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Body Dysmorphic Disorder — SCE Dermatology MCQ

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ModeratePsychodermatologyBody Dysmorphic DisorderSCE Dermatology

A 28-year-old woman with body dysmorphic disorder (BDD) presents repeatedly requesting removal of a normal-appearing mole that she perceives as disfiguring. She has significant psychological distress. What is the most appropriate initial management?

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Correct answer: A — Refer for psychological/psychiatric assessment and support

Body dysmorphic disorder (BDD) is classified as a psychodermatological condition. Surgery to remove perceived defects generally does not improve BDD symptoms and may worsen them or shift the preoccupation to another perceived defect or to the surgical scar. BAD/Royal College of Psychiatrists guidelines recommend referral for psychological/psychiatric assessment, with evidence-based treatments including CBT and SSRIs. Dermatologists should recognise BDD as it frequently presents in dermatology clinics. The skin should be confirmed as objectively normal before attributing symptoms to BDD.

Reference: BAD 2020 Psychodermatology Guidelines; NICE CG31 OCD/BDD