Body Dysmorphic Disorder

Finding The Right Treatment

Treatment

Treatment for BDD usually involves a combination of psychotherapy and medication. The good news is that most people's symptoms improve with a combination of therapy, medications, and lifestyle modifications.

Finding a therapist

Therapy has been proven to yield major improvements in the lives of those with BDD. Whether it be a recognition of one's symptoms, an understanding of how one's past might have impacted them, or a simple awareness of one's thoughts and their triggers, therapy can help people become more content versions of themselves. Not all therapists have experience working with adults with BDD; however, there are many therapists who can, and therapy is increasingly offered virtually (in the comfort of home).

There are different kinds of professionals who can provide effective therapy for BDD, including:

• Clinical psychologists (PhD)
• Licensed clinical social workers (LCSW or LMSW)
• Licensed professional counselors (LPC)
• Licensed clinical professional counselors (LCPC)
• Licensed Marriage and Family Therapists (LMFT)
• National certified counselors (NCC)

In recent years, more therapists employ cognitive behavioral therapy (CBT), which is a method that helps the individual identify unhelpful thought patterns and challenge self-destructive cognitions, and replaces them with more constructive thinking. In the treatment of BDD, most therapists use a specific form of CBT called exposure and response prevention (ERP). This modality is used to help patients decrease their repetitive behaviors and obsessional thinking related to their BDD. With this form of therapy, the person is led to challenge their fears on an escalating continuum of minor fears to more serious fears. For example, a person with BDD who hides behind several layers of makeup might be led to go out in public with only one layer of makeup, to see for themselves that others do not shrink back from them in horror.

The Decision to start therapy

Many people try to cope with their distress on their own, then feel disappointed when they find that this is very difficult to do. Deciding to start therapy can be hard; it takes courage.

For some people, it can take time to warm up to the idea of sharing one’s intimate thoughts or disclosing details of one’s life, especially for those who grew up in a culture where seeking psychological help was frowned upon.

Psychotherapy is increasingly accepted as not only a way to improve mental health symptoms, but also a means for self exploration and personal growth. No problem is too small for a trained therapist: an individual need not worry that others may have it worse. The willingness to reach out for help is increasing: in 2020, one out of every six Americans (men and women) reported seeing a therapist.

Seeing a therapist with whom one feels comfortable, and a sense of connection, and who also participates in their insurance network, is essential. It may take a couple tries to find a therapist who feels like the right fit. If therapy didn't help the first time around, it can be helpful to give another therapist a try because therapeutic styles vary so much from therapist to therapist.

Where to start

Requesting one’s physician to make a referral is often a good place to start. Many health insurance cards have websites or 1-800 numbers to call for a list of in-network providers.

To find a therapist who takes your insurance, the National Institute of Mental Health offers a comprehensive list of resources.

Psychology Today also lists therapists by type, location and insurance.

Determining whether medications will play a role in treatment

Although there are no medications approved specifically for the treatment of BDD, medications approved for other conditions such as depression and OCD are often prescribed.

Antidepressants

The key medications used to treat BDD include selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine (Prozac), fluvoxamine (Luvox), and escitalopram (Lexapro). In general, these medications take at least two weeks to become effective, and the longer the exposure, the greater the benefit. It is also worth noting that they are used in higher doses when treating BDD than when used for major depression. Clomipramine (Anafranil), a tricyclic antidepressant, is also approved to treat BDD. It can be quite effective, but is often less well tolerated than the SSRIs.

FDA Warning about suicide risk with antidepressants

Some research exists that, occasionally, newly initiated anti-depressants may increase the risk of suicide. If an individual begins to have these thoughts after starting an anti-depressant, they should stop this medicine and contact a prescriber immediately. This risk is more evident in children, adolescents, and young adults.

Healthcare providers that can prescribe medications

Psychiatrists, psychiatric nurse practitioners, and physician assistants are practitioners who are trained to diagnose and treat mental health conditions by prescribing medications. Sometimes it's hard to find a psychiatric provider because there are so many people who need them. So, individuals often choose to see a different kind of provider who can prescribe. This could be a doctor they already see, like a primary care doctor, family doctor or OB/GYN, or a new primary doctor.