It is estimated that anywhere from 3 to 11 percent of women have a preoccupation with how their body looks (1). These individuals are fixated on imaginary flaws in the physical appearance of their body and demonstrate an extraordinary amount of anguish and anxiety over it.
In North America, body dysmorphic disorder is often seen in plastic surgery and skin consults. The majority of these people suffer from occupational dysfunction and or social isolation. In addition, many show signs of mood changes.
Treatment of these individuals is difficult as many do not seek psychiatric referral but often seek more cosmetic surgery (2). Undergoing more cosmetic surgery often fails to improve symptoms of body dysmorphic disorder and they remain displeased with the results. Less than 3 percent of these individuals ever come to mental health care professionals, but this is only when they are financially broke, depressed or the family has insisted on treatment (3).
The treatment of body dysmorphic disorder is a combination of serotonin reuptake inhibitors and cognitive behavior therapy. To date, SSRIs have proven to be effective but the doses required are high and the treatment duration is long. If these individuals remain compliant with therapy, almost 50 percent will see a partial improvement or complete reduction in their symptoms (4) Studies have shown that SSRIs can decrease the obsessive features, depression, help develop insight, improve social performance and help the individual accept the body flaws. Sometimes the delusional symptoms may benefit from the use of low doses of anti psychotics.
When all drug treatments fail, Monoamine oxidase inhibitors remain the last choice. (5) However, because of severe dietary restrictions, these drugs should only be prescribed by specialist.
Most of these patients will discreetly seek psychiatric help for medications but will steadfastly refuse any type of psychotherapy for fear of being labeled "crazy." Thus, doctors must try to get on-site psychological evaluation. Cognitive behavior therapy (CBT) is helpful and encourages people with such behaviors to understand their situation and diminishes anxiety.