being unattractive as it is with the possibility that the blemish indicates the presence of a severe underlying disease.
In the midst of a depressive episode, patients may become concerned or convinced that they are deformed. This conviction, however, is intimately connected with the patient’s notion of sin and guilt, notions that are not part of dysmorphophobia.
Patients with schizophrenia may have all manner of concerns about their appearance; however, these tend to be bizarre and unusual and are accompanied by the other symptoms typical of the disease not found in dysmorphophobia.
As patients with dysmorphophobia are loath to consider their pathologic concerns per se, they rarely stay in treatment.
Both fluoxetine and clomipramine are effective in reducing the intensity of the patients’ concerns, and there is some preliminary evidence for the effectiveness of behavior therapy. Importantly, both clomipramine and fluoxetine are as effective in the psychotic subtype of dysmorphophobia as they are in the non-psychotic subtype.
Hollander E, Allen A, Kwon J, et al. Clomipramine vs. desipramine crossover trial in body dysmorphic disorder: selective efficacy of a serotonin reuptake inhibitor in imagined ugliness. Archives of General Psychiatry 1999;56:1033–1039.
McElroy SL, Phillips KA, Keck PE, et al. Body dysmorphic disorder: does it have a psychotic subtype? The Journal of Clinical Psychiatry 1993;54: 389–395.
McKay D. Two-year follow-up of behavioral treatment and maintenance for body dysmorphic disorder. Behavior Modification 1999;23:620–629.
Phillips KA, McElroy SL, Keck PE, et al. Body dysmorphic disorder: 30 cases of imagined ugliness. The American Journal of Psychiatry 1993; 150:302–308.
Phillips KA, McElroy SL, Keck PE, et al. A comparison of delusional and nondelusional body dysmorphic disorder in 100 cases. Psychopharmacology Bulletin 1994;30:179–186.
Phillips KA, Brant J, Siniscalchi J, et al. Surgical and nonpsychiatric medical treatment of patients with body dysmorphic disorder. Psychosomatics 2001;42:504–510.
Phillips KA, Albertini RS, Rasmussen SA. A randomized placebocontrolled trial of fluoxetine in body dysmorphic disorder. Archives of General Psychiatry 2002;59:381–388.
Thomas CS, Goldberg DP. Appearance, body image and distress in facial dysmorphophobia. Acta Psychiatrica Scandinavica 1995;92: 231–236.