This disorder,
formerly referred to as dysmorphophobia, tends to occur in young
adults equally in either gender. The patient becomes pre-occupied
with a non-existent or minimal cosmetic defect (nose, cleft
chin, blemish, breast size) and persistently seeks medical attention
to fix it surgically. Some clinicians feel it is a variant of
obsessive-compulsive
disorder. Many do well with surgery, but some remain persistently
disgruntled. It is important to distinguish them from psychotic
patients and those with highly disturbed global and body self-images,
since those patients will not be improved by surgery.
Body Dysmorphic Disorder (BDD) therefore is characterized by
certain key and associated features, specifically preoccupying
obsessions with a particular body part that the person considers
unattractive.
Cases of body dysmorphic disorder can range from relatively
mild to very severe. People with mild cases are bothered and
distressed, and their obsessions cause some degree of impairment.
The patient is preoccupied with an imagined defect of appearance
or is excessively concerned about a slight physical anomaly.
This preoccupation causes clinically important distress or impairs
work, social or personal functioning.
Another mental disorder (such as Anorexia
Nervosa) does not better explain the preoccupation.
Associated
Features:
Depressed
Mood
Somatic
or Sexual Dysfunction
Guilt or Obsession
Anxious or Fearful or Dependent
Personality
Differential
Diagnosis:
Some disorders display similar or sometimes even the same symptom.
The clinician, therefore, in his diagnostic attempt, has to
differentiate against the following disorders which one needs
to be ruled out to establish a precise diagnosis.
General Medical Condition.
Major Depressive Disorder.
Schizophrenia.
Social Phobia.
Obsessive-Compulsive
Disorder.
Anorexia Nervosa.
Bulimia Nervosa.
Cause:
Although
we still do not have a single clear cause for body dysmorphic
disorder, authorities believe that biological, psychological
and perhaps even social or cultural factors contribute to its
origins.
Treatment:
Counseling
and Psychotherapy [ See
Therapy Section ]:
Cognitive-behavior
therapy which includes education about BDD and its treatment,
and specific treatments to deal with faulty thoughts, assumptions
("cognition's") and problematic behaviors. The cognitive
aspects involve discovering, challenging and changing the underlying
negative thoughts and beliefs the sufferer keeps thinking.
The treatment's
behavioral components usually focus on exposure and response
prevention. Exposure usually involves having the sufferer gradually
learn to face and confront the situations they fear the most,
such as going into public places or exposing their embarrassing
body part to others' scrutiny without hiding or camouflaging
it. Response prevention involves getting the sufferer to conscientiously
and diligently refuse or avoid doing the self-damaging behaviors
they feel compelled to do, such as staring endlessly into mirrors
or picking at one's face. When sufferers are able to delay such
behaviors long enough, the impulse to do them sometimes dies
down, and these behaviors may be thwarted.
Available
evidence suggests that medication and cognitive-behavior therapies
can complement each other well. In addition to these treatments,
family education and counseling, to help family members understand
what is going on and how to help the sufferer, and group therapy
or support for those with BDD may be of benefit.
Pharmacotherapy
[ See
Psychopharmacology Section ] :
Treatment
with SRIs. These same SRI medications are also used to treat
depression, obsessive-compulsive disorder (OCD) and other anxiety
conditions.
Fluoxetine
Prozac.
Fluvoxamine Luvox.
Paroxetine Paxil.
Sertraline Zoloft.
Citalopram Celexa.
Clomipramine Anafranil.
