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This concept map depicts the main issues that cause the under-diagnosis of Body Dysmorphic Disorder (BDD) an anxiety disorder related to body image, how to address these issues and the recommended treatments. The definite causes of BDD are unknown and further research is needed, but it is thought to develop from psychological or genetic and neurobiological factors (Phillips, 2009). The BDD symptoms shown on the map are distinct from other appearance-focused disorders, yet it does have high comorbidity along with other mental health issues such as depression, obsessive compulsive disorder (OCD) and anxiety (Gunstad & Phillips, 2003). This means it can often lead to a misdiagnosis (Zimmerman & Mattia, 1998).        

The under-diagnosis of BDD is thought to be triggered by two issues, the first deriving from a patients’ reluctance or embarrassment to discuss their concerns and symptoms with practitioners which can cause patients to seek alternative and ineffective treatments such as cosmetic surgery (Phillips, 2002). Methods such as motivational interviewing techniques could be adopted to remove barriers to communication and encourage patients to discuss symptoms that ordinarily they would be reluctant to share (Miller & Rollnick, 2002).

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The second issue is the lack of awareness of the condition amongst medical professionals and poor understanding about how to identify symptoms or the adequate treatments available. Motivational interviewing and approved questionnaires, such as the Body Dysmorphic Disorder Examination (Rosen & Reiter, 1996) can address this, as it equips practitioners with the tools necessary for diagnosis and treatments. These can also be used by practitioners across industries such as mental health care and cosmetic fields to enable proper diagnosis, promote conversation between patient and practitioner and reduces chances of patients seeking unsuitable treatment such as cosmetic surgery (Veale, Ellison,Werner, Dodhia, Serfaty & Clarke, 2012;  Crerand, Phillips, Menard, & Fay, 2005).


Both pharmacotherapy and psychotherapy options can be used to treat BDD. Pharmacotherapy, such serotonin reuptake inhibitors (SRIs), should be the standard medication treatment for BDD, fluoxetine being found to be the most effective of these (Phillips, Albertini & Rasmussen, 2002). Cognitive behavioural therapy (CBT), a form of psychotherapy, is also an effective treatment for BDD (Bjornsson, Didie & Phillips, 2010), although it can be difficult to guarantee availability and access. This may be alleviated by therapist-guided internet-based CBT for patients with mild to moderate symptoms (Enander et al, 2016) and group therapy methods (Jónsson, Hougaard, & Bennedsen, 2011).  A meta-analysis study shows CBT may yield better results (Williams, Hadjistavropoulos & Sharpe, 2006), although both pharmacotherapy and therapy treatments may be mutually enhancing for serious cases (Phillips, 2009).

The map clearly depicts how both the treatment and underdiagnosis of BDD and their solutions are inextricably linked. In order to promote the correct diagnosis of the disorder, practitioners should build their knowledge of BDD (using either motivational interviewing or questionnaires), which in turn will help patients disclose symptoms, produce an accurate diagnosis and provide further insight into the suitable treatments necessary.  

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