Treatment

Patients with BDD may seek procedures via plastic surgeons. This is to be firmly discouraged since perceived defects occurring in BDD are either imagined or grossly disproportionate. Furthermore, surgical procedures carry risks and BDD symptoms are unlikely to improve following surgery. In fact, symptoms may well worsen, with concern about scars, or concern shifting to other parts of the body, leading to further surgery-seeking behaviors.

Psychotherapy

The use of Cognitive Behavioral Therapy (CBT) has been shown to be efficacious in reducing the symptoms associated with BDD. As the acronym CBT implies, we recommend the use of a combination of cognitive (e.g., challenging the belief that their appearance is defective and unattractive to others) and behavioral (exposure therapy targeting at decreasing the anxiety associated with either seeing themselves in the mirror or presenting themselves to other people) components. Given that BDD is associated with a variety of behaviors, such as skin picking, excessive mirror checking, and weight lifting or other exercising, addressing the behavioral components of BDD is vital.

Aspects of cognitive restructuring are to be used for BDD patients, including exposure and ritual prevention exercises. Cognitive restructuring should focus on the misinterpretation of their bodily features and embellishment of these perceived defects into negative emotions (feelings of worthlessness, anxiety, depression, etc.) and ritualistic behaviors (picking, weight-lifting, etc.). Mindfulness retraining should be used and include working with the patient to see the "whole body” when looking in the mirror (including standing a reasonable distance from the mirror and not inches away) instead of just the perceived defect, using non-judgmental language when they see themselves (i.e., “my lips are red and soft”) and how to interact with others without focusing on comparing his or her (for example) nose with the person with whom they are speaking. In addition, broadening the patients’ perceptions of their self-worth is important since patients with BDD often associate the defect with self-worth. Finally, aspects of relapse prevention should be implemented and include replacing BDD-related activities with healthy alternatives which may include hobbies the patient abandoned once the BDD-symptoms took over.

Psychological treatments should ideally be conducted twice each week for the first 4-6 weeks and then weekly thereafter. A total of 4-6 months of sessions lasting 60-90 minutes each have been shown to be efficacious in treating BDD. Continual assessment of mood, BDD symptom severity, and suicidal ideation should coincide with each therapy session.

 
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