What is the Best Treatment for Body Dysmorphic Disorder (BDD)?by Dr Emma Gray - 21st February, 2019
BDD is an anxiety disorder that effect approximately 1 in 50 people. It effects both men and women of any age but is particularly common in teenagers and young adults. For more information about BDD watch this video:
There are 2 types of treatment that have been proven to be effective for BDD, medication and talking therapy. I will explain a little about each of these and then go through what you can expect to be offered depending on the severity of your symptoms.
The biological origins of BDD are unclear, some theories suggest a genetic cause, others a chemical imbalance, others have found no biological cause. This makes developing an effective medication difficult and means that prescribing often involves a bit of trial and error in order to get the type and dose of the medication correct. Most commonly however, you will be prescribed an anti-depressant called an SSRI (Serotonin Reuptake Inhibitor). There are a number of different SSRIs that are used to treat BDD but the most common is Fluoxetine or Prozac. You will be monitored closely whilst taking this medication as it has a number of side effects, most notably in adults under 30 it can lead to self-harming behaviours and thoughts of suicide. If your symptoms have not improved after 12 weeks you may be prescribed a different type of anti-depressant (a tricyclic) called Clomipramine.
The most effective talking therapy for BDD is Cognitive Behavioural Therapy (CBT). The psychological origins of BDD are clearer than the biological origins so developing a treatment here has been more straightforward.
Treatment tends to have 2 phases. The first aims to help you to reduce your symptoms on a day to day basis by helping you to identify the thoughts that drive your BDD, assess their accuracy & helpfulness and then construct more accurate and helpful thoughts to replace them. This phase also involves a technique known as Exposure Response Prevention (ERP), where you learn to resist the rituals and routines associated with BDD (e.g. body checking) and manage the anxiety that this creates.
The second phase of treatment involves addressing the factors that have made you vulnerable to developing BDD in the first place and building your self esteem and confidence so that your symptoms don’t return in the future.
What type of treatment will you be offered
If your symptoms are assessed as being mild, you are likely to be offered a course of CBT, either in a group or 1-1 with a therapist.
If your symptoms are moderate or your symptoms do not respond to the initial treatment, you may be offered a more intensive course of CBT (usually more than 10 hours 1-1 with a therapist) or a course of SSRI anti-depressants.
If your symptoms are severe or your symptoms do not improve following previous treatment, you are likely to be offered a combination of an SSRI and a course of CBT.
For more information about BDD visit The Body Dysmorphic Disorder Foundation.