Body Dysmorphic Disorder Angela Fang, MA, Natalie L. Matheny, BA, Sabine Wilhelm, PhD* OVERVIEW: NATURE OF THE PROBLEM Characterized as a disorder of imagined ugliness, BDD has long been described in the psychiatric literature. BDD was introduced only in 1980 to the Diagnostic and Statisti- cal Manual of Mental Disorders (DSM)-III 1 as an atypical somatoform disorder, called dysmorphophobia, and was given a separate diagnosis in DSM (Third Edition Revised) 2 in the somatoform disorders section. By the time the DSM (Fourth Edition, Dr S. Wilhelm has received research support from National Institute of Mental Health grants 5 R01 MH091078-03, 5 R01 MH093402-03, the US Food and Drug Administration, the Interna- tional OCD Foundation, and the Tourette Syndrome Association. Forest Laboratories provided her with medication and matching placebo for a National Institute of Mental Health–funded study. Dr S. Wilhelm has received royalties from Elsevier Publications, Guilford Publications, New Harbinger Publications, and Oxford University Press. She has also received speaking honoraria from various academic institutions. OCD and Related Disorders Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, 185 Cambridge Street, 2nd Floor, Boston, MA 02114, USA * Corresponding author. E-mail address: wilhelm@psych.mgh.harvard.edu KEYWORDS  Body dysmorphic disorder  Obsessive-compulsive spectrum  Treatment  Cognitive-behavioral therapy  Serotonin reuptake inhibitor KEY POINTS  Body dysmorphic disorder (BDD) has garnered much research attention in the past decade. Pharmacologic and nonpharmacologic treatment options are available but limited.  The first-line pharmacotherapies for BDD are serotonin reuptake inhibitors (SRIs) which seem to require relatively high doses and long trial durations.  The most empirically supported nonpharmacologic intervention for BDD is cognitive- behavioral therapy (CBT), which is a time-limited, symptom-focused treatment that involves psychoeducation, cognitive restructuring, perceptual/mirror retraining, exposure and response prevention, and relapse prevention.  Available data from medication and CBT trials are limiting as far as generalizability and lack of well-controlled designs. It remains unclear which modality is more efficacious and whether combination therapies offer additional advantages over monotherapies.  Highly delusional patients may be more likely to seek treatment from nonpsychiatric professionals, such as cosmetic surgeons, dermatologists, and dentists, for their BDD concerns. Psychiatr Clin N Am 37 (2014) 287–300 http://dx.doi.org/10.1016/j.psc.2014.05.003 psych.theclinics.com 0193-953X/14/$ – see front matter Ó 2014 Elsevier Inc. All rights reserved.