Body Dysmorphic Disorder (BDD) is classified under OCD and Related Disorders in DSM-5. Which of the following treatment approaches is SPECIFICALLY contraindicated in BDD?
- A SSRIs at OCD-equivalent doses
- B Cosmetic surgery or dermatological procedures to address the perceived defect ✓
- C CBT with exposure and response prevention (ERP) adapted for BDD
- D Clomipramine for treatment-resistant cases
Correct answer: B. Cosmetic surgery or dermatological procedures to address the perceived defect
Explanation
In BDD, the perceived defect is not a real physical abnormality but a distorted body image — cosmetic procedures do not address the underlying psychiatric pathology and typically worsen outcomes. Studies consistently show that after cosmetic surgery, BDD symptoms persist or worsen in approximately 70% of patients, with some becoming more obsessed with a new perceived flaw. SSRIs (at higher OCD-range doses) and CBT-ERP adapted for BDD are evidence-based treatments. Clomipramine (TCA with serotonergic activity) is used in treatment-resistant cases.
Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.
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