No abstract

Many individuals with body dysmorphic disorder seek nonpsychiatric medical and surgical treatment to improve perceived defects in their physical appearance. However, the types of treatments sought and received, as well as the treatment outcome, have received little investigation. This study describes the frequency, types, and outcomes of treatments sought and received by 200 individuals with body dysmorphic disorder. Treatment was sought by 71.0% and received by 64.0%. Dermatological treatment was most frequently sought and received (most often, topical acne agents), followed by surgery (most often, rhinoplasty). Twelve percent of the subjects received isotretinoin. Such treatment rarely improved body dysmorphic disorder. Thus, nonpsychiatric medical treatments do not appear effective in its treatment.Body dysmorphic disorder (BDD), a distressing or impairing preoccupation with an imagined or slight defect in appearance, is associated with markedly impaired psychosocial functioning, suicidality, and notably poor quality of life.1 Despite the morbidity that BDD causes, few studies have investigated the treatments that individuals who suffer from it seek and receive.The plastic surgery and dermatology literatures contain anecdotal reports of patients with "minimal deformity" and "dermatological nondisease" who appear similar to patients with BDD. 2 Such reports typically noted poor outcomes and dissatisfaction with treatment.However, it was unclear whether they had DSM-defined BDD. Recent studies have suggested that DSM-IV BDD is relatively common in these settings. The rates of BDD among cosmetic surgery patients range from 7% to 15%; in dermatological settings, rates of 9% to 12% have been reported. 2Few studies have examined the converse-i.e., the rates of nonpsychiatric medical treatment received by individuals with BDD. In the largest study we know of, 3 76% of 250 adults sought and 66% received nonpsychiatric treatment for their perceived appearance "defect," most commonly dermatological and surgical. A study of 50 patients with BDD 4 found that 48% had sought surgical or dermatological treatment, and 26% had received at least one procedure. In a chart-review study of 50 patients, 40% had undergone plastic surgery. 5 These findings are consistent with evidence that the skin (e.g., acne), hair (e.g., thinning), and nose (e.g., size or shape) are the most common areas of concern. 1 These results are also consistent with evidence that most patients have poor insight regarding their perceived defects, believing that they have actual physical deformities for which medical treatment or surgery is needed.