BDD — MRCPsych Paper B MCQ

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ModerateAnxiety & Stress-Related DisordersBDDMRCPsych Paper B

A 40-year-old woman with body dysmorphic disorder has moderate functional impairment and is offered either an SSRI or individual cognitive behavioural therapy including exposure and response prevention. In NICE CG31, the stepped-care recommendations for body dysmorphic disorder are presented alongside those for which condition?

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Correct answer: C — Obsessive-compulsive disorder

The correct answer is C, obsessive-compulsive disorder (OCD). NICE CG31 is the joint guideline for the treatment of OCD and body dysmorphic disorder (BDD). For adults with BDD, treatment is determined by functional impairment: BDD-focused CBT including exposure and response prevention is recommended for mild impairment, an SSRI or more intensive CBT for moderate impairment, and combined treatment for severe impairment. Depression commonly coexists with BDD but has a separate treatment guideline. Social anxiety disorder can also involve fear of negative evaluation, while eating disorders may involve body-image disturbance, but neither shares this CG31 pathway. Schizophrenia is incorrect even when BDD beliefs are held with delusional intensity; NICE advises against antipsychotic monotherapy for BDD and recommends fluoxetine as the initial pharmacological treatment.

Reference: National Institute for Health and Care Excellence. Obsessive-compulsive disorder and body dysmorphic disorder: treatment. NICE clinical guideline CG31, especially recommendations 1.5.1.5–1.5.1.7 and 1.5.3.9. Published 2005; last reviewed 2024. https://www.nice.org.uk/guidance/cg31/chapter/Recommendations