Body dysmorphic disorder: Treatment and prognosis
- Katharine A Phillips, MD
Katharine A Phillips, MD
- Professor of Psychiatry and Human Behavior
- Warren Alpert Medical School of Brown University
Body dysmorphic disorder (BDD) is characterized by preoccupation with nonexistent or slight defects in physical appearance, such that patients believe that they look abnormal, unattractive, ugly, or deformed, when in reality they look normal. The preoccupation with perceived flaws leads to repetitive behaviors (eg, checking their appearance in mirrors), which are difficult to control and not pleasurable. BDD is common but usually under-recognized, causes distress and/or impaired functioning, and is often associated with suicidal ideation and behavior.
Patients with BDD may present to mental health professionals as well as other clinicians, such as dermatologists, plastic surgeons, primary care physicians, pediatricians, and dentists. Most patients seek nonpsychiatric treatment (most commonly dermatologic and surgical) for their perceived physical defects; this treatment appears to be ineffective for most patients and can be risky for clinicians to provide. By contrast, pharmacotherapy (ie, selective serotonin reuptake inhibitors or clomipramine) and/or cognitive-behavioral therapy tailored specifically to BDD are often efficacious.
This topic reviews the treatment and prognosis of BDD. The epidemiology, pathogenesis, clinical features, assessment, diagnosis, and differential diagnosis of BDD are discussed separately. (See "Body dysmorphic disorder: Epidemiology, pathogenesis, and clinical features" and "Body dysmorphic disorder: Assessment, diagnosis, and differential diagnosis".)
DIAGNOSIS OF BODY DYSMORPHIC DISORDER
●Preoccupation with at least one nonexistent or slight defect in physical appearance (eg, thinks about the perceived defects for at least one hour per day).
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- DIAGNOSIS OF BODY DYSMORPHIC DISORDER
- GENERAL TREATMENT PRINCIPLES
- Approach to the patient
- Cosmetic interventions
- MILD TO MODERATE ILLNESS
- Approach to treatment
- Initial treatment
- - Pharmacotherapy
- - Cognitive-behavioral therapy
- Treatment resistant patients
- Treatment refractory patients
- Other options
- SEVERE ILLNESS
- First line
- Treatment resistance
- MAINTENANCE TREATMENT
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS