[On the clinical significance of dysmorphophobic syndrome. I. On the phenomenological characteristics of dysmorphophobic syndrome].
- M V KORKINA
- Zhurnal nevropatologii i psikhiatrii imeni S.S…
This condition has often been considered as ominous because dysmorphophobia has earned the notoriety of being considered a harbinger of schizophrenia. Bychowski (1943) gives detailed case histories of patients where changes in body image appeared in the initial phase and the psychosis crystallised around these later on. Fenichel (1945) mentions similar bodily complaints in incipient schizophrenia, interpreting this as a sign of regression to narcissism. Stekel (1950) mentions dysmorphophobic preoccupation as an illustration of obessions developing into delusions. Gilles (1958) quotes patients complaining of asymmetry of the face or deformity of the nose, when the face is in reality quite pleasing and so on. This he considers as an early sign of schizophrenia. Korkina (1951) described 41 cases, emphasizing the rarity of the syndrome-35 out of these received a diagnosis of schizophrenia. Some authors, such as Meyer-Gross, have indeed felt that all padents who hold sensitive ideas of reference in regard to their bodies or bodily functions, are schizophrenic. Anderson (1964), while stressing the diagnostic difficulty in such patients, felt that the majority were probably mild cases of the schizophrenic illness. Thus there is abundant evidence for considering dysmorphophobia to be a malignant symptom, in the sense that it may be delusional, and even if it appears to be only of the nature of an obsessional pre-occupation the case may still be one of pseudoneurotic schizophrenia. Janet (1908) opined that dysmorphophobia is something rooted in the personality. Very often such cases can not be diagnosed as neurotic or psychotic without long-term observation. Walter (1965) also stresses the difficulty in diagnosis but in another way. He contrasts the hypochondriac with the dysmorphophobicthe former wanting to draw attention to himself by saying he is not normal, the latter wishing to appear normal but feeling that other people notice he is not. However, both these conditions are liable to delusional elaboration.