PS49 Socioeconomic status and personality patterns in Dorian Gray syndrome as a subtype of body dysmorphic disorder

Abstract

Body dysmorphic disorder (BDD) is a heterogeneous condition within the obsessive–compulsive spectrum. The modern ‘antiageing’ trend has led to recognition of Dorian Gray syndrome (DGS) – a proposed subtype of BDD characterized by preoccupation with preventing perceived ageing signs rather than correcting specific appearance defects. This study compared psychometric, clinical and personality characteristics of patients with DGS vs. those with typical BDD. A cross-sectional comparative study included 31 patients referred for psychiatric consultation due to dysmorphic concerns at a plastic surgery clinic. Patients were divided into groups with DGS (n = 8) and without DGS (n = 23). Assessment instruments included Dysmorphic Concern Questionnaire, Yale–Brown Obsessive Compulsive Scale modified for BDD (BDD-YBOCS), Body Image States Scale (BISS), Appearance Schema Inventory-Revised ­(ASI-R), Patient Health Questionnaire (PHQ)-9, Generalized Anxiety Disorder (GAD)-7, Five Factor Personality Questionnaire, and Structured Clinical Interview for DSM-IV Axis II Personality Disorders. Statistical analysis was carried out using the Mann–Whitney U-test and Fisher’s exact test (P < 0.05). The sample comprised predominantly women (94%) and the median age was 30 years. The groups did not differ significantly in age, education, body mass index, depression (PHQ-9), anxiety (GAD-7) or BDD severity measures (DCQ, BDD-YBOCS, BISS, ASI-R). Patients with DGS significantly more often self-reported higher income levels (38% vs. 4%, P = 0.03). Histrionic personality disorder was significantly more frequent in patients with DGS (75% vs. 17%, χ2 = 7.6; P = 0.006). Patients with DGS demonstrated significantly higher extraversion scores (median 57 vs. 51, P = 0.04). Trends towards higher frequencies of narcissistic personality disorder (88% vs. 65%) and antisocial personality disorder (50% vs. 22%) were observed in patients with DGS but did not reach statistical significance. DGS represents a distinct BDD subtype associated with higher self-reported socioeconomic status, higher histrionic personality disorder rate, and elevated extraversion. These findings suggest that psychotherapeutic approaches should account for the specific personality profile of patients with DGS, particularly demonstrative traits and need for recognition. Cognitive–behavioural therapy protocols may require adaptation focusing on distorted ageing perception and realistic expectations from cosmetic procedures.