Bilateral deep brain stimulation for the treatment of body dysmorphic disorder and obsessive-compulsive disorder.

Background: Body dysmorphic disorder (BDD) is classified under obsessive-compulsive and related disorders. BDD is characterized by intense preoccupation with the perception of deficits or flaws in appearance, with repetitive behaviors manifested by altered self-perception. These symptoms bring about significant distress, making normal functioning difficult. Patients tend to respond to a combination of cognitive and pharmacologic therapies, similar to the treatment responses of patients with other obsessive-compulsive spectrum disorders. However, in severe cases of intractable BDD when multiple modalities of therapy have failed, other treatments such as deep brain stimulation (DBS) could be considered. Case Description: A 23-year-old Caucasian male presents with a 5-year history of worsening BDD, OCD, and social phobia. A combination of cognitive behavioral therapy and standard pharmacological treatment was attempted, but symptoms progressed, leading to suicidal ideation. Ultimately, the patient elected to undergo placement of a DBS device bilaterally targeting the region bound by the ventral striatum, nucleus accumbens, and subgenual cingulate. The patient was evaluated using both the Yale-Brown Obsessive-Compulsive Scale Symptom Checklist and the Hamilton Rating Scale for Depression, both pre and postoperatively over the course of 21.5 months. Conclusion: Following DBS treatment, this patient demonstrated marked improvements in BDD-associated symptoms previously resistant to both cognitive behavioral and pharmacological therapy. This case highlights how DBS treatment can effectively improve symptoms in treatment-refractory BDD when first-line modalities have been exhausted and thus may be a potential consideration for clinical use.