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Gumpert M, Rautio D, Monzani B, Jassi A, Krebs G, Fernández de la Cruz L, Mataix-Cols D, Jansson-Fröjmark M. Psychometric evaluation of the appearance anxiety inventory in adolescents with body dysmorphic disorder. Cogn Behav Ther 2024; 53:254-266. [PMID: 38174353 DOI: 10.1080/16506073.2023.2299837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 12/18/2023] [Indexed: 01/05/2024]
Abstract
The Appearance Anxiety Inventory (AAI) is a self-report measure assessing the typical cognitions and behaviours of body dysmorphic disorder (BDD). Despite its use in research and clinical settings, its psychometric properties have not been evaluated in young people with BDD. We examined the factor structure, reliability, validity, and sensitivity to change of the AAI in 182 youths with BDD (82.9% girls; Mage = 15.56, SD = 1.37) consecutively referred to two specialist outpatient clinics in Stockholm, Sweden (n = 97) and London, England (n = 85). An exploratory factor analysis identified three factors, namely "threat monitoring", "camouflaging", and "avoidance", explaining 48.15% of the variance. The scale showed good internal consistency (McDonalds omega = 0.83) and adequate convergent validity with the Yale-Brown Obsessive-Compulsive Scale Modified for Body Dysmorphic Disorder for Adolescents (BDD-YBOCS-A; rs = 0.42) and the Clinical Global Impression-Severity Scale (rs = 0.32). Sensitivity to change was adequate, with AAI total scores and individual factor scores significantly decreasing over time in the subgroup of participants receiving multimodal treatment for BDD (n = 79). Change of AAI scores over treatment showed a positive statistically significant moderate-to-good correlation (r = 0.55) with changes in BDD symptom severity, measured by the BDD-YBOCS-A. The study provides empirical support for the use of the AAI in young people with BDD in clinical settings.
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Affiliation(s)
- Martina Gumpert
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Daniel Rautio
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Benedetta Monzani
- National and Specialist OCD, BDD, and Related Disorders Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Amita Jassi
- National and Specialist OCD, BDD, and Related Disorders Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, United Kingdom
| | - Georgina Krebs
- National and Specialist OCD, BDD, and Related Disorders Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, United Kingdom
- Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | - Lorena Fernández de la Cruz
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - David Mataix-Cols
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Markus Jansson-Fröjmark
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
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Möllmann A, Heinrichs N, Herwig A. A conceptual framework on body representations and their relevance for mental disorders. Front Psychol 2024; 14:1231640. [PMID: 38250111 PMCID: PMC10796836 DOI: 10.3389/fpsyg.2023.1231640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 12/11/2023] [Indexed: 01/23/2024] Open
Abstract
Many mental disorders are accompanied by distortions in the way the own body is perceived and represented (e.g., eating disorders, body dysmorphic disorder including muscle dysmorphia, or body integrity dysphoria). We are interested in the way these distortions develop and aim at better understanding their role in mental health across the lifespan. For this purpose, we first propose a conceptual framework of body representation that defines this construct and integrates different perspectives (e.g., cognitive neuroscience, clinical psychology) on body representations. The framework consists of a structural and a process model of body representation emphasizing different goals: the structural model aims to support researchers from different disciplines to structure results from studies and help collectively accumulate knowledge about body representations and their role in mental disorders. The process model is reflecting the dynamics during the information processing of body-related stimuli. It aims to serve as a motor for (experimental) study development on how distorted body representations emerge and might be changed. Second, we use this framework to review the normative development of body representations as well as the development of mental disorders that relate to body representations with the aim to further clarify the potential transdiagnostic role of body representations.
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Affiliation(s)
- Anne Möllmann
- Department of Psychology, Faculty of Psychology and Sports Science, Bielefeld University, Bielefeld, Germany
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3
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Rautio D, Andrén P, Gumpert M, Jolstedt M, Jassi A, Krebs G, Jansson-Fröjmark M, Lundgren T, Serlachius E, Mataix-Cols D, Fernández de la Cruz L. Therapist-guided, Internet-delivered cognitive behaviour therapy for adolescents with body dysmorphic disorder: A feasibility trial with long-term follow-up. Internet Interv 2023; 34:100688. [PMID: 38034863 PMCID: PMC10685040 DOI: 10.1016/j.invent.2023.100688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 10/21/2023] [Accepted: 10/27/2023] [Indexed: 12/02/2023] Open
Abstract
Body dysmorphic disorder (BDD) is a prevalent and impairing psychiatric condition that typically debuts in adolescence and is associated with risky behaviours. The disorder can be effectively treated with cognitive behaviour therapy (CBT). However, CBT for BDD is seldom available primarily due to a shortage of trained therapists. Internet-delivered CBT (ICBT) can be a way to increase treatment availability. The aim of this feasibility trial was to evaluate the feasibility, safety, and preliminary efficacy of a CBT protocol for adolescents with BDD, adapted to be delivered over the Internet with minimal therapist support. A total of 20 participants (12-17-year-olds) meeting criteria for BDD were recruited nationally to a specialist outpatient clinic in Stockholm, Sweden. One participant withdrew consent and their data could not be analysed. Nineteen participants were offered 12 modules of therapist-guided ICBT for BDD and were followed up to 12 months post-treatment. Preliminary efficacy was measured at the a priori primary endpoint (3-month follow-up) and at the 12-month follow-up with the clinician-rated Yale-Brown Obsessive Compulsive Scale Modified for BDD for Adolescents. The treatment was rated as both credible and satisfactory and was associated with a large and statistically significant reduction in BDD symptom severity (d = 2.94). The proportion of participants classified as responders at the primary endpoint was 73.7%, and the proportion of full or partial remitters was 63.2%. The average therapist support time was 8 min per participant per week. Treatment gains continued to accrue up to the 12-month follow-up. Two participants attempted suicide and another two reported non-suicidal self-injuries during the study period. ICBT with minimal therapist support is a feasible, potentially efficacious, and durable treatment for adolescents with BDD. Risky behaviours typical of this patient group should be carefully monitored during treatment.
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Affiliation(s)
- Daniel Rautio
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Per Andrén
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Martina Gumpert
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Maral Jolstedt
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Amita Jassi
- National and Specialist OCD, BDD, and Related Disorders Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, England, United Kingdom
| | - Georgina Krebs
- National and Specialist OCD, BDD, and Related Disorders Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, England, United Kingdom
- University College London, Research Department of Clinical, Educational and Health Psychology, London, England, United Kingdom
| | - Markus Jansson-Fröjmark
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Tobias Lundgren
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Eva Serlachius
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - David Mataix-Cols
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Lorena Fernández de la Cruz
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
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Bernstein EE, Phillips KA, Greenberg JL, Curtiss J, Hoeppner SS, Wilhelm S. Mechanisms of cognitive-behavioral therapy effects on symptoms of body dysmorphic disorder: a network intervention analysis. Psychol Med 2023; 53:2531-2539. [PMID: 37310300 PMCID: PMC10264834 DOI: 10.1017/s0033291721004451] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Body dysmorphic disorder (BDD) is a severe and undertreated condition. Although cognitive-behavioral therapy (CBT) is the first-line psychosocial treatment for this common disorder, how the intervention works is insufficiently understood. Specific pathways have been hypothesized, but only one small study has examined the precise nature of treatment effects of CBT, and no prior study has examined the effects of supportive psychotherapy (SPT). METHODS This study re-examined a large trial (n = 120) comparing CBT to SPT for BDD. Network intervention analyses were used to explore symptom-level data across time. We computed mixed graphical models at multiple time points to examine relative differences in direct and indirect effects of the two interventions. RESULTS In the resulting networks, CBT and SPT appeared to differentially target certain symptoms. The largest differences included CBT increasing efforts to disengage from and restructure unhelpful thoughts and resist BDD rituals, while SPT was directly related to improvement in BDD-related insight. Additionally, the time course of differences aligned with the intended targets of CBT; cognitive effects emerged first and behavioral effects second, paralleling cognitive restructuring in earlier sessions and the emphasis on exposure and ritual prevention in later sessions. Differences in favor of CBT were most consistent for behavioral targets. CONCLUSIONS CBT and SPT primarily affected different symptoms. To improve patient care, the field needs a better understanding of how and when BDD treatments and treatment components succeed. Considering patient experiences at the symptom level and over time can aid in refining or reorganizing treatments to better fit patient needs.
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Affiliation(s)
- Emily E Bernstein
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Katharine A Phillips
- Rhode Island Hospital and Alpert Medical School of Brown University, Providence, RI, USA
- New York-Presbyterian Hospital and Weill Cornell Medical College, New York, NY, USA
| | | | - Joshua Curtiss
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Susanne S Hoeppner
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Sabine Wilhelm
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
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5
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Body Dysmorphic Disorder. Psychiatr Clin North Am 2023; 46:197-209. [PMID: 36740353 DOI: 10.1016/j.psc.2022.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
This article summarizes current knowledge of body dysmorphic disorder across the life span. An overview of the epidemiology and phenomenology of this condition is provided, as well as clinical perspectives on assessment and treatment. Barriers to accessing treatment are considered, along with recent developments to improve access. Future directions in research and clinical care for this population are summarized.
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Stierle CMG, Taube KM. In or out?-Suggested criteria to systematically offer different treatment options to patients with body dysmorphic disorder. Front Med (Lausanne) 2022; 9:986781. [PMID: 36590961 PMCID: PMC9797497 DOI: 10.3389/fmed.2022.986781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Accepted: 11/03/2022] [Indexed: 12/16/2022] Open
Affiliation(s)
- Christian M. G. Stierle
- Psychology School, Fresenius University of Applied Sciences, Hamburg, Germany,*Correspondence: Christian M. G. Stierle,
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7
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Rautio D, Gumpert M, Jassi A, Krebs G, Flygare O, Andrén P, Monzani B, Peile L, Jansson-Fröjmark M, Lundgren T, Hillborg M, Silverberg-Mörse M, Clark B, Fernández de la Cruz L, Mataix-Cols D. Effectiveness of Multimodal Treatment for Young People With Body Dysmorphic Disorder in Two Specialist Clinics. Behav Ther 2022; 53:1037-1049. [PMID: 35987534 DOI: 10.1016/j.beth.2022.04.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 04/19/2022] [Accepted: 04/22/2022] [Indexed: 11/24/2022]
Abstract
Body dysmorphic disorder (BDD) typically originates in adolescence and is associated with considerable adversity. Evidence-based treatments exist but research on clinical outcomes in naturalistic settings is extremely scarce. We evaluated the short- and long-term outcomes of a large cohort of adolescents with BDD receiving specialist multimodal treatment and examined predictors of symptom improvement. We followed 140 young people (age range 10-18) with a diagnosis of BDD treated at two national and specialist outpatient clinics in Stockholm, Sweden (n = 96) and London, England (n = 44), between January 2015 and April 2021. Participants received multimodal treatment consisting of cognitive behavior therapy and, in 72% of cases, medication (primarily selective serotonin reuptake inhibitors). Data were collected at baseline, posttreatment, and 3, 6, and 12 months after treatment.The primary outcome measure was the clinician-rated Yale-Brown Obsessive-Compulsive Scale Modified for BDD, Adolescent version (BDD-YBOCS-A). Secondary outcomes included self-reported measures of BDD symptoms, depressive symptoms, and global functioning. Mixed-effects regression models showed that BDD-YBOCS-A scores decreased significantly from baseline to posttreatment (coefficient [95% confidence interval] = -16.33 [-17.90 to -14.76], p<0.001; within-group effect size (Cohen's d) = 2.08 (95% confidence interval, 1.81 to 2.35). At the end of the treatment, 79% of the participants were classified as responders and 59% as full or partial remitters. BDD symptoms continued to improve throughout the follow-up. Improvement was also seen on all secondary outcome measures. Linear regression models identified baseline BDD symptom severity as a predictor of treatment outcome at posttreatment, but no consistent predictors were found at the 12-month follow-up. To conclude, multimodal treatment for adolescent BDD is effective in both the short- and long-term when provided flexibly within a specialist setting. Considering the high personal and societal costs of BDD, specialist care should be made more widely available.
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Affiliation(s)
- Daniel Rautio
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet; Stockholm Health Care Services, Region Stockholm.
| | - Martina Gumpert
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet; Stockholm Health Care Services, Region Stockholm
| | - Amita Jassi
- National and Specialist OCD, BDD, and Related Disorders Clinic for Young People, South London and Maudsley NHS Foundation Trust
| | - Georgina Krebs
- Department of Clinical, Educational and Health Psychology, University College London
| | - Oskar Flygare
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet; Stockholm Health Care Services, Region Stockholm
| | - Per Andrén
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet; Stockholm Health Care Services, Region Stockholm
| | - Benedetta Monzani
- National and Specialist OCD, BDD, and Related Disorders Clinic for Young People, South London and Maudsley NHS Foundation Trust
| | - Lauren Peile
- National and Specialist OCD, BDD, and Related Disorders Clinic for Young People, South London and Maudsley NHS Foundation Trust
| | - Markus Jansson-Fröjmark
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet; Stockholm Health Care Services, Region Stockholm
| | - Tobias Lundgren
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet; Stockholm Health Care Services, Region Stockholm
| | | | | | - Bruce Clark
- National and Specialist OCD, BDD, and Related Disorders Clinic for Young People, South London and Maudsley NHS Foundation Trust
| | - Lorena Fernández de la Cruz
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet; Stockholm Health Care Services, Region Stockholm
| | - David Mataix-Cols
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet; Stockholm Health Care Services, Region Stockholm
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8
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Rajabi S, Kamran L, Joukar KamalAbadi M. Epidemiology of body dysmorphic disorder among adolescents: A study of their cognitive functions. Brain Behav 2022; 12:e01710. [PMID: 35307985 PMCID: PMC9015000 DOI: 10.1002/brb3.1710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 05/02/2020] [Accepted: 05/16/2020] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Body dysmorphic disorder (BDD) is characterized by a preoccupation with an imagined defect in one's appearance. In case of a slight physical anomaly, the person would experience an excessive concern. This disorder causes cognitive dysfunction. PURPOSE The aim of this study was to examine epidemiology of body dysmorphic disorder among students at secondary schools of the first and second stage in Shiraz, Iran. It also compares executive functions in students with BDD to healthy students. METHODS The Body Dysmorphic Disorder Questionnaire (BDDQ), Stroop Color and Word Test (SCWT),Wisconsin Card Sorting Test (WCST), Tower of London test (ToL), and Trail Making Test (TMT) were measured in participants with BDD (N = 52; Mage = 16.20; SD = 1.03) and healthy control group (N = 52; Mage = 15.91; SD = 0.96). RESULTS The frequency of BDD was significantly higher in women than men (14.8% vs. 6.8%), and its prevalence was 10.4% in total. There was a significant difference between the two groups of students concerning attentional set-shifting, inhibition of cognitive interference, visual-spatial searching, and sequencing, but not problem-solving tasks. CONCLUSIONS Students with BDD have cognitive deficits, which need to be addressed in cognitive rehabilitation.
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Affiliation(s)
- Soran Rajabi
- General Psychology, Persian Gulf University, Bushehr, Iran
| | - Leila Kamran
- General Psychology, Persian Gulf University, Bushehr, Iran
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Jannini TB, Lorenzo GD, Bianciardi E, Niolu C, Toscano M, Ciocca G, Jannini EA, Siracusano A. Off-label Uses of Selective Serotonin Reuptake Inhibitors (SSRIs). Curr Neuropharmacol 2022; 20:693-712. [PMID: 33998993 PMCID: PMC9878961 DOI: 10.2174/1570159x19666210517150418] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 04/22/2021] [Accepted: 05/05/2021] [Indexed: 11/22/2022] Open
Abstract
Psychiatric drugs have primacy for off-label prescribing. Among those, selective serotonin reuptake inhibitors (SSRIs) are highly versatile and, therefore, widely prescribed. Moreover, they are commonly considered as having a better safety profile compared to other antidepressants. Thus, when it comes to off-label prescribing, SSRIs rank among the top positions. In this review, we present the state of the art of off-label applications of selective serotonin reuptake inhibitors, ranging from migraine prophylaxis to SARS-CoV-2 antiviral properties. Research on SSRIs provided significant evidence in the treatment of premature ejaculation, both with the on-label dapoxetine 30 mg and the off-label paroxetine 20 mg. However, other than a serotoninergic syndrome, serious conditions like increased bleeding rates, hyponatremia, hepatoxicity, and post-SSRIs sexual dysfunctions, are consistently more prominent when using such compounds. These insidious side effects might be frequently underestimated during common clinical practice, especially by nonpsychiatrists. Thus, some points must be addressed when using SSRIs. Among these, a psychiatric evaluation before every administration that falls outside the regulatory agencies-approved guidelines has to be considered mandatory. For these reasons, we aim with the present article to identify the risks of inappropriate uses and to advocate the need to actively boost research encouraging future clinical trials on this topic.
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Affiliation(s)
- Tommaso B. Jannini
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Giorgio D. Lorenzo
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy;,IRCCS-Fondazione Santa Lucia, Rome, Italy
| | | | - Cinzia Niolu
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Massimiliano Toscano
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy;,Department of Neurology, Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy
| | - Giacomo Ciocca
- Department of Dynamic and Clinical Psychology, and Health Studies, Sapienza University of Rome, Rome, Italy
| | | | - Alberto Siracusano
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy;,Address correspondence to this author at the Department of Systems Medicine, University of Rome Tor Vergata, Via Montpellier 1, 00133 Rome, Italy; E-mail:
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10
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A smartphone app for the prevention and early intervention of body dysmorphic disorder: Development and evaluation of the content, usability, and aesthetics. Internet Interv 2022; 28:100521. [PMID: 35281703 PMCID: PMC8907679 DOI: 10.1016/j.invent.2022.100521] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 02/28/2022] [Accepted: 03/01/2022] [Indexed: 11/23/2022] Open
Abstract
Body dysmorphic disorder (BDD) is an impairing condition characterized by excessive appearance concerns that frequently begin in adolescence, thus making this phase an eminent target for prevention and early intervention. We developed a cognitive-behavioral app-based program (AINA) intended for prevention and early intervention of BDD. As part of the iterative development process, perceptions of usability, aesthetics, and content were investigated. A sample of 38 adolescents and young adults aged between 14 and 21 years tested the app in a laboratory setting and completed a survey of diagnostic and user experience questionnaires. Overall, usability, aesthetics, and content of the app received positive evaluations. Regression analyses did not point to any large effects of age, gender, years of education, self-esteem, or BDD symptom severity on user evaluations. On average, participants had no concerns about privacy or data security of the app, indicating that these aspects will presumably not act as barriers to usage. Altogether, the present results are encouraging. Future research needs to examine whether AINA is an efficacious measure for prevention and early intervention of BDD.
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11
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Racz JI, Mathieu SL, McKenzie ML, Farrell LJ. Paediatric Obsessive-Compulsive Disorder and Comorbid Body Dysmorphic Disorder: Clinical Expression and Treatment Response. Child Psychiatry Hum Dev 2022:10.1007/s10578-022-01314-x. [PMID: 35048227 DOI: 10.1007/s10578-022-01314-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/05/2022] [Indexed: 11/28/2022]
Abstract
This study explored the expression, occurrence, and treatment outcomes of comorbid body dysmorphic disorder (BDD) in 107 youth (7-17 years) seeking treatment for primary obsessive-compulsive disorder (OCD). In the overall sample, appearance anxiety (AA) was positively associated with OCD-related impairment, severity, symptom frequency, comorbid symptoms, and maladaptive emotion regulation. Comorbid BDD occurred in 9.35% of youth, equally affected males and females, and was associated with older age. AA negligibly reduced following treatment. Compared to those without (a) comorbid BDD and (b) without any comorbidity, youth with comorbid BDD reported greater social impairment and reduced global functioning but did not differ on the occurrence of comorbid anxiety and mood disorders. OCD response or remission rates did not differ. In youth with comorbid BDD, AA did not significantly reduce following treatment. Results suggest a more severe expression accompanies comorbid BDD in youth with OCD, with BDD persisting following OCD treatment.
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Affiliation(s)
- Jason I Racz
- School of Applied Psychology, Griffith University, Parklands Drive, Southport, QLD, 4222, Australia
| | - Sharna L Mathieu
- School of Applied Psychology, Griffith University, Parklands Drive, Southport, QLD, 4222, Australia
| | - Matthew L McKenzie
- School of Applied Psychology, Griffith University, Parklands Drive, Southport, QLD, 4222, Australia
| | - Lara J Farrell
- School of Applied Psychology, Griffith University, Parklands Drive, Southport, QLD, 4222, Australia.
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12
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Reddy YCJ, Arumugham SS, Balachander S. Cognitive-behavioral and related therapies for obsessive-compulsive and related disorders. Curr Opin Psychiatry 2021; 34:467-476. [PMID: 34292182 DOI: 10.1097/yco.0000000000000731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Cognitive behavioral therapy (CBT) with exposure and response prevention is the first-line treatment for obsessive-compulsive disorder (OCD) and related disorders such as body dysmorphic disorder (BDD). We review here recent developments in CBT and related therapies in treating OCD and related disorders. RECENT FINDINGS Superiority of CBT over medications in treating OCD is being questioned by some recent meta-analyses, nonetheless CBT continues to be the mainstay of treatment. Web-based therapies have been shown to be beneficial in treating at least mild-to-moderately ill patients. Mindfulness-based CBT, intensive residential treatment and Bergen 4-day concentrated exposure are also proving to be useful in treating OCD. Large well designed studies have demonstrated the efficacy CBT over supportive therapy in treating BDD. Research on the efficacy of CBT in treating hoarding disorder is accumulating. SUMMARY Efficacy of web-based CBT has a potential public health importance in that CBT may now become accessible to all and benefit at least mild-to-moderately ill patients who form most of the clinically ill sample. Similarly, efficacy of Bergen 4-day concentrated exposure will have a huge public health implication if the findings can be replicated in other centers across the world.
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Affiliation(s)
| | | | - Srinivas Balachander
- Obsessive-Compulsive Disorder (OCD) Clinic
- Accelerator Program for Discovery in Brain Disorders Using Stem Cells (ADBS)
- Department of Psychiatry, National Institute of Mental Health & Neurosciences (NIMHANS), Bangalore, India
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13
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Flygare O, Chen LL, Fernández de la Cruz L, Rück C, Andersson E, Enander J, Mataix-Cols D. Empirically Defining Treatment Response and Remission in Body Dysmorphic Disorder Using a Short Self-Report Instrument. Behav Ther 2021; 52:821-829. [PMID: 34134823 DOI: 10.1016/j.beth.2020.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 10/13/2020] [Accepted: 10/15/2020] [Indexed: 11/15/2022]
Abstract
Determining response or remission status in body dysmorphic disorder (BDD) usually requires a lengthy interview with a trained clinician. This study sought to establish empirically derived cutoffs to define treatment response and remission in BDD using a brief self-report instrument, the Appearance Anxiety Inventory (AAI). Results from three clinical trials of BDD were pooled to create a sample of 123 individuals who had received cognitive-behavioral therapy for BDD, delivered via the Internet. The AAI was compared to gold-standard criteria for response and remission in BDD, based on the clinician-administered Yale-Brown Obsessive Compulsive Scale, modified for BDD (BDD-YBOCS), and evaluated using signal detection analysis. The results showed that a ≥ 40% reduction on the AAI best corresponded to treatment response, with a sensitivity of 0.71 and a specificity of 0.84. A score ≤ 13 at posttreatment was the optimal cutoff in determining full or partial remission from BDD, with a sensitivity of 0.75 and a specificity of 0.88. These findings provide benchmarks for using the AAI in BDD treatment evaluation when resource-intensive measures administered by clinicians are not feasible.
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Affiliation(s)
- Oskar Flygare
- Centre for Psychiatry Research, Karolinska Institutet and Stockholm Health Care Services.
| | - Long-Long Chen
- Centre for Psychiatry Research, Karolinska Institutet and Stockholm Health Care Services
| | | | - Christian Rück
- Centre for Psychiatry Research, Karolinska Institutet and Stockholm Health Care Services
| | - Erik Andersson
- Centre for Psychiatry Research, Karolinska Institutet and Stockholm Health Care Services
| | - Jesper Enander
- Centre for Psychiatry Research, Karolinska Institutet and CAP Research Centre, Stockholm Health Care Services
| | - David Mataix-Cols
- Centre for Psychiatry Research, Karolinska Institutet and CAP Research Centre, Stockholm Health Care Services
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Atkinson MJ, Diedrichs PC. Assessing the impact of body image concerns on functioning across life domains: Development and validation of the Body Image Life Disengagement Questionnaire (BILD-Q) among British adolescents. Body Image 2021; 37:63-73. [PMID: 33581387 DOI: 10.1016/j.bodyim.2021.01.009] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 01/25/2021] [Accepted: 01/25/2021] [Indexed: 12/20/2022]
Abstract
Assessing the impact of body image on engagement in a range of life domains is important; however, there is a lack of validated measures for adolescents. The current research developed the Body Image Life Disengagement Questionnaire (BILD-Q) and validated it among four samples of British adolescents. Study 1 (N = 1707; 11-13 years) indicated a 9-item unidimensional scale based on Exploratory Factory Analysis. In Study 2 (N = 1403; 11-13 years), Confirmatory Factor Analysis (CFA) showed an acceptable fit overall, but better among girls than boys. Further exploration with CFA in Study 3 (N = 2034; 13-14 years) showed a good to excellent fit overall, and acceptable among both boys and girls. The scale showed good internal consistency and test-retest reliability, and gender invariance indicated the scale can be used comparatively. In Study 4 (N = 288; 13-14 years), convergent validity was supported via expected relationships with body image and related constructs. Concurrent and predictive incremental validity were also evidenced via explaining significant unique variance in well-being. These studies provide support for the BILD-Q as a reliable and valid measure of broader impacts of body image among adolescents, which may benefit intervention evaluation and policy change efforts.
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Affiliation(s)
- Melissa J Atkinson
- Department of Psychology, University of Bath, UK; Centre for Appearance Research, University of the West of England, UK.
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Hartmann AS, Schmidt M, Staufenbiel T, Ebert DD, Martin A, Schoenenberg K. ImaginYouth-A Therapist-Guided Internet-Based Cognitive-Behavioral Program for Adolescents and Young Adults With Body Dysmorphic Disorder: Study Protocol for a Two-Arm Randomized Controlled Trial. Front Psychiatry 2021; 12:682965. [PMID: 34113273 PMCID: PMC8185230 DOI: 10.3389/fpsyt.2021.682965] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 04/19/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Body dysmorphic disorder (BDD) is a relatively common mental disorder in adolescents and young adults, and is characterized by severe negative psychosocial consequences and high comorbidity as well as high mortality rates, mainly due to suicides. While patients in Germany have health insurance-financed access to evidence-based outpatient treatments, that is, cognitive-behavioral treatment (CBT), waiting lists are long. Furthermore, patients with BDD report diverse treatment barriers, primarily feelings of shame and the belief that they would be better off with treatments that would alter the perceived flaw(s). Given adolescents' and young adults' high affinity to electronic media, the accessibility of evidence-based care for this severe mental disorder could be improved by providing an internet-based therapist-guided CBT intervention. Methods: In a two-arm randomized controlled trial (N = 40), adolescents and young adults (15-21 years) with a primary diagnosis of BDD based on a semi-structured clinical expert interview will be randomly allocated to an internet-based therapist-guided CBT intervention or a supportive internet-based therapy intervention. Assessments will take place at baseline, after mid-intervention (after 6 weeks), post-intervention, and at 4-week follow-up. The primary outcome is expert-rated BDD symptom severity at the primary endpoint post-intervention. Secondary outcomes include responder and remission rates based on expert rating, self-reported BDD symptoms, and psychosocial variables associated with BDD. Interventions: The CBT-based intervention consists of six modules each comprising one to three sessions, which focus on psychoeducation, cognitive restructuring, work on self-esteem, exposure and ritual prevention, mirror retraining, and relapse prevention. A study therapist provides feedback after each session. The supportive therapy intervention consists of access to psychoeducational materials for the same 12-week period and at least one weekly supportive interaction with the study therapist. Conclusions: This is the first study to examine the feasibility and efficacy of an internet-based therapist-guided CBT intervention in adolescents and young adults with BDD. It could be an important first step to increase accessibility of care in this age group and for this severe and debilitating mental disorder. Clinical Trial Registration: German Register of Clinical Studies, DRKS00022055.
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Affiliation(s)
- Andrea S. Hartmann
- Institute of Psychology, Clinical Psychology and Psychotherapy, Osnabrück University, Osnabrück, Germany
| | - Michaela Schmidt
- Institute of Psychology, Clinical Psychology and Psychotherapy, Osnabrück University, Osnabrück, Germany
| | - Thomas Staufenbiel
- Institute of Psychology, Research Methods, Diagnostics and Evaluation, Osnabrück University, Osnabrück, Germany
| | - David D. Ebert
- Department of Sport and Health Sciences, Psychology and Digital Mental Health Care, Technical University Munich, Munich, Germany
| | - Alexandra Martin
- School of Human and Social Sciences, Clinical Psychology and Psychotherapy, University of Wuppertal, Wuppertal, Germany
| | - Katrin Schoenenberg
- School of Human and Social Sciences, Clinical Psychology and Psychotherapy, University of Wuppertal, Wuppertal, Germany
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Zamiri-Miandoab N, Hassanzadeh R, Kamalifard M, Mirghafourvand M. The effect of cognitive behavior therapy on body image and self-esteem in female adolescents: a systematic review and meta-analysis. Int J Adolesc Med Health 2021; 33:323-332. [PMID: 33915608 DOI: 10.1515/ijamh-2021-0029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 04/06/2021] [Indexed: 06/12/2023]
Abstract
Low self-esteem and negative body image expose girls to many risks and damages. Cognitive-behavior counseling is one of the ways of improving body image and self-esteem. The aim of this systematic review was to determine the effects of cognitive-behavior therapy on body image and self-esteem of adolescent girls. The English (Cochrane library, Web of sciences, EBSCO, PubMed, Google Scholar) and Persian (SID, MagIran) databases were searched without any time limit. The quality of included studies in terms of risk of bias was assessed using Cochran handbook and the quality of evidence was evaluated through Grading of Recommendations Assessment, Development and Evaluation (GRADE). Meta-analysis was performed using RevMan software. Heterogeneity of studies was analyzed by index I 2. Subgroup analysis was performed on the basis of outcome evaluation intervals (after intervention, one month and two months later). A total of 2,664 articles were accessed in different databases of which 2,655 articles were excluded and finally nine studies were systematically reviewed. Meta-analysis results on seven studies (228 participants) showed that the group receiving cognitive-behavior counseling was significantly better than the control group regarding body image (Standardized Mean Difference [SMD]: 13.01; 95% CI: 10.68 to 15.34; I²=26.1%). Likewise, meta-analysis results on two studies (50 participants) showed that self-esteem was not significantly different between the group receiving cognitive-behavior counseling and the control group (SMD: 1.13; 95% CI: -0.7 to 2.32, I²=73%). Meta-analysis results of this study represent effectiveness of cognitive-behavior therapy on body image of adolescent girls; however, since the number of studies in the field of self-esteem is low, more trials in this field with stronger designs are suggested.
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Affiliation(s)
- Nasrin Zamiri-Miandoab
- Department of Midwifery, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Robab Hassanzadeh
- Department of Midwifery, Bonab Branch, Islamic Azad University, Bonab, Iran
| | - Mahin Kamalifard
- Department of Midwifery, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mojgan Mirghafourvand
- Social Determinants of Health Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
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Weingarden H, Hoeppner SS, Snorrason I, Greenberg JL, Phillips KA, Wilhelm S. Rates of remission, sustained remission, and recurrence in a randomized controlled trial of cognitive behavioral therapy versus supportive psychotherapy for body dysmorphic disorder. Depress Anxiety 2021; 38:10.1002/da.23148. [PMID: 33724643 PMCID: PMC8443701 DOI: 10.1002/da.23148] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/19/2021] [Accepted: 03/02/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Little data exist on remission rates following psychotherapy for body dysmorphic disorder (BDD). METHODS Using data from a large study of therapist-delivered cognitive behavior therapy (CBT) versus supportive psychotherapy (SPT) for BDD (N = 120), we estimated remission rates at treatment endpoint, and rates of delayed remission, sustained remission, and recurrence at 6-month follow-up. We also examined improvement in broader mental health outcomes among remitters. RESULTS Full or partial remission rates at end-of-treatment were significantly higher following CBT (68%) than SPT (42%). At 6-month follow-up, an additional 10% (CBT) and 14% (SPT) experienced delayed remission, 52% (CBT) and 27% (SPT) experienced sustained remission, and 20% (CBT) and 14% (SPT) experienced recurrence. Remission was never achieved by 18% (CBT) and 45% (SPT). Participants in remission at end-of-treatment experienced significant improvements in functional impairment, depression severity, BDD-related insight, and quality of life compared to nonremitters. CONCLUSIONS Full or partial remission rates are high following CBT for BDD and higher than after SPT.
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Affiliation(s)
- Hilary Weingarden
- Massachusetts General Hospital & Harvard Medical School, Boston, MA 02114
| | | | - Ivar Snorrason
- Massachusetts General Hospital & Harvard Medical School, Boston, MA 02114
| | | | - Katharine A. Phillips
- New York-Presbyterian Hospital and Weill Cornell Medical College
- Rhode Island Hospital and Alpert Medical School of Brown University
| | - Sabine Wilhelm
- Massachusetts General Hospital & Harvard Medical School, Boston, MA 02114
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Watson C, Ban S. Body dysmorphic disorder in children and young people. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2021; 30:160-164. [PMID: 33565924 DOI: 10.12968/bjon.2021.30.3.160] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The incidence of body dysmorphic disorder (BDD) in young people is increasing. Causes of BDD are related to the prevalence of social media and adolescent development, especially the role that brain neuroplasticity has on influencing perception. There are long-term impacts of BDD, including depression and suicide. Prevention and promotion of positive body image are part of the nurse's role; treatment can prevent unnecessary aesthetic surgical interventions.
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Affiliation(s)
- Chloe Watson
- BSc Student Nurse (Child), Northumbria University/Great North Children's Hospital, Newcastle
| | - Sasha Ban
- Senior Lecturer, Nursing, Midwifery and Health Department, Northumbria University, Newcastle
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Affiliation(s)
- Amita Jassi
- National and Specialist OCD, BDD & Related Disorders Clinic for Young People, South London & Maudsley NHS Foundation Trust, London, UK
| | - Georgina Krebs
- National and Specialist OCD, BDD & Related Disorders Clinic for Young People, South London & Maudsley NHS Foundation Trust, London, UK.,Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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20
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The relation between normative rituals/routines and obsessive-compulsive symptoms at a young age: A systematic review. DEVELOPMENTAL REVIEW 2020. [DOI: 10.1016/j.dr.2020.100913] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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21
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Sevilla-Cermeño L, Rautio D, Andrén P, Hillborg M, Silverberg-Morse M, Lahera G, Mataix-Cols D, Fernández de la Cruz L. Prevalence and impact of insomnia in children and adolescents with body dysmorphic disorder undergoing multimodal specialist treatment. Eur Child Adolesc Psychiatry 2020; 29:1289-1299. [PMID: 31760510 PMCID: PMC7497371 DOI: 10.1007/s00787-019-01442-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2019] [Accepted: 11/12/2019] [Indexed: 11/25/2022]
Abstract
Pediatric body dysmorphic disorder (BDD) is challenging to treat. This study aimed to establish the prevalence of insomnia in youth with BDD and explore its impact on clinical outcomes. Sixty-six children and adolescents with BDD consecutively referred to a specialist clinic completed a range of clinical measures, including the Yale-Brown Obsessive-Compulsive Scale Modified for BDD-Adolescent Version (BDD-YBOCS-A), and the Insomnia Severity Index (ISI). Patients with clinical insomnia (ISI score ≥ 9) were compared to the rest of the sample on socio-demographic and clinical features. Fifty-six patients who received multimodal treatment were re-assessed post-treatment. A mixed-model ANOVA was performed to compare treatment outcomes between the insomnia vs. no insomnia groups, and Chi-squared tests were used to compare response and remission rates. According to the ISI, 48% of the sample qualified as having insomnia at baseline. These participants showed significantly higher self-reported BDD symptom severity, more depressive symptoms, and more functional impairment in daily activities. Patients with insomnia improved less on the BDD-YBOCS-A than those without insomnia, although the difference did not reach statistical significance. The rates of responders and remitters were lower in the insomnia group, compared to the non-insomnia group. Insomnia is prevalent in pediatric BDD, and is associated with more severe psychopathology and worse functioning in daily activities. Furthermore, youth experiencing BDD and insomnia may benefit from multimodal treatment to a lesser extent than those without insomnia. If these results are replicated in larger samples, treatment refinements for pediatric BDD could include specific modules to directly target insomnia.
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Affiliation(s)
- Laura Sevilla-Cermeño
- Karolinska Institutet, Department of Clinical Neuroscience, Child and Adolescent Psychiatry Research Center, Gävlegatan 22 (Entré B), Floor 8, 113 30, Stockholm, Sweden.
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden.
- Departamento de Medicina y Especialidades Médicas, Universidad de Alcalá, Madrid, Spain.
| | - Daniel Rautio
- Karolinska Institutet, Department of Clinical Neuroscience, Child and Adolescent Psychiatry Research Center, Gävlegatan 22 (Entré B), Floor 8, 113 30, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Per Andrén
- Karolinska Institutet, Department of Clinical Neuroscience, Child and Adolescent Psychiatry Research Center, Gävlegatan 22 (Entré B), Floor 8, 113 30, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Maria Hillborg
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | | | - Guillermo Lahera
- Departamento de Medicina y Especialidades Médicas, Universidad de Alcalá, Madrid, Spain
| | - David Mataix-Cols
- Karolinska Institutet, Department of Clinical Neuroscience, Child and Adolescent Psychiatry Research Center, Gävlegatan 22 (Entré B), Floor 8, 113 30, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Lorena Fernández de la Cruz
- Karolinska Institutet, Department of Clinical Neuroscience, Child and Adolescent Psychiatry Research Center, Gävlegatan 22 (Entré B), Floor 8, 113 30, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
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Abstract
A new measure specifically designed for adolescents to assess body dysmorphic disorder (BDD) symptoms is needed to identify youth who could benefit from intervention to reduce their BDD-related symptomology. To address this gap, the Multidimensional Youth Body Dysmorphic Inventory (MY BODI) was developed and the psychometric properties were evaluated. Following development and expert assessment, Australian secondary school students (N = 582; 55% female; Mage = 13.62, SD = 1.59, aged 11 to 18 years, grades 7 to 12) completed a survey with the new items and validation measures. Results from the factor analysis supported a 3-factor, 21-items measure, which aligned with the DSM-5 diagnostic criteria of Impairment/avoidance, Preoccupation/repetitive behaviours, and Insight/distress. Supporting the convergent validity of the measure, the MY BODI total score and sub-scale scores correlated with measures of BDD symptoms, including the Appearance Anxiety Inventory (AAI) and Body Dysmorphic Disorder Questionnaire-Adolescent Version (BDDQ-A). This study provides preliminary validation of the MY BODI, a self-report measure of BDD symptoms and symptom severity, using a response set aimed to facilitate more reliable reporting, which may identify risk for BDD, and symptoms of BDD.
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Abstract
Background and Objectives:
Body Dysmorphic Disorder (BDD) is characterized
by an abnormal preoccupation with alleged misshapen body parts. There is often poor insight
and effort is made to hide the imagined defects, and consultation may be sought seeking
unnecessary cosmetic surgery or procedures. It is underdiagnosed and established treatment
protocols are lacking. The disease has a chronic and undulating course and is seriously
compromises quality of life. Despite the fact that the prime age of onset of BDD is during
adolescence relatively little has been written about it during this phase of life. This review
aims to comprehensively cover the present understanding of BDD, including clinical
features, epidemiology, psychopathology, nomenclature, comorbidity and management.
Methods:
A literature search was undertaken using suitable key words on Google Scholar,
MEDLINE & PsychoINFO up to June 2018 limited to articles in English.
Results:
he prevalence of BDD is variable in the general and psychiatric population with
equal gender distribution. Both sexes are equally affected. It is associated with poor
functioning and a chronic course. There is considerable comorbidity and diagnostic overlap
between BDD and obsessive-compulsive disorder, major depressive disorder, social anxiety
disorder, anorexia nervosa, schizophrenia spectrum disorders and personality disorders.
Psychiatric consultation is often late. Selective Serotonin Reuptake Inhibitors (SSRIs) and
Cognitive Behavior Therapy (CBT) are currently the first line modalities for treatment.
Internet based CBT, Acceptance and commitment therapy, and repetitive Transcranial
Magnetic Stimulation (rTMS) are emerging treatment options.
Conclusions:
BDD is a complex disorder with still lot of uncertainty about its diagnostic
placement, treatment approaches, especially for refractory patients, and prognosis. Further
study is needed to clarify its prevalence, especially in adolescents; to fully understand its
neurobiological aspects, to determine its exact relation to obsessive compulsive related
disorders, and to develop better treatment approaches.
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Affiliation(s)
- Himanshu Sharma
- Pramukh Swami Medical College & Shree Krishna Hospital, Karamsad, India
| | - Bharti Sharma
- Government Arts College, Garbada, Dahod, Gujarat, India
| | - Nisheet Patel
- Pramukh Swami Medical College & Shree Krishna Hospital, Karamsad, India
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Dong N, Nezgovorova V, Hong K, Hollander E. Pharmacotherapy in body dysmorphic disorder: relapse prevention and novel treatments. Expert Opin Pharmacother 2019; 20:1211-1219. [DOI: 10.1080/14656566.2019.1610385] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Nancy Dong
- Department of Psychiatry and Behavioral Sciences, Autism and Obsessive-Compulsive Spectrum Program, Anxiety and Depression Program, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Vera Nezgovorova
- Department of Psychiatry and Behavioral Sciences, Autism and Obsessive-Compulsive Spectrum Program, Anxiety and Depression Program, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Kevin Hong
- Department of Psychiatry and Behavioral Sciences, Autism and Obsessive-Compulsive Spectrum Program, Anxiety and Depression Program, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
| | - Eric Hollander
- Department of Psychiatry and Behavioral Sciences, Autism and Obsessive-Compulsive Spectrum Program, Anxiety and Depression Program, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA
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25
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Perkins A. Body dysmorphic disorder: The drive for perfection. Nursing 2019; 49:28-33. [PMID: 30720669 DOI: 10.1097/01.nurse.0000553273.24557.58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Body dysmorphic disorder (BDD) is an obsessive-compulsive and related disorder that pushes people toward perfection, affecting 5 to 7.5 million people in the US. Individuals with BDD spend a great deal of time focusing on perceived flaws and ways in which to hide these flaws. The time spent on these negative thoughts can interfere with quality of life and the ability to carry out daily tasks. This article discusses BDD, including symptoms, diagnosis, treatment, complications, and the nurse's role.
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Affiliation(s)
- Amanda Perkins
- Amanda Perkins is an assistant professor of nursing at Vermont Tech in Randolph, Vt
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Enander J, Ljótsson B, Anderhell L, Runeborg M, Flygare O, Cottman O, Andersson E, Dahlén S, Lichtenstein L, Ivanov VZ, Mataix-Cols D, Rück C. Long-term outcome of therapist-guided internet-based cognitive behavioural therapy for body dysmorphic disorder (BDD-NET): a naturalistic 2-year follow-up after a randomised controlled trial. BMJ Open 2019; 9:e024307. [PMID: 30647044 PMCID: PMC6340432 DOI: 10.1136/bmjopen-2018-024307] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Most patients with body dysmorphic disorder (BDD) do not receive evidence-based treatment. A randomised controlled trial (RCT) has found that a therapist-guided internet-based cognitive-behavioural therapy (CBT) programme for BDD (BDD-NET) can be delivered safely via the internet with significant improvements in BDD symptom severity in the short term. The purpose of this study was to evaluate if the therapeutic gains of BDD-NET are maintained 2 years after treatment. SETTING Academic medical centre. PARTICIPANTS A naturalistic 2-year follow-up study of the 88 self-referred adult outpatients with a diagnosis of BDD that had received BDD-NET within the context of the RCT. PRIMARY AND SECONDARY OUTCOMES The primary outcome was the BDD-Yale-Brown Obsessive-Compulsive Scale (YBOCS). Responder status was defined as a ≥30% reduction in symptoms. Remission was defined as no longer meeting Diagnostic and Statistical Manual of Mental Disorders 5th edition criteria for BDD. Secondary outcomes included measures of depression, global functioning and quality of life. RESULTS The efficacy of BDD-NET was sustained long- term, with further improvements observed on the BDD-YBOCS during the follow-up period. At follow-up, 69% (95% CI 57% to 80%) were classified as responders and 56% (95% CI 43% to 69%) were in remission. Gains on depressive symptoms and global functioning were also sustained but not quality of life. A majority of participants reported that the main reason for seeking help for their BDD was the possibility to access the treatment from home. CONCLUSION BDD-NET is an effective treatment for BDD, and the patients' gains are maintained in the long term. BDD-NET has the potential to increase access to CBT and may lower the threshold for BDD sufferers to seek help in the first place. TRIAL REGISTRATION NUMBER NCT02010619.
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Affiliation(s)
- Jesper Enander
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Brjánn Ljótsson
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Lina Anderhell
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Martin Runeborg
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Oskar Flygare
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Oskar Cottman
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Erik Andersson
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Sofia Dahlén
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Linn Lichtenstein
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Volen Z Ivanov
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - David Mataix-Cols
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Christian Rück
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
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Kunzler LS, Naves LA, Casulari LA. The Effect of Cognitive-Behavioral Therapy on Acromegalics After a 9-Month Follow-Up. Front Endocrinol (Lausanne) 2019; 10:380. [PMID: 31244782 PMCID: PMC6581695 DOI: 10.3389/fendo.2019.00380] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 05/28/2019] [Indexed: 11/16/2022] Open
Abstract
Introduction: The quality of life of acromegalics is compromised. Treatment with the "Think healthy and feel the difference" technique has been described as effective in the improvement of the quality of life of these patients in the short term. However, its effectiveness in the long term needs to be evaluated. Objective: The purpose of this study was to evaluate whether the good results obtained from the "Think healthy and feel the difference" technique in the short term persists in the long term, after the end of the treatment. Method: This is a non-randomized longitudinal study with 23 acromegalic divided into two groups: an intervention group with 10 patients and a control group with 13 patients. The intervention itself covered nine group sessions, organized weekly, using a technique called "Think healthy and feel the difference." The control group did not receive the aforementioned treatment. The Short Form 36 Question Health Survey (SF-36) and the Beck Depression Inventory were administered before the sessions began, at the end of the nine therapy sessions and at the 9-month follow-up. Results: At the end of the treatment, the results of the SF-36 showed improvement in the mental health of the intervention group compared to the control group. The effects of therapy were maintained at the 9 month follow-up. Conclusion: Cognitive-behavioral therapy, applied in a group format, can improve the quality of life of acromegalic patients in the short- and long-term.
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Affiliation(s)
- Lia Silvia Kunzler
- Directory of Health, University of Brasilia, Brasilia, Brazil
- *Correspondence: Lia Silvia Kunzler
| | - Luciana Ansaneli Naves
- Department of Endocrinology, Faculty of Medicine, University of Brasilia, Brasilia, Brazil
| | - Luiz Augusto Casulari
- Endocrinology Service of the Brasilia University Hospital, Brasilia, Brazil
- Clinic of Neurology and Endocrinology, Brasilia, Brazil
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Beilharz F, Castle DJ, Phillipou A, Rossell SL. Visual training program for body dysmorphic disorder: protocol for a novel intervention pilot and feasibility trial. Pilot Feasibility Stud 2018; 4:189. [PMID: 30598835 PMCID: PMC6302469 DOI: 10.1186/s40814-018-0384-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 12/07/2018] [Indexed: 01/08/2023] Open
Abstract
Background Body dysmorphic disorder (BDD) is a characterised by perceived defects or flaws in appearance which are associated with distressing thoughts, repetitive or obsessive behaviours, and significant impairment in social and occupational functioning. A core feature of BDD involves abnormalities of visual processing, although this is not typically a focus of psychological and psychiatric treatments. While current treatments generally show moderate effectiveness in the short-term, those with BDD can have high relapse rates, as they still 'see' their flaws or defects. The current research trials a visual training program designed to remediate visual abnormalities and reduce symptom severity of BDD. Methods This is a single-group open-label pilot study assessing the feasibility and potential efficacy of a 10-week visual training program. This pilot trial will be conducted at Swinburne University of Technology, Melbourne, Australia, and will recruit up to 20 participants diagnosed with BDD. These participants will complete pre- and post-assessments and a 10-week visual training program encompassing three phases of basic visual processing, face and emotion recognition, and self-perception. The primary outcomes focus on feasibility and acceptability of the intervention, with secondary outcomes exploring clinical outcomes related to symptom severity, quality of life and eye movements. Discussion This pilot trial will translate the empirical findings of abnormalities in visual processing among those diagnosed with BDD, to an innovative treatment method across a range of visual processing levels. This trial will assess the feasibility and potential efficacy of such a visual training program, paving the way for further research including a future definitive randomised control trial. Trial registration Australian New Zealand Clinical Trial Registry, ACTRN 12618000274279, Registered 22nd February 2018.
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Affiliation(s)
- Francesca Beilharz
- 1Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
| | - David J Castle
- 1Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia.,2Department of Psychiatry, St Vincent's Hospital, Melbourne, Australia.,3Psychiatry, Faculty of Medicine, University of Melbourne, Melbourne, Australia
| | - Andrea Phillipou
- 1Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia.,2Department of Psychiatry, St Vincent's Hospital, Melbourne, Australia.,3Psychiatry, Faculty of Medicine, University of Melbourne, Melbourne, Australia
| | - Susan L Rossell
- 1Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia.,2Department of Psychiatry, St Vincent's Hospital, Melbourne, Australia
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Badenes-Ribera L, Fabris MA, Longobardi C. The relationship between internalized homonegativity and body image concerns in sexual minority men: a meta-analysis. PSYCHOLOGY & SEXUALITY 2018. [DOI: 10.1080/19419899.2018.1476905] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Affiliation(s)
- Laura Badenes-Ribera
- Faculty of Psychology. Department of Methodology of the Behavioral Sciences, University of Valencia, Valencia, Spain
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30
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Abstract
Body dysmorphic disorder (BDD) is a disabling illness with a high worldwide prevalence. Patients demonstrate a debilitating preoccupation with one or more perceived defects, often marked by poor insight or delusional convictions. Multiple studies have suggested that selective serotonin reuptake inhibitors and various cognitive behavioral therapy modalities are effective first-line treatments in decreasing BDD severity, relieving depressive symptoms, restoring insight, and increasing quality of life. Selective serotonin reuptake inhibitors have also recently been shown to be effective for relapse prevention. This review provides a comprehensive summary of the current understanding of BDD, including its clinical features, epidemiology, genetics, and current treatment modalities. Additional research is needed to fully elucidate the relationship between BDD and comorbid illnesses such as obsessive–compulsive-related disorders and depression and to develop therapies for refractory patients and those who have contraindications for pharmacological intervention.
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Affiliation(s)
- Kevin Hong
- Department of Psychiatry and Behavioral Sciences, Autism and Obsessive-Compulsive Spectrum Program, Anxiety and Depression Program, Albert Einstein College of Medicine, Montiefiore Medical Center, The Bronx, New York, USA
| | - Vera Nezgovorova
- Department of Psychiatry and Behavioral Sciences, Autism and Obsessive-Compulsive Spectrum Program, Anxiety and Depression Program, Albert Einstein College of Medicine, Montiefiore Medical Center, The Bronx, New York, USA
| | - Eric Hollander
- Department of Psychiatry and Behavioral Sciences, Autism and Obsessive-Compulsive Spectrum Program, Anxiety and Depression Program, Albert Einstein College of Medicine, Montiefiore Medical Center, The Bronx, New York, USA
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31
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Krebs G, Fernández de la Cruz L, Mataix-Cols D. Recent advances in understanding and managing body dysmorphic disorder. EVIDENCE-BASED MENTAL HEALTH 2017; 20:71-75. [PMID: 28729345 PMCID: PMC5566091 DOI: 10.1136/eb-2017-102702] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 05/30/2017] [Accepted: 05/30/2017] [Indexed: 11/07/2022]
Abstract
Body dysmorphic disorder (BDD) is a relatively common and disabling psychiatric disorder characterised by excessive and persistent preoccupation with perceived defects or flaws in one's appearance, which are unnoticeable to others, and associated repetitive behaviours (eg, mirror checking). The disorder generally starts in adolescence, but often goes unnoticed and is severely underdiagnosed. Left untreated, BDD typically persists and causes marked functional impairment in multiple domains. This clinical review considers recent advances in the epidemiology and classification of BDD, including its reclassification in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders under the new 'Obsessive-Compulsive and Related Disorders' chapter. Key issues in assessment are outlined including the use of validated screening instruments to minimise misdiagnosis and the importance of risk assessment in this population given the high rates of suicidality and inappropriate use of cosmetic treatments. In addition, current knowledge regarding the causes and mechanisms underlying BDD are summarised. The recommended treatments for BDD are outlined, namely cognitive behavioural therapy (CBT) and antidepressants, such as selective serotonin reuptake inhibitors. Both CBT and pharmacotherapy have been shown to be efficacious treatments for BDD in adult populations, and evidence is emerging to support their use in young people. Although the majority of patients improve with existing evidence-based treatment, a large proportion are left with clinically significant residual symptoms. Priorities for future research are therefore discussed including the need to further refine and evaluate existing interventions with the goal of improving treatment outcomes and to increase their availability.
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Affiliation(s)
- Georgina Krebs
- National and Specialist OCD, BDD and Related Disorders Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | | | - David Mataix-Cols
- Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
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32
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Beilharz F, Rossell SL. Treatment Modifications and Suggestions to Address Visual Abnormalities in Body Dysmorphic Disorder. J Cogn Psychother 2017; 31:272-284. [PMID: 32755901 DOI: 10.1891/0889-8391.31.4.272] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Recent psychophysical and neurocognitive findings implicate abnormal visual processing for a range of stimuli in body dysmorphic disorder (BDD); such abnormalities differentiate BDD from other mental health disorders. Current treatments most commonly involve cognitive behavior therapy with or without accompanying antidepressant medications. These are moderately successful yet appear to overlook the core phenomenological aspect of abnormal perception in BDD. The following text summarizes the current literature of perceptual abnormalities within BDD and how these findings may be applied and incorporated into treatment options. Possible modifications of cognitive behavioral therapy (CBT) based on the widespread visual abnormalities within BDD include making perceptual mirror retraining a compulsory component of therapy and implementing self-exposure tasks within exposure and response prevention. Alternative options such as a visual training program to remediate visual abnormalities across a range of visual stimuli are also explored, which may be included as an adjunctive treatment alongside CBT.
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Affiliation(s)
- Francesca Beilharz
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
| | - Susan L Rossell
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia.,The Alfred Hospital and Monash University Central Clinical School, Melbourne, Australia.,Department of Psychiatry, St. Vincent's Hospital, Melbourne, Australia
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Turner C, Cadman J. When Adolescents Feel Ugly: Cognitive Behavioral Therapy for Body Dysmorphic Disorder in Youth. J Cogn Psychother 2017; 31:242-254. [PMID: 32755899 DOI: 10.1891/0889-8391.31.4.242] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Adolescence is a critical time for physical development and maturation, and with these important physiological changes comes greater awareness of body image and appearance, which, for a proportion of young people can become excessive, signaling the onset of body dysmorphic disorder (BDD). BDD in adolescence is associated with significant impairment and suicidality, is poorly understood, and currently there is limited evidence for the effectiveness of psychological therapy. Cognitive behavioral therapy (CBT) is currently the most promising and best available psychological therapy for BDD in youth. The aim of this article is to provide clinicians with information on CBT treatment for BDD in young people and to provide guidance based on clinical experience of working with this complex population group. The article will include discussion of strategies including maximizing psychoeducation with parental involvement, the use of cognitive therapy techniques, exposure with response prevention, and perceptual visual training techniques, including attention training and mirror retraining.
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Affiliation(s)
- Cynthia Turner
- School of Psychology, Australian Catholic University, Brisbane, Australia
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