Body dysmorphic disorder

Overview 
Theory 
Diagnosis 
Management 
Follow up 
Resources 

Please note that formulations/routes and doses may differ between drug names and brands, drug formularies, or locations. Treatment recommendations are specific to patient groups: see disclaimer

ACUTE

mild or moderate symptoms

1st line – pharmacotherapy

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1st line –

pharmacotherapy

For patients with mild symptoms (i.e., those with a score of 20-24 on the Yale-Brown Obsessive-Compulsive Scale Modified for Body Dysmorphic Disorder [BDD-YBOCS]) pharmacotherapy is a first-line option. For patients with moderate symptoms (i.e., those with a score of 25-30 on the BDD-YBOCS) pharmacotherapy (with or without cognitive behavioral therapy [CBT]) is a first-line option.[57]

When choosing between pharmacotherapy and CBT, consider factors such as patient preference, presence of a comorbidity that is likely to improve with pharmacotherapy, availability of CBT, and the patient’s treatment history.

No medications are approved for BDD in the US because pharmaceutical companies have not sought licensing for this indication. Therefore, the use of these medications is considered off-label for BDD.

Selective serotonin-reuptake inhibitors (SSRIs) such as fluoxetine, sertraline, and escitalopram, and the tricyclic antidepressant clomipramine are first-line pharmacotherapy options for BDD.[53][64][69] SSRIs are usually tried before clomipramine because they are usually better tolerated. High doses of SSRIs and clomipramine are usually needed, typically in the range used for obsessive-compulsive disorder and higher than those typically used for other disorders (e.g., depression).[33] Escitalopram has the disadvantage of requiring ECG monitoring at doses that are relatively low compared with fluoxetine and sertraline (although escitalopram has fewer drug-drug interactions than some of the other SSRIs).[64] There is also some evidence to not use escitalopram, or use it with caution, in patients over 65 years.[71] ECG monitoring is recommended with clomipramine.[33][64] Do not give citalopram for patients with BDD because the maximum dose is often too low to effectively treat BDD.[72][73] Clomipramine blood levels are recommended to guide dosing, where available (follow your local protocols).[64] In the author’s opinion, clomipramine blood levels must always be carried out.

Lower than standard starting doses are usually used for younger patients (ages under 18 years), elderly patients, and those with panic disorder or a history of sensitivity to medication adverse effects. Based on the author’s experience, gradually increase the dose over 5-10 weeks to reach the maximum approved dose, unless a lower dose starts to improve the symptoms, in which case the lower dose can be continued for a longer time to see if it is sufficiently helpful. An adequate trial of medication should be at least 12-16 weeks, with at least 4 of these weeks on the maximum approved dose (if a lower dose is not effective).[33] If it takes longer than 5-10 weeks to reach the maximum approved dose, the trial will need to be longer before deciding whether the medication is effective. Clinical experience indicates that an effective SSRI or clomipramine should be continued for at least 3-4 years.

For those receiving clomipramine, blood levels of clomipramine are recommended, where available, during dose titration to determine when the level is in the therapeutic range (follow your local protocols).[64] In the author’s opinion, clomipramine blood levels must always be carried out. During maintenance treatment, follow-up levels can be obtained (for example, yearly); levels should be obtained when medications are added that could affect serum clomipramine levels.

ECGs are recommended during clomipramine titration and for escitalopram even at relatively low doses, although clinical practice varies (check your local protocols).[33][64] Consider an ECG: for patients on a high dose of other SSRIs (especially sertraline and fluoxetine); when SSRIs or clomipramine are combined with atypical antipsychotics; and when patients take other medications that may prolong the QTc interval.[33][64] A baseline ECG is recommended for patients with a personal or family history of long QT syndrome, arrhythmia, or other potentially relevant cardiac condition.[64] See Monitoring.

Effective SSRI treatment decreases and protects against suicidal ideation in adults with BDD.[75][76] This has not been studied in children and adolescents with BDD; clinical observations indicate that suicidality in children and adolescents usually decreases with effective SSRI treatment. Manufacturers warn that antidepressants may increase the risk of suicidal thoughts and behavior in children, adolescents, and young adults. Closely monitor all patients started on SSRIs for the emergence or worsening of suicidal thoughts and behaviors, and advise families and caregivers of the need for close observation.

Primary options

fluoxetine: 20 mg orally (immediate-release) once daily initially, increase gradually according to response, maximum 80 mg/day

Higher doses than the approved maximum dose recommended here are often required in patients with body dysmorphic disorder. Consult the American Psychiatric Association practice guideline for obsessive-compulsive disorder or the International College of Obsessive-Compulsive Spectrum Disorders BDD treatment synthesis and consensus for more information on these higher doses.[64][70]

sertraline: 50 mg orally once daily initially, increase gradually according to response, maximum 200 mg/day

escitalopram: 10 mg orally once daily initially, increase gradually according to response, maximum 20 mg/day

Secondary options

clomipramine: 25 mg orally (immediate-release) once daily initially, increase gradually according to response, maximum 250 mg/day

Consider – cognitive behavioral therapy (CBT)

Back

Consider –

cognitive behavioral therapy (CBT)

Treatment recommended for SOME patients in selected patient group

For patients with moderate symptoms, CBT may be added on to pharmacotherapy.[57]

CBT is the psychotherapy of choice for people with BDD.[33] CBT must be tailored to the specific symptoms of BDD. CBT for BDD consists of psychoeducation, setting valued goals, and building a CBT model of the patient’s BDD. Then cognitive restructuring, ritual prevention (gradually reducing and stopping repetitive behaviors/rituals, such as excessive mirror checking), exposure with behavioral experiments, and mirror retraining are introduced. Mirror retraining is a brief (e.g., 5 minute) daily exercise that helps the patient learn to see themselves more holistically and nonjudgmentally; it does not involve staring at perceived flaws in the mirror. Behavioral activation is used for patients with more severe depressive symptoms or those who are inactive, and habit reversal training addresses skin picking and hair pulling/plucking.

For patients who obtain CBT for BDD, 6 months of weekly, hour-long CBT sessions are typically needed, with symptom monitoring at the beginning of each session.[81] Patients with milder BDD may need fewer sessions and those with more severe BDD may need a longer duration of treatment, or more days per week, and/or more hours per day of CBT. The median time to response of BDD to weekly hour-long CBT (showing a 30% or greater improvement) is about 11 weeks, but more treatment is usually needed for additional improvement in symptoms.[82]

Once patients have improved, CBT booster sessions (e.g., monthly) may be helpful, and are sometimes needed for a period of time to prevent relapse. Frequency and duration of CBT booster sessions should be tailored to each patient.

CBT can be challenging, but this is necessary for improvement to occur. The patient should practice their learned CBT skills between therapist sessions.[78]

1st line – cognitive behavioral therapy (CBT)

Back

1st line –

cognitive behavioral therapy (CBT)

For patients with mild symptoms (i.e., those with a score of 20-24 on the Yale-Brown Obsessive-Compulsive Scale Modified for Body Dysmorphic Disorder [BDD-YBOCS]) CBT is a first-line option. For patients with moderate symptoms (i.e., those with a score of 25-30 on the BDD-YBOCS) CBT (with or without pharmacotherapy) is a first-line option.[57]

When choosing between CBT and pharmacotherapy, consider factors such as patient preference, presence of a comorbidity that is likely to improve with pharmacotherapy, availability of CBT, and the patient’s treatment history.

For patients who obtain CBT for BDD, six months of weekly, hour-long CBT sessions are typically needed, with symptom monitoring at the beginning of each session.[81] Patients with milder BDD may need fewer sessions and those with more severe BDD may need a longer duration of treatment, or more days per week, and/or more hours per day of CBT. The median time to response of BDD to weekly hour-long CBT (showing a 30% or greater improvement) is about 11 weeks, but more treatment is usually needed for additional improvement in symptoms.[82]

CBT can be challenging, but this is necessary for improvement to occur. The patient should practise their learned CBT skills between therapist sessions.[78]

Consider – pharmacotherapy

Back

Consider –

pharmacotherapy

Treatment recommended for SOME patients in selected patient group

For patients with moderate symptoms (i.e., those with a score of 25-30 on the BDD-YBOCS) pharmacotherapy may be added on to CBT.[57]

No medications are approved for BDD in the US because pharmaceutical companies have not sought licensing for this indication. Therefore, the use of these medications is considered off-label for BDD.

Primary options

fluoxetine: 20 mg orally (immediate-release) once daily initially, increase gradually according to response, maximum 80 mg/day

sertraline: 50 mg orally once daily initially, increase gradually according to response, maximum 200 mg/day

escitalopram: 10 mg orally once daily initially, increase gradually according to response, maximum 20 mg/day

Secondary options

clomipramine: 25 mg orally (immediate-release) once daily initially, increase gradually according to response, maximum 250 mg/day

2nd line – increase dose of current medication or combination drug therapy

Back

2nd line –

increase dose of current medication or combination drug therapy

If first-line pharmacotherapy does not adequately improve BDD after the initial 12-16-week trial (and after reaching the maximum approved dose), the first step (in the author’s opinion) is to gradually increase the dose of the current medication further, if tolerated, to the maximum daily dose. Clinical experience suggests that this approach is often the simplest and best tolerated, and it is often effective. Consult the American Psychiatric Association practice guideline for obsessive-compulsive disorder or the International College of Obsessive-Compulsive Spectrum Disorders BDD treatment synthesis and consensus for more information on these higher doses (not citalopram, which is not recommended for BDD). APA: treatment of patients with obsessive-compulsive disorder Opens in new window ECNP: body dysmorphic disorder Opens in new window

Augmenting the selective serotonin-reuptake inhibitor (SSRI) or clomipramine with buspirone (a nonbenzodiazepine anxiolytic) or an atypical antipsychotic (e.g., aripiprazole), or combining an SSRI and clomipramine is the next step if increasing the dose of the initial medication has not been effective or was not considered clinically appropriate.

If severe comorbid depression, a concerning level of suicidality, or moderate- to- severe comorbid OCD are present, augment the treatment with an atypical antipsychotic such as aripiprazole before augmentation with buspirone or clomipramine. Patients receiving antipsychotic treatment require metabolic monitoring and monitoring for the possible development of abnormal movements (tardive dyskinesia).

Case series data and clinical experience indicate that augmentation of an SSRI or clomipramine with buspirone meaningfully improves BDD in 33% to 46% of patients.[74] This strategy can also improve depression and anxiety. Buspirone is usually well tolerated.[33][64]

Clomipramine can be added to an SSRI (or vice versa), but SSRIs can dramatically and unpredictably increase blood levels of clomipramine, which has a narrow therapeutic index. Thus, clomipramine should be started at a low dose when added to an SSRI. Monitoring of clomipramine blood levels is essential to ensure that the therapeutic range is not exceeded. Monitoring should be continued until a therapeutic blood level is achieved. ECGs should also be monitored.[33][64] The concomitant use of an SSRI and a tricyclic antidepressant, such as clomipramine, can increase the risk of QT interval prolongation and serotonin syndrome.

Augmentation agents are added to an SSRI or clomipramine individually, but over time they can be combined if needed.

Lower doses of clomipramine may be required when it is added to an SSRI. If an SSRI is added to clomipramine, the clomipramine dose may need to be lowered so it does not exceed the therapeutic range. Titrate doses carefully.

No medications are approved for BDD in the US because pharmaceutical companies have not sought licensing for this indication. Therefore, the use of these medications is considered off-label for BDD.

Primary options

fluoxetine: 20 mg orally (immediate-release) once daily initially, increase gradually according to response, maximum 80 mg/day

sertraline: 50 mg orally once daily initially, increase gradually according to response, maximum 200 mg/day

escitalopram: 10 mg orally once daily initially, increase gradually according to response, maximum 20 mg/day

clomipramine: 25 mg orally (immediate-release) once daily initially, increase gradually according to response, maximum 250 mg/day

-- AND --

aripiprazole: 2-5 mg orally once daily initially, increase gradually according to response, maximum 15 mg/day

buspirone: 15 mg/day orally initially given in 2-3 divided doses, increase gradually according to response, maximum 60 mg/day

fluoxetine: 20 mg orally (immediate-release) once daily initially, increase gradually according to response, maximum 80 mg/day

sertraline: 50 mg orally once daily initially, increase gradually according to response, maximum 200 mg/day

escitalopram: 10 mg orally once daily initially, increase gradually according to response, maximum 20 mg/day

-- AND --

clomipramine: 25 mg orally (immediate-release) once daily initially, increase gradually according to response, maximum 250 mg/day

Consider – cognitive behavioral therapy (CBT)

Back

Consider –

cognitive behavioral therapy (CBT)

Treatment recommended for SOME patients in selected patient group

Patients on CBT should continue on treatment.

For patients who obtain CBT for BDD, 6 months of weekly, hour-long CBT sessions are typically needed, with symptom monitoring at the beginning of each session.[81] Patients with milder BDD may need fewer sessions and those with more severe BDD may need a longer duration of treatment, or more days per week, and/or more hours per day of CBT. The median time to response of BDD to hour-long weekly CBT (showing a 30% or greater improvement) is about 11 weeks, but more treatment is usually needed for additional improvement in symptoms.[82]

CBT can be challenging, but this is necessary for improvement to occur. The patient should practice their learned CBT skills between therapist sessions.[78]

3rd line – switch to a different medication

Back

3rd line –

switch to a different medication

If augmenting a selective serotonin-reuptake inhibitor (SSRI) or clomipramine with buspirone, or combining clomipramine and an SSRI has not been effective, the next option is to switch to a different SSRI or to clomipramine (or vice versa if clomipramine was trialed initially).

No medications are approved for BDD in the US because pharmaceutical companies have not sought licensing for this indication. Therefore, the use of these medications is considered off-label for BDD.

High doses of SSRIs and clomipramine are usually needed, typically in the range used for obsessive-compulsive disorder and higher than those typically used for other disorders (e.g., depression).[33] Escitalopram has the disadvantage of requiring ECG monitoring at doses that are relatively low compared with fluoxetine and sertraline (although escitalopram has fewer drug-drug interactions than some of the other SSRIs).[64] There is also some evidence to not use escitalopram, or use it with caution, in patients over 65 years.[71] ECG monitoring is recommended with clomipramine.[33][64] Do not give citalopram for patients with BDD because the maximum dose is often too low to effectively treat BDD.[72][73] Clomipramine blood levels are recommended to guide dosing, where available (follow your local protocols).[64] In the author’s opinion, clomipramine blood levels must always be carried out.

Primary options

fluoxetine: 20 mg orally (immediate-release) once daily initially, increase gradually according to response, maximum 80 mg/day

sertraline: 50 mg orally once daily initially, increase gradually according to response, maximum 200 mg/day

escitalopram: 10 mg orally once daily initially, increase gradually according to response, maximum 20 mg/day

Secondary options

clomipramine: 25 mg orally (immediate-release) once daily initially, increase gradually according to response, maximum 250 mg/day

Consider – cognitive behavioral therapy (CBT)

Back

Consider –

cognitive behavioral therapy (CBT)

Treatment recommended for SOME patients in selected patient group

Patients on CBT should continue on treatment.

For patients who obtain CBT for BDD, 6 months of weekly, hour-long CBT sessions are typically needed, with symptom monitoring at the beginning of each session.[81] Patients with milder BDD may need fewer sessions and those with more severe BDD may need a longer duration of treatment, or more days per week, and/or more hours per day of CBT. The median time to response of BDD to hour-long weekly CBT (showing a 30% or greater improvement) is about 11 weeks, but more treatment is usually needed for additional improvement in symptoms.[82]

CBT can be challenging, but this is necessary for improvement to occur. The patient should practice their learned CBT skills between therapist sessions.[78]

severe and extremely severe symptoms

1st line – pharmacotherapy

Back

1st line –

pharmacotherapy

For patients with severe and extremely severe symptoms (i.e., those with 31-40 on the Yale-Brown Obsessive-Compulsive Scale Modified for Body Dysmorphic Disorder [BDD-YBOCS] have severe symptoms, and those with 41-48 on the BDD-YBOCS have extremely severe symptoms) give pharmacotherapy (in combination with cognitive behavioral therapy [CBT]).[57]

No medications are approved for BDD in the US because pharmaceutical companies have not sought licensing for this indication. Therefore, the use of these medications is considered off-label for BDD.

Selective serotonin-reuptake inhibitors (SSRIs) such as fluoxetine, sertraline, and escitalopram, and the tricyclic antidepressant clomipramine are first-line pharmacotherapy options for BDD.[64][69][75] SSRIs are usually tried before clomipramine because they are usually better tolerated. High doses of SSRIs and clomipramine are usually needed, typically in the range used for obsessive-compulsive disorder and higher than those typically used for other disorders (e.g., depression).[33] Escitalopram has the disadvantage of requiring ECG monitoring at doses that are relatively low compared with fluoxetine and sertraline (although escitalopram has fewer drug-drug interactions than some of the other SSRIs).[64] There is also some evidence to not use escitalopram, or use it with caution, in patients over 65 years.[71] ECG monitoring is recommended with clomipramine.[33][64] Do not give citalopram for patients with BDD because the maximum dose is often too low to effectively treat BDD.[72][73] Clomipramine blood levels are recommended to guide dosing, where available (follow your local protocols).[64] In the author’s opinion, clomipramine blood levels must always be carried out.

For patients with severe symptoms, high levels of suicidality, suicide attempts, psychiatric hospitalizations, or a history of relapses when SSRIs were discontinued, longer-term and even lifelong treatment with a SSRI should be considered.[69]

Primary options

fluoxetine: 20 mg orally (immediate-release) once daily initially, increase gradually according to response, maximum 80 mg/day

sertraline: 50 mg orally once daily initially, increase gradually according to response, maximum 200 mg/day

escitalopram: 10 mg orally once daily initially, increase gradually according to response, maximum 20 mg/day

Secondary options

clomipramine: 25 mg orally (immediate-release) once daily initially, increase gradually according to response, maximum 250 mg/day

Plus – cognitive behavioral therapy (CBT)

Back

Plus –

cognitive behavioral therapy (CBT)

Treatment recommended for ALL patients in selected patient group

For patients who obtain CBT for BDD, 6 months of weekly, hour-long CBT sessions are typically needed, with symptom monitoring at the beginning of each session.[81] Patients with severe BDD may need a longer duration of treatment, or more days per week, and/or more hours per day of CBT. CBT given by a more experienced practitioner, or in an intensive outpatient or residential setting may be needed. The median time to response of BDD to weekly hour-long CBT (showing a 30% or greater improvement) is about 11 weeks, but more treatment is usually needed for additional improvement in symptoms.[82]

CBT can be challenging, but this is necessary for improvement to occur. The patient should practice their learned CBT skills between therapist sessions.[78]

2nd line – increase dose of current medication or combination drug therapy

Back

2nd line –

increase dose of current medication or combination drug therapy

If first-line pharmacotherapy does not adequately improve BDD after the initial 12- to 16-week trial (and reaching the maximum approved dose), the first step (in the author’s opinion) is to gradually increase the dose of the current medication further, if tolerated, to the maximum daily dose. Clinical experience suggests that this approach is often the simplest and best tolerated, and it is often effective. Consult the American Psychiatric Association practice guideline for obsessive-compulsive disorder (OCD) or the International College of Obsessive-Compulsive Spectrum Disorders BDD treatment synthesis and consensus for more information on these higher doses (not citalopram, which is not recommended for BDD). APA: treatment of patients with obsessive-compulsive disorder Opens in new window ECNP: body dysmorphic disorder Opens in new window

Augmenting the selective serotonin-reuptake inhibitor (SSRI) with buspirone (a nonbenzodiazepine anxiolytic) or an atypical antipsychotic (e.g., aripiprazole), or combining an SSRI and clomipramine is the next step if increasing the dose of the initial medication has not been effective or was not considered clinically appropriate.

Clinical experience indicates that adding an atypical antipsychotic (e.g., aripiprazole) can be effective. Because of the possible adverse effect profile, the author usually reserves this augmentation approach for patients who still have severe BDD, depression, agitation, suicidality, or moderate to severe OCD, after treatment with an SSRI or clomipramine alone. For patients with severe depression, severe agitation, or concerning levels of suicidality at the beginning of treatment, an atypical antipsychotic can be added before completing an adequate trial of an SSRI or clomipramine. Patients receiving antipsychotic treatment require metabolic monitoring and monitoring for the possible development of abnormal movements (tardive dyskinesia).

Clomipramine can be added to an SSRI (or vice versa), but SSRIs can dramatically and unpredictably increase blood levels of clomipramine, which has a narrow therapeutic index. Thus, clomipramine should be started at a low dose when added to an SSRI. Monitoring of clomipramine blood levels is essential to ensure that the therapeutic range is not exceeded. Monitoring should be continued until a therapeutic blood level is achieved. ECGs should also be monitored.[33][64] The concomitant use of an SSRI and a tricyclic antidepressant can increase the risk of QT interval prolongation and serotonin syndrome.

Augmentation agents are added to an SSRI or clomipramine individually, but over time they can be combined if needed.

No medications are approved for BDD in the US because pharmaceutical companies have not sought licensing for this indication. Therefore, the use of these medications is considered off-label for BDD.

Primary options

fluoxetine: 20 mg orally (immediate-release) once daily initially, increase gradually according to response, maximum 80 mg/day

sertraline: 50 mg orally once daily initially, increase gradually according to response, maximum 200 mg/day

escitalopram: 10 mg orally once daily initially, increase gradually according to response, maximum 20 mg/day

clomipramine: 25 mg orally (immediate-release) once daily initially, increase gradually according to response, maximum 250 mg/day

-- AND --

aripiprazole: 2-5 mg orally once daily initially, increase gradually according to response, maximum 15 mg/day

buspirone: 15 mg/day orally initially given in 2-3 divided doses, increase gradually according to response, maximum 60 mg/day

fluoxetine: 20 mg orally (immediate-release) once daily initially, increase gradually according to response, maximum 80 mg/day

sertraline: 50 mg orally once daily initially, increase gradually according to response, maximum 200 mg/day

escitalopram: 10 mg orally once daily initially, increase gradually according to response, maximum 20 mg/day

-- AND --

clomipramine: 25 mg orally (immediate-release) once daily initially, increase gradually according to response, maximum 250 mg/day

Plus – cognitive behavioral therapy (CBT)

Back

Plus –

cognitive behavioral therapy (CBT)

Treatment recommended for ALL patients in selected patient group

Patients should continue CBT.

For patients who obtain CBT for BDD, 6 months of weekly, hour-long CBT sessions are typically needed, with symptom monitoring at the beginning of each session.[81] Patients with severe BDD may need a longer duration of treatment, or more days per week, and/or more hours per day of CBT. CBT given by a more experienced practitioner or in an intensive outpatient or residential setting may be needed. The median time to response of BDD to weekly hour-long CBT (showing a 30% or greater improvement) is about 11 weeks, but more treatment is usually needed for additional improvement in symptoms.[82]

CBT can be challenging, but this is necessary for improvement to occur. The patient should practice their learned CBT skills between therapist sessions.[78]

3rd line – switch to a different medication

Back

3rd line –

switch to a different medication

If augmenting a selective serotonin-reuptake inhibitor (SSRI) or clomipramine with buspirone or aripiprazole, or combining an SSRI and clomipramine has not been effective, the next option is to switch to a different SSRI or to clomipramine (or vice versa if clomipramine was trialed initially).

No medications are approved for BDD in the US because pharmaceutical companies have not sought licensing for this indication. Therefore, the use of these medications is considered off-label for BDD.

Primary options

fluoxetine: 20 mg orally (immediate-release) once daily initially, increase gradually according to response, maximum 80 mg/day

sertraline: 50 mg orally once daily initially, increase gradually according to response, maximum 200 mg/day

escitalopram: 10 mg orally once daily initially, increase gradually according to response, maximum 20 mg/day

Secondary options

clomipramine: 25 mg orally (immediate-release) once daily initially, increase gradually according to response, maximum 250 mg/day

Plus – cognitive behavioral therapy (CBT)

Back

Plus –

cognitive behavioral therapy (CBT)

Treatment recommended for ALL patients in selected patient group

Patients should continue CBT.

For patients who obtain CBT for BDD, 6 months of weekly, hour-long CBT sessions are typically needed, with symptom monitoring at the beginning of each session.[81] Patients with severe BDD may need a longer duration of treatment, or more days per week, and/or more hours per day of CBT. CBT given by a more experienced practitioner, or in an intensive outpatient or residential setting may be needed. The median time to response of BDD to weekly hour-long CBT (showing a 30% or greater improvement) is about 11 weeks, but more treatment is usually needed for additional improvement in symptoms.[82]

CBT can be challenging, but this is necessary for improvement to occur. The patient should practise their learned CBT skills between therapist sessions.[78]

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Body dysmorphic disorder

Treatment algorithm

mild or moderate symptoms

pharmacotherapy

Primary options

Secondary options

cognitive behavioral therapy (CBT)

cognitive behavioral therapy (CBT)

pharmacotherapy

Primary options

Secondary options

increase dose of current medication or combination drug therapy

Primary options

cognitive behavioral therapy (CBT)

switch to a different medication

Primary options

Secondary options

cognitive behavioral therapy (CBT)

severe and extremely severe symptoms

pharmacotherapy

Primary options

Secondary options

cognitive behavioral therapy (CBT)

increase dose of current medication or combination drug therapy

Primary options

cognitive behavioral therapy (CBT)

switch to a different medication

Primary options

Secondary options

cognitive behavioral therapy (CBT)