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The urge to change appearance in different psychopathological categories

Published online by Cambridge University Press:  24 June 2014

Joost à Campo*
Mondriaan Zorggroep, Heerlen, the Netherlands
Solange Hardy
Mondriaan Zorggroep, Heerlen, the Netherlands
Harald Merckelbach
Department of Experimental Psychology and the Faculty of Law, Maastricht University, Maastricht, the Netherlands
Henk Nijman
Forensic psychiatric hospital ‘De Kijvelanden’, Poortugaal, the Netherlands Radboud University, Nijmegen, the Netherlands
Almar Zwets
Forensic psychiatric hospital ‘De Kijvelanden’, Poortugaal, the Netherlands
Joost à Campo, Mondriaan Zorggroep, P.O. Box 4436, 6401 CX, Heerlen, the Netherlands. Tel: 31455736135; Fax: 31455741277; E-mail:



In professional literature, mainly anecdotic descriptions can be found of striking, sometimes even bizarre manipulations of the appearance by psychiatric patients.


In this study, it was examined whether the inclination to (drastically) change the appearance is related to (pre)psychotic symptoms.


By means of a questionnaire, the frequency and nature of changing the appearance was studied among a sample of healthy volunteers (n = 38) and psychiatric patients (n = 61). The psychiatric group consisted of 1) patients with schizophrenia (n = 22), 2) patients with a borderline personality disorder (n = 20) and 3) patients with a depressive disorder (n = 19).


In accordance with previous findings, self-reports of drastic changes of appearance were associated with scores on various schizotypy scales. Psychiatric patients reported more changes of appearance, compared with healthy volunteers. Patients with schizophrenia reported most changes, followed by the group of patients with borderline personality disordered.


Perhaps, drastic changes of the appearance are a visible expression of the loss of ego boundaries and/or of the sense of reality.

Research Article
Copyright © 2007 Blackwell Munksgaard

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Strawn, K, Ryken, T, Black, DW. Extreme haircutting and psychosis. Am J Psychiatry 1987;144:11021103. Google Scholar
Markowitz, J. More on haircutting and psychosis. Am J Psychiatry 1988;145:271272. Google Scholar
Ryken, T, Merrell, A. Haircutting and psychosis revisited. J Clin Psychiatry 1990;51:83. Google Scholar
Feldmann, TB, Paynter, CN. Further examination of extreme haircutting and psychosis. Am J Psychiatry 1988;145:395. Google Scholar
à Campo, J, Merckelbach, H. Schizofrene patiënten en haardracht [Schizophrenic patients and hairstyle]. Tijdschrift voor Psychiatrie [Dutch J Psychiatry] 1996;38:690695. Google Scholar
Raspa, RF, Cusack, J. Psychiatric implications of tattoos. Am Fam Physician 1990;41:14811486. Google Scholar
Birmingham, L, Mason, D, Grubin, D. The psychiatric implications of visible tattoos in an adult male prison population. J Forens Psychiatry 1999;10:687695. Google Scholar
à Campo, J, Nijman, H, Merckelbach, H. Changes in appearance and psychosis. Psychiatry 2001;64:165167. Google Scholar
Newman, G. The implications of tattooing in prisoners. J Clin Psychiatry 1982;43:231234. Google Scholar
Grumet, GW. Psychodynamic implications of tattoos. Am J Orthopsychiatry 1983;53:482492. Google Scholar
Earls, JH, Hester, R. Tattooed sailors: some sociopsychological correlates. Mil Med 1967;132:4853. Google Scholar
Gelder, M, Gath, D, Mayou, R, Cowen, P. Oxford textbook of psychiatry. Oxford: Oxford University Press, 1996. Google Scholar
Arnold, VK, Rosenthal, TL, Dupont, RT, Hilliard, D. Redundant clothing: a readily observable marker for schizophrenia in the psychiatric emergency room population. J Behav Ther Exp Psychiatry 1993;24:4547. Google Scholar
Howard, RJWM, Valori, RM. Hospital patients who wear tinted spectacles – physical sign of psychoneurosis: a controlled study. J R Soc Med 1989;82:606608. Google Scholar
Ishigooka, J, Iwao, M, Suzuki, M, Fukuyama, Y, Murasaki, M, Miura, S. Demographic features of patients seeking cosmetic surgery. Psychiatry Clin Neurosci 1998;52:283287. Google Scholar
Finney, JC, Brandsma, JM, Tondow, M, Lemaistre, G. A study of transsexuals seeking gender reassignment. Am J Psychiatry 1975;132:962964. Google Scholar
à Campo, JMLG, Nijman, H, Evers, C, Merckelbach, HL, Decker, I. Genderidentiteitsstoornissen als bijverschijnsel van psychose, in het bijzonder schizofrenie [Gender identity disorders as comorbid phenomena of psychosis and schizophrenia]. Ned Tijdschr Geneeskd 2001;145:18761880. Google Scholar
à Campo, J, Nijman, H, Merckelbach, H, Evers, C. Psychiatric comorbidity of gender identity disorders: a survey among Dutch psychiatrists. Am J Psychiatry 2003;160:13321336. Google Scholar
à Campo, J, Nijman, H, Merckelbach, H. Changes in appearance and schizotypy in normal subjects. Acta Neuropsychiatrica 2004;16:138141. Google Scholar
Chapman, LJ, Chapman, JP, Raulin, ML. Scales for physical and social anhedonia. J Abnorm Psychol 1976;85:374407. Google Scholar
Eckblad, M, Chapman, LJ. Magical ideation as an indicator of schizotypy. J Consult Clin Psychol 1983;51:215225. Google Scholar
Chapman, LJ, Chapman, JP, Raulin, ML. Body-image aberration in schizophrenia. J Abnorm Psychol 1978;87:399407. Google Scholar
Chapman, JP, Chapman, LJ, Kwapil, TR. Scales for the measurement of schizotypy. In: Raine, A, Lencz, T, Mednick, SA, eds. Schizotypal personality. New York: Press Syndicate of the University of Cambridge, 1995. Google Scholar
Compton, NH. Body-image boundaries in relation to clothing fabric and design preferences of a group of hospitalized psychotic women. J Home Econ 1964;56:4045. Google Scholar
Theberge, L, Kernaleguen, A. Importance of cosmetics related to aspects of the self. Percept Mot Skills 1979;48:827830. Google Scholar
Wilkonson-Ryan, T, Westen, D. Identity disturbance in borderline personality disorder: an empirical investigation. Am J Psychiatry 2000;157:528541. Google Scholar
Conquest, RA. An investigation of body image variables in patients with the diagnosis of schizophrenic reaction. Doctoral dissertation, Western Reserve University, 1963. Google Scholar
Fisher, S. Development and structure of the body image, Vols 1 and 2. Hillsdale: Erlbaum, 1986. Google Scholar