Body dysmorphic disorder: often unseen yet demands clinical attention

Case scenario

Summa presents to your pharmacy and hands in a new prescription for fluoxetine 20 mg. She is wearing oversized clothing, her face is partially covered with a hood and she iswearing a face mask. Summa appears uneasy and starts walking towards a quiet corner of the pharmacy while keeping her head down. You approach Summa, ask if she is okay, and enquire about respiratory symptoms, noting her mask. She denies any. Concerned, you invite Summa into the counselling room, where she shares that she has been feeling severely depressed and anxious about leaving the house due to fears of being judged for her appearance.

Introduction

Body dysmorphic disorder (BDD) is recognised in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) as a psychiatric condition characterised by significant distress secondary to a distorted perception of one’s own face or body compared to reality.¹ Not simply body image concerns, BDD is a distinct and serious condition which can profoundly affect an individual’s day-to-day functioning and their overall quality of life. Studies have found that people with BDD are four times more likely to die by suicide compared to the general population.^1,2 Additionally, around 30% of people living with BDD do not attend school or do not have a job due to significant limitations in social engagement.³ BDD is often under-recognised in the healthcare system, affecting prognosis and rates of recovery.⁴ As primary healthcare professionals, pharmacists could play an essential role in supporting people living with BDD.

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