Prognosis

Course of illness

​Patients typically have BDD for up to 15 years before receiving mental health treatment.[89]​ BDD is typically chronic unless it is effectively treated. During up to 4 years of prospective follow-up, the cumulative probability for full remission is only 0.20 and for full or partial remission is 0.55.[90]​ More severe BDD symptoms, longer lifetime duration of BDD, and being an adult all confer a lower likelihood of full or partial remission.[90] Among individuals who partially or fully remit from BDD, the cumulative probability for subsequent full relapse is 0.42 and for subsequent full or partial relapse is 0.63.[90] Full or partial relapse is predicted by more severe BDD and earlier age at BDD onset.[90] Of note, most of the participants in this study had not received adequate treatment for BDD.

Prognosis with good treatment

Appropriate pharmacotherapy and cognitive behavioural therapy for BDD results in high response and remission rates.[91][92]​​​ Discontinuation of an effective selective serotonin-reuptake inhibitor (SSRI) or clomipramine not uncommonly leads to symptom relapse, and longer-term treatment with these drugs is often (but not always) needed.[91] Worsening or relapse of BDD symptoms may occur when effective pharmacotherapy is continued, but clinical observations suggest that this is usually due to medication non-adherence and that improving adherence usually improves symptoms again.[91] Following successful cognitive behavioural therapy for BDD treatment, symptom improvement is usually maintained over the first 6-12 months post-treatment.[77]​​[79][93]​​​​ Over a longer follow-up period (years), many patients maintain their improvement, but a significant number of patients maintain chronic symptoms after treatment; these patients may need a longer-term or more complex intervention and medication treatment.[94]

Use of this content is subject to our disclaimer