Mental health articles

Case study: body dysmorphic disorder

Susan is a 33-year-old hairdresser who attended her GP following a recent bout of ill-health involving panic attacks, low mood, attempted suicide and avoidance of leaving the house. The problem began six weeks earlier when she developed a light rash (which she called spots) over her neck area. She believed that she was ‘smelly, disgusting, ugly, revolting and hideous’ as a consequence. She took sick leave for three weeks until it cleared up and did not leave the house or let anyone see her during this period except her boyfriend who lived with her. She constantly asked him for reassurance, and she estimated the frequency of this as approximately every 15 minutes. The consequence was that her boyfriend could not cope and moved out, which she said reinforced her belief in being hideous. She said that she woke up one morning and when she looked in the mirror noticed the problem. She had an immediate panic attack (breathlessness, palpitations, shaking) and remembers thinking, ‘Oh my God what has happened to me?’ Since the ‘outbreak’ she was constantly in fear of a re-occurrence and developed a number of coping behaviours. She washed her neck hourly with perfumefree soap (including bed-time, setting her alarm clock), constantly mirrorchecked (for example, at work, when shopping), constantly asked her boyfriend (who had returned to their home) to check her skin, washed her bed sheets and pillowcase daily. Furthermore, she could not allow any piece of clothing to touch her neck for fear of a reaction. She avoided all make-up and perfume and began to eat only plain foods and also avoided eating out.

Furthermore, she became panicky when in smoky environments and ceased all socializing. Any sign of a spot/blemish would immediately result in a panic attack and thoughts of being disgusting.

Treatment efficacy: body dysmorphic disorder

No NHS guidance is currently available of treatment efficacy for trichotillomania, due to the few trials available. Although many single case or case series cognitive behavioural treatments (CBT) had been described . It is only more recently that a systematic and controlled study of the effectiveness of CBT has been undertaken (Veale et al. 1996). In all the salient treatment literature, exposure therapy as part of CBT has been the prerequisite for all successful treatment outcomes.

Tags: body dysmorphic disorder, disorder