Body Dysmorphic Disorder

Abstract

Introduction: Body dysmorphia disorder (BDD) is defined as a preoccupation with an imagined or a very slight defect in physical appearance that causes significant distress to the individual. Patients with body dysmorphia may approach cosmetic surgeons or dermatologists seeking surgery or medical treatments, and this places the doctor at risk of having a patient who is continually dissatisfied with whatever is done. Symptoms: With BDD there is preoccupation with the supposed appearance problem. The patient takes actions to “hide” the defect or avoid certain situations because they feel ugly and do not want to be seen by others. Many patients with BDD also suffer from depression and from obsessive compulsive disorders, such as eating disorders, anxiety disorders, trichotillomania (hair pulling), and abuse of drugs or alcohol. There is a high rate of suicidal ideation. Discussion: Serotonin-reuptake inhibitors (SRIs) are a group of medications that appear to be useful and effective in patients with BDD. Cognitive behavioral therapy appears to be an effective treatment for BDD. The behavioral component consists of exposure and response prevention, where the patient exposes his or her defect in situations that they would usually avoid and response prevention involves helping the patient stop the compulsive behavior related to the defect. Conclusion: Treatment for patients with BDD is medication, usually SRIs, or psychiatric care with cognitive behavioral therapy. Surgeons need to identify patients with BDD before surgery, tell them that surgery is not the treatment for their problem, and refer them to a psychiatrist for treatment.