Abstract
Objective: Explore the limitations of the classification of body dysmorphic disorder.
Clinical picture: A Chinese male relentlessly pursued castration to relieve painful erections which were never substantiated. The testes and corpora spongiosum had been removed. No psychotic symptom was prominent.
Treatment: Cognitive therapy and psychotropics were tried.
Outcome: The remaining corpora cavernosa was removed subsequently.
Conclusion: The distorted somatic perception and secondary cognitive amplification (painful erections) could represent a variant of body dysmorphic disorder involving internal body image; diagnostic classifications should accommodate such a category.