Update on Body Dysmorphic Disorder

Clinical Features, Epidemiology, Pathogenesis, Assessment, and Treatment

Kelly, Megan M. PhD
Phillips, Katharine A. MD

Megan M. Kelly, PhD, is the Bedford Site Director, Veterans Integrated Service Network 1 (VISN 1) New England Mental Illness Research, Education, and Clinical Center, Edith Nourse Rogers Memorial Veterans Hospital; and an Assistant Professor, Department of Psychiatry, University of Massachusetts Medical School. Katharine A. Phillips, MD, is a Professor of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University; a Senior Research Scholar, the Director of the Body Dysmorphic Disorder Program, and the Director of Research for Adult Psychiatry, Rhode Island Hospital.

Address correspondence to Megan M. Kelly, PhD, Veteran Affairs, VISN 1 New England Mental Illness Research, Education, and Clinical Center, 200 Springs Road, Bedford, MA 01730; email: [email protected].

Disclaimer: No medications are approved by the US Food and Drug Administration (FDA) for the treatment of body dysmorphic disorder. Some of the dosing recommendations exceed maximum FDA-approved doses for other uses, although these recommendations are consistent with the American Association Practice Guideline for the treatment of obsessive-compulsive disorder.

Disclosure: The authors have no relevant financial relationships to disclose.

Psychiatric Annals 47(11):p 552-558, November 01, 2017. | DOI: 10.3928/00485713-20171004-02

Body dysmorphic disorder (BDD) is common and characterized by distressing or impairing preoccupations with perceived defects in one's bodily appearance as well as repetitive, compulsive behaviors aimed at hiding, improving, checking, or coping with appearance concerns. Avoidance of social situations is common. BDD is associated with high rates of suicidal ideation and behavior, co-occurring depression and substance use disorders, psychiatric hospitalization, and notably poor psychosocial functioning. Despite BDD's prevalence, severity, and morbidity, this disorder is often underrecognized and undertreated. Cosmetic treatment is often sought but not recommended. First-line treatments consist of serotonin-reuptake inhibitors (often at high doses) and cognitive-behavioral therapy that is tailored to BDD's unique symptoms. This review presents up-to-date information on the clinical features, epidemiology, pathogenesis, assessment, and treatment of BDD. [Psychiatr Ann. 2017;47(11):552–558.]