possible because the person may have already been suffering for an extended period of time and as bdd has a high suicide rate, at 2-12 times higher than the national average. treatment medication and psychotherapy anti-depressant medication, such as selective serotonin reuptake inhibitors (ssris), and cognitive-behavioral therapy (cbt) are considered effective. ssris can help relieve obsessive-compulsive and delusional traits, while cognitive-behavioral therapy can help patients recognize faulty thought patterns. a study was done by dr. sabine wilhelm where she and her colleagues created and tested a treatment manual specializing in bdd symptoms that resulted in improved symptoms with no asymptomatic decline. core treatment elements include psychoeducation and case formulation, cognitive restructuring, exposure and ritual prevention and mindfulness/perceptual retraining. before treatment, it can help to provide psychoeducation, as with self-help books and support websites. self-improvement for many people with bdd cosmetic surgery does not work to alleviate the symptoms of bdd as their opinion of their appearance is not grounded in reality. it is recommended that cosmetic surgeons and psychiatrists work together in order to screen surgery patients to see if they have bdd, as the results of the surgery could be harmful for them. history in 1886, enrico morselli reported a disorder that he termed dysmorphophobia, which described the disorder as a feeling of being ugly even though there does not appear to be anything wrong with the person's appearance. in 1980, the american psychiatric association recognized the disorder, while categorizing it as an atypical somatoform disorder, in the third edition of its diagnostic and statistical manual of mental disorders (dsm). classifying it as a distinct somatoform disorder, the dsm-iii's 1987 revision switched the term to body dysmorphic disorder. published in 1994, dsm-iv defines bdd as a preoccupation with an imagined or trivial defect in appearance, a preoccupation causing social or occupational dysfunction, and not better explained as another disorder, such as anorexia nervosa. published in 2013, the dsm-5 shifts bdd to a new category (obsessive–compulsive spectrum), adds operational criteria (such as repetitive behaviors or intrusive thoughts), and notes the subtype muscle dysmorphia (preoccupation that one's body is too small or insufficiently muscular or lean). the term "dysmorphic" is derived from the greek word, 'dusmorphíā' - the prefix 'dys-' meaning abnormal or apart, and 'morphḗ' meaning shape. morselli described people who felt a subjective feeling of ugliness as people who were tormented by a physical deficit. sigmund freud (1856-1939), the austrian founder of psychoanalysis, once called one of his patients "wolf man," as he was experiencing classical symptoms of bdd. the person he was referring to was a wealthy russian aristocrat named sergei pankejeff (1886-1979).