Treatment Choice and Sequencing of Treatment

Modular cognitive-behavioral therapy (CBT) or serotonin reuptake inhibitors (SRIs) either alone or in conjunction with one another, are first-line treatments of choice for BDD. If the use of CBT provides inadequate symptom relief or when depressive or anxiety symptoms are present, SRIs should augment CBT treatment. SRIs should still be used for patients with delusional BDD.

Dermatologic Consultation

Many patients with BDD pick relentlessly at a specific area of the body, causing significant excoriation, lesions, and open wounds. As such, dermatologic consultation should occur where significant inflammation or damage of the skin occurs at the site of picking.

Clinical Pearls for Body Dysmorphic Disorder

  • • Cognitive behavioral therapy and SRIs are the treatments of choice
  • • Rates of suicide are high in individuals with BDD
  • • BDD is highly co-morbid with excoriation (Skin Picking) Disorder, OCD, Substance Use Disorders, and major depression

Key References

  • • Bjornsson AS, Didie ER, Phillips KA. Body dysmorphic disorder. Dialogues Clin Neurosci. 2010;12(2):221-32.
  • • Phillips KA, Wilhelm S, Koran LM, Didie ER, Fallon BA, Feusner J, Stein DJ. Body dysmorphic disorder: some key issues for DSM-V. Depress Anxiety. 2010 Jun;27(6):573-91.
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