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.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Tax calculation will be finalised during checkout.
Subscribe to journal
Immediate online access to all issues from 2019. Subscription will auto renew annually.
Tax calculation will be finalised during checkout.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Moss, T. P. (2005). The relationships between objective and subjective ratings of disfigurement severity, and psychological adjustment. Body Image, 2, 151–159.
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.
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.
Phillips, K. A. (1996). Body dysmorphic disorder: Diagnosis and treatment of imagined ugliness. Journal of Clinical Psychiatry, 57(Suppl. 8), 61–64.
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.
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.
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.
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.
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.
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.
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.
Shamloul, R. (2005). Treatment of men complaining of short penis. Urology, 65, 1183–1185. doi:10.1016/j.urology.2004.12.066.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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).
About this article
Cite this article
Veale, D., Miles, S., Read, J. et al. Penile Dysmorphic Disorder: Development of a Screening Scale. Arch Sex Behav 44, 2311–2321 (2015). https://doi.org/10.1007/s10508-015-0484-6
- Body dysmorphic disorder
- Penis size
- Small penis syndrome
- Penile dysmorphic disorder