While BDD is present in 2.4% of the general population, it can range from 9 - 14% in dermatology clinics. There are red flags that dermatologists can watch for, and depending on the severity, dermatologists may consider referring patients to mental health professionals.
Body dysmorphic disorder (BDD) is a relatively recent diagnosis and is under-recognized, according to a dermatologist speaking at the 73rd annual meeting of the American Academy of Dermatology (San Francisco, 2015) about how to detect BDD in dermatology practices.
“It (BDD) is present in up to 2.4% of the general population, but in dermatology clinics it is (present in) anywhere from 9 - 14% (of patients),” says Neelam Vashi, M.D., assistant professor of dermatology, director, Boston University Center for Ethnic Skin, Cosmetic and Laser Center, Boston University School of Medicine, Boston Medical Center in Boston, Mass. “It is important to recognize this disorder, so we can screen these patients because they will not be happy with cosmetic treatments.”
Research suggests that 90% of patients with BDD report their symptoms unchanged or worsened after a dermatological procedure, Dr. Vashi says.
The suicide rate for BDD patients is much higher than in the general population, Dr. Vashi stresses. “A total of 0.3% of patients with BDD die annually due to suicide, a rate which is 37 times higher than in the general population,” she says.
Screening questionnaires such as the Body Dysmorphic Disorder Questionnaire-Dermatology Version, the Dysmorphic Concern Questionnaire, and the Body Image Concern Inventory, which have all been validated by psychiatrists, can be employed to identify patients in dermatology practices suspected of having BDD, but posing some key questions to patients might reveal that a patient has BDD, according to Dr. Vashi.
“Asking patients why they are requesting a specific procedure, how much distress the (perceived) condition is causing them, and how much they think about this condition on a daily basis (are fundamental questions),” she says. “Answers to those questions will give you a lot of insight and you don’t necessarily need to (use a screening tool).”
A “red flag” that a patient may have BDD is that a patient has been “doctor shopping” and has visited numerous dermatologists, requesting a particular procedure, Dr. Vashi says. “They may tell you that they have been to a dozen physicians and that they have not been helped,” she says.
Some examples of what patients with BDD may request include a hair transplant when no thinning of hair is present or laser treatment to treat a scar that is non-existent, she says.
Dermatologists may consider referring patients with BDD to mental health professionals for cognitive-behavioral therapy. Depending on the severity of BDD in patients, pharmacotherapy such as selective serotonin reuptake inhibitors may be warranted, according to Dr. Vashi.