Although dysmorphophobia, a subjective feeling of ugliness in a person of normal appearance, constitutes a distinctive symptom cluster occasionally seen in patients requesting cosmetic surgery, it is not included in current major psychiatric diagnostic systems. Patients with dysmorphophobia are usually young and perfectionistic and have both schizoid and narcissistic traits. The authors present two representative case histories and suggest that study of more patients with dysmorphophobia is needed to determine whether it is a symptom of an underlying disease or is itself a separate disease entity.