Body dysmorphic disorder (BDD) treatment is very similar to the treatment for related disorders like obsessive-compulsive disorder (OCD), somatic and eating disorders. While some specialized body dysmorphic disorder treatment centers have been established, most people with BDD can be successfully treated on an outpatient basis by a single mental health professional.
There are differing opinions on how to treat body dysmorphia but a general clinical consensus on best practices has been established. Treatment of body dysmorphic disorder usually focuses on individual therapy to address the cognitive and behavioral aspects of the condition. Medications are sometimes used for body dysmorphia treatment, especially when a person with BDD has co-occurring mental health conditions.
Medications Used for Treating Body Dysmorphic Disorder
Medication for body dysmorphic disorder remains a somewhat controversial topic. While mental health professionals commonly treat BDD with either antidepressant or antipsychotic medications, the Food and Drug Administration (FDA) has not formally approved any drug for the treatment of body dysmorphic disorder.
The best body dysmorphic disorder medications are a class of antidepressant medications called selective serotonin reuptake inhibitors (SSRIs). Clinicians have found that SSRIs not only resolve symptoms of anxiety and depression but also treat OCD-related obsessions and compulsions. Researchers theorize that the increased availability of serotonin helps shift cognition away from fixating on negative stimuli, possibly through helping the brain build new neuronal connections.
A meta-analysis by Soomro, Altman, Rajagopal, and Browne shows that SSRIs effectively treat symptoms of OCD that are also symptoms of BDD, including obsessive thoughts and compulsive behavior. Other studies show SSRIs are effective at specifically treating body dysmorphia. A study by Phillips, Albertini and Rasmussen found the SSRI fluoxetine (Prozac) to be more effective than placebo in the treatment of BDD.
Therapy Options for Body Dysmorphic Disorder
Therapy for body dysmorphic disorder focuses on the distorted thought patterns behind the compulsive behavior, impaired functioning and psychological distress associated with BDD. For this reason, cognitive behavioral therapy (CBT) is the most common therapeutic intervention used to treat body dysmorphia.
Cognitive Behavioral Therapy
While CBT is well-established as an effective intervention for most mental health conditions, it is especially effective for disorders that are primarily driven by negative or distorted thinking. Because BDD is rooted in beliefs about a person’s physical appearance and how others judge them, cognitive behavioral therapy for body dysmorphic disorder focuses on helping a person identify these troublesome thoughts, then question them and change them.
One study that establishes BDD’s foundation on distorted cognition is a study by Crerand, Phillips, Menard and Fay. The researchers found that non-psychiatric medical treatment of BDD, including cosmetic surgery and dermatological treatment, rarely improved body dysmorphia. In other words, achieving the physical changes they desired did not change how people with BDD thought or felt about their bodies. It’s not uncommon for people with obsessive disorders to fixate upon a new target after resolving the issue at the core of a particular obsession.
In CBT, a person learns about the connections between the way they think and the way they feel and act. Most of the distress associated with obsessive thoughts come from believing that these thoughts are true. A therapist who practices CBT helps clients identify painful thoughts that are false or distorted. Once people with BDD start to realize other people do not perceive the same faults that they do or judge them in the way they fear being judged, their distress is diminished. A study by Reiter and Orosan found that CBT completely eliminated the disorder in about 80 percent of the cases they studied.
An alternative to CBT that has a slightly different approach is acceptance and commitment therapy (ACT). This intervention also focuses on helping people identify cognitive distortions or thoughts that cause them distress. However, instead of having them try to change these thoughts, ACT teaches people techniques to help them let go of these thoughts and create enough cognitive distance that they can act independently from them. Research by Arch and others shows that ACT is as effective as CBT in the same areas.
Other Therapies for Body Dysmorphic Disorder
While CBT has been clearly established as an effective treatment for BDD, its effects can be enhanced through the incorporation of other therapeutic techniques. Many therapists who practice CBT use additional interventions that target other areas of concern, including trauma and pre-cognitive emotional reactions.
Many therapeutic techniques specifically focus on healing the negative effects of trauma. People with BDD often have histories of childhood trauma and can be helped by these approaches. Trauma-focused interventions proven to be effective include eye movement desensitization and reprocessing therapy (EMDR) and dialectical behavioral therapy (DBT).
Psychodynamic psychotherapy can help resolve painful issues rooted in childhood experiences. This traditional approach helps people gain insight into the roots of their thoughts and feelings and to become aware of previously unconscious reactions. For example, recovering memories of being shamed by a parent about a particular physical feature and learning that this parent’s judgments were not authoritative or accurate can help a person let go of thought patterns derived from these childhood experiences.
While psychodynamic therapy has fallen out of style, recent research shows it can be just as effective as CBT in treating a wide range of psychiatric conditions.
Treatments for Body Dysmorphic Disorder with Co-Occurring Disorders
Body dysmorphic disorder is rarely diagnosed independently and is associated with several commonly co-occurring conditions. Anywhere from 8 to 37 percent of people with OCD also have BDD. About 12 percent of people with social anxiety disorder have body dysmorphia, and BDD and depression are especially common co-occurring conditions, with 14 to 42 percent of people with major depressive disorder also having BDD.
About 7 percent of people with anxiety disorders have co-occurring body dysmorphic disorder. People with social anxiety disorder (SAD) are more likely to have comorbid BDD, though it is not unusual for people with generalized anxiety disorder, panic disorder, or OCD to also have BDD. Fortunately, the most effective therapies for anxiety disorders are the same as those for BDD: SSRIs and therapy, especially CBT. Many of the same cognitive distortions arise in BDD and anxiety disorders, especially SAD, and can be addressed with the same intervention.
When it arises as a co-occurring disorder with BDD, depression intensifies the symptoms of both disorders. A study by Phillips, Siniscalchi and McElroy found that people with comorbid BDD and depression reported higher levels of depression and anxiety symptoms, somatization, and anger-hostility. In other words, people with both disorders were more likely to experience significant physical and mental discomfort.
As with anxiety, the same treatments are effective for both depression and BDD. Actually, CBT and SSRIs can effectively treat all three: BDD, depression, and anxiety. This is important not just for the sake of convenience, but because these disorders often have overlapping symptoms and interact in complex ways. Working with the same therapist can help a person address negative thought patterns that increase anxiety, depression, and BDD-related shame and self-judgment.
Co-Occurring Substance Use Disorders
Treating addiction frequently involves a suite of connected services including treatment groups, individual therapy, medication management, peer support, and complementary therapies. For these interventions to be successful, they need to be closely coordinated.
It is even more important for people who have substance use disorders and co-occurring mental health conditions to receive integrated treatment. The best interventions for BDD and other mental health disorders, including SSRIs and CBT, can also be effective in the treatment of addiction when combined with other needed therapies.
People who are dually diagnosed respond better to services provided by the same organization or those that are closely coordinated between treatment teams. This prevents interventions that target one condition from causing prolonged regression in another area. For example, if a client starts processing trauma in individual therapy for depression or BDD, associated distress may increase the risk that person will resume substance use, especially early in recovery.
When treating professionals communicate and coordinate services, they can update and tailor their work to address this and other similar changes and risks. This leads to better outcomes in the treatment of both mental health and substance use disorders.
At The Recovery Village, a team of professionals offers a number of treatment programs for substance use and co-occurring disorders. If you or someone you love is struggling with both a substance use and co-occurring disorder, help is available. Call and speak with a representative to learn more about which program could work for you.