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Treatments and drugs
By Mayo Clinic staffTreatment of body dysmorphic disorder can be difficult, especially if you aren't a willing and active participant in your care. But effective treatment is often successful.
Treatment options: Psychotherapy and medications
The two main treatments for body dysmorphic disorder are:
- Psychotherapy
- Medications
Often, treatment involves a combination of psychotherapy and medications.
Psychotherapy for body dysmorphic disorder
Psychotherapy can help you learn about your condition and your feelings, thoughts, mood and behavior. Using the insights and knowledge you gain in psychotherapy, you can learn to stop automatic negative thoughts and to see yourself in a more realistic and positive way. You can also learn healthy ways to handle urges or rituals, such as mirror checking or skin picking.
Specific types of psychotherapy that may be helpful for body dysmorphic disorder include:
- Cognitive behavioral therapy
- Behavior therapy
You and your therapist can talk about which type of therapy is right for you, your goals for therapy, and other issues, such as the number of sessions and the length of treatment. Therapy can be as an individual or in a group setting.
Medications for body dysmorphic disorder
There are no medications specifically approved by the Food and Drug Administration to treat body dysmorphic disorder. However, psychiatric medications used to treat other conditions, such as depression, can also be prescribed for body dysmorphic disorder off-label — that is, even if they haven't been specifically FDA approved for that use.
Because body dysmorphic disorder is thought be caused in part by problems related to the brain chemical serotonin, the medications prescribed most commonly are those that affect serotonin, including:
- Selective serotonin reuptake inhibitors (SSRIs)
- Tricyclic antidepressants
These medications can help control your obsessions and repetitive behaviors. In general, treatment of body dysmorphic disorder requires higher doses of these medications than does depression. You can gradually increase your dose to make sure you can tolerate the medication and possible side effects.
It may take as long as 12 weeks for noticeable improvement in your symptoms. You may need to try two or more medications before finding one that works well for you and has the fewest side effects. And you may need to try other types of antidepressants or medications if the main choices aren't effective enough.
In some cases, you may benefit from taking medications in addition to your primary antidepressant medication. For instance, your doctor may recommend that you take an antipsychotic medication in addition to an SSRI if you have delusions related to body dysmorphic disorder.
The risk of relapse is typically high once you stop taking a medication for body dysmorphic disorder. You may need to continue to take a medication indefinitely, especially if you've had suicidal thoughts or behavior in the past.
Hospitalization
In some cases, your body dysmorphic disorder symptoms may be so severe that you require psychiatric hospitalization. Psychiatric hospitalization is generally recommended only when you aren't able to care for yourself properly or when you're in immediate danger of harming yourself or someone else. Psychiatric hospitalization options include 24-hour inpatient care, partial or day hospitalization, or residential treatment, which offers a supportive place to live.
Cosmetic procedures
While it may seem that a procedure to "fix" your perceived flaw is a good option, cosmetic surgery, dentistry or other approaches usually don't relieve the distress of body dysmorphic disorder. You may not get the results you hoped for, or you may simply begin obsessing about another aspect of your appearance and seek out more cosmetic procedures. Cosmetic procedures don't address your underlying condition — they are only temporary fixes, at best.
- Moore DP, et al. Body dysmorphic disorder. In: Moore DP, et al. Handbook of Medical Psychiatry. 2nd ed. Philadelphia, Pa.: Mosby, Inc.; 2004. http://www.mdconsult.com/das/book/body/107599999-2/0/1243/0.html. Accessed Aug. 20, 2008.
- Castle DJ, et al. An update on body dysmorphic disorder. Current Opinion in Psychiatry. 2006;19:74-78.
- Buescher LS, et al. Body dysmorphic disorder. Dermatologic Clinics. 2006;24:251-257.
- Body dysmorphic disorder. In: Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR. Arlington, Va.:American Psychiatric Association, 2000. www.psychiatryonline.com. Accessed Aug. 20, 2008.
- Hunt TJ, et al. The mirror lies: Body dysmorphic disorder. American Family Physician. 2008;78(2):217-222, 223-224.
- Phillips KA, et al. Body dysmorphic disorder: Treating an underrecognized disorder. American Journal of Psychiatry. 2008;165(9).
- Hall-Flavin DK (expert opinion). Mayo Clinic, Rochester, Minn. Oct. 17, 2008.
