**7. Conclusions**

BDD, but most of these patients have their BDD not noticed as the primary pathology, which, usually, lead to a failure of treatment [59]. Some patients may resist referral to psychiatrists and psychologists, because they continue to believe that their problems are physical and not psychological. It is often fruitless to try to convince these patients that their beliefs are irrational [8]. Appearance-enhancing treatments should not be implemented, because these may even exacerbate the psychological symptoms [76]. Concluding, the difficulty in recognizing and diagnosing BDD has been appointed as the main factor of morbidity and mortality of this pathology [29].

This topic presents a personal perspective of a clinical psychiatrist who has practiced in sev-

During almost 20 years of clinical practice of psychiatry, I have observed several patients with what was once called "epileptical personality," possibly involving temporal lobe disorders. They do not necessarily have seizures or absence of crises. Some of them have what it is called Geshwin's syndrome. They usually have migraine, with photophobia and misophonia (these last two symptoms may occur not necessarily during migraine crisis). They often have reports of somnambulism (i.e., sleepwalking), night terror, nocturnal enuresis while infants or during

An important number of them have some relatives (grandparents, parents, cousins, siblings) with classical epilepsia, involving seizures or partial epilepsy complex, which suggests that they may have inherited a low threshold to resist a convulsion. However, they usually also have an acquired factor: premature birth delivery with complications, head trauma in the first

A large number of these patients evolve, usually, after puberty with changes in behavior. Some of them develop episodes of rage and mood swing. In girls, it is notorious after the menarche and gets worse during the menstrual period, showing that hormones play a very

In males, the symptoms can be more constant because there is no hormones see-saw involved, but the onset of behavioral disturbance is related to puberty too. In addition, it can be related to violence or hostility more frequently, reminding of the explosive intermittent disorder's

With this in mind, the aim of presenting this previous information is to report a few cases of BDD patients I have seen all over these years too. They are 12 patients, and in all of them, I could find traits of epileptical personality; some of them had alterations in the electroencephalogram (EEG) test, frequently on the right temporal lobe or in both. A reduced number

I am going to report a case of a young man who was 19 years old at the time of his first appointment. He was taken to my private practice by his parents, because he had no conscious of his

**6. The diagnosis and treatment by a clinical perspective**

eral mental health settings and who aims to present one illustrative case.

puberty (or even in adults), and/or history of feverish crisis while in infants.

year of life, encephalitis, and so on.

14 Pathophysiology - Altered Physiological States

important role in these phenomena.

of cases had alterations in the frontal lobe too.

described features.

In summary, this chapter has addressed the main characteristics and related psychopathology of the body dysmorphic disorder, as well as some clinical associations and influencing factors. Moreover, this chapter has also presented one illustrative case of the diagnosis and treatment of body dysmorphic disorder symptoms by an experienced clinical psychiatrist.

We hope that this chapter contributes to the diagnosis, prevention, treatment, and management of body dysmorphic disorder in different health-care settings, by providing a more comprehensive and integrated understanding of this underdiagnosed mental disorder.

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Body Dysmorphic Disorder: Characteristics, Psychopathology, Clinical Associations, and…

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