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. 2021 Mar 1;36(2):61-75.
doi: 10.1097/YIC.0000000000000342.

Body dysmorphic disorder: a treatment synthesis and consensus on behalf of the International College of Obsessive-Compulsive Spectrum Disorders and the Obsessive Compulsive and Related Disorders Network of the European College of Neuropsychopharmacology

David Castle  1 , Francesca Beilharz  2 , Katharine A Phillips  3 , Vlasios Brakoulias  4 , Lynne M Drummond  5 , Eric Hollander  6 , Konstantinos Ioannidis  7 , Stefano Pallanti  6   8 , Samuel R Chamberlain  9   10   11   12 , Susan L Rossell  13 , David Veale  14 , Sabine Wilhelm  15 , Michael Van Ameringen  16 , Bernardo Dell'Osso  17 , Jose M Menchon  18 , Naomi A Fineberg  19
Affiliations

Body dysmorphic disorder: a treatment synthesis and consensus on behalf of the International College of Obsessive-Compulsive Spectrum Disorders and the Obsessive Compulsive and Related Disorders Network of the European College of Neuropsychopharmacology

David Castle et al. Int Clin Psychopharmacol. .

Abstract

Body dysmorphic disorder (BDD) is characterized by a preoccupation with a perceived appearance flaw or flaws that are not observable to others. BDD is associated with distress and impairment of functioning. Psychiatric comorbidities, including depression, social anxiety, and obsessive-compulsive disorder are common and impact treatment. Treatment should encompass psychoeducation, particularly addressing the dangers associated with cosmetic procedures, and may require high doses of selective serotonin reuptake inhibitors* (SSRI*) and protracted periods to establish full benefit. If there is an inadequate response to SSRIs, various adjunctive medications can be employed including atypical antipsychotics*, anxiolytics*, and the anticonvulsant levetiracetam*. However, large-scale randomized controlled trials are lacking and BDD is not an approved indication for these medications. Oxytocin* may have a potential role in treating BDD, but this requires further exploration. Cognitive-behavioural therapy has good evidence for efficacy for BDD, and on-line and telephone-assisted forms of therapy are showing promise. CBT for BDD should be customized to address such issues as mirror use, perturbations of gaze, and misinterpretation of others' emotions, as well as overvalued ideas about how others view the individual.

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Conflict of interest statement

K.A.P. discloses over the past 3 years; Royalties/honoraria – Oxford University Press, International Creative Management, Inc., UpToDate (Wolters Kluwer), Merck Manual (Merck Publishing), Guilford Publications, Aesculap Academia (Braun Medical Limited), Wheeler, Trigg, O’Donnell, LLP, New York Times, Oakstone Publishing: Speaking honoraria/travel reimbursement from academic institutions and professional organizations. E.H.: research grants from Department of Defense, Food and Drug Administration, GW Pharma, Roche, editorial stipend from Elsevier. S.R.C.’s research is funded by a Wellcome Trust Clinical Fellowship (references 110049/Z/15/A and 110049/Z/15/Z). S.R.C. consults for Promentis and receives stipends from Elsevier for editorial work at Comprehensive Psychiatry, and at the Neuroscience and Biobehavioral Reviews. V.B. has received lecture honoraria from Janssen, Lundbeck and Otsuka. V.B. is a clinical investigator in a clinical trial funded by Boeringher Ingelheim and has obtained competitive grant funding from a Pfizer Neuroscience Grant, the Nepean Medical Research Foundation, the University of Sydney, Western Sydney University, Western Sydney Local Health District and the Better Foundation. S.W. is a presenter for the Massachusetts General Hospital Psychiatry Academy in educational programs supported through independent medical education grants from pharmaceutical companies; she has received royalties from Elsevier Publications, Guilford Publications, New Harbinger Publications, Springer, and Oxford University Press. S.W. has also received speaking honoraria from various academic institutions and foundations, including the International Obsessive Compulsive Disorder Foundation, Tourette Association of America, and Brattleboro Retreat. In addition, she received payment from the Association for Behavioral and Cognitive Therapies for her role as Associate Editor for the Behavior Therapy journal, as well as from John Wiley & Sons, Inc. for her role as Associate Editor on the journal Depression & Anxiety. S.W. has also received honorarium from One-Mind for her role in PsyberGuide Scientific Advisory Board. S.W. has received salary support from Novartis and Telefonica Alpha, Inc. B.D.O. has received consultant fees from Lundbeck, Janssen, Livanova, Angelini and Pfizer and lecture fees from Neuraxpharma, Arcapharma, Livanova. M.V.A. reports being on the Advisory Boards of Allergan, Almatica, Brainsway, Janssen, Lundbeck, Myriad Neuroscience, Otsuka, and Purdue Pharma (Canada); M.V.A. is on the Speaker’s Bureau for Allergan, Lundbeck, Otsuka, Pfizer, Purdue Pharma (Canada) and Takeda; and has received research support from Janssen, Purdue Pharma (Canada), the Canadian Foundation for Innovation, and Hamilton Academic Health Sciences Organization (HAHSO). J.M.M. has received research or networking funding from the spanish official research agencies CIBERSAM-ISCIII and AGAUR, has received consultation fees from Janssen, lecture fees from AbBiotics, Exeltis, and research funding from Janssen, AbBiotics, and Medtronic in the last 36 months. N.F. has held research or networking grants from the ECNP, UK NIHR, EU H2020, MRC, University of Hertfordshire, accepted travel and/or hospitality expenses from the BAP, ECNP, RCPsych, CINP, the International Forum of Mood and Anxiety Disorders, World Psychiatric Association, Indian Association for Biological Psychiatry, Sun, received payment from Taylor and Francis and Elsevier for editorial duties and accepted a paid speaking engagement in a webinar sponsored by Abbott. She leads an NHS treatment service for OCD/BDD, holds Board membership for various registered charities linked to OCD/BDD and gives expert advice on psychopharmacology to the UK MHRA. N.F. is supported by a COST Action Grant (CA16207) and NIHR grant (NIHR RfPB PB-PG-1216-20005). For the remaining authors, there are no conflicts of interests.

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