A 25-year-old woman is preoccupied with the belief that a small, barely noticeable scar on her chin is grotesquely disfiguring. She spends 3–4 hours daily examining it in mirrors, frequently seeks reassurance from family, and has withdrawn from social activities. She has seen three dermatologists who found no significant abnormality. She acknowledges others do not seem to notice the scar but remains convinced it is hideous. What is the most appropriate first-line pharmacotherapy?
- A Fluoxetine (SSRI) ✓
- B Risperidone
- C Clonazepam
- D Lithium
Correct answer: A. Fluoxetine (SSRI)
Explanation
Body dysmorphic disorder (BDD) is classified in DSM-5-TR within the OCD and related disorders chapter. It involves a preoccupation with a perceived defect in physical appearance that is either absent or minimal to others, with repetitive behaviors (mirror checking, seeking reassurance) performed in response. First-line pharmacotherapy is SSRIs at doses typically higher than used for depression, similar to OCD treatment, reflecting shared serotonergic pathophysiology. Antipsychotics are not first-line even when the patient appears to lack insight.
Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.