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. Moreover, CBT can help improve self-esteem, erase distorted thoughts and helps one develop coping strategies. People with body dysmorphic disorder remain at a high risk for depression and risk for suicides (6).
Many experience severe social and occupational isolation because they are constantly scrutinized about the latest cosmetic surgery they underwent. These individuals truly believe that a change in their body is a major prerequisite to them being happy.
Unfortunately, the prognosis for people with this disorder is not good. Most fall out of treatments and continue to agonize about the imaginary defects in their bodies. Most end up undergoing countless cosmetic surgeries and finally end up with real complications as a direct result of the surgery.
Sources:
1. Otto MW, Wilhelm S, Cohen LS, Harlow BL. Prevalence of body dysmorphic disorder in a community sample of women. Am J Psychiatry. Dec 2001;158(12):2061-3. http://www.ncbi.nlm.nih.gov/pubmed?term=Otto%20MW%2C%20Wilhelm%20S%2C%20Cohen%20LS%2C%20Harlow%20BL
2. Haas CF. Champion A. Secor D. Motivating factors for seeking cosmetic surgery: a synthesis of the literature. Plastic Surgical Nursing. Oct-Dec 2008;28(4):177-82. http://www.ncbi.nlm.nih.gov/pubmed?term=Haas%20CF.%20Champion%20A.%20Secor%20D.
3. Body dysmorphic disorder. http://emedicine.medscape.com/article/291182-clinical.
4. 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. May 2009;54(5):331-43. http://www.ncbi.nlm.nih.gov/pubmed?term=Ravindran%20AV%2C%20da%20Silva%20TL%2C%20Ravindran%20LN%2C%20Richter%20MA%2C%20Rector%20NA
5. Pharmacologic Treatment of Body Dysmorphic Disorder: Review of the Evidence and a Recommended Treatment Approach . http://www.primarypsychiatry.com/aspx/articledetail.aspx?articleid=2172
6. Phillips KA, Menard W. Suicidality in body dysmorphic disorder: a prospective study. Am J Psychiatry. Jul 2006;163(7):1280-2. http://www.ncbi.nlm.nih.gov/pubmed/16816236
Reviewed June 30, 2011
by Michele Blacksberg R.N.
Edited by Alison Stanton