A small MRI

study found that BDD subjects, compared with healthy control participants, exhibited significantly abnormal asymmetry of the caudate nucleus, with a leftward shift in laterality quotient, as well as greater total white matter volume.96 A second small study similarly found greater white matter volume in BDD relative to controls, in addition to smaller orbitofrontal cortex and anterior cingulate and larger thalamic volumes.97 However, a third study found no significant volumetric differences in BDD vs healthy controls.98 A small BDD single proton-emission computed tomography study showed relative perfusion deficits in bilateral anterior Inhibitors,research,lifescience,medical temporal and occipital regions and asymmetric perfusion in the parietal lobes.99 In another study, when viewing a photograph of their Inhibitors,research,lifescience,medical own face vs a familiar face, BDD subjects had relative hyperactivity in left orbitofrontal cortex and bilateral head of the caudate compared with controls; frontostriatal activation correlated with aversiveness ratings of faces and BDD severity.100 These results are similar to those in OCD symptom provocation studies,101 suggesting

that BDD and OCD symptoms may possibly be mediated by the same orbitofrontal-subcortical circuit (although this study did not directly compare BDD and OCD). Cosmetic treatment for BDD A majority of individuals with Inhibitors,research,lifescience,medical BDD seek (71% to 76%) and receive (64% to 66%) cosmetic treatment (eg, surgical, dermatologic, or dental) for their perceived appearance flaws.102,103

In a general population sample from Germany, 7.2% of those with BDD had received cosmetic surgery, compared with only 2.8% of those without BDD.30 However, such treatment appears to only Inhibitors,research,lifescience,medical rarely improve overall BDD symptoms. In a study of 200 individuals with BDD, subjects retrospectively reported that only 3.6% of all treatments resulted in overall improvement in BDD.102 In another study (n=250), only 7% of Inhibitors,research,lifescience,medical treatments (retrospectively assessed) led to overall improvement in BDD.103 Veale et al found that 81% of 50 BDD patients were dissatisfied with past medical consultation or surgery.81 Such an outcome can have serious negative consequences for both patients and physicians. In the previously noted survey of cosmetic also surgeons, 40% of respondents indicated that dissatisfied BDD patients had threatened them physically or legally85 It is therefore important for BDD patients and their mental health PLX3397 providers to be aware that non-mental health interventions appear unlikely to successfully treat BDD symptoms. Pharmacotherapy Pharmacologic treatment for BDD is described in more detail elsewhere,1,26 including in a Cochrane review and a guideline from the United Kingdom’s National Institute of Clinical Excellence (NICE) on the treatment of OCD and BDD, which recommend SRIs for the treatment of BDD.