Body dysmorphic disorder Health Article

Diagnosis

The diagnosisof BDD in children and adolescents is often made by physicians in family practice because they are more likely to have developed long-term relationships of trust with the young people. With adults, it is often specialists in dermatology, cosmetic dentistry, or plastic surgery who may suspect that the patient suffers from BDD because of frequent requests for repeated or unnecessary procedures. Reported rates of BDD among dermatology and cosmetic surgery patients range between 6% and 15%. The diagnosis is made on the basis of the patient's history together with the physician's observations of the patient's overall mood and conversation patterns. People with BDD often come across to others as generally anxious and worried. In addition, the patient's dress or clothing styles may suggest a diagnosis of BDD.

As of 2002, there are no diagnostic questionnaires specifically for BDD, although a semi-structured interview called the BDD Data Form is sometimes used by researchers to collect information about the disorder from patients. The BDD Data Form includes demographic information, information about body areas of concern and the history and course of the illness, and the patient's history of hospitalizationor suicideattempts, if any. The diagnostic questionnaire most frequently used to identify BDD patients is the Structured Clinical Interview for DSM-III-R Disorders, or SCID-II.

There are no brain imaging studiesor laboratory tests as of 2002 that can be used to diagnose BDD.

Treatments

The standard treatment regimen for body dysmorphic disorder is a combination of medications and psychotherapy. Surgical, dental, or dermatologic treatments have been found to be ineffective.

Medications

The medications most frequently prescribed for patients with BDD are the selective serotonin reuptake inhibitors, most commonly fluoxetine(Prozac) or sertraline(Zoloft). Other SSRIs that have been used with this group of patients include fluvoxamine(Luvox) and paroxetine(Paxil). In fact, it is the relatively high rate of positive responses to SSRIs among BDD patients that led to the hypothesis that the disorder has a neurobiological component related to serotonin levels in the body. An associated finding is that patients with BDD require higher dosages of SSRI medications to be effective than patients who are being treated for depression with these drugs.

Psychotherapy

The most effective approach to psychotherapy with BDD patients is cognitive-behavioral therapy, of which cognitive restructuring is one component. Since the disorder is related to delusionsabout one's appearance, cognitive-oriented therapy that challenges inaccurate self-perceptions is more effective than purely supportive approaches. Relaxation techniques also work well with BDD patients when they are combined wih cognitive restructuring.

Hospitalization

BDD patients have high rates of self-destructive behavior, including performing surgery on themselves at home (liposuction followed by skin stapling, sawing down teeth, and removing facial scars with sandpaper) and attempted or completed suicide. Many are unable to remain in school, form healthy relationships, or keep steady jobs. In one group of 100 patients diagnosed with BDD, 48% had been hospitalized for psychiatric reasons, and 30% had made at least one suicide attempt.

Alternative treatments

Although no alternative or complementary form of treatment has been recommended specifically for BDD, herbal remedies for depressed feelings, such as St. John's wort, have been reported as helping some BDD patients. Aromatherapyappears to be a useful aid to relaxation techniques as well as a pleasurable physical experience for BDD patients. Yogahas helped some persons with BDD acquire more realistic perceptions of their bodies and to replace obsessions about external appearance with new respect for the inner structure and functioning of their bodies.

Prognosis

As of 2002, researchers do not know enough about the lifetime course of body dysmorphic disorder to offer a detailed prognosis. The DSM-IV-TRnotes that the disorder "has a fairly continuous course, with few symptom-free intervals, although the intensity of symptoms may wax and wane over time."

Prevention

Given the pervasive influence of the mass media in contemporary Western societies, the best preventive strategy involves challenging those afflicted with the disorder and who consequently have unrealistic images of attractive people. Parents, teachers, primary health care professionals, and other adults who work with young people can point out and discuss the pitfalls of trying to look "perfect." In addition, parents or other adults can educate themselves about BDD and its symptoms, and pay attention to any warning signs in their children's dress or behavior.

See also Aromatherapy; Yoga