Question

A 40 year old single unemployed man is referred by his primary care physician because of repeated consultations related to his complain of hair loss. Multiple dermatologists had evaluated the patient, found no pathology, and told him that the minimal hair loss was normal, but he refused to accept their judgement and demanded further consultations. He told one of them "everything else about me is fine. This needs to be corrected for completeness." He had become increasingly indebted financially to pay for consultations.

The most likely diagnosis is:
A. delusional disorder, somatic type
B. hypochondriasis
C. Body dysmorphic disorder
D. Paranoid schizophrenia
E. Psychotic depression

Answer 1

The 40-year-old man's fixation on his normal hair loss, rejection of multiple dermatologists' judgments, and significant financial expenditures for consultations most likely point to Body dysmorphic disorder (BDD), a mental health condition focused on imagined or slight physical flaws.

Step-by-step explanation:

The most likely diagnosis for the 40-year-old man who is preoccupied with his hair loss despite multiple dermatologists confirming that there is no pathology, is Body dysmorphic disorder (BDD). This condition is characterized by an intense preoccupation with one or more perceived defects or flaws in physical appearance, which are not observable or appear slight to others. In the case presented, the patient's fixation on his hair loss, refusal to accept medical advice, and the financial hardship he's willing to endure for repeated consultations are indicative of BDD. This disorder is distinct from delusional disorder, somatic type, wherein the individual has a fixed, false belief involving a body part that is clearly not true. It also differs from hypochondriasis which is excessive worry about having a serious illness, and paranoid schizophrenia and psychotic depression, which include symptoms such as hallucinations and delusions, but not limited to concerns over appearance.