Over the past 40 years, considerable evidence has accumulated in support of cognitive behavioral therapy (CBT) for various mental health disorders. Cognitive behavioral therapy has demonstrated efficacy on par with medication, significantly augmenting it and surpassing its durability. 1,2 Despite this strong record, efficacy may be weaker if refractory elements (eg, rumination in patients with major depression) are not specifically targeted, 3 and although no other psychosocial treatment has been studied as rigorously as CBT, a number of trials failed to include important high-quality indicators reflecting this rigor (eg, randomization, an active comparator, fidelity and integrity analyses, consideration of participant dropouts), and those that do demonstrate smaller effect sizes. 1 Body dysmorphic disorder (BDD) is a refractory condition that involves the propensity to imagine or exaggerate a bodily flaw and go to great lengths to hide this perceived flaw. Although also associated with social anxiety, it has recently been classified within the obsessive-compulsive spectrum, given a number of studies that demonstrate overlap with OCD, including shared phenomenology manifested as intrusive cognitive characteristics and ritualistic efforts to control exposure of perceived flaws, as well as the preoccupation with the flaws themselves. 4 Although not highly prevalent (in that point prevalence is approximately 2.4% 4 ), it is typically quite debilitating, with a long-term course, lowered quality of life, and considerable suicidal ideation (80%) and attempt rates (25%). 4 Despite this, to date and to my knowledge, there has been a paucity of pharmacotherapy trials. Psychosocial trials, while more numerous, have been uneven in rigor, with particular limitations in randomization, manualization, active-comparator usage, and specification to BDD phenomena. 4,5