Comorbid social anxiety and body dysmorphic disorder: managing the complicated patient

Patients with body dysmorphic disorder (BDD) have an obsessive preoccupation with an imagined defect in appearance or, if a slight physical abnormality exists, a grossly excessive concern with it. This preoccupation causes significant distress or impairment of social, occupational, or other functioning. Social anxiety is a prominent component of BDD, and social avoidance resulting from BDD symptoms may markedly impair social functioning. In severe cases, avoidance of social situations in combination with occupational and academic impairment may result in patients becoming housebound. The prevalence of BDD is 1% to 2% in the U.S. population and 11% to 12% in patients with social anxiety disorder. Behaviors associated with BDD include mirror checking, physician visits, hair grooming, use of cosmetics, and social avoidance. Distress over BDD may lead patients to undergo repeated cosmetic surgeries in futile attempts to conceal or correct perceived defects. Additionally, depression and suicide are frequent complications of BDD. Pharmacologic and nonpharmacologic treatments for the management of BDD with coexisting social anxiety are presented in this article.