Patient discussions
An adequate trial of a selective serotonin-reuptake inhibitor (SSRI) or clomipramine requires 12 weeks or even longer to see if the medication will work. Response to medication can be delayed from 8-12 weeks (or longer if dose titration is slow). Improvement with cognitive behavioural therapy (CBT) can take even longer (median of about 11 weeks for 30% or greater improvement in BDD symptoms).[69][81][82] Longer CBT treatment is usually needed for additional improvement in symptoms.[82] Initial non-response to treatment is not a reason to stop it.[105]
Medication adverse effects sometimes occur before symptom improvement does; patients should not be discouraged by this. Adverse effects often improve with time or can be effectively managed.
Medications for BDD must be taken every day; otherwise they may not work. Medication should not be discontinued without first discussing this with the prescribing clinician. Medication should not be discontinued simply because the patient is feeling well, because symptom relapse may occur.[91] An effective SSRI or clomipramine should be continued for at least 3-4 years. For patients who have had more severe symptoms, high levels of suicidality, or psychiatric hospitalisations, longer-term and even lifelong treatment with an SSRI or clomipramine should be considered.[69] How long to continue an effective antipsychotic should be tailored to each patient based on prior illness severity, medication tolerability, adverse effect risk, and other patient-specific factors.
CBT can be challenging, but this is necessary for improvement to occur. Therapists will not ask patients to do things that are clearly too difficult or that patients do not agree to try.[78] For CBT to work, it is essential to do CBT homework (practise learned CBT skills) between therapist sessions.[78]
Patients with the muscle dysmorphia form of BDD should avoid use of drugs or supplements in order to build muscle or burn fat, especially anabolic androgenic steroids and other substances that are potentially dangerous to their health.
Good self-care is recommended. This includes, for example, getting sufficient sleep and exercise, eating a healthy diet, and trying to minimise stress.
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