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15-Jul-2015 22:18

Self-defeating interpretations foster negative feelings (e.g., anxiety, shame, sadness) that patients try to neutralize with rituals (e.g., excessive mirror checking, surgery seeking) and avoidance (e.g., social situations).

Because rituals and avoidance may temporarily reduce painful feelings they are negatively reinforced and thus maintain maladaptive beliefs and coping strategies.

Then, the therapist and patient develop an individualized model of BDD based on the patient’s specific symptoms.

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In addition, CBT usually includes techniques such as cognitive restructuring, exposure and ritual prevention, and relapse prevention.

Clinicians should be aware of clues in clinical presentation such as appearance (e.g., scarring due to skin picking) and behaviors (e.g, wearing camouflage), ideas or delusions of reference (e.g., feelings that people talk about them, stare at them), panic attacks (e.g., when looking into the mirror), depression, social anxiety, substance abuse and suicidal ideation as well as being housebound.

Additionally, differential diagnosis should be clarified in a structured clinical interview including eating disorders, obsessive compulsive disorder, depression, and social phobia.

Clinicians should inquire about BDD-related areas of concern, thoughts, behaviors, and impairment.

It is important to ask specifically about BDD symptoms as it often goes undetected in clinical settings (e.g., Grant et al., 2002) due to embarrassment and shame.Patients are then encouraged to monitor their appearance-based thoughts in and outside of the session and identify cognitive errors (e.g., “Why am I so nervous about riding the subway?

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