Diagnostic criteria for
300.7 Body Dysmorphic Disorder
( cautionary statement )
This disorder, formerly referred to as dysmorphophobia, tends to occur in young adults equally in either gender. The patient becomes pre-occupied with a non-existent or minimal cosmetic defect (nose, cleft chin, blemish, breast size) and persistently seeks medical attention to fix it surgically. Some clinicians feel it is a variant of obsessive-compulsive disorder. Many do well with surgery, but some remain persistently disgruntled. It is important to distinguish them from psychotic patients and those with highly disturbed global and body self-images, since those patients will not be improved by surgery.
Body Dysmorphic Disorder (BDD) therefore is characterized by certain key and associated features, specifically preoccupying obsessions with a particular body part that the person considers unattractive.
Cases of body dysmorphic disorder can range from relatively mild to very severe. People with mild cases are bothered and distressed, and their obsessions cause some degree of impairment.
Criteria for diagnosis are:
A. Preoccupation with an imagined defect in appearance. If a slight physical anomaly is present, the person's concern is markedly excessive. B. The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.
C. The preoccupation is not better accounted for by another mental disorder (e.g., dissatisfaction with body shape and size in Anorexia Nervosa ).
Associated Features:
Depressed Mood
Somatic or Sexual Dysfunction
Guilt or Obsession
Anxious or Fearful or Dependent Personality
Differential Diagnosis:
Some disorders display similar or sometimes even the same symptom. The clinician, therefore, in his diagnostic attempt, has to differentiate against the following disorders which one needs to be ruled out to establish a precise diagnosis.
General Medical Condition.
Major Depressive Disorder.
Schizophrenia.
Social Phobia.
Obsessive-Compulsive Disorder.
Anorexia Nervosa.
Bulimia Nervosa.
Cause:
Although we still do not have a single clear cause for body dysmorphic disorder, authorities believe that biological, psychological and perhaps even social or cultural factors contribute to its origins.
Treatment:
Counseling and Psychotherapy:
Cognitive-behavior therapy which includes education about BDD and its treatment, and specific treatments to deal with faulty thoughts, assumptions ("cognition's") and problematic behaviors. The cognitive aspects involve discovering, challenging and changing the underlying negative thoughts and beliefs the sufferer keeps thinking.
The treatment's behavioral components usually focus on exposure and response prevention. Exposure usually involves having the sufferer gradually learn to face and confront the situations they fear the most, such as going into public places or exposing their embarrassing body part to others' scrutiny without hiding or camouflaging it. Response prevention involves getting the sufferer to conscientiously and diligently refuse or avoid doing the self-damaging behaviors they feel compelled to do, such as staring endlessly into mirrors or picking at one's face. When sufferers are able to delay such behaviors long enough, the impulse to do them sometimes dies down, and these behaviors may be thwarted.
Available evidence suggests that medication and cognitive-behavior therapies can complement each other well. In addition to these treatments, family education and counseling, to help family members understand what is going on and how to help the sufferer, and group therapy or support for those with BDD may be of benefit.
Pharmacotherapy:
Treatment with SRIs. These same SRI medications are also used to treat depression, obsessive-compulsive disorder (OCD) and other anxiety conditions.
Fluoxetine Prozac.
Fluvoxamine Luvox.
Paroxetine Paxil.
Sertraline Zoloft.
Citalopram Celexa.
Clomipramine Anafranil.
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