The delusional-nondelusional issue is relevant to other disorders, such as  and social fobia. Like BDD these disorders appear to span a spectrum of insight, with insight sometimes fluctuating along a continuum. This interesting issue needs to be further studied and has important implications for the classification and treatment of a number of psychiatric disorders.
From a clinical perspective, I’d consider delusional and nondelusional BDD to be the same disorder and would generally treat them the same way. In particular, I’d recommend treating delusional BDD with an SRI, even though this isn’t how other disorders characterized by delusions are usually treated. I’d also recommend that delusional BDD (and nondelusional BDD) not be treated with a neuroleptic (antipsychotic) alone. CBT treatment for these forms of BDD is generally similar, although people with delusional BDD might benefit from a heavier emphasis on cognitive restructuring and behavioral experiments (although this issue hasn’t been studied). Despite similarities between BDD’s delusional and nondelusional forms, it’s important to keep in mind that delusional people with BDD are typically more severely ill and suicidal, and may be less likely to accept psychiatric treatment.
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THE DELUSIONAL VARIANT OF BDD: THE DELUSIONAL-NONDELUSIONAL ISSUEThe delusional-nondelusional issue is relevant to other disorders, such as  and social fobia. Like BDD these disorders appear to span a spectrum of insight, with insight sometimes fluctuating along a continuum. This interesting issue needs to be further studied and has important implications for the classification and treatment of a number of psychiatric disorders.From a clinical perspective, I’d consider delusional and nondelusional BDD to be the same disorder and would generally treat them the same way. In particular, I’d recommend treating delusional BDD with an SRI, even though this isn’t how other disorders characterized by delusions are usually treated. I’d also recommend that delusional BDD (and nondelusional BDD) not be treated with a neuroleptic (antipsychotic) alone. CBT treatment for these forms of BDD is generally similar, although people with delusional BDD might benefit from a heavier emphasis on cognitive restructuring and behavioral experiments (although this issue hasn’t been studied). Despite similarities between BDD’s delusional and nondelusional forms, it’s important to keep in mind that delusional people with BDD are typically more severely ill and suicidal, and may be less likely to accept psychiatric treatment.*390\204\8*

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