eMedicine Specialties > Psychiatry > Psychosomatic

Body Dysmorphic Disorder: Follow-up

Author: Gary K Arthur, MD, Clinical Assistant Professor, Department of Psychiatry and Behavioral Medicine, University of South Florida College of Medicine
Coauthor(s): Kim Monnell, DO, Consulting Staff, Department of Neurology, Sarasota Memorial Hospital
Contributor Information and Disclosures

Updated: Aug 20, 2007

Follow-up

Further Outpatient Care

BDD is considered a chronic condition and requires maintenance therapy and regulation of SSRIs. The American Psychiatric Association recommends seeing patients who are taking maintenance medications a minimum of 3-4 times per year. Approximately 53% of those with BDD experience relapse within 6 months of discontinuation of treatment.

Inpatient & Outpatient Medications

To treat a chronic disorder such as BDD, prescribing the same dosages of medications for initial treatment and ongoing maintenance is usually considered prudent. The concept of lower maintenance dosages is less valid because more studies support higher relapse rates at lower maintenance dosages.

Complications

Some patients who are not treated may become delusional or may become increasingly depressed or suicidal. Moreover, when treating a person with this disorder, challenging or working with the delusion can make that individual more depressed.

Prognosis

  • The prognosis generally is good with full and appropriate treatment with both medication and psychotherapy.
  • The presence of a delusional intensity of belief or comorbid conditions may require more extensive and intensive therapy and follow-up.

Patient Education

  • The cognitive-behavioral psychotherapy and behavioral modification approaches include significant patient education. As noted above, education of family members also is valuable.
  • For excellent patient education resources, visit eMedicine's Eating Disorders Center and Depression Center. Also, see eMedicine's patient education articles Anorexia Nervosa and Depression.

Miscellaneous

Medicolegal Pitfalls

Patients frequently consult cosmetic specialists (eg, dermatologists, plastic surgeons). These patients tend to be unhappy with the results of the procedure.

  • Patients with BDD generally become focused on the original perceived defect or find a new one with which to be concerned, including any surgical blemishes or scars.
  • Thoroughly document and discuss treatment with patients in suspected cases of BDD. For planned surgical changes, a presurgery psychiatric consultation might be protective.

 


More on Body Dysmorphic Disorder

Overview: Body Dysmorphic Disorder
Differential Diagnoses & Workup: Body Dysmorphic Disorder
Treatment & Medication: Body Dysmorphic Disorder
Follow-up: Body Dysmorphic Disorder
References
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Further Reading

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Keywords

BDD, somatoform disorder, imagined defect of the body, low self-esteem, obsessive-compulsive disorder, OCD, major depression, delusion, social phobia, social anxiety disorder, SAD

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Contributor Information and Disclosures

Author

Gary K Arthur, MD, Clinical Assistant Professor, Department of Psychiatry and Behavioral Medicine, University of South Florida College of Medicine
Gary K Arthur, MD is a member of the following medical societies: American Psychiatric Association
Disclosure: Nothing to disclose.

Coauthor(s)

Kim Monnell, DO, Consulting Staff, Department of Neurology, Sarasota Memorial Hospital
Kim Monnell, DO is a member of the following medical societies: American Academy of Neurology and American Osteopathic Association
Disclosure: Nothing to disclose.

Medical Editor

Denis F Darko, MD, Director, Central Nervous System Clinical Research, Clinical Science, Green Hospital
Denis F Darko, MD is a member of the following medical societies: American Academy of Sleep Medicine, American College of Physicians, American Medical Association, American Psychiatric Association, American Psychosomatic Society, and Endocrine Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

David Bienenfeld, MD, Vice-Chair, Program Director, Professor, Department of Psychiatry, Wright State University School of Medicine
David Bienenfeld, MD is a member of the following medical societies: American Medical Association, American Psychiatric Association, and Association for Academic Psychiatry
Disclosure: Nothing to disclose.

CME Editor

Harold H Harsch, MD, Program Director of Geropsychiatry, Department of Geriatrics/Gerontology, Associate Professor, Department of Psychiatry and Department of Medicine, Froedtert Hospital, Medical College of Wisconsin
Harold H Harsch, MD is a member of the following medical societies: American Psychiatric Association
Disclosure: lilly Honoraria Speaking and teaching; BMS Honoraria Speaking and teaching; Forest Labs Honoraria Speaking and teaching; AstraZeneca Honoraria Speaking and teaching; Pfizer Grant/research funds Other; Northstar Grant/research funds Other; Novartis  Other

Chief Editor

Stephen Soreff, MD, President of Education Initiatives, Nottingham, NH; Faculty, Metropolitan College of Boston University, Boston, MA
Stephen Soreff, MD is a member of the following medical societies: American College of Mental Health Administration
Disclosure: Nothing to disclose.

 
 
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