Body Dysmorphic Disorder Homework

Body Dysmorphic Disorder

How would you define the disorder?

Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM 5) (2013), defines body dysmorphic disorder (BDD) as a preoccupation with one or more flaws in physical appearance that others do not see that causes social anxiety and avoidance. Individuals who have BDD excessively look at themselves in the mirror, and they are always grooming themselves. These types of behaviors cause a significant amount of distress which affects one’s everyday functioning. The person with BDD cannot control these behaviors and therefore has a high level of anxiety. They are always concerned about their appearance and try to compare themselves with others. Their preoccupation is not related to their weight or body fat therefore they do not have an eating disorder (American Psychiatric Association, 2013). Some individuals with this disorder have beliefs that their body is built too thin with insufficient muscles. Additionally, individuals have compulsions and obsessions that are mainly focused on their physical appearance, and they are usually time-consuming as well as difficult to control (American Psychiatric Association, 2013). According to Nicewicz and Boutrouille (2021), BDD was first recognized as an atypical somatoform disorder.

What signs/symptoms would one see in the patient that demonstrate the disorder?

The signs and symptoms that one would see that demonstrate body dysmorphic disorder are individuals engaging in repetitive behaviors, such as excessive mirror checking, compulsive skin picking, camouflaging, participating in excessive grooming, excessive weightlifting, or pervasive mental acts that involve them comparing themselves to other people (Field, 2018). These perceived physical flaws most commonly occur on the skin, hair, or nose, but any body part can be involved. An individual is hyper-focused on his/her appearance which makes them believe that they are ugly and unattractive. They are usually concerned about their eyes, teeth, lips, breasts, stomach, genitals, and legs among others (American Psychiatric Association, 2013). They compare themselves with other people, they think other people are taking note of their negative appearance and they might repeatedly apply makeup to try to cover flaws. Some individuals end up seeking medical procedures, excessively tanning their skin, and changing their clothes excessively (American Psychiatric Association, 2013). They also tend to seek reassurance from others about how they look and sometimes avoid social situations due to fear of being judged or maybe people will notice their imperfections.

What are the main DSM-5 criteria for this disorder?

According to the DSM 5, body dysmorphic disorder is classified under obsessive-compulsive and related disorders. An individual exhibits the four of the following features to meet the diagnostic criteria:

Preoccupation with one or more perceived defects or flaws in physical appearance that are not observable by others or others slightly notices them (American Psychiatric Association, 2013, p.242).

The person performs repetitive behaviors such as checking mirrors, excessive grooming, skin picking, reassurance-seeking, or mental acts that are concerning to their appearance (American Psychiatric Association, 2013, p.242).

The preoccupation causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. (American Psychiatric Association, 2013, p.242).

The appearance preoccupation is not explained by concerns with body fat or weight that one meets the criteria for an eating disorder. (American Psychiatric Association, 2013, p.242).

What is the top 3 differential diagnosis for this disorder from the DSM-5?

The three top differential diagnoses from the DSM-5 include Obsessive-compulsive disorder whereby there are preoccupations and repetitive behaviors. However, in BDD they are more focused on their appearance hence the skin picking to improve how they look. The second is an eating disorder this can be comorbid. Thirdly is anxiety disorders which are common in body dysmorphic disorder. However, in BDD the anxiety is appearance-related and not social or avoidance (American Psychiatric Association, 2013).

What medications would you use? Why? Black box warnings?

Before prescribing any medications, I would first obtain consent for treatment. It is important to explain to the patient all the risks versus benefits of the medication. The medication class that is preferred for patients with BDD is selective serotonin reuptake inhibitors (SSRIs). According to Nicewicz and Boutrouille (2021), Fluoxetine is the recommended drug to treat BDD. The dosage will be 20mg daily as it is important to start low and see how the patient might tolerate the drug. The goal will be to reduce the symptoms. The onset of action is usually delayed 2-4 weeks and if it is not working within 6-8 but the patient is tolerating the drug then it should be increased. The side effects that need to be discussed with the patient include nausea, diarrhea, headache, drowsiness or activation, sexual dysfunction, or desire. Serious adverse effects include suicidal thoughts and/or behaviors, mania, and seizures (Stahl, 2021). While waiting on the therapeutic effects to take effect, the patient can also be started on a small dose of benzodiazepine short-term to give some relief to the distressing symptoms.

What type of therapy would you recommend for this patient?

The types of therapy that have shown to be beneficial for patients with BDD include cognitive-behavioral therapy (CBT) and metacognitive therapy (Phillipou et al., 2016). CBT is the recommended first line of treatment for BDD. These types of therapy will help the patient to work on his/her self-confidence. Also, help in identifying the behaviors and triggers that cause these feelings.

What do you see as the possible outcomes for this patient?

Clinicians need to communicate realistic expectations to patients who are diagnosed with BDD at the beginning of treatment and explain that their disorder might not be cured but the goal is a reduction of symptoms. The outcome for the patient would be to continue taking fluoxetine until the symptoms of BDD have resolved or have been significantly reduced. Also, for the patient to participate in cognitive behavioral therapy to manage negative thoughts and modify behaviors.

What are the 5 components of a suicide risk assessment that the patient needs to be asked?

The five components of the suicide risk assessment that the patient needs to be asked are do you have current thoughts of killing yourself, what are your intentions, do you have a plan, have you ever tried to kill yourself in the past, what is keeping you alive, or what might decrease the chances of you trying to kill yourself as suicidality is high within individuals with body dysmorphic disorder. Furthermore, 80% of individuals with body dysmorphic disorder think about suicide while approximately 26% of those individuals have attempted suicide (Koenig et al., 2021).

In addition to the suicide risk assessment questions, the clinical can conduct a physical assessment of an individual who has body dysmorphic disorder, he or she might notice some skin lesions secondary to skin picking. Most patients with BDD have a history of self-inflicted injuries. Although clients might not want to share with the clinicians about their disorders, it is important to ask them questions about any cosmetic procedures, or surgical interventions. Also find out how they feel about their appearance, how much time they spend worrying about their appearance, and ask whether their condition affects their quality of life. Find out if the patient has other dermatologic issues. Find out the onset and duration of symptoms. Ask if the patient has mental health history in his or her family or if he/she is experiencing any significant life changes or stressors. It is also imperative for the clinician to assess and rule out disorders and other comorbidities like social anxiety disorder and obsessive-compulsive disorder (American Psychiatric Association 2013).

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