Bilateral deep brain stimulation for the treatment of body dysmorphic disorder and obsessive-compulsive disorder

Body dysmorphic disorder (BDD) is classified under obsessive-compulsive and related disorders. BDD is characterized by intense preoccupation with the perception of deficits or flaws in appearance, with repetitive behaviors manifested by altered self-perception. These symptoms bring about significant distress, making normal functioning difficult. Patients tend to respond to a combination of cognitive and pharmacologic therapies, similar to the treatment responses of patients with other obsessive-compulsive spectrum disorders. However, in severe cases of intractable BDD when multiple modalities of therapy have failed, other treatments such as deep brain stimulation (DBS) could be considered.

A 23-year-old Caucasian male presents with a 5-year history of worsening BDD, OCD, and social phobia. A combination of cognitive behavioral therapy and standard pharmacological treatment was attempted, but symptoms progressed, leading to suicidal ideation. Ultimately, the patient elected to undergo placement of a DBS device bilaterally targeting the region bound by the ventral striatum, nucleus accumbens, and subgenual cingulate. The patient was evaluated using both the Yale-Brown Obsessive-Compulsive Scale Symptom Checklist and the Hamilton Rating Scale for Depression, both pre and postoperatively over the course of 21.5 months.

Following DBS treatment, this patient demonstrated marked improvements in BDD-associated symptoms previously resistant to both cognitive behavioral and pharmacological therapy. This case highlights how DBS treatment can effectively improve symptoms in treatment-refractory BDD when first-line modalities have been exhausted and thus may be a potential consideration for clinical use.