Dorian Gray syndrome

# Overview
Dorian Gray Syndrome (DGS) denotes a cultural and societal phenomenon characterized by an excessive preoccupation with the individual's own appearance  accompanied by difficulties coping with the aging process and with the requirements of maturation. Sufferers of Dorian Gray Syndrome are heavy users of cosmetic medical procedures and products in an attempt to preserve their youth. Dorian Gray Syndrome is not recognized in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).

# Definition
The Dorian Gray Syndrome is defined by a triad of symptoms combining diagnostic signs of dysmorphophobia, narcissistic character traits, and arrests in psychic maturation often seen in paraphilias. Dorian Gray patients frequently are excessive users of "medical lifestyle" products.

# History
The syndrome was first described at a symposium on lifestyle drugs and aesthetic medicine (Brosig 2000, Brosig et al. 2001, Euler 2003 et al.). The name alludes to Oscar Wildes famous novel The Picture of Dorian Gray in which the protagonist, as a handsome young man, looks at a just-painted portrait of himself and wishes that it would grow old rather than himself. He is then unable to mature, and "gives his soul away" in order to not grow old. Wilde's artistic condensation in the form of the Dorian Gray portrait both cites and transgresses narcissistic mirror motives, and eternal beauty and the process of aging and maturation are represented by the person and mirror dyad. Wilde's artistic creation serves as a background for the clinical description of the syndrome.

# Causes
Psychodynamically, an interplay between narcissistic tendencies ("timeless beauty"), the inability to progress and mature ("developmental arrest") and, finally, as a defense, the use of "medical lifestyle" products (hair growth restorers, erectile dysfunction drugs, weight loss medication, mood lifters, laser treatment of the skin, and aesthetic surgery to remove signs of the aging process) are seen. The syndrome is delineated from the concurring clinical concepts of narcissistic personality, dysmorphophobia, and paraphilia. While Dorian Gray patients display diagnostic features of these disorders, the syndrome describes a common underlying psychodynamic behind these disorders in form of a narcissistic defence against time-dependent maturation -- the seeking of eternal beauty. An estimated 3% of the total population displays features of the syndrome (compare Brosig, et al. 2005, based on a representative study of the German population).

# Diagnosis
The following operational criteria have to be fulfilled for a DGS diagnosis:
- Signs of Dysmorphophobia
- Inability to mature and to progress in terms of psychic development
- Utilization of at least two medical lifestyle offers (different areas required):
Hair growth restorers (e.g., finasteride)
Antiadiposita (e.g., orlistat)
Medication against Erectile Dysfunction  (e.g., Sildenafil)
Mood uplifters (e.g. Fluoxetine)
Cosmetic dermatology (e.g., laser resurfacing)
Aesthetic surgery (e.g., face lifting liposuction)
- Hair growth restorers (e.g., finasteride)
- Antiadiposita (e.g., orlistat)
- Medication against Erectile Dysfunction  (e.g., Sildenafil)
- Mood uplifters (e.g. Fluoxetine)
- Cosmetic dermatology (e.g., laser resurfacing)
- Aesthetic surgery (e.g., face lifting liposuction)

# Sequelae
Clinically, depressive episodes and suicidal crises are often observed in DGS patients if the utilization of lifestyle offers as mechanisms of defense is not sufficient to preserve the patient's beauty. If the defensive "acting out" character of the syndrome is not understood properly and the patient continuously uses lifestyle products without noticing the psychodynamics involved, a chronic state of depression or narcissistic emptiness can arise. In some instances, other forms of autodestruction by drug intake or surgery were seen.

# Literature
- Brosig B.(2000) The "Dorian Gray Syndrome" and other fountains of youth. Paper presented at the Continuous Medical Education Board of the  Landesarztekammer Hessen, Clinical Pharmacology Section, on 29. 4. 2000 in Bad Nauheim, FRG.
- Brosig B, Kupfer J, Niemeier V, Gieler U. The "Dorian Gray Syndrome": psychodynamic need for hair growth restorers and other "fountains of youth." Int J Clin Pharmacol Ther. 2001 Jul;39(7):279-83. PMID 11471770.
- Brosig, B., Euler, S., Brahler, E., Gieler, U. (2005) Das Dorian Gray Syndrom. In: Trueb, R. A. (Hg.) : Smart aging. Darmstadt, Steinkopff (in press).
- Euler, S., Brahler, E., Brosig, B. (2003): Das Dorian-Gray-Syndrom als ethnische Storung der Spatmoderne. Psychosozial 26, 73-89.