Review Question - QID 220649

This patient presents with a preoccupation with a minor perceived physical defect that results in distress and psychosocial impairment suggestive of body dysmorphic disorder. The treatment of choice is a selective serotonin reuptake inhibitor such as fluoxetine.

In patients with body dysmorphic disorder, the patient becomes preoccupied with
a physical defect that is either nonexistent or slight. Patients will engage in repetitive behaviors or mental acts at some point during the illness course to deal with this perceived deformity including mirror checking, skin picking, or excessive grooming. Patients will constantly compare their self appearance to others and this can result in distress or psychosocial impairment. The preoccupation with appearance cannot be better explained by an eating disorder. The treatment is with selective serotonin reuptake inhibitors and cognitive behavioral therapy.

Fang et al. review the evidence regarding the diagnosis and treatment of body dysmorphic disorder. They discuss how this disease can be debilitating to patients. They recommend a combination of pharmacologic and behavioral therapy treatment options.

Figure/Illustration A is a clinical photograph demonstrating a normal face without substantial abnormalities in the nose (red circle). Patients with body dysmorphic disorder tend to have normal features.

Incorrect Answers:
Answer 1: Aripiprazole is a partial agonist at the dopamine receptor that is typically used in the treatment of schizophrenia. This disorder would present with psychosis as well as delusions. It is not used in the treatment of body dysmorphic disorder.

Answer 2: Duloxetine is a serotonin-norepinephrine reuptake inhibitor. It can be used to treat depression and anxiety in adults. This exclusive focus on a minor aspect of body appearance is more consistent with body dysmorphic disorder.

Answer 4: Lithium is a mood stabilizer used in patients with bipolar disorder. This disorder presents with alternating periods of mania and depression. Mania would present with excessive energy associated with periods of grandiosity and flight of ideas.

Answer 5: Methylphenidate is used in the treatment of patients with attention deficit hyperactivity disorder. This disease would present with an inability to focus and excessive stimulation during other parts of life.

Bullet Summary:
Body dysmorphic disorder presents with an obsession on a perceived physical defect and treatment is with selective serotonin reuptake inhibitors.