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SURGERY, DERMATOLOGIC TREATMENT, AND OTHER NONPSYCHIATRIC MEDICAL TREATMENT FOR BDD: DO THESE TREATMENTS WORK?

The answer to this question seems to be no—they usually don’t. In the study I’ve been describing of 250 people with BDD who received these treatments, 72% of the treatments resulted in no change in overall BDD severity.
Considering all types of nonpsychiatric treatment combined (“any treatment”), only 11.7% of all treatments improved overall BDD symptoms, and 16.3% were followed by worsening of overall BDD symptoms. Most often, BDD didn’t change. In my series of 200 additional people, even fewer treatments improved BDD: only 3.6% (91.0% led to no change, and 5.4% led to worsening). What about surgery, which is generally the most definitive and expensive treatment that’s received? In the study 18, 58.3%
Number of treatments received in each category: Any treatment: 453, surgery: 15, dermatologic treatment: 265, dental: 34, other medical: 17, paraprofessional: 22 of surgeries resulted in no change in BDD symptoms, and 24.3% were reported to make BDD symptoms worse. In other words, after surgery nearly one quarter of patients were even more preoccupied with the perceived appearance flaw, more distressed, and more impaired by their appearance concerns. Eighty five percent of treatments received from a dentist, 100% of other treatments received from other types of doctors (e.g., endocrinologist), and 91% of treatments received from a paraprofessional led to no change or worsening of BDD symptoms. It’s worth noting that surgery and dental treatments were particularly likely to worsen BDD symptoms.
Dr. Veale’s study, done in England, had similar results. He found that 81% of the 50 BDD patients he saw in a psychiatric setting were dissatisfied or very dissatisfied with the outcome of nonpsychiatric medical consultation or surgery. Repeated surgery tended to fuel increasing dissatisfaction. Although I didn’t ask patients about their satisfaction per se, it’s my impression that experiencing no change in the appearance concern—and certainly experiencing a worsening of this concern—causes people with BDD to feel quite dissatisfied. Sometimes the dissatisfaction is intense, leading to panic, despair, and sometimes even suicidal or violent behavior.
Although only some patients find that BDD gets worse after surgery or medical treatment, in some cases the outcome is extremely poor—even life-threatening. One man I saw who had multiple ear surgeries became suicidal and violent each time the bandages were removed after surgery, necessitating repeated emergency hospitalization. A young man whose surgeon turned him down for forehead surgery but who gave him some facial cream thought the cream created huge, dark spots on his face. He became so enraged over this that he went on a rampage around his parents’ house, threatening them with a hammer and splintering their furniture. A number of patients threatened to sue, or expressed fantasies of harming, their surgeon.
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Posted on Thursday, December 30th, 2010 at 11:31 am and is filed under Anti Depressants-Sleeping Aid. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.

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