I got home from the pub the other night and was casually scanning through the TV channels, when I happened across the second half of a curiously compelling documentary.  ‘The Perfect Penis‘ was about an American psychology student who was paying $4000 to have his penis lengthened.  This is not my area of expertise, but apparently this involves cutting a ligament located in the pubis.  A lot of the penis is actually in the body and cutting this lets a bit more of it protrude. 

The next bit sounds worse: to complete the job, the gentleman must then hang a weight off his member for no less than eight hours a day for several weeks after the op.  As well as sounding painful and unbelievably tedious, the results appear barely worth the trouble, with Wikipedia quoting an increase in penis length of 2-3cm and netdoctor stating that the only study available suggested that average increase in length was 0.5cm.  

The chap who was having it done actually seemed pretty normal, although my suspicions of obsessive/narcissistic personality traits were raised by his buff physique.  I didn’t catch all the programme so I didn’t see if he had a psychiatric evaluation.  I suspect not, as it might have spoilt things and there was a bit where he was talking to this psychology supervisor, who said sensible things which were completely ignored.  We got to have a look at the ‘inadequate’ equipment towards the end of the show and it looked perfectly fine to me.  We were also told at the end of the show that the penis surgeon had recently bought a new house in which to keep his four rollers;  I couldn’t help thinking our poor boy had been done. 

Leaving no grotesque stone unturned, the documentary makers included an interview with ‘Mister Mark’.  Mark is a gentleman who has injected enough silicon in his testicles and penis to make his scrotum 1ft in circumference.  He was appeared pleased as punch about this, and even has a website called ‘extremecock.org’ dedicated to his enlarged genitals (full admission: in the spirit of ‘frontier psychiatry’ I did visit this website, but I really wouldn’t recommend it to anyone of an even slightly queasy disposition).  

If I was trying to drum up business for myself, I’d be concerned if the psychology student was suffering from body dysmorphic disorder; Mister Mark is a subject for another day.  At the end of the show it was revealed that he was unwell and that he may be suffering from a silicon embolis.

Body dysmorphic disorder (Also known as dymorphophobia) was first described by Morselli in 1886:

‘A subjective description of ugliness and physical defect which the patient feels is noticable to others, although the appearance is within normal limits.  The dysmorphophobic patient is really miserable in the middle of his daily routines, everywhere and at any time, he is caught by the doubt of deformity’

Typically the patient is convinced that some part of his/her body is too large, too small or misshapen.  This is usually a part of the face, but can be any body part.  To other people the appearance is normal or there may be some slight abnormality.  The patient may be constantly preoccupied and tormented by his/her mistaken belief;  he/she may blame all his other difficulties on it.  For instance they may think that if only their nose were a better shape then they might have a better life or job. 

There may be time consuming behaviours.  I once had a patient who was constantly late for work as he used to spend hours examining his nose in the mirror. There is substantial overlap with other psychiatric disorders, especially depression and social phobia.  At its extreme the BDD may be very disabling and may leave the patient housebound and unemployed.  In the absence of corrective operations, people have been known to take matters into their own hands, for instance using a clothes iron to remove wrinkles on their face.

The prevalence is 1% in the community. The treatment is often difficult and  surgery is usually contraindicated.  Patients usually will have unrealistic expectations and once the operation is complete their concern may transfer to another part of the body. 

Dr David Veale’s site has a BDD reference page which is worth a look.