PATIENTS’ RESPONSES TO BDD TREATMENT DAVID: A GOOD RESPONSE TO MEDICATION PLUS COGNITIVE-BEHAVIORAL THERAPY
PATIENTS’ RESPONSES TO BDD TREATMENT DAVID: A GOOD RESPONSE TO MEDICATION PLUS COGNITIVE-BEHAVIORAL THERAPYDavid was feeling desperate. A 32-year-old disc jockey, he was at the point of quitting his job. He couldn’t focus on his work because of his hair obsessions, and was often late because he couldn’t tear himself away from the mirror in the morning. Even the expensive new hairpiece he’d bought to hide his slightly receding hairline didn’t help him feel any better. “I don’t like going out in public, and I’ve given up on dating,” he said. “I don’t want to date because someone will run their fingers through my hair and know it’s a hairpiece. I can’t focus on conversations because I think people are looking at my hair. At times I stay in completely; I don’t even food shop.”In the week before he first saw me, David missed work three times and had considered going to an emergency room because he was so panicked about his hair. “I hate myself and how I look. I’m really down on myself. I’ve even had thoughts of ending my life. I can’t live the rest of my life like this. How can you live in your own body if you can’t stand it?”David started taking fluoxetine (Prozac) right away. He continued supportive psychotherapy (see description below) which had helped him cope a little better but didn’t diminish his BDD symptoms. As expected, the medication didn’t work immediately, and the first month of treatment was rocky. David and I considered hospitalization several times. But with the support of friends, family, and his therapist, he maintained his will to live. About a month after beginning treatment, David started to feel somewhat better. His hair preoccupation began to wane, and the thoughts were less painful. He was more willing to see his friends. He didn’t check mirrors all the time, and he sought reassurance less often. He was no longer considering suicide.He then started CBT while continuing the medication. His CBT therapist helped him stop mirror checking and reassurance seeking. He started going out more and seeing friends. Finally, he even gave up his hairpiece. He received many compliments on his new hair style, and his self-confidence greatly improved.*229\204\8*
