There is hope for BDD sufferers! Psychiatric and psychological treatment often improves BDD symptoms and the suffering it causes. The treatments that appear most effective are certain medications (serotonin-reuptake inhibitors) and a type of therapy known as cognitive-behavioral therapy (CBT)  

MEDICATIONS ARE OFTEN HELPFUL FOR PEOPLE WITH BDD;

The medications that are currently recommended for BDD are the serotonin-reuptake inhibitors (also known as SRIs or SSRIs). The SRIs are antidepressant medications that also help stop obsessive thinking and excessive compulsive behaviors such as mirror checking. They are often used to treat other disorders such as Depression, Social Anxiety Disorder, and Obsessive-Compulsive Disorder. SRIs appear to be effective for a majority of people with BDD. These medications are not addictive and are usually well tolerated.

The following medications are SRIs:

• Fluvoxamine (brand name Luvox)
• Fluoxetine (brand name Prozac)
• Sertraline (brand name Zoloft)
• Citalopram (brand name Celexa)
• Escitalopram (brand name Lexapro)
• Clomipramine (brand name Anafranil)

                                                     

The popular SSRI antidepressant drug Paxil (Generic: Paroxetine) used by millions has been linked to Suicide, Self-Mutilation/Harm and a variety of severe Birth Defects including Persistent Pulmonary Hypertension (PPHN), Heart, Lung, Abdominal and Cranial Defects. www.paroxetine.com

A number of research studies have shown that SRIs substantially improve BDD symptoms in a majority of people. These medications can significantly diminish bodily preoccupation, emotional distress, depression, and anxiety. They can also significantly increase control over one's thoughts and behaviors. They also often improve daily functioning - for example, making it easier to be around other people or to concentrate at work or school. In some cases (for example, when people are suicidal), they are lifesaving.

 It's important, however, to use a high enough SRI dose for a long enough time to give the medicine a chance to work!

ADVICE;

• Use an SRI as a first-line medication for BDD, including delusional BDD.
• You can try any SRI. All of the SRI's appear effective for BDD, so you can use any of them.
• It is suggested that you reach the maximum SRI dose that's recommended by the pharmaceutical company or that you can tolerate, unless a lower dose works for you. It's very important to use a high enough SRI dose. There needs to be more research on this important issue, but it does appear that many people with BDD need higher SRI doses than those typically used for Depression.
• Don't give up on an SRI until you've tried it for 12 to 16 weeks, while reaching a high enough dose.
• If you respond to an SRI, you're likely to continue to feel well for as long as you take it.
• It is suggested that you continue an effective SRI for a year or two, or in some cases longer.
• If you decide to stop an effective SRI, plan this carefully with you're doctor.
• An important reminder! Be sure your doctor knows from the beginning that you have BDD. Don't tell him or her that you just have Depression or Anxiety, because your BDD symptoms may not improve if they aren't targeted directly with proper treatment.

Each person with BDD requires individualized assessment of their BDD and other symptoms. If other disorders are present along with the BDD, this may influence the medication that's selected. Possible side effects, your response to past treatment, your treatment preference, or a need for immediate symptom relief are some of the factors that may influence treatment decisions. You may have a comprehensive evaluation by a psychiatrist and get an individualized treatment plan that includes close monitoring. The above suggestions are only general guidelines that must be tailored to you in consultations with your GP.

A new website which provides information about the range of medication on offer in the treatment of mental health problems is here. The website is aimed at people who use and are about to take any medication to help with the symptons of most mental health difficulties, as well as their carers and health personnel. The site contains a wealth of information and is the result of a collaboration between the United Kingdom Psychiatric Pharmacy, College of Mental Health Pharmacists, the Pharmaceutical Schizophrenia Initative and the National Institute of Mental Health in England. www.choiceandmedication.org.uk

COGNITIVE BEHAVIOURAL THERAPY IS OFTEN HELPFUL FOR BDD;

Cognitive-Behavioral Therapy (CBT) is the best-studied and most promising type of psychotherapy for BDD. When used by trained therapists, CBT is effective for such disorders as Depression, Phobias, Panic Disorder, Obsessive Compulsive Disorder, and Eating Disorders. Available research studies indicate that CBT substantially improves BDD symptoms in a majority of people, diminishing obsessive appearance preoccupations and compulsive behaviors, depressive symptoms, anxiety, and also improving body image and self esteem.

WHAT CBT CONSISTS OF;

CBT is a practical 'here and now' treatment that focuses on changing problematic BDD thoughts and behaviors. The purpose of CBT is to learn practical skills that can help a person cope with and overcome BDD, skills that can be used now and in the future to keep BDD under control.

• The cognitive aspects of CBT focus on cognitions-that is, appearance-related thoughts and beliefs. In treatment, you learn about the relationship between thoughts, feelings, and behaviors. The aim of CBT is to identify and evaluate current ways of thinking and to develop more accurate and helpful appearance beliefs.
• The behavioral aspects of CBT focuses on learning to face and feel more comfortable in situations (such as social situations) that may be avoided or endured with anxiety. The treatment also helps reduce problematic compulsive behaviors, for example, mirror checking and comparing your appearance with other people. The aim is to develop healthier, more adaptive coping behaviors.
• CBT may also include other components, such as increasing involvement in enjoyable activities, improving self-esteem, and developing ways to look at the 'big picture' when looking in the mirror, rather than just focusing on certain features.
• Usually, cognitive and behavioral approaches are combined-hence, the commonly used term 'Cognitive Behavioral Therapy.'

 A FEW KEY CONSIDERATIONS!

• It's important to determine whether a therapist has been specifically trained in Cognitive-Behavioral Therapy and is familiar with BDD and its treatment.
• CBT requires motivation and a willingness to do the treatment during sessions and to do homework between sessions.
• For those who have severe BDD or are very depressed or suicidal, it is recommended they consider taking an SRI before or during CBT.
• Other types of therapy (for example, Counseling or general Psychotherapy) do not appear to be effective when used alone for BDD.

Try me - Quick CBT Lesson - Choose and achieve your goals.

 

Make your goals specific - Make your goals specific for example, 'I want to feel normal nervousness speaking with a stranger' rather than feel petrified.

 

Make your goals positive - Don't look backwards, this is about you creating your future.

Be specific again, 'I want to be more assertive' instead of 'I want to be less passive.'

 

Be realistic - Stick to what is achievable.

Your goals need to be within your reach and control.

Concentrate on changes that you can elicit within yourself, you cannot change others.

 

Set yourself a time frame - Give yourself a deadline by which to reach your goals so that you can keep focused and motivated.

Be flexible though, some goals will take longer to reach than others.

 

EXPOSURE AND RESPONSE THERAPY (ERP);

ERP involves repeatedly confronting feared situations that are avoided (a process called 'exposure') For the treatment to be successful, the exposure needs to be long enough for the anxiety to subside. The fear needs to be constant and the exposure should be repeated often. Exposure needs to be done without performing a compulsion (a process called 'response prevention') and in this way allow the person to tolerate the discomfort that occurs.

If a compulsion is performed, then the exposure should be repeated in order to 'undo' the compulsion. In using CBT with ERP an individual evaluates anxiety and creates a personal hierarchy. This means that each person starts by confronting relatively easy situations and then gradually works up to more difficult ones. Facing up to each fear becomes easier and easier and the anxiety gradually subsides. The short-term side effect consists of anxiety and distress, but these will gradually decrease and, in the long term, the fear will subside. No one is forced to confront their fears but the person with OCD/BDD is encouraged to take responsibility for devising their own programme. A therapist does not have to be present, although it may help some individuals at the start of the treatment programme. Tasks need to be challenging but not overwhelming.

In research trials, about 25% of patients either do not choose to take part in a programme of exposure and response prevention or fail to adhere to a programme. Of those that do adhere, about 75% are helped significantly after 10-20 sessions as an outpatient. The risk of relapse after treatment is about 25%, when the person may require additional treatment. Most severe cases may be helped by a more intensive programme as an inpatient or at home.

HOW TO OBTAIN CBT WITH ERP;

Whether you see a therapist through the NHS or privately it is important to ensure that they are properly qualified, have appropriate training and receive regular supervision. Be sure to make it clear that you are looking for a therapist who specializes in and has experience of treating OCD/BDD and Spectrum disorders. Therapists come from a variety of professional backgrounds and may have titles such as 'Clinical Psychologist', 'Psychiatrist', 'Clinical Nurse', 'Counselor' or 'Social Worker.'

If you are going through the NHS 1; Go to your General Practitioner and ask to be 'referred for an assessment.' This will probably be with someone from your mental health team. 2; If you receive a diagnosis of OCD/BDD, ask to be referred for CBT with ERP. (There is often a long wait for treatment through the NHS)

If you are paying privately, The British Association for Behavioral and Cognitive Psychotherapies (BABCP) keep a regularly updated list of approved and qualified therapists. Please contact therapists directly for more information. You can access this list through their website, telephone them on 01254 875277 or email them at info@babcp.com

How to use the BABCP website; Go to http://www.babcp.com/, go to 'Find a therapist', go to 'Location', Select your location, Scroll down a little on the page, Go to 'Areas of Competence', Select 'Obsessive Compulsive Disorders' from the list, Press 'submit' The site generates a list of therapists within your chosen location and specialty. If there are no search results, please review the entire locations list for another location nearby. Cognitive Behavioral Therapists do not need to be accredited by the BABCP and many do not register, but it does guarantee a certain minimum standard of training.

HOSPITAL TREATMENT;

Most people with BDD do not have to stay in hospital for treatment. But if your symptoms are severe, and/or you cannot look after yourself properly, or have thoughts of suicide, your healthcare professional may think that you will benefit by staying in hospital for treatment (this is called inpatient treatment) In patient treatment may also be suitable for you if are not able to get to a clinic during the day time. Your healthcare professional may also consider inpatient treatment if you have had BDD for a long time and lots of different treatments have not made you feel any better. Inpatient treatment may sometimes help if you have other problems or conditions such as an Eating Disorder, Severe Depression or Schizophrenia as well as OCD/BDD. In hospital you should be able to receive treatments that are more in-depth and you will be treated by experts in the fields of your disorder/s. If you have had BDD for a very long time and have difficulty living on your own, you should be helped to find suitable accommodation with people who can help you to become more independant.

TREATMENTS THAT DO NOT APPEAR TO WORK;

Even though there are effective treatments for BDD (CBT and serotonin-reuptake inhibitor medications), most people with BDD seek and receive treatments that do not seem to work. These ineffective treatments include surgery, dermatologic treatment, and other non psychiatric treatment (for example, dental treatment). People with BDD can waste lots of time and money pursuing these treatments, and can end up bitterly disappointed when they don't obtain the relief they're so desperately seeking.

It makes sense that these treatments almost never improve BDD. BDD isn't a problem with actual appearance, it's a problem with how the person sees themselves, their body image, and so changing ones actual appearance through surgery doesn't appear to work. More research however is still needed to confirm that these treatments don't work for BDD, in the meantime, based on current knowledge, it is suggested that people with BDD avoid them. They don't appear to help, and they can even make BDD worse. BDD is a serious mental illness that requires psychiatric treatment, and this certainly does appear to help.

THERE IS NO CLINICAL EVIDENCE THAT PSYCHOLOGICAL TREATMENT OTHER THAN CBT WITH ERP ARE EFFECTIVE. THIS INCLUDES 'PSYCHOANLISIS' 'TRANSACTIONAL ANAYLISIS' 'HYPNOSIS' AND 'MARITAL/COUPLE COUNSELLING.'

DO NOT GIVE UP!

It may take a while to find the exact treatment that works for you. In addition, medication treatment and therapy need to be tailored to each individual. Most people with BDD do eventually get better with an SRI and/or CBT. Some people respond to the first treatment they try, whereas others need to try more than one. Some people improve quickly, whereas others need more time. Most people who persist in trying recommended treatments do improve.