Management of body dysmorphia Body Dysmorphic Disorder Key Info • Obsessive compulsive-related disorder Management Approach in young people and adults • • • • Ideally managed by an OCD spectrum specialist Because there is limited evidence to inform the management of body dysmorphic disorder, treatment recommendations are extrapolated from evidence in obsessive compulsive disorder. - Same thing applies for children If pharmacotherapy is initiated in a young person, it should be done by a clinician with expertise in psychotropics in young people Use concurrently with pharmacotherapy and psychotherapy - Some require pharmacotherapy before Approach in children • First line -> psychological interventions - If no response after 12 weeks -> consider pharmacology Psychological interventions • • • Psychoeducation CBT with an exposure and response prevention component In children - Should be adapted to their chronological and developmental age ➔ Include their parents and family Initial Pharmacotherapy • Anti-depressants - Consider ADRs, comorbidities, age, is the patient planning pregnancy, are the pregnant or breastfeeding - SSRIs -> first line e.g. fluoxetine - If cannot tolerate SSRIs or have poor response -> SNRIs e.g. duloxetine. - Doses required are often higher than other indications. ➔ Older adults -> lower doses ➔ Hyponatremia limits choice of anti-psychotics for older adults - ➔ Younger people susceptible to suicide with anti-depressants Monitor for adverse effect of the dose is high monitor for adverse effects e.g., ECG May replace when withdrawn -> so long-term therapy is needed. Children Follow up period • • Activation and suicide more common during the first 7 to 10 days Full benefit may take eight weeks or longer