis?

Image licensed under Creative Commons Attribution ShareAlike License.


Alex said...

body dysmorphic disorder?

deardoc said...

body dysmorphic disorder

Craig Chen said...

Surgeon Shopping

This is body dysmorphic disorder, a preoccupation with an imagined or exaggerated defect in physical appearance that causes significant clinical distress or functional impairment and is not better explained by another illness. It is associated with other psychiatric comorbidities and suicidal ideation. The nose shown in the image is a normal nose.

Sources: UpToDate; Wikipedia.