Diagnosis

After a medical evaluation to help rule out other medical conditions, your primary care provider may make a referral to a mental health professional for further evaluation.

Diagnosis of body dysmorphic disorder is typically based on:

  • A psychological evaluation that assesses risk factors and thoughts, feelings, and behaviors related to negative self-image
  • Personal, social, family and medical history
  • Symptoms listed in the Diagnostic and Statistical Manual of Mental Disorders DSM-5, published by the American Psychiatric Association

Treatment

Treatment for body dysmorphic disorder often includes a combination of cognitive behavioral therapy and medications.

Cognitive behavioral therapy

Cognitive behavioral therapy for body dysmorphic disorder focuses on:

  • Helping you learn how negative thoughts, emotional reactions and behaviors maintain problems over time
  • Challenging automatic negative thoughts about your body image and learning more-flexible ways of thinking
  • Learning alternate ways to handle urges or rituals to help reduce mirror checking or reassurance seeking
  • Teaching you other behaviors to improve your mental health, such as addressing social avoidance

You and your therapist can talk about your goals for therapy and develop a personalized treatment plan to learn and strengthen coping skills. Involving family members in treatment may be particularly important, especially for teenagers.

Medications

Although there are no medications specifically approved by the Food and Drug Administration (FDA) to treat body dysmorphic disorder, medications used to treat other mental health conditions ― such as depression and obsessive-compulsive disorder ― can be effective.

  • Selective serotonin reuptake inhibitors (SSRIs). Because body dysmorphic disorder is thought to be caused in part by problems related to the brain chemical serotonin, SSRIs may be prescribed. SSRIs appear to be more effective for body dysmorphic disorder than other antidepressants and may help control your negative thoughts and repetitive behaviors.
  • Other medications. In some cases, you may benefit from taking other medications in addition to an SSRI, depending on your symptoms.

Hospitalization

In some cases, your body dysmorphic disorder symptoms may be so severe that you require psychiatric hospitalization. This is generally recommended only when you aren't able to keep up with day-to-day responsibilities or when you're in immediate danger of harming yourself.

Lifestyle and home remedies

Body dysmorphic disorder warrants treatment from a mental health professional. But you can do some things to build on your treatment plan, such as:

  • Stick to your treatment plan. Don't skip therapy sessions, even if you don't feel like going. Even if you're feeling well, continue to take your medications. If you stop, symptoms may come back. You could also experience withdrawal-like symptoms from stopping a medication too suddenly.
  • Learn about your disorder. Education about body dysmorphic disorder can empower you and motivate you to stick to your treatment plan.
  • Pay attention to warning signs. Work with your doctor or therapist to learn what might trigger your symptoms. Make a plan so you know what to do if symptoms return. Contact your doctor or therapist if you notice any changes in symptoms or how you feel.
  • Practice learned strategies. At home, routinely practice the skills you learn during therapy so they become stronger habits.
  • Avoid drugs and alcohol. Alcohol and recreational drugs can worsen symptoms or interact with medications.
  • Get active. Physical activity and exercise can help manage many symptoms, such as depression, stress and anxiety. Consider walking, jogging, swimming, gardening or taking up another form of physical activity you enjoy. However, avoid excessive exercise as a way to fix a perceived flaw.

Coping and support

Talk with your doctor or therapist about improving your coping skills, and ways to focus on identifying, monitoring and changing the negative thoughts and behaviors about your appearance.

Consider these tips to help cope with body dysmorphic disorder:

  • Write in a journal. This can help you better identify negative thoughts, emotions and behaviors.
  • Don't become isolated. Try to participate in normal activities and regularly get together with friends and family who can act as healthy supports.
  • Take care of yourself. Eat healthy, stay physically active and get sufficient sleep.
  • Join a support group. Connect with others facing similar challenges.
  • Stay focused on your goals. Recovery is an ongoing process. Stay motivated by keeping your recovery goals in mind.
  • Learn relaxation and stress management. Try practicing stress-reduction techniques such as meditation or deep breathing.
  • Don't make important decisions when you're feeling despair or distress. You may not be thinking clearly and may regret your decisions later.

Preparing for your appointment

Although you may start out talking with your primary care provider about your concerns, you'll likely be referred to a mental health professional, such as a psychiatrist or psychologist, for further evaluation and specialized treatment.

What you can do

Before your appointment, make a list of:

  • Any symptoms you or your family noticed, and for how long. Ask friends or family members if they've felt concerned about your behavior and what they've noticed.
  • Key personal information, including traumatic events in your past and any current, major stressors. Find out about your family's medical history, including any history of mental health conditions such as body dysmorphic disorder and obsessive-compulsive disorder.
  • Your medical information, including other physical or mental health conditions with which you've been diagnosed.
  • All medications you take, including the names and doses of any medications, herbs, vitamins or other supplements you're taking.
  • Questions you want to ask your doctor to make the most of your appointment.

Some basic questions to ask your doctor or mental health professional include:

  • What do you think is most likely causing my symptoms?
  • What are other possible causes of my symptoms?
  • Could behavior therapy be helpful?
  • Are there medications that might help?
  • How long will treatment take?
  • What can I do to help myself?
  • Do you have any brochures or other printed materials that I can have?
  • Are there any websites that you can recommend?

Don't hesitate to ask additional questions during your appointment.

What to expect from your doctor

Your doctor or mental health professional may ask you questions, such as:

  • Are you concerned about your appearance?
  • When did you first begin worrying about your appearance?
  • How is your daily life affected by your symptoms?
  • How much time do you spend each day thinking about your appearance?
  • What other treatment, if any, have you had?
  • What cosmetic procedures, if any, have you had?
  • What have you tried on your own to feel better or control your symptoms?
  • What things make you feel worse?
  • Have friends or family commented on your mood or behavior?
  • Do you have any relatives who've been diagnosed with a mental health condition?
  • What do you hope to gain from treatment?
  • What medications, herbs or other supplements do you take?

Your doctor or mental health professional will ask additional questions based on your responses, symptoms and needs. Preparing and anticipating questions will help you make the most of your time with the doctor.

Oct. 29, 2019
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  2. Sadock BJ, et al., eds. Obsessive-compulsive and related disorders. In: Kaplan & Sadock's Comprehensive Textbook of Psychiatry. 10th ed. Wolters Kluwer; 2017. http://www.ovid.com/site/index.jsp. Accessed April 11, 2019.
  3. Body dysmorphic disorder. Merck Manual Professional Version. https://www.merckmanuals.com/professional/psychiatric-disorders/obsessive-compulsive-and-related-disorders/body-dysmorphic-disorder#. Accessed April 11, 2019.
  4. Krebs G, et al. Recent advances in understanding and managing body dysmorphic disorder. Evidence Based Mental Health. 2017; doi:10.1136/eb-2017-102702.
  5. Phillips KA, et al. Pharmacotherapy relapse prevention in body dysmorphic disorder: A double-blind, placebo-controlled trial. American Journal of Psychiatry. 2016; doi:10.1176/appi.ajp.2016.15091243.
  6. Krebs G, et al. Long-term outcomes of cognitive-behavioral therapy for adolescent body dysmorphic disorder. Behavior Therapy. 2017; doi:10.1016/j.beth.2017.01.001.
  7. For people with mental health problems. MentalHealth.gov. https://www.mentalhealth.gov/talk/people-mental-health-problems. Accessed April 13, 2019.
  8. Managing stress. National Alliance on Mental Illness. https://www.nami.org/Find-Support/Living-with-a-Mental-Health-Condition/Managing-Stress. Accessed April 13, 2019.
  9. Sawchuk CN (expert opinion). Mayo Clinic. Oct. 18, 2019.

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Body dysmorphic disorder