Psychiatric/psychological treatment often improves BDD symptoms and the
suffering it causes. The treatments that appear most effective are
certain medications (serotonin-reuptake inhibitors) and a type of
therapy known as cognitive-behavioral therapy (CBT). For more detailed
advice about recommended treatment approaches, please see Katharine A.
Phillips, MD's revised and updated book on BDD (Understanding Body
Dysmorphic Disorder: An Essential Guide).
Medications Are Often
Helpful for BDD
The medications that are currently recommended for BDD are the
serotonin-reuptake inhibitors (also known as SRIs or SSRIs). The SRIs
are antidepressant medications that also help stop obsessional thinking
and excessive compulsive behaviors such as mirror checking. They are
often used to treat other disorders, such as depression, social anxiety
disorder and obsessive-compulsive disorder. SRIs appear to be effective
for a majority of people with BDD. These medications are not addicting
and are usually well tolerated.
The following medications are SRIs:
A number of research studies done by our group and other researchers
have shown that SRIs substantially improve BDD symptoms in a majority of
people. These medications can significantly diminish bodily
preoccupation, emotional distress, depression and anxiety. They can also
significantly increase control over one's thoughts and behaviors. They
also often improve daily functioning, for example, making it easier to
be around other people or to concentrate at work or school. In some
cases (for example, when people are suicidal), they are lifesaving.
In one of our studies, we found that the SRI fluoxetine (Prozac) was
more effective than placebo (a sugar pill) for BDD symptoms and daily
functioning. In a study of the SRI clomipramine (Anafranil), done by
Eric Hollander, MD, at Mount Sinai Medical Center in New York City, the
SRI clomipramine was superior to the non-SRI antidepressant desipramine
in improving BDD symptoms and functioning. In other studies, we have
found that escitalopram (Lexapro), citalopram (Celexa), and fluvoxamine
(Luvox) were effective for most patients. It's important, however, to
use a high enough SRI dose for a long enough time to give the medicine a
chance to work.
We need a lot more scientific research to give us more information about
effective treatments for BDD. In the meantime, based on the scientific
evidence that is available, as well as Phillips's extensive clinical
experience treating people with BDD, we generally recommend the
Other medications appear to sometimes be helpful when used in
combination with an SRI. Please see Understanding Body Dysmorphic
Disorder: An Essential Guide for details on this topic. The book
also covers many other treatment issues, such as what to do if an SRI
doesn't work well enough for you.
Each person with BDD requires individualized assessment of BDD and other
symptoms. If other disorders are present along with the BDD, this may
influence the medication that's selected. Possible side effects, your
response to past treatment, your treatment preference, or a need for
immediate symptom relief are some of the factors that my influence
treatment decisions. We recommend a comprehensive evaluation by a
psychiatrist and development of an individualized treatment plan that
includes close monitoring. The above suggestions only general guidelines
that must be tailored to you in consultations with your doctor.
Please also note that no medication has been approved by the FDA for the
treatment of BDD. This is because not enough studies that are
specifically designbed to obtain such approval have been done.
Nonetheless, all of the research that to our knowledge has been done on
medications for BDD indicates that the SRIs are effective for BDD
symptoms in a majority of people with this disorder.
Responses to Some Misconceptions
About Medication Treatment of BDD
Many people have misconceptions about medications, including SRIs, Here
are some brief responses to some of the more common misconceptions.
More BDD treatment research studies are greatly needed! We need more and
better studies of the treatment options discussed above. We also need
research to develop new and even more effective treatments for BDD. Find
out further information on how our program is dedicated to this cause
and the various medication treatment studies we are offering for children, adolescents and
Cognitive Behavioral Therapy
Is Often Helpful for BDD
Cognitive-behavioral therapy (CBT) is the best-studied and most
promising type of psychotherapy for BDD. When used by trained
therapists, CBT is effective for such disorders as depression, phobias,
panic disorder, obsessive compulsive disorder and eating disorders.
Available research studies indicate that CBT substantially improves BDD
symptoms in a majority of people, diminishing obsessional appearance
preoccupations and compulsive behaviors, depressive symptoms, and
anxiety, and improving body image and self-esteem.
Still, more research is needed. We and our colleagues at Massachusetts
General Hospital/Harvard Medical School in Boston (Sabine Wilhelm, PhD)
and Boston University (Gail Steketee, PhD) are currently doing a CBT
study, funded by the National Institute of Mental Health.
What CBT Consists Of
CBT is a practical “here and now” treatment that focuses on changing
problematic BDD thoughts and behaviors. The purpose of CBT is to learn
practical skills that can help a person cope with and overcome
BDD—skills that can be used now and in the future to keep BDD under
A Few Key Considerations
Treatments That Don't Appear to
Work for BDD
Even though there are effective treatments for BDD (CBT and
serotonin-reuptake inhibitor medications), most people with BDD seek and
receive treatments that don't seem to work. These ineffective treatments
include surgery, dermatologic treatment, and other nonpsychiatric
treatment (for example, dental treatment). People with BDD can waste
lots of time and money pursuing these treatments, and can end up
bitterly disappointed when they don't obtain the relief they're so
It makes sense that these treatments almost never improve BDD. BDD isn't
a problem with actual appearance; it's a problem with how the person
sees themselves - their body image - so changing one's actual appearance
through surgery doesn't seem to work. Although more research is needed
to confirm that these treatments don't work for BDD, in the meantime,
based on current knowledge, we recommend that people with BDD avoid
them. They don't seem to help, and they can even make BDD worse. BDD is
a serious mental illness that requires psychiatric treatment, which is
often very helpful.
Don't Give Up
It may take a while to find the exact treatment that works for you. In
addition, medication treatment and therapy need to be tailored to each
individual. However, most people with BDD do eventually get better with
an SRI and/or CBT. Some people respond to the first treatment they try,
whereas others need to try more than one. Some people improve quickly,
whereas others need more time. But most people who persist in trying
recommended treatments do improve. In addition, I and other researchers
are continually trying to learn more about what treatments work and to
find and develop even more effective treatments for BDD—so new treatment
options will hopefully become available in the future.
What if you’re reluctant to try recommended treatment? Please read
Phillips’s thoughts about this in an excerpt from her book Understanding Body Dysmorphic Disorder: An
Where Can I Find More Information
on Treatments for BDD?
Understanding Body Dysmorphic
Disorder: An Essential Guide (Published by Oxford University
Press in 2009)
This book, written by Katharine Phillips, MD, is a comprehensive and
up-to-date source on BDD and its treatment.
In addition, as research on what treatments work for BDD is completed in
upcoming years, the results will be published in articles in scientific
journals. The journals are the most authoritative source about effective
treatments. This is a good way to stay abreast of new information about
treatment for BDD. Clink the following link for more information on how
to access these articles about BDD.