Psychiatry Research EG

Cases of preoccupation with feelings of unbearable ugliness caused by an imagined bodily defect or grossly excessive concerns about slight physical anomalies have been well documented in psychiatric reports from industrialized countries [1–3]. This tendency has been called ‘‘Thersites’’ or the ‘‘Quasimodo’’ complex [4]. In 1891, Morselli introduced the term dysmorphophobia to describe the pathological concern with appearance [5]. The concept was variously encapsulated into the writings of Kraepelin, Janet and Freud [6]. Preoccupation with an imagined defect is currently known as body dysmorphic disorder (BDD), a somatoform disorder. Since BDD sufferers tend to be concerned with appearance and with ritual behaviours, it has been suggested it is closely related to obsessive–compulsive disorder [7,8]. Although Munro suggested BDD is independent of culture, to date there is a dearth of cross-cultural reports to substantiate this view [9]. With the exception of anecdotal reports of preoccupation with parasitosis, infestation and bromosis [10–14], to our knowledge there are no reports from developing countries of cases of preoccupation with physical appearance. This case study from Oman, an Arab Islamic country, indicates the universality of BDD. By examining illness and illness behaviours in their cultural context, it shows the way health and illness are perceived and interpreted among this sociocultural group.