Treatments for Body Dysmorphic Disorder Discussed

Body dysmorphic disorder (BDD) is common, often severely impairing, and associated with high rates of suicidal ideation and attempts, yet it usually goes unrecognized and undiagnosed in clinical practice. Katharine Phillips, M.D., director of the Body Dysmorphic Disorder Program at Rhode Island Hospital and a professor of psychiatry and human behavior at the Alpert Medical School of Brown University, discussed evidence-based treatments for this often-disabling disorder today at APA’s 2015 annual meeting in Toronto.

First-line pharmacotherapy for BDD is an SRI; relatively high doses are often needed, advised Phillips. SRIs are also recommended for patients with delusional BDD beliefs (complete conviction that they look abnormal or ugly). The first-line psychosocial treatment is manualized cognitive-behavioral therapy that is tailored to BDD’s unique clinical features. She emphasized that because insight is so often absent or poor in BDD (that is, most patients believe that they truly look abnormal), motivational interviewing techniques and other strategies are often needed to engage and retain patients in psychiatric treatment. Surgery, dermatologic treatment, and other cosmetic treatments, although usually sought, are not recommended; they usually appear to be ineffective and can even make BDD symptoms worse.

The symposium, chaired by Deborah Sookman, Ph.D., an associate professor of psychiatry and director of the Obsessive Compulsive Disorder Clinic at the McGill University Health Centre, also included presentations on cutting-edge treatments for obsessive-compulsive disorder (OCD) and other obsessive-compulsive and related disorders (OCRDs). Other speakers were Naomi Fineberg, M.B.B.S., M.A., of the Hertfordshire Partnership University in the United Kingdom and Margaret Richter, M.D., of the Sunnybrook Health Sciences Centre in Toronto.

These disorders are also the focus of a new book, Handbook on Obsessive-Compulsive and Related Disorders, published this month by American Psychiatric Publishing. This book, edited by Phillips and Dan Stein, M.D., Ph.D., provides comprehensive and cutting-edge coverage of OCRDs—a new chapter in DSM-5—for clinicians and trainees. Chapters cover OCD, BDD, hoarding disorder (a new disorder in DSM), trichotillomania (hair-pulling disorder), excoriation (skin-picking) disorder (a new disorder), and other related conditions, ensuring that readers are current on both the research and standard of care for these illnesses. The first book focused on the OCRDs to be published since the development of DSM-5, it reflects a deep understanding of the disorders and the DSM-5 development process. Phillips and Stein were chairs of the DSM-5 work group and the DSM-5 sub-work group, respectively, that oversaw the development of the OCRD category.

APA members may purchase the book at a discount here.