Body Dysmorphic Disorder Treatment Protocol

The treatment regimen for somatic disorders deals in detail with the general principles of treatment and the most effective methods available today. In fact, the regimen will be adjusted according to the clinical form, symptom severity and response ability of each patient.

Treatment regimen for body dysmorphic disorder
The body dysmorphic disorder treatment protocol deals with the principle and the most effective treatment methods

Outline

Somatoform Disorder is also known as conversion disorder. This term refers to the recurrence of physical symptoms but no physical cause can be found on physical examination. Recurrence of these symptoms leaves patients with a persistent need to be examined and treated – even when the doctor has determined that the patient is completely free of any health problems.

Somatic disorders with onset in adolescence or early adulthood. The etiology is unknown but is often related to chronic stress. This disease is more common in women, the treatment process is still difficult and the disease is easily confused with illness anxiety disorder or dissociative disorder.

Diagnose

Somatic disorders have many clinical forms. Each form will have different manifestations and characteristics.

1. Body dysmorphic disorder

Body dysmorphic disorder is a common body disorder. The typical presentation is the continuous recurrence of physical symptoms that prompt the patient to request medical examination and treatment over a long period of time. People with this disease always have a need for diagnosis and treatment even after receiving negative results many times and the doctor also commits that the patient is completely healthy.

Somatization disorders are diagnosed when the following criteria are met:

  • The physical symptoms are varied, variable, and persist for at least 2 years for which no satisfactory physical explanation can be found.
  • Refuse and do not accept the doctor’s reassurance and advice about your health condition.
  • Some disorders of family and social activities can be attributed to the nature of the behavior and symptoms caused, such as delusional disorder, suspected disorder, depression, anxiety disorder, and psychosis types,…

2. Suspected disorder

Suspicious disorder is a type of transformation disorder in which people believe that even minor physical symptoms are signs of serious health problems. Similar to somatic disorders, the patient also persistently sought medical attention despite the reassurances and affirmations of the physician that the patient was completely healthy.

Treatment regimen for body dysmorphic disorder
Suspected disorder is one of the clinical forms of body dysmorphic disorder

According to ICD-10, a suspected disorder will have the following typical manifestations:

  • Believing that your symptoms are due to a serious medical condition. This persistent mentality makes patients always look for doctors with the desire to be examined and treated. However, physical examination did not reveal any satisfactory cause that could explain the appearance of symptoms.
  • Refuse the reassurance and advice of the doctor.
  • Excessive preoccupation with the disease causes the patient to significantly reduce social, occupational function, etc.
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3. Body-type autonomic dysfunction

Somatic autonomic dysfunction is one of the clinical forms of conversion disorder. People with this disease will experience symptoms such as disorders of the autonomic nervous system (disorders of the urinary system – genitourinary, respiratory, stomach, cardiovascular, …). The most common is sweating, flushing, nervousness, palpitations, burning sensation in the skin, etc.

Somatic autonomic dysfunction is diagnosed when the following criteria are met (according to ICD-10):

  • Occurrence of symptoms of autonomic nervous excitement such as blushing, sweating, palpitations, etc. Symptoms occur persistently, causing a certain discomfort.
  • The patient is persistently concerned and distressed because he thinks he has a serious illness, despite repeated reassurances and confirmations from the doctor.
  • Additional subjective symptoms attributed to system-specific or organ-specific
  • No evidence of organ dysfunction or entity was found.

Somatic autonomic dysfunction will be differentiated from delusional disorder, somatization disorder, and generalized anxiety disorder.

4. Persistent somatic pain disorder

Persistent somatic pain disorder is also known as radiculopathy. People with this disease always experience persistent pain but cannot determine the specific cause.

Treatment regimen for body dysmorphic disorder
Persistent somatic pain disorder characterized by persistent and severe pain but no specific cause can be found

According to the ICD-10, radiculopathy will have the following symptoms:

  • There are somatic symptoms, which predominate with persistent pain symptoms and are severe enough to cause distress to the patient. Pain symptoms could not be determined despite a thorough examination.
  • Pain occurs along with emotional conflict when the patient receives attention and support from medical staff and those around them.

5. Other body type disorder

Somatic disorder has many other clinical forms. The common feature of these forms is that patients complain of somatic symptoms that are not mediated by the nervous system and are often localized to specific areas of the body.

  • Cervical torticollis and other disorders of spasmodic movement (excluding Tourette’s syndrome)
  • Psychogenic menstrual disorder
  • Psychogenic itching (except for urticaria, atopic dermatitis, eczema, hair loss, etc.)
  • The sensation of a lump in the throat that causes difficulty swallowing (called hysteria) and other forms of swallowing difficulty
  • Chatter

In addition to clinical manifestations, patients with suspected somatic disorder will have to perform some additional laboratory tests such as:

  • ECG
  • EEG measurement
  • General blood count test

Somatic dysmorphic disorder does not have any characteristic subclinical signs. However, these tests will help in ruling out other possibilities.

Treatment regimen for body dysmorphic disorder

1. General principles

The etiology of somatic disorders is complex and often involves both psychological and physical causes. Most patients do not accept psychological causes as the cause of physical symptoms. Therefore, persuading patients to intervene in treatment will take a long time and in many cases, they will voluntarily abandon treatment.

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General principles when treating somatic disorders:

  • Psychotherapy is the mainstay of treatment for somatic disorders. This therapy helps to resolve internal conflicts, thereby bringing a sense of comfort and relaxation to help patients gradually reduce anxiety, suffering and physical symptoms.
  • With each disease group and the specific condition of each patient, the doctor will choose the appropriate psychotherapy.
  • Severe cases, complicated developments must be treated in the hospital to prevent complications in time.
  • Patients with somatic disorders will be applied relaxation methods to reduce physical symptoms. This method is also highly effective in preventing disease recurrence.
  • Improve the patient’s ability to tolerate stress from stress caused by studying, working, living, etc. At the same time, guide the patient on how to adapt to unfavorable conditions to prevent stress and prevent disease recurrence.

2. Specific treatment

The two most effective methods of treating somatic disorders are psychotherapy and pharmacotherapy. The specific treatment regimen will depend on the clinical form, severity of the disease and the aetiological factors of each patient.

Psychotherapy:

  • Psychotherapy has a dominant role in the treatment of somatic disorders, most commonly behavioral therapy and cognitive therapy.
  • Currently, the effectiveness of psychotherapy is still limited because patients voluntarily quit treatment and the awareness of people around this therapy is not really deep.
  • Body dysmorphic disorder is a chronic, progressive disease with a high risk of treatment resistance.

– Pharmacotherapy:

Pharmacotherapy is considered when the patient has symptoms of anxiety, depression, panic attacks, agitation, etc. The type of drug used will depend on the clinical presentation and specific condition of each patient.

Treatment regimen for body dysmorphic disorder
Pharmacotherapy is part of the treatment regimen for somatic disorders in addition to psychotherapy

*Antidepressants

Persistent preoccupation with physical symptoms leaves the patient vulnerable to anxiety and depression. In this case, antidepressants will be used to improve. Preferred options are serotonin reuptake inhibitors and tricyclic antidepressants.

The dosage of the drug is the same as when treating depression. The drug takes effect quite late, usually after about 4-8 weeks of use. Similar to when treating depression, the drug will be taken long-term to prevent relapse.

*Anti-anxiety medications:

Anti-anxiety medications are used in cases where the patient presents with anxiety. Because the drug can be addictive, it is mainly used for short-term use. Moreover, the patient will also be clearly explained and advised by the doctor about the risk of drug abuse and addiction to use the drug properly.

Anti-anxiety medications are given in low doses, then gradually increased until the desired effect is achieved. As with other potentially addictive drugs, the dose should be gradually reduced before stopping completely to avoid unwanted effects.

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The anti-anxiety medication used to treat somatic disorder is usually one of three types:

  • Non-benzodiazepine anti-anxiety medication (Etifoxine Chlorhydrate)
  • Benzodiazepine anxiety medication
  • Antihistamine H1 (Hydroxyzine Hydrochloride)

Treatment regimens for somatic disorders focus on symptom control and frequency reduction in order to improve patient quality. The actual regimen will be individualized depending on the clinical form, disease severity and specific health status of each case.

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