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Clinical Features and Treatment of Body Dysmorphic Disorder

From Butler Hospital and the Department of Psychiatry and Human Behavior, Brown Medical School, Providence, Rhode Island.

Correspondence: Send reprint requests to Dr. Phillips, Butler Hospital, 345 Blackstone Blvd., Providence, RI 02906; e-mail: katharine_phillips{at}brown.edu.

Body dysmorphic disorder (BDD), a distressing or impairing preoccupation with an imagined or slight defect in appearance, is a severe and relatively common disorder that usually goes undiagnosed in clinical practice. Individuals with BDD have a high rate of functional impairment, a markedly poor quality of life, and high rates of suicidal ideation and suicide attempts. A majority receive nonpsychiatric medical (e.g., dermatologic) or surgical treatment, which is usually ineffective. In contrast, serotonin reuptake inhibitors (SRIs) and cognitive behavior therapy seem to be efficacious for a majority of patients. Although data are limited, it appears that higher SRI doses and longer treatment trials than those used for many other psychiatric disorders are often needed to treat BDD effectively. This article provides a clinically focused overview of BDD, including its clinical features, recognition and diagnosis of the disorder, and effective treatment strategies.

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