Body Dysmorphic Disorder

Cassandra is a 24-year-old single female self-referral living alone with persistent anxiety and social withdrawal. Beginning around age 16, she developed a preoccupation with perceived facial flaws (acne, asymmetry) leading to mirror checking, avoidance of photographs, social avoidance, and work impairment, with associated feelings of hopelessness. She has a prior GAD diagnosis (age 19), a history of low mood and passive suicidal ideation (no attempts, intent, or plan), a discontinued trial of sertraline (8 months, stopped due to perceived weight gain and fatigue), and two prior CBT attempts she found unhelpful.