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Body Dysmorphic Disorder Treatment & Management

  • Author: Iqbal Ahmed, MBBS, FRCPsych(UK); Chief Editor: David Bienenfeld, MD  more...
Updated: Mar 23, 2016

Approach Considerations

Treatment of body dysmorphic disorder (BDD) may include cognitive-behavioral therapy (CBT), pharmacologic interventions, and other psychosocial interventions that promote social functioning. The basic goals of treatment are as follows:

  • To prevent adoption of the sick role
  • To minimize unnecessary costs and complications by avoiding unwarranted hospitalizations, diagnostic and therapeutic procedures, medications, and, in particular, corrective surgical procedures (BDD patients are rarely satisfied with the results of corrective surgery, and in some cases, they become even more obsessed after such treatment)
  • To achieve pharmacologic control of comorbid syndromes and BDD

The primary treatment modalities for BDD are selective serotonin reuptake inhibitor (SSRI) therapy and CBT.[63] Both modalities are supported by level 2 evidence, which includes at least 1 double-blinded randomized controlled trial with placebo or an active comparison condition.[64] Pharmacologic agents are employed on an off-label basis; at present, no medications have been specifically approved by the US Food and Drug Administration (FDA) for the treatment of BDD. Drugs with potential for abuse or addiction must be avoided.

The United Kingdom’s National Collaborating Centre for Mental Health published guidelines on core interventions in the treatment of BDD and obsessive-compulsive disorder (OCD), which may be of interest.[65]



Pharmacologic Therapy

Evidence supports the use of SSRIs such as fluoxetine, fluvoxamine, escitalopram, and citalopram in the treatment of BDD.[64] The tricyclic antidepressant (TCA) clomipramine has been widely used as well.[66, 67] Other pharmacologic agents, such as neuroleptics, trazodone, lithium, benzodiazepines, TCAs other than clomipramine, and anticonvulsants have been much less beneficial or ineffective.

Clomipramine has adverse effects similar to those of other TCAs (eg, sedation, anticholinergic effects, orthostatic hypotension, sexual dysfunction, weight gain, cardiac conduction slowing, and a potential for fatal overdose). In a study comparing clomipramine with the selective norepinephrine reuptake inhibitor desipramine in patients with BDD, superior results were noted with clomipramine, including improvements in obsessive characteristics, depression, insight, social performance, and disorder severity.[68]

The SSRIs fluoxetine and fluvoxamine usually have milder adverse effect profiles than clomipramine does; however, they may be associated with adverse effects such as initial anxiety or agitation, nausea or other gastrointestinal (GI) disturbance, headache, sexual dysfunction (eg, delayed orgasm or loss of libido), and occasional apathy. In addition, they may be associated with various cutaneous reactions, such as the following[69] :

  • Spontaneous bruising
  • Pruritus
  • Urticaria
  • Angioedema
  • Erythema multiforme
  • Stevens-Johnson syndrome
  • Toxic epidermal necrolysis
  • Erythema nodosum
  • Alopecia
  • Hypertrichosis
  • Leukocytoclastic vasculitis
  • Acneiform eruption

Because cross-reactions may occur between SSRIs, even those with different chemical structures, switching to another family of antidepressants may be advisable if an SSRI is linked to a serious skin eruption.

Clomipramine and SSRIs often must be given at high dosages and for lengthy treatment periods (eg, 6-16 weeks for SSRIs[70] ) before symptoms improve; drug trials should continue for several months after the target dose is reached. Dosages should be increased gradually to prevent possible adverse effects. Almost 58% of patients with BDD achieve either partial improvement or complete resolution of symptoms with an SRI regimen.

In some situations, patients who show resistance to normal treatment may have positive results when treated with SSRIs in combination with clomipramine. In this case, clomipramine levels should be monitored because SSRIs increase clomipramine concentrations in the blood.

Even when the patient’s perceptions are distorted to the point where they are felt to be psychotic, the use of neuroleptics may not ameliorate the delusions. Some patients may still benefit from adjunctive antipsychotics. However, when used at higher dosages similar to those used in the treatment of OCD, SSRIs are frequently effective at ameliorating symptoms.[57] The response to SSRIs is often partial rather than complete, and 40-50% of patients may not respond adequately to medication alone.[64]

BDD patients with delusional symptoms may benefit from a therapeutic regimen that includes the antipsychotic agent pimozide in addition to an SSRI. Patient insight may improve with the use of pimozide alone. A pimozide-clomipramine combination may lengthen the QT interval on the electrocardiogram (ECG); therefore, close monitoring of the ECG is required.

Pimozide has the adverse effects common to other typical high-potency antipsychotic medications (ie, extrapyramidal symptoms such as dystonia, parkinsonism, akathisia, neuroleptic malignant syndrome, and tardive dyskinesia). It also can slow cardiac conduction and cause hyperprolactinemia.

For the one third of patients who do not respond to treatment with SSRIs or clomipramine alone, the addition of buspirone may prove helpful.

If all other treatment modalities fail, monoamine oxidase inhibitors (MAOIs) may be given, though their use necessitates the imposition of dietary and other restrictions (eg, avoidance of tyramine-containing foods and certain medications). These drugs probably should be prescribed only by experienced specialists.

An open-label trial of the serotonin-norepinephrine reuptake inhibitor venlafaxine suggested that it may be an effective treatment for BDD.[71] .

Use of SSRIs in pediatric patients

Physicians are advised to be aware of the following information and use appropriate caution when considering treatment with SSRIs in the pediatric population.

In December 2003, the UK Medicines and Healthcare Products Regulatory Agency (MHRA) issued an advisory stating that most SSRIs are not suitable for use by persons younger than 18 years for treatment of “depressive illness.” After review, this agency decided that the risks SSRI treatment poses to pediatric patients outweigh the benefits, except in the case of fluoxetine, which appears to have a positive risk-benefit ratio for the treatment of depressive illness in patients younger than 18 years.

In October 2003, the FDA issued a public health advisory regarding reports of suicidality in pediatric patients being treated with antidepressant medications for major depressive disorder. This advisory reported suicidality (both ideation and attempts) in clinical trials of various antidepressant drugs in pediatric patients. Accordingly, the FDA asked that additional studies be performed because suicidality occurred in both treated and untreated patients with major depression and thus could not be definitively linked to drug treatment.

However, a study of more than 65,000 children and adults treated for depression between 1992 and 2002 by the Group Health Cooperative in Seattle found that suicide risk declines, rather than rises, with the use of antidepressants. To date, this is the largest study to date to address this issue.

Currently, no evidence associates OCD and other anxiety disorders treated with SSRIs with an increased risk of suicide.


Psychiatric and Behavioral Interventions

Psychotherapy (especially CBT) and behavioral modification therapy are highly recommended in addition to treatment with SSRIs.[72] Approaches include systematic desensitization, exposure techniques, self-confrontational techniques, and cognitive imagery.

General strategies include the following:

  • Consistent treatment, generally by the same physician
  • Supportive office visits scheduled at regular intervals
  • Gradual shifting of focus from symptoms to personal and social problems
  • Efforts to prevent body inspection rituals and reassurance seeking [1, 2]

CBT may be beneficial in situations where patients develop a structured and predictable strategy for identifying cognitive errors and maladaptive thinking. When CBT is efficacious, patients learn to alter cognitive distortions and are able to maintain and generalize more adaptive thought patterns in daily life. Therapy within a group setting and supportive psychotherapy may be adequate for people who are not truly delusional. A few studies have claimed successful results with behavior modification alone.

A small study of CBT in 13 adolescents with BDD found symptoms were improved at 3- and 6-month followup. Treatment was delivered in 12-22 weekly individual sessions.[73]

Although nonpharmacologic psychiatric treatment is often effective in the treatment of BDD, patients with this condition are likely to try to avoid psychiatric therapy. An on-site psychiatric liaison may be helpful in bridging the gap between dermatologic and psychological treatments.

Therapy with family members, spouses, or significant others should be strongly considered as a means of helping to improve the patient’s outcome. On one hand, people who have a close relationship with the patient may agree with the patient’s perception of the defect and may reinforce his or her maladaptive beliefs and behaviors. On the other, people with a close relationship to the patient may disagree with what the patient thinks is necessary for treatment and may be able to urge a more effective approach.


Surgical Interventions

Patients with BDD frequently consult cosmetic specialists (eg, dermatologists or plastic surgeons) for treatment of their imagined defect. However, cosmetic surgery frequently fails to improve BDD symptoms. Most people with BDD will be displeased with the results, commonly either becoming increasingly preoccupied with the original perceived defect or finding a new one with which to be concerned (such as a surgical blemish or scar from the cosmetic surgery itself).

Given that more than 90% of BDD patients report symptoms that are unchanged and often exacerbated after surgical procedures, plastic or cosmetic surgery intended to correct the perceived defect in BDD is contraindicated. These patients constitute a disproportionate litigious risk for surgeons. Of even greater concern for surgeons considering providing surgical treatment to BDD patients are reports of individuals who become violent after the operation and cause physical harm to their healthcare providers.[74]

In all suspected cases of BDD, any proposed surgical treatment must be thoroughly documented and discussed with patients. Preoperatively, if a surgeon suspects that a patient may meet diagnostic criteria for BDD, referral to a psychiatrist for further evaluation is indicated. Surgeons are advised not to perform surgery on patients who have been definitively diagnosed with BDD.



Physicians should refer patients to a psychiatrist for a thorough psychiatric evaluation to confirm a suspected diagnosis of BDD, as well as to assess the patient for possible comorbid psychiatric diagnoses and provide appropriate treatment recommendations.[75, 39] Because many of these patients present to surgeons seeking surgical correction of what they consider a clear physical defect, with little or no awareness of their underlying psychiatric disorder, they may react negatively and angrily to such a referral.[74, 76]

The referring surgeon or other physician is advised to treat the referral to a psychiatrist as they would a referral to any other health professional. Treating the referral as a standard aspect of preoperative care increases the likelihood that the patient follows up with the referral and should mitigate the possibility of patient dissatisfaction with the referring surgeon or physician.[39]


Long-Term Monitoring

Over the long term, patients achieve the best results when treated by a consistent medical and mental health team. They may derive the greatest benefit from a combination of SSRIs and therapy sessions.

As a chronic condition, BDD requires maintenance therapy and monitoring of SSRI tolerance. According to the American Psychiatric Association, patients who are taking maintenance medications should be seen at least 3-4 times per year. Approximately 53% of those with BDD experience relapse within 6 months of discontinuance of treatment.

For long-term management of a chronic disorder such as BDD, it is usually considered prudent to prescribe the same dosages of medications for initial treatment and ongoing maintenance. The concept of lower maintenance dosages is not well supported; the majority of studies have reported higher relapse rates at lower maintenance dosages.

Contributor Information and Disclosures

Iqbal Ahmed, MBBS, FRCPsych(UK) Faculty, Department of Psychiatry, Tripler Army Medical Center; Clinical Professor of Psychiatry, Uniformed Services University of the Health Sciences; Clinical Professor of Psychiatry, Clinical Professor of Geriatric Medicine, University of Hawaii, John A Burns School of Medicine

Iqbal Ahmed, MBBS, FRCPsych(UK) is a member of the following medical societies: Academy of Psychosomatic Medicine, American Neuropsychiatric Association, American Society of Clinical Psychopharmacology, Royal College of Psychiatrists, American Association for Geriatric Psychiatry, American Psychiatric Association

Disclosure: Nothing to disclose.


Robert A Schwartz, MD, MPH Professor and Head of Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, Rutgers New Jersey Medical School; Visiting Professor, Rutgers University School of Public Affairs and Administration

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, New York Academy of Medicine, American Academy of Dermatology, American College of Physicians, Sigma Xi

Disclosure: Nothing to disclose.

Lawrence Genen, MD, MBA Board Certified Psychiatrist; Diplomate, American Board of Psychiatry and Neurology; Founder, The Genen Group - A Multi-Specialty Psychiatry and Psychotherapy Practice

Disclosure: Nothing to disclose.

Thomas Cook, MD Resident Physician, Department of Psychiatry, University of Hawaii, John A Burns School of Medicine

Disclosure: Nothing to disclose.

Chief Editor

David Bienenfeld, MD Professor, Departments of Psychiatry and Geriatric Medicine, Wright State University, Boonshoft School of Medicine

David Bienenfeld, MD is a member of the following medical societies: American Medical Association, American Psychiatric Association, Association for Academic Psychiatry

Disclosure: Nothing to disclose.


Carol Diane Berkowitz, MD Executive Vice Chair, Department of Pediatrics, Professor, Harbor-University of California at Los Angeles Medical Center

Carol Diane Berkowitz, MD is a member of the following medical societies: Alpha Omega Alpha, Ambulatory Pediatric Association, American Academy of Pediatrics, American College of Emergency Physicians, American Medical Association, American Pediatric Society, and North American Society for Pediatric and Adolescent Gynecology

Disclosure: Nothing to disclose.

O Joseph Bienvenu III, MD, PhD Assistant Professor, Department of Psychiatry, Johns Hopkins University School of Medicine

O Joseph Bienvenu III, MD, PhD is a member of the following medical societies: Alpha Omega Alpha, American Medical Association, and American Psychiatric Association

Disclosure: Nothing to disclose.

M Peter Chodynicki, MD Staff Physician, Department of Psychiatry, Johns Hopkins University School of Medicine

M Peter Chodynicki, MD is a member of the following medical societies: American Psychiatric Association

Disclosure: Nothing to disclose.

Dirk M Elston, MD Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Sing-Yi Feng, MD Assistant Professor, Department of Pediatrics, Division of Emergency Medicine, Section of Medical Toxicology, Univerity of Texas Southwestern Medical Center; Staff Toxicologist, North Texas Poison Center, Parkland Memorial Hospital

Sing-Yi Feng, MD is a member of the following medical societies: American Academy of Pediatrics and American College of Medical Toxicology

Disclosure: Nothing to disclose.

Camila K Janniger, MD Clinical Professor of Dermatology, Clinical Associate Professor of Pediatrics, Chief of Pediatric Dermatology, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

Camila K Janniger, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

Jeffrey Meffert, MD Assistant Clinical Professor of Dermatology, University of Texas School of Medicine at San Antonio

Jeffrey Meffert, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, Association of Military Dermatologists, and Texas Dermatological Society

Disclosure: Nothing to disclose.

James J Nordlund, MD Professor Emeritus, Department of Dermatology, University of Cincinnati College of Medicine

James J Nordlund, MD is a member of the following medical societies: American Academy of Dermatology, Sigma Xi, and Society for Investigative Dermatology

Disclosure: Nothing to disclose.

Caroly Pataki, MD Professor of Clinical Psychiatry and Behavioral Sciences, Department of Psychiatry, Division Chair, Child and Adolescent Psychiatry, Keck School of Medicine of the University of Southern California

Caroly Pataki, MD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, New York Academy of Sciences, and Physicians for Social Responsibility

Disclosure: Nothing to disclose.

Wanda M Patterson, MD Department of Dermatology, UMDNJ-New Jersey Medical School

Wanda M Patterson, MD is a member of the following medical societies: Sigma Xi

Disclosure: Nothing to disclose.

Robert A Schwartz, MD, MPH Professor and Head, Dermatology, Professor of Pathology, Pediatrics, Medicine, and Preventive Medicine and Community Health, University of Medicine and Dentistry of New Jersey-New Jersey Medical School

Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, New York Academy of Medicine, and Sigma Xi

Disclosure: Nothing to disclose.

Jagvir Singh, MD Director, Division of Pediatric Emergency Medicine, Lutheran General Hospital of Park Ridge

Jagvir Singh, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Richard P Vinson, MD Assistant Clinical Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine; Consulting Staff, Mountain View Dermatology, PA

Richard P Vinson, MD is a member of the following medical societies: American Academy of Dermatology, Association of Military Dermatologists, Texas Dermatological Society, and Texas Medical Association

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

  1. Neziroglu F, Hsia C, Yaryura-Tobias JA. Behavioral, cognitive, and family therapy for obsessive-compulsive and related disorders. Psychiatr Clin North Am. 2000 Sep. 23(3):657-70. [Medline].

  2. Krebs G, Turner C, Heyman I, Mataix-Cols D. Cognitive behaviour therapy for adolescents with body dysmorphic disorder: a case series. Behav Cogn Psychother. 2012 Jul. 40(4):452-61. [Medline].

  3. Thomas I, Patterson WM, Szepietowski JC, Chodynicki MP, Janniger CK, Hendel PM, et al. Body dysmorphic disorder: more than meets the eye. Acta Dermatovenerol Croat. 2005. 13(1):50-3. [Medline].

  4. McElroy SL, Phillips KA, Keck PE Jr, Hudson JI, Pope HG Jr. Body dysmorphic disorder: does it have a psychotic subtype?. J Clin Psychiatry. 1993 Oct. 54(10):389-95. [Medline].

  5. Jakubietz M, Jakubietz RJ, Kloss DF, Gruenert JJ. Body dysmorphic disorder: diagnosis and approach. Plast Reconstr Surg. 2007 May. 119(6):1924-30. [Medline].

  6. Cotterill, JA, Millard, LG. Psychocutaneous disorders. Champion RH, Rook A, Ebling FJ, Wilkinson DS, eds. Rook/Wilkinson/Ebling Textbook of Dermatology. 6th ed. London, England: Blackwell Science; 1998. 2792-4.

  7. Phillips KA, McElroy SL. Insight, overvalued ideation, and delusional thinking in body dysmorphic disorder: theoretical and treatment implications. J Nerv Ment Dis. 1993 Nov. 181(11):699-702. [Medline].

  8. American Psychiatric Association. Obsessive-Compulsive and Related Disorders. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. 5th ed. Arlington, Va: American Psychiatric Association; 2013.

  9. Phillips KA, Menard W, Fay C, Pagano ME. Psychosocial functioning and quality of life in body dysmorphic disorder. Compr Psychiatry. 2005 Jul-Aug. 46(4):254-60. [Medline]. [Full Text].

  10. Didie ER, Walters MM, Pinto A, Menard W, Eisen JL, Mancebo M, et al. A comparison of quality of life and psychosocial functioning in obsessive-compulsive disorder and body dysmorphic disorder. Ann Clin Psychiatry. 2007 Jul-Sep. 19(3):181-6. [Medline].

  11. Phillips KA, Diaz SF. Gender differences in body dysmorphic disorder. J Nerv Ment Dis. 1997 Sep. 185(9):570-7. [Medline].

  12. Phillips KA, Menard W, Fay C. Gender similarities and differences in 200 individuals with body dysmorphic disorder. Compr Psychiatry. 2006 Mar-Apr. 47(2):77-87. [Medline]. [Full Text].

  13. Phillips KA, Menard W. Suicidality in body dysmorphic disorder: a prospective study. Am J Psychiatry. 2006 Jul. 163(7):1280-2. [Medline]. [Full Text].

  14. Rief W, Buhlmann U, Wilhelm S, Borkenhagen A, Brähler E. The prevalence of body dysmorphic disorder: a population-based survey. Psychol Med. 2006 Jun. 36(6):877-85. [Medline].

  15. Koran LM, Abujaoude E, Large MD, Serpe RT. The prevalence of body dysmorphic disorder in the United States adult population. CNS Spectr. 2008 Apr. 13(4):316-22. [Medline].

  16. Haas CF. Champion A. Secor D. Motivating factors for seeking cosmetic surgery: a synthesis of the literature. Plastic Surgical Nursing. 2008 Oct-Dec. 28(4):177-82. [Medline].

  17. Phillips KA. Body dysmorphic disorder: the distress of imagined ugliness. Am J Psychiatry. 1991 Sep. 148(9):1138-49. [Medline].

  18. Allen A, Hollander E. Body dysmorphic disorder. Psychiatr Clin North Am. 2000 Sep. 23(3):617-28. [Medline].

  19. Cleveland WL, DeLaPaz RL, Fawwaz RA, Challop RS. High-dose glycine treatment of refractory obsessive-compulsive disorder and body dysmorphic disorder in a 5-year period. Neural Plast. 2009. 2009:768398. [Medline].

  20. Feusner JD, Moody T, Hembacher E, Townsend J, McKinley M, Moller H. Abnormalities of visual processing and frontostriatal systems in body dysmorphic disorder. Arch Gen Psychiatry. 2010 Feb. 67(2):197-205. [Medline].

  21. Monzani B, Rijsdijk F, Anson M, Iervolino AC, Cherkas L, Spector T, et al. A twin study of body dysmorphic concerns. Psychol Med. 2012 Sep. 42(9):1949-55. [Medline].

  22. Feusner JD, Yaryura-Tobias J, Saxena S. The pathophysiology of body dysmorphic disorder. Body Image. 2008 Mar. 5(1):3-12. [Medline].

  23. Deckersbach T, Savage CR, Phillips KA. Characteristics of memory dysfunction in body dysmorphic disorder. J Int Neuropsychol Soc. 2000 Sep. 6(6):673-81. [Medline].

  24. Phillips KA, Atala KD, Albertini RS. Case study: body dysmorphic disorder in adolescents. J Am Acad Child Adolesc Psychiatry. 1995 Sep. 34(9):1216-20. [Medline].

  25. Didie ER, Kuniega-Pietrzak T, Phillips KA. Body image in patients with body dysmorphic disorder: evaluations of and investment in appearance, health/illness, and fitness. Body Image. 2010 Jan. 7(1):66-9. [Medline].

  26. Calogero RM, Park LE, Rahemtulla ZK, Williams KC. Predicting excessive body image concerns among British university students: the unique role of Appearance-based Rejection Sensitivity. Body Image. 2010 Jan. 7(1):78-81. [Medline].

  27. Buhlmann U, Teachman BA, Naumann E, Fehlinger T, Rief W. The meaning of beauty: implicit and explicit self-esteem and attractiveness beliefs in body dysmorphic disorder. J Anxiety Disord. 2009 Jun. 23(5):694-702. [Medline].

  28. Bienvenu OJ, Samuels JF, Riddle MA, Hoehn-Saric R, Liang KY, Cullen BA, et al. The relationship of obsessive-compulsive disorder to possible spectrum disorders: results from a family study. Biol Psychiatry. 2000 Aug 15. 48(4):287-93. [Medline].

  29. Phillips KA, McElroy SL, Hudson JI, Pope HG Jr. Body dysmorphic disorder: an obsessive-compulsive spectrum disorder, a form of affective spectrum disorder, or both?. J Clin Psychiatry. 1995. 56 Suppl 4:41-51; discussion 52. [Medline].

  30. Stein DJ, Hollander E. Dermatology and conditions related to obsessive-compulsive disorder. J Am Acad Dermatol. 1992 Feb. 26(2 Pt 1):237-42. [Medline].

  31. Stein DJ, Hollander E. : APA Press. The spectrum of obsessive-compulsive related disorders. Hollander E, ed. Obsessive-Compulsive Related Disorders. Washington, DC: 1992. 241-71.

  32. Feusner JD, Arienzo D, Li W, Zhan L, Gadelkarim J, Thompson PM, et al. White matter microstructure in body dysmorphic disorder and its clinical correlates. Psychiatry Res. 2013 Feb 28. 211(2):132-40. [Medline]. [Full Text].

  33. Arienzo D, Leow A, Brown JA, Zhan L, Gadelkarim J, Hovav S, et al. Abnormal brain network organization in body dysmorphic disorder. Neuropsychopharmacology. 2013 May. 38(6):1130-9. [Medline]. [Full Text].

  34. Buhlmann U, Marques LM, Wilhelm S. Traumatic experiences in individuals with body dysmorphic disorder. J Nerv Ment Dis. 2012 Jan. 200(1):95-8. [Medline].

  35. Cotterill JA. Body dysmorphic disorder. Dermatol Clin. 1996 Jul. 14(3):457-63. [Medline].

  36. Mackley CL. Body dysmorphic disorder. Dermatol Surg. 2005 May. 31(5):553-8. [Medline].

  37. Phillips KA, Dufresne RG Jr, Wilkel CS, Vittorio CC. Rate of body dysmorphic disorder in dermatology patients. J Am Acad Dermatol. 2000 Mar. 42(3):436-41. [Medline].

  38. Sarwer DB, Wadden TA, Pertschuk MJ, Whitaker LA. Body image dissatisfaction and body dysmorphic disorder in 100 cosmetic surgery patients. Plast Reconstr Surg. 1998 May. 101(6):1644-9. [Medline].

  39. Alavi M, Kalafi Y, Dehbozorgi GR, Javadpour A. Body dysmorphic disorder and other psychiatric morbidity in aesthetic rhinoplasty candidates. J Plast Reconstr Aesthet Surg. 2011 Jun. 64(6):738-41. [Medline].

  40. Conrado LA, Hounie AG, Diniz JB, Fossaluza V, Torres AR, Miguel EC, et al. Body dysmorphic disorder among dermatologic patients: Prevalence and clinical features. J Am Acad Dermatol. 2010 Aug. 63(2):235-43. [Medline].

  41. Phillips KA, Kaye WH. The relationship of body dysmorphic disorder and eating disorders to obsessive-compulsive disorder. CNS Spectr. 2007 May. 12(5):347-58. [Medline].

  42. Phillips KA, Didie ER, Feusner J, Wilhelm S. Body dysmorphic disorder: treating an underrecognized disorder. Am J Psychiatry. 2008 Sep. 165(9):1111-8. [Medline]. [Full Text].

  43. Perugi G, Akiskal HS, Giannotti D, Frare F, Di Vaio S, Cassano GB. Gender-related differences in body dysmorphic disorder (dysmorphophobia). J Nerv Ment Dis. 1997 Sep. 185(9):578-82. [Medline].

  44. Grieve FG. A conceptual model of factors contributing to the development of muscle dysmorphia. Eat Disord. 2007 Jan-Feb. 15(1):63-80. [Medline].

  45. Bjornsson AS, Dyck I, Moitra E, Stout RL, Weisberg RB, Keller MB, et al. The clinical course of body dysmorphic disorder in the Harvard/Brown Anxiety Research Project (HARP). J Nerv Ment Dis. 2011 Jan. 199(1):55-7. [Medline]. [Full Text].

  46. Veale D, Boocock A, Gournay K, Dryden W, Shah F, Willson R, et al. Body dysmorphic disorder. A survey of fifty cases. Br J Psychiatry. 1996 Aug. 169(2):196-201. [Medline].

  47. Cotterill JA, Cunliffe WJ. Suicide in dermatological patients. Br J Dermatol. 1997 Aug. 137(2):246-50. [Medline].

  48. Phillips KA, Quinn G, Stout RL. Functional impairment in body dysmorphic disorder: a prospective, follow-up study. J Psychiatr Res. 2008 Jul. 42(9):701-7. [Medline]. [Full Text].

  49. Rabe-Jablonska J. [Results of long-term observation (3-11 years) of patients with dual diagnosis: body dysmorphic disorder and delusional disorder, somatic type]. Psychiatr Pol. 1998 Mar-Apr. 32(2):143-53. [Medline].

  50. Dingemans AE, van Rood YR, de Groot I, van Furth EF. Body dysmorphic disorder in patients with an eating disorder: prevalence and characteristics. Int J Eat Disord. 2012 May. 45(4):562-9. [Medline].

  51. Phillips KA, Pagano ME, Menard W, Stout RL. A 12-month follow-up study of the course of body dysmorphic disorder. Am J Psychiatry. 2006 May. 163(5):907-12. [Medline]. [Full Text].

  52. Phillips KA, Hollander E, Rasmussen SA, Aronowitz BR, DeCaria C, Goodman WK. A severity rating scale for body dysmorphic disorder: development, reliability, and validity of a modified version of the Yale-Brown Obsessive Compulsive Scale. Psychopharmacol Bull. 1997. 33(1):17-22. [Medline].

  53. Butler Hospital. Butler Hospital Screening Questionnaire for Adolescents: Do I have BDD. Butler Hospital. Available at Accessed: 6.6.10.

  54. Veale D, Eshkevari E, Ellison N, Cardozo L, Robinson D, Kavouni A. Validation of genital appearance satisfaction scale and the cosmetic procedure screening scale for women seeking labiaplasty. J Psychosom Obstet Gynaecol. 2013 Mar. 34(1):46-52. [Medline].

  55. Hunter-Yates J, Dufresne RG Jr, Phillips KA. Tanning in body dysmorphic disorder. J Am Acad Dermatol. 2007 May. 56(5 Suppl):S107-9. [Medline].

  56. Phillips KA, Taub SL. Skin picking as a symptom of body dysmorphic disorder. Psychopharmacol Bull. 1995. 31(2):279-88. [Medline].

  57. Yutzy, SParish, B. Somatoform Disorders. Tasman, A, Kay, J, Lieberman, J, First, M, Maj, M. Psychiatry. Third. London: John Wiley & Sons; 2008. 2: 1538-1542/74.

  58. Nakata AC, Diniz JB, Torres AR, de Mathis MA, Fossaluza V, Bragancas CA, et al. Level of insight and clinical features of obsessive-compulsive disorder with and without body dysmorphic disorder. CNS Spectr. 2007 Apr. 12(4):295-303. [Medline].

  59. Conroy M, Menard W, Fleming-Ives K, Modha P, Cerullo H, Phillips KA. Prevalence and clinical characteristics of body dysmorphic disorder in an adult inpatient setting. Gen Hosp Psychiatry. 2008 Jan-Feb. 30(1):67-72. [Medline]. [Full Text].

  60. Phillips KA, Kelly MM. Suicidality in a placebo-controlled fluoxetine study of body dysmorphic disorder. Int Clin Psychopharmacol. 2009 Jan. 24(1):26-8. [Medline]. [Full Text].

  61. Picavet V, Gabriëls L, Jorissen M, Hellings PW. Screening tools for body dysmorphic disorder in a cosmetic surgery setting. Laryngoscope. 2011 Dec. 121(12):2535-41. [Medline].

  62. Wilhelm S, Greenberg JL, Rosenfield E, Kasarskis I, Blashill AJ. The Body Dysmorphic Disorder Symptom Scale: Development and preliminary validation of a self-report scale of symptom specific dysfunction. Body Image. 2016 Mar 10. 17:82-87. [Medline].

  63. Ipser JC, Sander C, Stein DJ. Pharmacotherapy and psychotherapy for body dysmorphic disorder. Cochrane Database Syst Rev. 2009 Jan 21. CD005332. [Medline].

  64. Ravindran AV, da Silva TL, Ravindran LN, Richter MA, Rector NA. Obsessive-compulsive spectrum disorders: a review of the evidence-based treatments. Can J Psychiatry. 2009 May. 54(5):331-43. [Medline].

  65. [Guideline] British Psychological Society, Royal College of Psychiatrists. Obsessive-compulsive disorder: core interventions in the treatment of obsessive-compulsive disorder and body dysmorphic disorder. National Guideline Clearinghouse. 2006;. Available at

  66. Phillips KA, Hollander E. Treating body dysmorphic disorder with medication: evidence, misconceptions, and a suggested approach. Body Image. 2008 Mar. 5(1):13-27. [Medline]. [Full Text].

  67. Sondheimer A. Clomipramine treatment of delusional disorder-somatic type. J Am Acad Child Adolesc Psychiatry. 1988 Mar. 27(2):188-92. [Medline].

  68. Hollander E, Allen A, Kwon J, Aronowitz B, Schmeidler J, Wong C, et al. Clomipramine vs desipramine crossover trial in body dysmorphic disorder: selective efficacy of a serotonin reuptake inhibitor in imagined ugliness. Arch Gen Psychiatry. 1999 Nov. 56(11):1033-9. [Medline].

  69. Krasowska D, Szymanek M, Schwartz RA, Myslinski W. Cutaneous effects of the most commonly used antidepressant medication, the selective serotonin reuptake inhibitors. J Am Acad Dermatol. 2007 May. 56(5):848-53. [Medline].

  70. Phillips KA. Body dysmorphic disorder: clinical aspects and treatment strategies. Bull Menninger Clin. 1998 Fall. 62(4 Suppl A):A33-48. [Medline].

  71. Allen A, Hadley SJ, Kaplan A, Simeon D, Friedberg J, Priday L, et al. An open-label trial of venlafaxine in body dysmorphic disorder. CNS Spectr. 2008 Feb. 13(2):138-44. [Medline].

  72. [Guideline] National Collaborating Centre for Mental Health. Obsessive-compulsive disorder: core interventions in the treatment of obsessive-compulsive disorder and body dysmorphic disorder. London (UK): British Psychological Society, Royal College of Psychiatrists; 2006. 350 p. (National clinical practice guideline; no. 31).

  73. Greenberg JL, Mothi SS, Wilhelm S. Cognitive-Behavioral Therapy for Adolescent Body Dysmorphic Disorder: A Pilot Study. Behav Ther. 2016 Mar. 47 (2):213-24. [Medline].

  74. Crerand CE, Infield AL, Sarwer DB. Psychological considerations in cosmetic breast augmentation. Plast Surg Nurs. 2007 Jul-Sep. 27(3):146-54. [Medline].

  75. Polo M. Body dysmorphic disorder: a screening guide for orthodontists. Am J Orthod Dentofacial Orthop. 2011 Feb. 139(2):170-3. [Medline].

  76. Sheppard NP, O'Loughlin S, Malone JP. Psychogenic skin disease: a review of 35 cases. Br J Psychiatry. 1986 Nov. 149:636-43. [Medline].

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