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• W2766752839 abstract "L’obsession de dysmorphie corporelle ou body dysmorphic disorder (BDD), anciennement décrit sous le terme de dysmorphophobie, se caractérise par une préoccupation excessive concernant un défaut physique léger ou imaginaire perçu comme difforme par le patient à l’origine de la réalisation de comportements répétitifs. Relativement fréquent en population psychiatrique et d’évolution chronique en l’absence de prise en charge, il est souvent responsable d’un retentissement majeur pouvant constituer un véritable handicap social et professionnel avec comorbidité dépressive, et d’un risque suicidaire élevé. Si peu d’études répondant aux standards de l’evidence-based medicine ont été réalisées, la thérapie cognitivo-comportementale et les inhibiteurs de la recapture de la sérotonine à forte dose semblent montrer leur efficacité en termes d’amélioration des symptômes et de la qualité de vie, toutefois d’autres stratégies de prise en charge restent à étudier. Un faible insight du trouble induit un recours initial fréquent à des soins cosmétiques ou chirurgicaux pouvant apporter un bénéfice initial transitoire mais n’améliorant pas la rémission à long terme et pouvant même aggraver les préoccupations du patient. Une sensibilisation des professionnels de santé est indispensable, des outils cliniques de dépistage validés en population cosmétique ont été développés, leur utilisation doit permettre un meilleur repérage du trouble et un accompagnement des patients vers une prise en charge adaptée. Body dysmorphic disorder (BDD) is characterized by excessive preoccupation with a slight or imagined defect in one's physical appearance, believing they look ugly, abnormal or deformed. While the most common preoccupations focus on the skin, hair and nose, any part of the body may be involved. Preoccupations are intrusive, time-consuming and hard to control. Repetitive behaviors are performed in response to the preoccupations. BDD is associated with marked impairment in socio-professional functioning, poor quality of life and high suicide rates. BDD appears to be relatively common with a prevalence rate between 1 and 2% in general population with a chronic course evolution without treatment, it is also associated with a high rate of depression and suicide. The current prevalence in adult psychiatric population is estimated over 10%; prevalence is also elevated in dermatology and cosmetic surgery patients. Adequate treatments may improve symptoms and quality of life. International guidelines recommend cognitive behavior therapy (CBT) as first line of treatment. Several studies have shown evidence of CBT benefit. High dose selective serotonin reuptake inhibitors (SRI) for at least 12 weeks are recommended in more severe cases. SRI augmentation strategies with antipsychotic adjunction do not report benefit in small-size sample. Antipsychotic medication for BDD even with delusional beliefs is not indicated. Attachment based interpersonal psychotherapy, analyzing and correcting interpersonal relationship from individuals with BDD may represent an alternative therapy improving self-esteem. Insight is generally poor and patients often require cosmetic and surgical treatments to “correct” their imagined defect with sometimes a transitional initial benefit but without positive impact on long-term remission and can exacerbate preoccupation. Healthcare professionals need to be aware of an early detection of this trouble, clinical tools validated in cosmetic population can help them to identify BDD in order to provide education about diagnosis and refer patients to a psychiatrist. More collaboration between psychiatrists and cosmetic practitioners is necessary." @default.
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• W2766752839 date "2018-06-01" @default.
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• W2766752839 title "L’obsession de dysmorphie corporelle : perspectives d’évolution de la prise en charge" @default.
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• W2766752839 doi "https://doi.org/10.1016/j.encep.2017.08.001" @default.
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