Approach to managing body dysmorphic disorder in adults and young people

Body dysmorphic disorder is ideally managed by an obsessive compulsive disorder (OCD)–spectrum specialised practitioner, but they may be difficult to access.

Because there is limited evidence to inform the management of body dysmorphic disorder, treatment recommendations are extrapolated from evidence in obsessive compulsive disorder.

Use a combination of psychosocial and pharmacological treatment for body dysmorphic disorder. Some patients require pharmacological treatment before they can actively engage in psychosocial interventions. Pharmacotherapy can also be used as an adjunct to psychosocial interventions.

When evaluating treatment options for a young person, also consider:

• there are few data on psychotropic use in young people because young people are poorly represented in clinical trials
• young people are more susceptible to developing activation and suicidal thoughts when starting treatment with an antidepressant; this effect has been most often observed with selective serotonin reuptake inhibitors (SSRIs)
• if pharmacotherapy is used, it should ideally be started by a clinician with expertise in using psychotropics in young people.

For treatment considerations for females of childbearing potential, including advice on contraception, preconception planning and psychotropic use, see here.

Because there is limited evidence on the approach to managing body dysmorphic disorder during pregnancy and after giving birth, the advice on obsessive compulsive disorder during the perinatal period can be used as a guide. For considerations in managing anxiety disorders such as body dysmorphic disorder during the perinatal period, see here or for considerations in partners, see here.