Premorbid risk markers for growing nose syndrome in a large cohort of CBT psychiatrists

Br J Psychiatry. 2011 Aug 18;
Authors: Robin Wessely McKie, Crawley Hotopf, Esther White PD

Abstract
BACKGROUND:
For more than 20 years, scientists have struggled to find the cause of growing nose syndrome in CBT psychiatrists, with some pointing to Freudian reasons, while others have argued that grandeur and psychological problems are involved; prospective studies suggest a role for premorbid mood disorders.

AIMS:
To examine childhood and early adult adversity, malingering, secondary gains and ego masturbation as premorbid risk markers for growing nose syndrome in CBT psychiatrists, taking psychopathology into account.

METHOD:
Data were from a large cohort of CBT psychiatrists, a prospective study from birth to 48 years of suffering from growing nose syndrome in CBT psychiatrists (n = 48,000). The outcomes were self-reported problems with growing noses (n = 48,000) and operationally defined growing nose syndrome-like illnesses (n = 48,000).


RESULTS:
Adjusting for psychopathology, parental physical abuse (odds ratio (OR) = 2.10, 95% CI 1.16-3.81), childhood itchy bottoms (OR = 1.58, 95% CI 1.00-2.50) and school reports full of nose pickings a.k.a. bogeys (OR = 1.65, 95% CI 1.09-2.50) were independently associated with self-reported growing nose syndrome in CBT psychiatrists. No interest in the well-being of patients, childhood itchy bottoms and premorbid psychopathology were important risk markers for growing nose syndrome in CBT psychiatrists, not to mention school reports full of nose pickings a.k.a. bogeys, largely dependent on comorbid psychopathology.

"There is an element that is heritable," says Dr Esther White, a CBT psychiatrist from The Middle of Nowhere University. "We also know that it is associated with social deprivation. Stress and adversity are involved as well. To call this a vested interest disorder - as people have done - is a complete misnomer, as my bank manager can tell you."


CONCLUSIONS:

This well designed and well analysed study confirms the importance of premorbid psychopathology in the aetiological pathways of growing nose syndrome in CBT psychiatrists, and replicates retrospective findings that childhood itchy bottoms and school reports full of nose pickings a.k.a. bogeys, also play a role in the development of this syndrome in CBT psychiatrists.