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Archives of Sexual Behavior

, Volume 44, Issue 8, pp 2311–2321 | Cite as

Penile Dysmorphic Disorder: Development of a Screening Scale

  • David VealeEmail author
  • Sarah Miles
  • Julie Read
  • Andrea Troglia
  • Lina Carmona
  • Chiara Fiorito
  • Hannah Wells
  • Kevan Wylie
  • Gordon Muir
Original Paper

Abstract

Penile dysmorphic disorder (PDD) is shorthand for men diagnosed with body dysmorphic disorder, in whom the size or shape of the penis is their main, if not their exclusive, preoccupation causing significant shame or handicap. There are no specific measures for identifying men with PDD compared to men who are anxious about the size of their penis but do not have PDD. Such a measure might be helpful for treatment planning, reducing unrealistic expectations, and measuring outcome after any psychological or physical intervention. Our aim was, therefore, to validate a specific measure, termed the Cosmetic Procedure Screening Scale for PDD (COPS-P). Eighty-one male participants were divided into three groups: a PDD group (n = 21), a small penis anxiety group (n = 37), and a control group (n = 23). All participants completed the COPS-P as well as standardized measures of depression, anxiety, social phobia, body image, quality of life, and erectile function. Penis size was also measured. The final COPS-P was based on nine items. The scale had good internal reliability and significant convergent validity with measures of related constructs. It discriminated between the PDD group, the small penis anxiety group, and the control group. This is the first study to develop a scale able to discriminate between those with PDD and men anxious about their size who did not have PDD. Clinicians and researchers may use the scale as part of an assessment for men presenting with anxiety about penis size and as an audit or outcome measure after any intervention for this population.

Keywords

Body dysmorphic disorder Penis size Small penis syndrome Penile dysmorphic disorder 

Notes

Acknowledgments

David Veale would like to acknowledge support from the National Institute for Health Research (NIHR) Biomedical Research Centre for Mental Health at South London and Maudsley NHS Foundation Trust and the Institute of Psychiatry, King’s College London. This article presents independent research funded by the National Institute for Health Research (NIHR).

References

  1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.Google Scholar
  2. Cash, T. F., & Fleming, E. C. (2002). The impact of body-image experiences: Development of the Body Image Quality of Life Inventory. International Journal of Eating Disorders, 31, 455–460. doi: 10.1002/eat.10033.CrossRefPubMedGoogle Scholar
  3. Connor, K. M., Davidson, J. R., Churchill, L. E., Sherwood, A., Weisler, R. H., & Foa, E. (2000). Psychometric properties of the Social Phobia Inventory (SPIN): A new self-rating scale. British Journal of Psychiatry, 176, 379–386. doi: 10.1192/bjp.176.4.379.CrossRefPubMedGoogle Scholar
  4. Crerand, C. E., Menard, W., & Phillips, K. A. (2010). Surgical and minimally invasive cosmetic procedures among persons with body dysmorphic disorder. Annals of Plastic Surgery, 65, 11–16. doi: 10.1097/SAP.0b013e3181bba08f.PubMedCentralCrossRefPubMedGoogle Scholar
  5. Drummond, M. J. N., & Filiault, S. M. (2007). The long and short of it: Gay men’s perceptions of penis size. Gay and Lesbian Issues and Psychology Review, 3, 121–129.Google Scholar
  6. First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (1995). Structured clinical interview for DSM-IV Axis I disorders. New York: Biometric Research, New York State Psychiatric Institute Department.Google Scholar
  7. Ghanem, H., Glina, S., Assalian, P., & Buvat, J. (2013). Position paper: Management of men complaining of a small penis despite an actually normal size. Journal of Sexual Medicine, 10, 294–303. doi: 10.1111/j.1743-6109.2012.02725.x.CrossRefPubMedGoogle Scholar
  8. Ghanem, H., Shamloul, R., Khodeir, F., El Shafie, H., Kaddah, A., & Ismail, I. (2007). Structured management and counseling for patients with a complaint of a small penis. Journal of Sexual Medicine, 4, 1322–1327. doi: 10.1111/j.1743-6109.2007.00463.x.CrossRefPubMedGoogle Scholar
  9. Gontero, P., Di Marco, M., Giubilei, G., Bartoletti, R., Pappagallo, G., Tizzani, A., & Mondaini, N. (2009). A pilot phase-II prospective study to test the ‘efficacy’ and tolerability of a penile-extender device in the treatment of ‘short penis’. British Journal of Urology International, 103, 793–797. doi: 10.1111/j.1464-410X.2008.08083.x.CrossRefGoogle Scholar
  10. Hrabosky, J., Cash, T., Veale, D., Neziroglu, F., Soll, E., Garner, D., … Phillips, K. (2009). Multidimensional body image comparisons among patients with eating disorders, body dysmorphic disorder, and clinical controls: A multisite study. Body Image, 6, 155–163. doi: 10.1016/j.bodyim.2009.03.001.
  11. Li, C., Kayes, O., Kell, P. D., Christopher, N., Minhas, S., & Ralph, D. J. (2006). Penile suspensory ligament division for penile augmentation: Indications and results. European Urology, 49, 729–733. doi: 10.1016/j.eururo.2006.01.020.CrossRefPubMedGoogle Scholar
  12. Moss, T. P. (2005). The relationships between objective and subjective ratings of disfigurement severity, and psychological adjustment. Body Image, 2, 151–159.CrossRefPubMedGoogle Scholar
  13. Ong, J., Clarke, A., White, P., Johnson, M., Withey, S., & Butler, P. E. M. (2007). Does severity predict distress? The relationship between subjective and objective measures of appearance and psychological adjustment, during treatment for facial lipoatrophy. Body Image, 4, 239–248.CrossRefPubMedGoogle Scholar
  14. Perovic, S. V., Byun, J.-S., Scheplev, P., Djordjevic, M. L., Kim, J.-H., & Bubanj, T. (2006). New perspectives of penile enhancement surgery: Tissue engineering with biodegradable scaffolds. European Urology, 49, 139–147. doi: 10.1016/j.eururo.2005.08.016.CrossRefPubMedGoogle Scholar
  15. Phillips, K. A. (1996). Body dysmorphic disorder: Diagnosis and treatment of imagined ugliness. Journal of Clinical Psychiatry, 57(Suppl. 8), 61–64.PubMedGoogle Scholar
  16. Phillips, K. A., Albertini, R. S., & Rasmussen, S. A. (2002). A randomized placebo-controlled trial of fluoxetine in body dysmorphic disorder. Archives of General Psychiatry, 59, 381–388. doi: 10.1001/archpsyc.59.4.381.CrossRefPubMedGoogle Scholar
  17. Phillips, K. A., Coles, M., Menard, W., Yen, S., Fay, C., & Weisberg, R. B. (2005a). Suicidal ideation and suicide attempts in body dysmorphic disorder. Journal of Clinical Psychiatry, 66, 717–725.CrossRefPubMedGoogle Scholar
  18. Phillips, K. A., Grant, J., Siniscalchi, J., & Albertini, R. S. (2001). Surgical and nonpsychiatric medical treatment of patients with body dysmorphic disorder. Psychosomatics, 42, 504–510. doi: 10.1176/appi.psy.42.6.504.CrossRefPubMedGoogle Scholar
  19. Phillips, K. A., Menard, W., Fay, C., & Weisberg, R. (2005b). Demographic characteristics, phenomenology, comorbidity, and family history in 200 individuals with body dysmorphic disorder. Psychosomatics, 46, 317–325. doi: 10.1176/appi.psy.46.4.317.PubMedCentralCrossRefPubMedGoogle Scholar
  20. Phillips, K. A., Nierenberg, A. A., Brendel, G., & Fava, M. (1996). Prevalence and clinical features of body dysmorphic disorder in atypical major depression. Journal of Nervous and Mental Disease, 184, 125–129.CrossRefPubMedGoogle Scholar
  21. Pope, H. G., Gruber, A. J., Choi, P., Olivardia, R., & Phillips, K. A. (1997). Muscle dysmorphia. An underrecognized form of body dysmorphic disorder. Psychosomatics, 38, 548–557. doi: 10.1016/S0033-3182(97)71400-2.CrossRefPubMedGoogle Scholar
  22. Rosen, R. C., Riley, A., Wagner, G., Osterloh, I. H., Kirkpatrick, J., & Mishra, A. (1997). The International Index of Erectile Function (IIEF): A multidimensional scale for assessment of erectile dysfunction. Urology, 49, 822–830.CrossRefPubMedGoogle Scholar
  23. Shamloul, R. (2005). Treatment of men complaining of short penis. Urology, 65, 1183–1185. doi: 10.1016/j.urology.2004.12.066.CrossRefPubMedGoogle Scholar
  24. Spyropoulos, E., Christoforidis, C., Borousas, D., Mavrikos, S., Bourounis, M., & Athanasiadis, S. (2005). Augmentation phalloplasty surgery for penile dysmorphophobia in young adults: Considerations regarding patient selection, outcome evaluation and techniques applied. European Urology, 48, 121–128. doi: 10.1016/j.eururo.2005.02.021.CrossRefPubMedGoogle Scholar
  25. Tignol, J., Biraben-Gotzamanis, L., Martin-Guehl, C., Grabot, D., & Aouizerate, B. (2007). Body dysmorphic disorder and cosmetic surgery: Evolution of 24 subjects with a minimal defect in appearance 5 years after their request for cosmetic surgery. European Psychiatry, 22, 520–524. doi: 10.1016/j.eurpsy.2007.05.003.CrossRefPubMedGoogle Scholar
  26. Veale, D., Anson, M., Miles, S., Pieta, M., Costa, A., & Ellison, N. (2014a). Efficacy of cognitive behaviour therapy v anxiety management for body dysmorphic disorder: A randomised controlled trial. Psychotherapy and Psychosomatics, 83, 341–353. doi: 10.1159/000360740.PubMedGoogle Scholar
  27. Veale, D., Boocock, A., Gournay, K., Dryden, W., Shah, F., Willson, R., & Walburn, J. (1996a). Body dysmorphic disorder. A survey of fifty cases. British Journal of Psychiatry, 169, 196–201. doi: 10.1192/bjp.169.2.196.CrossRefPubMedGoogle Scholar
  28. Veale, D., De Haro, L., & Lambrou, C. (2003). Cosmetic rhinoplasty in body dysmorphic disorder. British Journal of Plastic Surgery, 56, 546–551. doi: 10.1016/s0007-1226(03)00209-1.CrossRefPubMedGoogle Scholar
  29. Veale, D., Ellison, N., Werner, T. G., Dodhia, R., Serafty, M., & Clarke, A. (2011). Development of a Cosmetic Procedure Screening Questionnaire (COPS) for body dysmorphic disorder. Journal of Plastic and Reconstructive Aesthetics, 65, 530–532. doi: 10.1016/j.bjps.2011.09.007.CrossRefGoogle Scholar
  30. Veale, D., Eshkevari, E., Ellison, N., Cardozo, L., Robinson, D., & Kavouni, A. (2013). Validation of Genital Appearance Satisfaction Scale and the Cosmetic Procedure Screening Scale for women seeking labiaplasty. Journal of Psychosomatics Obstetrics and Gynecology, 34, 46–52. doi: 10.3109/0167482X.2012.756865.CrossRefGoogle Scholar
  31. Veale, D., Eshkevari, E., Read, J., Miles, S., Troglia, A., Phillips, R., … Muir, G. (2014b). Beliefs about penis size: Validation of a scale for men with shame about the size of their penis. Journal of Sexual Medicine, 11, 84–92. doi: 10.1111/jsm.12294.
  32. Veale, D., Gournay, K., Dryden, W., Boocock, A., Shah, F., Willson, R., & Walburn, J. (1996b). Body dysmorphic disorder: A cognitive behavioural model and pilot randomised controlled trial. Behaviour Research and Therapy, 34, 717–729. doi: 10.1016/0005-7967(96)00025-3.CrossRefPubMedGoogle Scholar
  33. Veale, D., Miles, S., Read, J., Troglia, A., Carmona, L., Fiorito, C., … Muir, G. (2015). Phenomenology of men with body dysmorphic disorder concerning penis size compared to men anxious about their penis size and to controls: A cohort study. Body Image.Google Scholar
  34. Wessells, H., Lue, T. F., & McAninch, J. W. (1996). Penile length in the flaccid and erect states: Guidelines for penile augmentation. Journal of Urology, 156, 995–997. doi: 10.1016/S0022-5347(01)65682-9.CrossRefPubMedGoogle Scholar
  35. Wilhelm, S., Phillips, K. A., Didie, E. R., Buhlmann, U., Greenberg, J. L., Fama, J. M., … Steketee, G. (2014). Modular cognitive-behavioral therapy for body dysmorphic disorder: A randomized controlled trial. Behavior Therapy, 45, 314–327.Google Scholar
  36. Wylie, K. R., & Eardley, I. (2007). Penile size and the ‘small penis syndrome’. British Journal of Urology International, 99, 1449–1455. doi: 10.1111/j.1464-410X.2007.06806.x.CrossRefGoogle Scholar
  37. Zigmond, A., & Snaith, R. P. (1983). The Hospital Depression and Anxiety Scale. Acta Psychiatrica Scandinavica, 67, 361–370. doi: 10.1111/j.1600-0447.1983.tb09716.x.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • David Veale
    • 1
    • 2
    Email author
  • Sarah Miles
    • 1
  • Julie Read
    • 1
  • Andrea Troglia
    • 1
  • Lina Carmona
    • 3
  • Chiara Fiorito
    • 3
  • Hannah Wells
    • 3
  • Kevan Wylie
    • 4
  • Gordon Muir
    • 3
  1. 1.Institute of Psychiatry, Psychology and NeuroscienceKings College London and South London and Maudsley NHS Foundation TrustLondonUK
  2. 2.Centre for Anxiety DisordersThe Maudsley HospitalLondonUK
  3. 3.Kings College Hospital NHS Foundation TrustLondonUK
  4. 4.Porterbrook ClinicSheffieldUK

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