Recognizing and treating body dysmorphic disorder.

BACKGROUND: Body dysmorphic disorder (BDD) is a relatively common and often-disabling obsessive compulsive spectrum disorder that often goes unrecognized in clinical practice.
METHODS: The present review examines the clinical features of BDD, its relationship to other disorders, and what is known about effective treatment.
RESULTS: BDD consists of a distressing and impairing preoccupation with imagined or slight defects in appearance that can focus on any body area. Insight is usually poor or absent; nearly half of patients are delusional. Typical associated behaviors include skin picking, mirror checking, excessive grooming, and camouflaging. It appears that higher doses of serotonin reuptake inhibitors and longer treatment trials than those used for many other psychiatric disorders, including depression, are often needed to effectively treat BDD. Cognitive-behavioral therapy also appears efficacious and is currently considered the psychotherapy of choice for BDD. Core techniques are cognitive restructuring, behavioral experiments, response (ritual) prevention, and exposure.
CONCLUSIONS: Further research is needed to minimize the underrecognition of BDD and to improve proper treatment. Because of the high rates of comorbidity in patients with BDD, treatment studies need to include subjects with co-occurring disorders and thereby attempt to understand how these other disorders affect treatment response. Finally, more research needs to address the pathophysiology of BDD (for example, by incorporating imaging and genetics).