How do we treat BDD?

           1. Serotonin reuptake inhibitors (SRIs) 

• SRIs are antidepressant medications that helps to diminish obsessional thinking and compulsive behaviors
• SRI (Selective Serotonin Reuptake Inhibitors) such as Fluoxetine, Fluvoxamine, Citalopram appear to be effective in treating BDD
• Community treatment is usually inadequate (low dosage and short duration)
• Fluoxetine is significantly better than placebo (35% decrease in severity vs.14% on placebo)
• Non-responders should switch to another SRI, or augmented with Buspirone
• Patients should receive an SRI for at least 12 weeks before switching, and that the highest SRI dose recommended by the manufacturer (if tolerated) be reached if lower doses are ineffective.
• Long-term treatment appears often necessary
• Adding an antipsychotic to an SRI is worth considering for delusional patients
• Highly anxious patients often benefit from a benzodiazepine in addition to an SRI
• Behavioral symptoms may improve less on medications than distress measures
• Symptoms continue to improve with maintenance treatment up to several years
• Side effect: Black Box warning of increased risk of suicidal ideation

  2. Psychotherapy  (CBT)

• Cognitive
  • Identification of appearance related automatic thoughts
  • Identification of cognitive distortions and self-defeating thoughts
  • Cognitive restructuring aimed at challenging faulty appearance-related beliefs
  • Cognitive Interventions
    • Rehearsing/journaling adaptive responses to thoughts
    • Replacing critical self-talk with more descriptive/objective remarks
• Behavioral
  • Exposure and Response Prevention
  • Reduce social avoidance and repetitive behaviors
  • Engaging in social setting without  engaging in preferred compulsion (e.g. camouflaging)
  • Refraining from mirror checking
  • Setting limits on grooming time

  3. Psychoeducation

• Referrals to relevant books or websites
• Emphasize that treatment is likely to decrease their suffering and improve functioning

References:

Phillips, K. A. (2004). Body dysmorphic disorder: recognizing and treating imagined ugliness. World Psychiatry, 3(1), 12.

Phillips, K. A., & Hollander, E. (2008). Treating body dysmorphic disorder with medication: evidence, misconceptions, and a suggested approach. Body Image, 5(1), 13-27.