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The Adonis Complex: The Secret Crisis of Male Body Obsession

Volume 2, Number 2, 2000

Authored by: Harrison Pope, M.D. Katherine Phillips, M.D. and Robert Olivardia, PhD
Publisher: Free Press, New York, NY, 2000.
Reviewed by: Robert Yoho, M.D.

As a former primary care physician with a significant personal interest in psychology and psychiatry, I have long observed, with perhaps a more sophisticated eye than some surgeons, a significant psychological pathology in some cases in the cosmetic surgery patients I treat. Particularity, the hair transplant patients frequently have an obsessive quality in their ruminations about their appearance. The amount of time devoted to this issue in academic conference by cosmetic and plastic surgeons is almost nil.

After reading The Adonis Complex, a book written for the layman, the issue surrounding these patients snapped into focus for me. It is my belief that as physicians we are responsible for more than just the cosmetic appearance of our patients; we are responsible to some degree for their psychiatric health.

In any case, these patients fit into one small corner of the DSM-IV. The following is a quote from "Diagnostic Criteria for Body Dysmorphic Disorder": "... preoccupation with an imagined defect in appearance. If a slight physical anomaly is present, the person's concern is markedly excessive. The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. The preoccupation is not better accounted for by another mental disorder."

This disorder is a variant of, or closely related to, obsessive-compulsive disorder. The patients spend multiple episodes per day thinking about their imagined or exaggerated defect. Body areas that cause distress among men with dysmorphic disorder include hair (more than 50%), forehead, eyebrows, nose, chin, neck, hands, feet, stomach, genitals, legs, and several other areas, including weight and body build.

The fascinating descriptions of these patients match my clinical experience. One man, who was chronically preoccupied that his hair was getting thinner, would feel compelled to stand in front of the mirror for 15 or 20 minutes, meticulously examining his head to see if he had lost any hair in the last 24 hours. Often, during the course of the day, he would have to interrupt what he was doing to find a mirror to re-examine his head. He realized that his worries and compulsive behaviors were excessive, but he couldn't turn them off. He had seen several therapists of different types over the years, but none had seemed to help. In fact, his obsessions about hair loss had been growing steadily worse, and he admitted that on a bad day his "mirror time" could approach 2 hours. This patient was treated with SSRI-class antidepressants (Prozac-type) and responded after 6 weeks. The patient said, "Over the last couple of weeks, practically all my preoccupation with my hair went away. It just lifted — like a cloud. It used to be that when I opened my eyes in the morning, the first thought in my head would be about my hair, and the thoughts would continue all day long until the last minute when I closed my eyes at night. Now the thoughts are almost gone. I can actually think about how it's a nice day outside. Why didn't someone give me this stuff before?"