Although cognitive behavior therapy has been found to be very effective in the treatment of body dysmorphic disorder (BDD), there still remain a number of challenges that clinicians face in the treatment of individuals with BDD. In this article, we discuss issues related to comorbid depression, suicidality, substance use disorders, personality disorders as well as the role of early life experiences, delusional intensity of beliefs, and motivation to change. The aim of this review is to provide a treatment aid to clinicians by offering specific recommendations for improved care based on the available literature as well as our clinical experience.