What are the recommended first-line treatment options for patients diagnosed with BDD?

Recommended first-line treatment options for patients diagnosed with body dysmorphic disorder (BDD) include psychological interventions and pharmacological treatments.

For adults with BDD, cognitive behavioural therapy (CBT), particularly including exposure and response prevention (ERP), is recommended as a first-line psychological treatment. Low-intensity CBT options, such as brief individual CBT with structured self-help materials, brief individual CBT by telephone, or group CBT, may be offered especially if the functional impairment is mild or the patient prefers a low-intensity approach.

Pharmacologically, selective serotonin reuptake inhibitors (SSRIs) are recommended as first-line medication treatment for BDD. Clomipramine may be considered as an alternative first-line drug if SSRIs are contraindicated or if the patient prefers it or has had a previous good response.

Children and young people diagnosed with BDD should also receive evidence-based psychological treatments, with assessment and management of suicide risk prior to treatment. Involvement of family or carers in treatment is advised where appropriate.

Patients with more severe functional impairment, comorbidities, or poor response to initial treatment should be referred to specialist mental health services with expertise in OCD and BDD.

Healthcare professionals should assess and manage risks of self-harm and suicide, especially in those with comorbid depression, and collaborate with cosmetic surgeons and dermatologists to identify and manage BDD appropriately.

Overall, the first-line approach prioritises psychological therapy (CBT including ERP) and SSRIs, with treatment intensity and setting tailored to severity and patient preference.

References: ¹