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Wolfe EC, Snorrason I, Laky ZE, Miyares P, Klare D, Fang A, Summers B, Phillips KA, Wilhelm S, Greenberg JL. Clinical characteristics among sexual minority and heterosexual women with body dysmorphic disorder. Body Image 2024; 49:101687. [PMID: 38471234 DOI: 10.1016/j.bodyim.2024.101687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 02/19/2024] [Accepted: 02/21/2024] [Indexed: 03/14/2024]
Abstract
Body dysmorphic disorder (BDD) is a common disorder associated with substantial comorbidity, impairment, and poor quality of life. Research on subcultural variations of BDD is limited but may impact assessment and treatment of the disorder. The current study examined clinical features in a sample of sexual minority (SM; n = 43) and heterosexual (n = 155) women with diagnosed BDD. Participants completed self-report and clinician-administered measures of demographic and clinical characteristics. Results indicated largely similar clinical features across groups with some exceptions: compared to non-SM women, SM women were younger (M = 25.50 vs 31.96 years, p < .001), had better BDD-related insight (M = 14.51 vs 16.26, p = .01), endorsed a greater number of disliked body parts, and were more likely to express preoccupation with body build (OR = 4.6, 95% CI [2.0, 10.9]), chin/jaw (OR = 4.7, 95% CI [2.1, 10.3]), and shoulders (OR = 10.1, 95% CI [2.7, 37.9]), possibly reflecting nuanced beauty ideals within the SM community. There were no significant group differences in other body parts of concern, BDD severity, or depression. Future studies are needed in larger, more inclusive samples to explore the relationship between diverse identities on BDD and its associated features.
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Affiliation(s)
- Emma C Wolfe
- University of Virginia, 485 McCormick Road, Charlottesville, VA 22903, USA.
| | - Ivar Snorrason
- Massachusetts General Hospital and Harvard Medical School, 185 Cambridge Street, Suite 2000, Boston MA 02114, USA
| | - Zoë E Laky
- Massachusetts General Hospital and Harvard Medical School, 185 Cambridge Street, Suite 2000, Boston MA 02114, USA; American University, 4400 Massachusetts Avenue, NW, Washington, DC 20016, USA
| | - Peyton Miyares
- Massachusetts General Hospital and Harvard Medical School, 185 Cambridge Street, Suite 2000, Boston MA 02114, USA
| | - Dalton Klare
- Massachusetts General Hospital and Harvard Medical School, 185 Cambridge Street, Suite 2000, Boston MA 02114, USA
| | - Angela Fang
- University of Washington, 3751 West Stevens Way NE, Seattle WA 98195, USA
| | - Berta Summers
- Massachusetts General Hospital and Harvard Medical School, 185 Cambridge Street, Suite 2000, Boston MA 02114, USA
| | - Katharine A Phillips
- Rhode Island Hospital and Alpert Medical School of Brown University, 222 Richmond St, Providence, RI 02903, USA; New York-Presbyterian Hospital and Weill Cornell Medical College, 315 East 62nd Street, New York, NY 10065, USA
| | - Sabine Wilhelm
- Massachusetts General Hospital and Harvard Medical School, 185 Cambridge Street, Suite 2000, Boston MA 02114, USA
| | - Jennifer L Greenberg
- Massachusetts General Hospital and Harvard Medical School, 185 Cambridge Street, Suite 2000, Boston MA 02114, USA
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Hoeppner SS, Hall MD, Hiranandani M, Greenberg JL, Wilhelm S, Phillips KA. Time to Response in Therapy for Body Dysmorphic Disorder: A Comparison of Cognitive Behavioral Therapy and Supportive Psychotherapy. Behav Ther 2024; 55:68-79. [PMID: 38216238 PMCID: PMC10965039 DOI: 10.1016/j.beth.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 05/09/2023] [Accepted: 05/11/2023] [Indexed: 01/14/2024]
Abstract
Psychotherapy has been shown to be effective for individuals with body dysmorphic disorder (BDD); however, time to treatment response for different treatments have not yet been examined. We randomized 120 patients to either weekly cognitive behavioral therapy (CBT) or supportive psychotherapy (SPT) at two academic medical research centers. In this secondary data analysis, we aimed to determine the time to first response (30% or greater reduction in BDD symptom severity) in both treatment conditions among those who attended at least one post-baseline assessment (n = 109). As previously reported, CBT for BDD was associated with more consistent improvement in symptom severity and quality of life than SPT. In a pooled analysis combining both sites, the median time to first response was shorter for CBT (76 days [10.9 weeks], 95% CI: 76-107 days) than for SPT (88 days [12.6 weeks], 95% CI: 88-nonestimable days; Χ2df=1 = 3.85, p = .0498). For CBT, the estimated 75th percentile response times were 148 days [21.1 weeks] at site 1 and 134 days [19.1 weeks] at site 2. Response times were not estimable for SPT at either site because the response rate was too low. Thus, therapy clients seeking treatment for BDD and clinicians should be aware that an initial treatment response requires more than 11 therapy sessions for the majority of clients, and that 21 or even more sessions may be required. Treatment response is likely to occur earlier with CBT for BDD (the first-line therapy for BDD) than with supportive psychotherapy.
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Affiliation(s)
| | | | | | | | - Sabine Wilhelm
- Massachusetts General Hospital and Harvard Medical School
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Wang Z, Tan Q, Frank SM, Sasaki Y, Sheinberg D, Phillips KA, Watanabe T. Learning of the same task subserved by substantially different mechanisms between patients with Body Dysmorphic Disorder and healthy individuals. bioRxiv 2023:2023.12.19.571882. [PMID: 38187719 PMCID: PMC10769234 DOI: 10.1101/2023.12.19.571882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
It is generally believed that learning of a perceptual task involving low-level neuronal mechanisms is similar between individuals. However, it is unclear whether this assumption also applies to individuals with psychiatric disorders that are known to have altered brain activation during visual processing. We investigated this question in patients with body dysmorphic disorder (BDD), a psychiatric disorder characterized by distressing or impairing preoccupation with nonexistent or slight defects in one's physical appearance, and in healthy controls. Participants completed six training sessions on separate days on a visual detection task for human faces with low spatial frequency (LSF) components. Brain activation during task performance was measured with functional magnetic resonance imaging (fMRI) on separate days prior to and after training. The behavioral results showed that both groups of participants improved on the visual detection task to a similar extent through training. Despite this similarity in behavioral improvement, neuronal changes in the Fusiform Face Area (FFA), a core cortical region involved in face processing, with training were substantially different between groups. First, activation in the right FFA for LSF faces relative to High Spatial Frequency (HSF) faces that were used as an untrained control increased after training in BDD patients but decreased in controls. Second, resting state functional connectivity between left and right FFAs decreased after training in BDD patients but increased in controls. Contrary to the assumption that learning of a perceptual task is subserved by the same neuronal mechanisms across individuals, our results indicate that the neuronal mechanisms involved in learning of a face detection task differ fundamentally between patients with BDD and healthy individuals. The involvement of different neuronal mechanisms for learning of even simple perceptual tasks in patients with BDD might reflect the brain's adaptations to altered functions imposed by the psychiatric disorder.
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Affiliation(s)
- Zhiyan Wang
- Department of Cognitive, Linguistic and Psychological Sciences, Brown University, 190 Thayer St., Providence, RI 02912, USA
- Institute for Psychology, University of Regensburg, Universitätsstraße 31, Regensburg 93053, Germany
| | - Qingleng Tan
- Department of Cognitive, Linguistic and Psychological Sciences, Brown University, 190 Thayer St., Providence, RI 02912, USA
| | - Sebastian M. Frank
- Department of Cognitive, Linguistic and Psychological Sciences, Brown University, 190 Thayer St., Providence, RI 02912, USA
- Institute for Psychology, University of Regensburg, Universitätsstraße 31, Regensburg 93053, Germany
| | - Yuka Sasaki
- Department of Cognitive, Linguistic and Psychological Sciences, Brown University, 190 Thayer St., Providence, RI 02912, USA
| | - David Sheinberg
- Warren Alpert Medical School, Brown University, 222 Richmond St., Providence, RI 02903, USA
- Department of Neuroscience, Brown University, 185 Meeting St., Providence, RI 02912, USA
| | - Katharine A. Phillips
- Warren Alpert Medical School, Brown University, 222 Richmond St., Providence, RI 02903, USA
- Present address: Department of Psychiatry, Weill Cornell Medicine, Cornell University 15 E 62nd St 5th floor, New York, NY 10065, USA
| | - Takeo Watanabe
- Department of Cognitive, Linguistic and Psychological Sciences, Brown University, 190 Thayer St., Providence, RI 02912, USA
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Phillips KA, Susser LC. Body Dysmorphic Disorder in Women. Psychiatr Clin North Am 2023; 46:505-525. [PMID: 37500247 DOI: 10.1016/j.psc.2023.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
Body dysmorphic disorder (BDD) consists of distressing or impairing preoccupation with perceived defects in physical appearance that are actually nonexistent or only slight. This common and often-severe disorder, which affects more women than men, frequently goes unrecognized. BDD is associated with marked impairment in functioning, poor quality of life, and high rates of suicidality. Most patients seek cosmetic treatment, which virtually never improves BDD symptoms. In contrast, serotonin-reuptake inhibitors, often at high doses, and cognitive behavioral therapy that is tailored to BDD's unique clinical features are often effective. This article provides a clinical overview of BDD, including BDD in women.
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Affiliation(s)
- Katharine A Phillips
- New York-Presbyterian/Weill Cornell Medical Center and Weill Cornell Medical College, Weill Cornell Psychiatry Specialty Center, 315 East 62nd Street, New York, NY 10065, USA.
| | - Leah C Susser
- New York-Presbyterian/Weill Cornell Medical Center and Weill Cornell Medical College, Outpatient Department, 21 Bloomingdale Road, White Plains, NY 10605, USA
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Rieder EA, Andriessen A, Cutler V, Gonzalez ME, Greenberg JL, Lio P, Love EM, Park JH, Andriessen H, Phillips KA. Dermatology in Contemporary Times: Building Awareness of Social Media's Association With Adolescent Skin Disease and Mental Health. J Drugs Dermatol 2023; 22:817-825. [PMID: 37556525 DOI: 10.36849/jdd.7596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/11/2023]
Abstract
BACKGROUND The contribution of psychological disorders to the burden of skin disease has been poorly explored in adolescent patients. The review aims to provide insights into the psychological, social, occupational, and social medias' association with acne, atopic dermatitis (AD), and aesthetics in adolescent patients. METHODS The project used a modified Delphi process comprising face-to-face discussions followed up online. The systematic literature search results informed the 14 draft statements. During an expert panel meeting, the draft statements underwent the panel's evaluation at a workshop, followed by a plenary discussion adopting five statements using evidence from the literature coupled with the panel's opinions and experiences. Results: Studies reported an association between poor sleep, social impairment, and mental health disorders, including body dysmorphic disorder (BDD) with acne or AD in adolescents with acne or AD. Education for patients and parents may improve self-management skills and self-responsibility, promoting better outcomes for acne and AD. The use of certain types of social media can contribute to unrealistic expectations regarding the outcomes of cosmetic procedures. Social media use may also be associated with, and potentially contribute to unrealistic appearance expectations and certain mental health conditions. However, social media use may have benefits, such as connection, diversity, social support, increased self-esteem, safe identity experimentation, and an increased opportunity for self-disclosure. Conclusions: The association with negative life events, BDD, suicidal ideation, depression, and anxiety are thought to be high for adolescent patients with acne or AD. Using social media for information has both positive and negative aspects. Awareness of the risks and benefits of receiving health information about dermatological disease among adolescents needs to be improved through the education of patients and clinicians. Action-oriented items need to be developed to help dermatologists address these issues in clinical practice.Rieder EA, Andriessen A, Cutler V, et al. Dermatology in contemporary times: building awareness of social media's association with adolescent skin disease and mental health. J Drugs Dermatol. 2023;22(8):817-825. doi:10.36849/JDD.7596.
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Ghadimi TR, Rieder EA, Phillips KA. "Zoom Dysmorphia?" Language and Body Dysmorphic Disorder in the Age of Social Media. Dermatol Surg 2023; 49:720-721. [PMID: 37093681 DOI: 10.1097/dss.0000000000003806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Affiliation(s)
- T Roxana Ghadimi
- The Ronald O. Perelman Department of Dermatology, New York University Grossman, School of Medicine, New York, New York
| | - Evan A Rieder
- The Ronald O. Perelman Department of Dermatology, New York University Grossman, School of Medicine, New York, New York
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Abstract
BACKGROUND Serotonin-reuptake inhibitors (SRIs) are first-line pharmacotherapy for the treatment of body dysmorphic disorder (BDD), a common and severe disorder. However, prior research has not focused on or identified definitive predictors of SRI treatment outcomes. Leveraging precision medicine techniques such as machine learning can facilitate the prediction of treatment outcomes. METHODS The study used 10-fold cross-validation support vector machine (SVM) learning models to predict three treatment outcomes (i.e. response, partial remission, and full remission) for 97 patients with BDD receiving up to 14-weeks of open-label treatment with the SRI escitalopram. SVM models used baseline clinical and demographic variables as predictors. Feature importance analyses complemented traditional SVM modeling to identify which variables most successfully predicted treatment response. RESULTS SVM models indicated acceptable classification performance for predicting treatment response with an area under the curve (AUC) of 0.77 (sensitivity = 0.77 and specificity = 0.63), partial remission with an AUC of 0.75 (sensitivity = 0.67 and specificity = 0.73), and full remission with an AUC of 0.79 (sensitivity = 0.70 and specificity = 0.79). Feature importance analyses supported constructs such as better quality of life and less severe depression, general psychopathology symptoms, and hopelessness as more predictive of better treatment outcome; demographic variables were least predictive. CONCLUSIONS The current study is the first to demonstrate that machine learning algorithms can successfully predict treatment outcomes for pharmacotherapy for BDD. Consistent with precision medicine initiatives in psychiatry, the current study provides a foundation for personalized pharmacotherapy strategies for patients with BDD.
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Affiliation(s)
- Joshua E. Curtiss
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Emily E. Bernstein
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Sabine Wilhelm
- Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Katharine A. Phillips
- Rhode Island Hospital, Butler Hospital, and Alpert Medical School of Brown University, Providence, RI, USA
- New York-Presbyterian Hospital and Weill Cornell Medical College, New York, NY, USA
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Greenberg JL, Phillips KA, Hoeppner SS, Jacobson NC, Fang A, Wilhelm S. Mechanisms of cognitive behavioral therapy vs. supportive psychotherapy in body dysmorphic disorder: An exploratory mediation analysis. Behav Res Ther 2023; 161:104251. [PMID: 36640457 PMCID: PMC9892287 DOI: 10.1016/j.brat.2022.104251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 11/12/2022] [Accepted: 12/30/2022] [Indexed: 01/11/2023]
Abstract
Body dysmorphic disorder (BDD) is common, severe, and often chronic. Cognitive behavioral therapy (CBT) is the first-line psychosocial treatment for BDD, with well-established efficacy. However, some patients do not improve with CBT, and little is known about how CBT confers its effects. Neurocognitive processes have been implicated in the etiology and maintenance of BDD and are targeted by CBT-BDD treatment components. Yet, the malleability of these factors in BDD, and their potential role in mediating symptom improvement, are not well understood. Understanding how treatment works could help optimize treatment outcomes. In this secondary data analysis of a randomized clinical trial of CBT vs. supportive psychotherapy (SPT) in BDD (n = 120), we examined whether treatment-related changes in detail processing (Rey-Osterrieth Complex Figure test), maladaptive appearance beliefs (Appearance Schemas Inventory-Revised), and emotion recognition (Emotion Recognition Task) mediated treatment outcome. All constructs improved over time and were associated with symptom improvement. CBT was associated with greater improvements in maladaptive beliefs than SPT. None of the variables examined mediated symptom improvement. Findings suggest that with successful treatment, individuals with BDD demonstrate reduced neurocognitive deficits (detail processing, emotion recognition, maladaptive beliefs) and that CBT is more likely than SPT to improve maladaptive appearance beliefs. More work is needed to understand mechanisms of change and thus maximize treatment outcomes.
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Affiliation(s)
- Jennifer L Greenberg
- Massachusetts General Hospital and Harvard Medical School, 185 Cambridge Street, Suite 2000, Boston, MA, 02114, USA.
| | - Katharine A Phillips
- Rhode Island Hospital and Alpert Medical School of Brown University, 222 Richmond St, Providence, RI, 02903, USA; New York-Presbyterian Hospital and Weill Cornell Medical College, 315 East 62nd Street, New York, NY, 10065, USA.
| | - Susanne S Hoeppner
- Massachusetts General Hospital and Harvard Medical School, 185 Cambridge Street, Suite 2000, Boston, MA, 02114, USA.
| | - Nicholas C Jacobson
- Massachusetts General Hospital and Harvard Medical School, 185 Cambridge Street, Suite 2000, Boston, MA, 02114, USA; Geisel School of Medicine at Dartmouth College, 46 Centerra Parkway, EverGreen Center, Suite 315, Lebanon, NH, 03766, USA.
| | - Angela Fang
- Massachusetts General Hospital and Harvard Medical School, 185 Cambridge Street, Suite 2000, Boston, MA, 02114, USA; University of Washington, 3751 West Stevens Way NE, Seattle, WA, 98195, USA.
| | - Sabine Wilhelm
- Massachusetts General Hospital and Harvard Medical School, 185 Cambridge Street, Suite 2000, Boston, MA, 02114, USA.
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Bernstein EE, Weingarden H, Greenberg JL, Williams J, Hoeppner SS, Snorrason I, Phillips KA, Harrison O, Wilhelm S. Credibility and expectancy of smartphone-based cognitive behavioral therapy among adults with body dysmorphic disorder. J Obsessive Compuls Relat Disord 2023; 36:100781. [PMID: 38313683 PMCID: PMC10835574 DOI: 10.1016/j.jocrd.2023.100781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Few patients receive cognitive behavioral therapy, the gold-standard for body dysmorphic disorder (CBT-BDD). Smartphones can make evidence-based interventions, like CBT-BDD, more accessible and scalable. A key question is: how do patients view it? Low credibility and expectancy would likely translate to low uptake and engagement outside of research settings, diminishing the impact. Thus, it is important to understand patients' beliefs about digital CBT-BDD. METHODS We compared credibility and expectancy in a coach-guided app-based CBT-BDD trial (N=75) to a previous in-person CBT-BDD trial (N = 55). We further examined the relationship of perceptions of digital CBT-BDD to baseline clinical and demographic factors and dropout. RESULTS Credibility did not differ between the in-person (M=19.3) and digital (M=18.3) trials, p=.24. Expectancy for improvement was moderately higher for in-person (M=58.4) than digital (M=48.3) treatment, p=.005. In the digital trial, no demographic variables were associated with credibility or expectancy. Better BDD-related insight and past non-CBT BDD therapy were associated with greater expectancy. Credibility was associated with lower likelihood of dropout. DISCUSSION Digital CBT-BDD was regarded as similarly credible to in-person CBT-BDD but with lower expectancy. Tailored expectancy-enhancing strategies could strengthen this novel approach, particularly among those with poorer insight and without prior BDD treatment.
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Affiliation(s)
| | | | | | | | | | | | - Katharine A. Phillips
- Rhode Island Hospital and Alpert Medical School of Brown University
- New York-Presbyterian Hospital and Weill Cornell Medical College
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Greenberg JL, Jacobson NC, Hoeppner SS, Bernstein EE, Snorrason I, Schwartzberg A, Steketee G, Phillips KA, Wilhelm S. Early response to cognitive behavioral therapy for body dysmorphic disorder as a predictor of outcomes. J Psychiatr Res 2022; 152:7-13. [PMID: 35700586 PMCID: PMC9447469 DOI: 10.1016/j.jpsychires.2022.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Revised: 04/14/2022] [Accepted: 06/06/2022] [Indexed: 10/18/2022]
Abstract
Individuals with body dysmorphic disorder (BDD) suffer from distressing or impairing preoccupations with perceived imperfections in their appearance. This often-chronic condition is associated with significant functional impairment and elevated rates of psychiatric comorbidity and morbidity, including depression, substance use disorders, and suicidality. Cognitive behavioral therapy (CBT) for BDD has been shown to be efficacious. However, this intervention is long (up to 24 weeks) relative to many manualized approaches for other related conditions, there is a significant shortage of clinicians trained in CBT for BDD, and some patients drop out of treatment and/or do not respond. Thus, there is great interest in understanding and predicting who is most likely to respond, to better allocate clinical resources. This secondary data analysis of participants enrolled in prior uncontrolled and controlled studies of CBT for BDD explored whether early response to CBT, operationalized as percentage change in symptom severity within the first four weeks and the first 12 weeks of this 24-week treatment, predicts clinical outcomes for patients with BDD (n = 90). The findings indicated that minimal early symptom change was not indicative of eventual non-response. This suggests that patients and clinicians should not be discouraged by limited early improvement but should instead continue with a full course of treatment before reevaluating progress and alternative interventions. Overall, the results support the view that treatment success is more likely if a longer CBT protocol is followed. More work is needed to understand mechanisms of change and thus match optimal interventions to patient characteristics.
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Affiliation(s)
- Jennifer L. Greenberg
- Massachusetts General Hospital and Harvard Medical School, 185 Cambridge Street, Suite 2000, Boston, MA, 02114, USA,Corresponding author. (J.L. Greenberg)
| | - Nicholas C. Jacobson
- Massachusetts General Hospital and Harvard Medical School, 185 Cambridge Street, Suite 2000, Boston, MA, 02114, USA,Geisel School of Medicine at Dartmouth College, 46 Centerra Parkway, EverGreen Center, Suite 315, Lebanon, NH, 03766, USA
| | - Susanne S. Hoeppner
- Massachusetts General Hospital and Harvard Medical School, 185 Cambridge Street, Suite 2000, Boston, MA, 02114, USA
| | - Emily E. Bernstein
- Massachusetts General Hospital and Harvard Medical School, 185 Cambridge Street, Suite 2000, Boston, MA, 02114, USA
| | - Ivar Snorrason
- Massachusetts General Hospital and Harvard Medical School, 185 Cambridge Street, Suite 2000, Boston, MA, 02114, USA.
| | - Anna Schwartzberg
- Massachusetts General Hospital and Harvard Medical School, 185 Cambridge Street, Suite 2000, Boston, MA, 02114, USA.
| | - Gail Steketee
- Boston University School of Social Work, 264 Bay State Rd, Boston, MA, 02215, USA.
| | - Katharine A. Phillips
- Rhode Island Hospital and Alpert Medical School of Brown University, 222 Richmond St, Providence, RI, 02903, USA,New York-Presbyterian Hospital and Weill Cornell Medical College, 315 East 62nd Street, New York, 10065, USA
| | - Sabine Wilhelm
- Massachusetts General Hospital and Harvard Medical School, 185 Cambridge Street, Suite 2000, Boston, MA, 02114, USA.
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Summers BJ, Hoeppner SS, Beatty CC, Blais MA, Greenberg JL, Phillips KA, Wilhelm S. An Evaluation of the Body Dysmorphic Disorder Symptom Scale as a Measure of Treatment Response and Remission in Psychotherapy and Medication Trials. Behav Ther 2022; 53:521-534. [PMID: 35473654 PMCID: PMC9046685 DOI: 10.1016/j.beth.2021.12.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 12/08/2021] [Accepted: 12/13/2021] [Indexed: 11/02/2022]
Abstract
The Body Dysmorphic Disorder Symptom Scale (BDD-SS) is a self-report tool that captures an array of representative behavioral and cognitive symptoms commonly displayed by individuals with BDD. The BDD-SS is regularly used among experts in the field, though its utility as a measure of treatment response has not yet been formally evaluated. Results from two clinical trials of BDD treatment were pooled from an archived database to create a sample of 220 BDD participants who received either psychosocial or medication-based interventions for BDD. We used baseline BDD-SS scores to describe psychometric properties, baseline correlations with other scales to examine the content validity of the BDD-SS, and longitudinal symptom data to evaluate capacity to detect clinically relevant change. Results indicated that the BDD-SS has good psychometric properties and is able to detect symptom change over time, although it showed lower rates of reliable change with treatment relative to the gold standard rater-administered Yale-Brown Obsessive-Compulsive Scale Modified for BDD (BDD-YBOCS). The BDD-SS offers meaningful information about treatment response in a self-report format and may be particularly useful to employ in clinical practice settings as a means of gathering symptom and treatment response data via self-report when rater-administered interviews are not feasible, although it may underestimate the extent of improvement with treatment.
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Affiliation(s)
- Berta J. Summers
- University of North Carolina Wilmington,Massachusetts General Hospital, Harvard Medical School
| | | | - Clare C. Beatty
- Massachusetts General Hospital, Harvard Medical School,Department of Psychology, Stony Brook University, Stony Brook, NY
| | - Mark A. Blais
- Massachusetts General Hospital, Harvard Medical School
| | | | - Katharine A. Phillips
- Butler Hospital and Rhode Island Hospital, Warren Alpert Medical School of Brown University,New York-Presbyterian Hospital, Weill Cornell Medical College
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Phillips KA, Kelly MM. Body Dysmorphic Disorder: Clinical Overview and Relationship to Obsessive-Compulsive Disorder. Focus (Am Psychiatr Publ) 2021; 19:413-419. [PMID: 35747292 PMCID: PMC9063569 DOI: 10.1176/appi.focus.20210012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 07/07/2021] [Accepted: 08/20/2021] [Indexed: 06/15/2023]
Abstract
Body dysmorphic disorder (BDD), characterized by a distressing or impairing preoccupation with nonexistent or slight defects in appearance, is associated with markedly poor quality of life and high rates of suicidality. Onset of BDD is usually in childhood or adolescence and, unless appropriately treated, tends to be chronic. The first-line pharmacologic approach for both delusional and non-delusional BDD is serotonin reuptake inhibitors (SRIs), often at high doses. SRI augmentation and switching strategies can be effective. The first-line psychotherapy is cognitive-behavioral therapy (CBT) tailored to BDD's unique clinical features. Cosmetic treatment (such as surgery or dermatologic treatment), although received by a majority of patients with BDD, is not recommended. BDD has many similarities to obsessive-compulsive disorder (OCD) and appears closely related to OCD but also has some important differences. This article, which updates a 2015 article on BDD that we published in this journal, provides a clinically focused overview of BDD and its relationship to OCD.
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Affiliation(s)
- Katharine A Phillips
- New York-Presbyterian/Weill Cornell Medical Center, New York (Phillips); Department of Psychiatry, Weill Cornell Medical College, New York (Phillips); U.S. Department of Veterans Affairs VA Bedford Healthcare System, Bedford, Massachusetts (Kelly); Department of Psychiatry, University of Massachusetts Medical School, Worcester (Kelly)
| | - Megan M Kelly
- New York-Presbyterian/Weill Cornell Medical Center, New York (Phillips); Department of Psychiatry, Weill Cornell Medical College, New York (Phillips); U.S. Department of Veterans Affairs VA Bedford Healthcare System, Bedford, Massachusetts (Kelly); Department of Psychiatry, University of Massachusetts Medical School, Worcester (Kelly)
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14
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Sookman D, Phillips KA, Anholt GE, Bhar S, Bream V, Challacombe FL, Coughtrey A, Craske MG, Foa E, Gagné JP, Huppert JD, Jacobi D, Lovell K, McLean CP, Neziroglu F, Pedley R, Perrin S, Pinto A, Pollard CA, Radomsky AS, Riemann BC, Shafran R, Simos G, Söchting I, Summerfeldt LJ, Szymanski J, Treanor M, Van Noppen B, van Oppen P, Whittal M, Williams MT, Williams T, Yadin E, Veale D. Knowledge and competency standards for specialized cognitive behavior therapy for adult obsessive-compulsive disorder. Psychiatry Res 2021; 303:113752. [PMID: 34273818 DOI: 10.1016/j.psychres.2021.113752] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 01/21/2021] [Indexed: 12/19/2022]
Abstract
Obsessive-Compulsive Disorder (OCD) is a leading cause of disability world-wide (World Health Organization, 2008). Treatment of OCD is a specialized field whose aim is recovery from illness for as many patients as possible. The evidence-based psychotherapeutic treatment for OCD is specialized cognitive behavior therapy (CBT, NICE, 2005, Koran and Simpson, 2013). However, these treatments are not accessible to many sufferers around the world. Currently available guidelines for care are deemed to be essential but insufficient because of highly variable clinician knowledge and competencies specific to OCD. The phase two mandate of the 14 nation International OCD Accreditation Task Force (ATF) created by the Canadian Institute for Obsessive Compulsive Disorders is development of knowledge and competency standards for specialized treatments for OCD through the lifespan deemed by experts to be foundational to transformative change in this field. This paper presents knowledge and competency standards for specialized CBT for adult OCD developed to inform, advance, and offer a model for clinical practice and training for OCD. During upcoming ATF phases three and four criteria and processes for training in specialized treatments for OCD through the lifespan for certification (individuals) and accreditation (sites) will be developed based on the ATF standards.
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Affiliation(s)
- Debbie Sookman
- Department of Psychology, McGill University Health Center, 1025 Pine Ave W, Montreal, Quebec, H3A 1A1, Canada; Department of Psychiatry, McGill University, 845 Sherbrooke St W, Montreal, Quebec, H3A 0G4, Canada.
| | - Katharine A Phillips
- Department of Psychiatry, Weill Cornell Medicine, 1300 York Ave, New York, NY 10065, United States.
| | - Gideon E Anholt
- Department of Psychology, Marcus Family Campus, Ben-Gurion University of the Negev, Beer Sheva, P.O.B. 653 Beer-Sheva, 8410501, Israel.
| | - Sunil Bhar
- Department of Psychological Sciences, Faculty of Health, Arts and Design, Swinburne University of Technology, 1 John St, Hawthorn, Victoria, 3122, Australia.
| | - Victoria Bream
- Oxford Health Specialist Psychological Interventions Clinic and Oxford Cognitive Therapy Centre, Warneford Hospital, Oxford, OX3 7JX, United Kingdom.
| | - Fiona L Challacombe
- Institute of Psychiatry, Psychology and Neuroscience, Kings College London, De Crespigny Park, London, SE5 8AF, United Kingdom.
| | - Anna Coughtrey
- Great Ormond Street Hospital for Children, London WC1N 3JH, United Kingdom; UCL Great Ormond Street Institute of Child Health, 30 Guilford St, Holborn, London, WC1N 1EH, United Kingdom.
| | - Michelle G Craske
- Anxiety and Depression Research Center, Depression Grant Challenge, Innovative Treatment Network, Staglin Family Music Center for Behavioral and Brain Health, UCLA Department of Psychology and Department of Psychiatry and Biobehavioral Sciences, Box 951563, 1285 Franz Hall, Los Angeles, CA, United States.
| | - Edna Foa
- Center for the Treatment and Study of Anxiety, University of Pennsylvania Perelman SOM, 3535 Market Street, Philadelphia, PA 19104, United States.
| | - Jean-Philippe Gagné
- Department of Psychology, Concordia University, 7141 Sherbrooke St, West, Montreal, Quebec H4B 1R6, Canada.
| | - Jonathan D Huppert
- Department of Psychology, The Hebrew University of Jerusalem, Mt. Scopus, Jerusalem, 91905, Israel.
| | - David Jacobi
- Rogers Behavioral Health, 34700 Valley Road, Oconomowoc, WI, 53066, United States.
| | - Karina Lovell
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Oxford Rd, Manchester, M13 9PL, United Kingdom; Manchester Academic Health Science Centre, Greater Manchester Mental Health NHS Foundation Trust, Manchester, M13 9PL, United Kingdom.
| | - Carmen P McLean
- National Center for PTSD, Dissemination and Training Division, VA Palo Alto Healthcare System, 795 Willow Road, Menlo Park, CA, 94025, United States; Department of Psychiatry and Behavioral Sciences, Stanford University, 450 Serra Mall, Stanford, CA, 94305, United States.
| | - Fugen Neziroglu
- Bio-Behavioral Institute, 935 Northern Boulevard, Suite 102, Great Neck, NY, 11021, United States.
| | - Rebecca Pedley
- Division of Nursing, Midwifery and Social Work, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, M13 9PL, United Kingdom.
| | - Sean Perrin
- Department of Psychology, Lund University, Box 213, 22100, Lund, Sweden.
| | - Anthony Pinto
- Zucker School of Medicine at Hofstra/Northwell, Zucker Hillside Hospital - Northwell Health, 265-16 74th Avenue, Glen Oaks, NY, 11004, United States.
| | - C Alec Pollard
- Center for OCD and Anxiety-Related Disorders, Saint Louis Behavioral Medicine Institute, 1129 Macklind Ave, St. Louis, MO, 63110, United States; Department of Family and Community Medicine, Saint Louis University School of Medicine, Saint Louis, MO, 63110, United States.
| | - Adam S Radomsky
- Department of Psychology, Concordia University, 7141 Sherbrooke St, West, Montreal, Quebec H4B 1R6, Canada.
| | - Bradley C Riemann
- 34700 Valley Road, Rogers Behavioral Health, Oconomowoc, WI, 53066, United States.
| | - Roz Shafran
- Population, Policy and Practice Research and Teaching Department, UCL Great Ormond Street Hospital Institute of Child Health, Holborn, London, WC1N 1EH, United Kingdom.
| | - Gregoris Simos
- Department of Educational and Social Policy, University of Macedonia, 156 Egnatia Street, 54636 Thessaloniki, Greece.
| | - Ingrid Söchting
- Departments of Psychology, University of British Columbia, 2136 West Mall, Vancouver, British Columbia, V6T 1Z4, Canada.
| | - Laura J Summerfeldt
- Department of Psychology, Trent University, 1600 West Bank Drive, Peterborough, K9L 0G2 Ontario, Canada.
| | - Jeff Szymanski
- International OCD Foundation, 18 Tremont Street, #308, Boston MA, 02108, United States.
| | - Michael Treanor
- Anxiety and Depression Research Center, University of California, Los Angeles, Box 951563, 1285 Franz Hall, Los Angeles, CA, United States.
| | - Barbara Van Noppen
- Clinical Psychiatry and Behavioral Sciences, OCD Southern California, 2514 Jamacha Road Ste, 502-35 El Cajon, CA, 92019, United States; Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, 2250 Alcazar Street, Suite 2200, Los Angeles, CA, 90033, United States.
| | - Patricia van Oppen
- Department of Psychiatry, Amsterdam UMC, location VUmc, Netherlands; Amsterdam Public Health Research Institute - Mental Health, Netherlands; GGZ inGeest Specialized Mental Health Care, Netherlands.
| | - Maureen Whittal
- Vancouver CBT Centre, 302-1765 W8th Avenue, Vancouver, British Columbia, V6J5C6, Canada; Department of Psychiatry, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Monnica T Williams
- School of Psychology, University of Ottawa, 136 Jean-Jacques Lussier Pvt, Ottawa, K1N 6N5, Ontario, Canada.
| | - Timothy Williams
- Department of Psychology, University of Reading, PO Box 217, Reading, Berkshire, RG6 6AH, United Kingdom.
| | - Elna Yadin
- Department of Psychiatry, University of Pennsylvania, 3535 Market Street, 2nd Floor, Philadelphia, PA 19104, United States.
| | - David Veale
- South London and the Maudsley NHS Foundation Trust & King's College London, Denmark Hill, London, SE5 8 AZ, United Kingdom.
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Pittenger C, Brennan BP, Koran L, Mathews CA, Nestadt G, Pato M, Phillips KA, Rodriguez CI, Simpson HB, Skapinakis P, Stein DJ, Storch EA. Specialty knowledge and competency standards for pharmacotherapy for adult obsessive-compulsive disorder. Psychiatry Res 2021; 300:113853. [PMID: 33975093 PMCID: PMC8536398 DOI: 10.1016/j.psychres.2021.113853] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 03/01/2021] [Indexed: 12/12/2022]
Abstract
Obsessive-compulsive disorder (OCD) affects approximately one person in 40 and causes substantial suffering. Evidence-based treatments can benefit many; however, optimal treatment can be difficult to access. Diagnosis is frequently delayed, and pharmacological and psychotherapeutic interventions often fail to follow evidence-based guidelines. To ameliorate this distressing situation, the International OCD Accreditation Task Force of the Canadian Institute for Obsessive-Compulsive Disorders has developed knowledge and competency standards for specialized treatments for OCD through the lifespan. These are foundational to evidence-based practice and will form the basis for upcoming ATF development of certification/accreditation programs. Here, we present specialty standards for the pharmacological treatment of adult OCD. We emphasize the importance of integrating pharmacotherapy with clear diagnosis, appreciation of complicating factors, and evidence-based cognitive behavioral therapy. Clear evidence exists to inform first- and second-line pharmacological treatments. In disease refractory to these initial efforts, multiple strategies have been investigated, but the evidence is more equivocal. These standards summarize this limited evidence to give the specialist practitioner a solid basis on which to make difficult decisions in complex cases. It is hoped that further research will lead to development of a clear, multi-step treatment algorithm to support each step in clinical decision-making.
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Affiliation(s)
- Christopher Pittenger
- Department of Psychiatry and Yale Child Study Center, Yale University School of Medicine, New Haven, CT, United States.
| | - Brian P Brennan
- Biological Psychiatry Laboratory and Obsessive-Compulsive Disorder Institute, McLean Hospital, Belmont, MA, United States; Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Lorrin Koran
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States
| | - Carol A Mathews
- Department of Psychiatry, University of Florida, Gainesville, FL, United States
| | - Gerald Nestadt
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Michele Pato
- Institute for Genomic Health and Department of Psychiatry, SUNY Downstate College of Medicine, Brooklyn, NY, United States
| | - Katharine A Phillips
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, and Department of Psychiatry, Weill Cornell Medical College, New York, NY, United States
| | - Carolyn I Rodriguez
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, United States; Veterans Affairs Palo Alto Health Care System, Palo Alto, CA, United States
| | - H Blair Simpson
- Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States; Office of Mental Health, Research Foundation for Mental Hygiene, New York Psychiatric Institute, New York, NY, United States
| | - Petros Skapinakis
- Department of Psychiatry, School of Health Sciences, University of Ioannina, Ioannina, Greece
| | - Dan J Stein
- Department of Psychiatry and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
| | - Eric A Storch
- Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
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16
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Phillips KA, Greenberg JL, Hoeppner SS, Weingarden H, O’Keefe S, Keshaviah A, Schoenfeld DA, Wilhelm S. Predictors and moderators of symptom change during cognitive-behavioral therapy or supportive psychotherapy for body dysmorphic disorder. J Affect Disord 2021; 287:34-40. [PMID: 33773357 PMCID: PMC8276884 DOI: 10.1016/j.jad.2021.03.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 02/28/2021] [Accepted: 03/02/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Research on predictors of treatment outcome in body dysmorphic disorder, a common and severe disorder, is very limited, and no prior studies have examined moderators of outcome. Because treatment is often but not always efficacious, it is important to identify who is more likely to benefit. We examined predictors and moderators of improvement with therapist-delivered cognitive-behavioral therapy versus supportive psychotherapy in the only study of these treatments for body dysmorphic disorder. This report presents secondary analyses from a study whose primary findings have previously been published (Wilhelm et al., 2019). METHODS Participants (N=120) with DSM-IV body dysmorphic disorder were randomized to therapist-delivered weekly cognitive-behavioral therapy or supportive therapy for 24 weeks. Using reliable and valid measures, we tested baseline body dysmorphic disorder severity, insight/delusionality, and depression severity as predictors and moderators of overall and treatment modality-specific symptom change. We explored additional variables as predictors and moderators of outcome. RESULTS Greater treatment credibility (p=0.02) and presence of obsessive-compulsive personality disorder (p=0.03) predicted greater improvement. Serotonin-reuptake inhibitor treatment at baseline (unchanged during the study) (p=0.01) predicted less improvement. No other variables predicted or moderated outcome (all p>0.05). LIMITATIONS The study was not powered a priori to detect predictor or moderation effects, which limited our ability to detect them unless they were strong. CONCLUSIONS Because greater treatment credibility predicted better outcomes, fostering credibility during therapy may maximize gains. Improvement was not impeded by more severe body dysmorphic disorder, depressive symptoms, or poorer insight. No variables moderated treatment-specific improvement.
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Affiliation(s)
- Katharine A. Phillips
- Rhode Island Hospital,Alpert Medical School of Brown University,New York-Presbyterian Hospital,Weill Cornell Medical College, Cornell University
| | | | | | | | | | - Aparna Keshaviah
- Massachusetts General Hospital,Harvard Medical School,Mathematica Policy Research
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Sookman D, Phillips KA, Mataix-Cols D, Veale D. Introduction to knowledge and competency standards for specialized treatments for obsessive-compulsive disorder throughout the lifespan: Phase two series by the International Accreditation Task Force of the Canadian Institute for Obsessive Compulsive Disorders (CIOCD, www.ciocd.ca). Psychiatry Res 2021; 298:113753. [PMID: 33578061 DOI: 10.1016/j.psychres.2021.113753] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 01/21/2021] [Indexed: 01/05/2023]
Abstract
This paper presents an introduction to the phase two series of papers by the 14 nation International Obsessive-Compulsive Disorders Task Force (ATF) of the Canadian Institute for Obsessive Compulsive Disorders. These papers present evidence-based knowledge and competency standards developed by the ATF for specialized treatments for obsessive-compulsive disorder (OCD) through the lifespan, operationalized as clinician abilities. Specialty standards for OCD do not currently exist and are deemed by experts to be foundational to transformative improvement globally in quality and accessibility of evidence-based treatments for this crippling disorder. Currently available guidelines for care are deemed to be essential but insufficient because of highly variable clinician knowledge and competencies specific to this disorder. The ATF standards encompass specialized cognitive behavior therapy, and pharmacotherapy, for pediatric and adult OCD. Evidence-based methodology with integration of expert opinion are described. Upcoming ATF phases three and four will involve development and implementation of training criteria and processes for certification (individual clinicians) and accreditation (clinical sites) based on the ATF standards. These standards will require periodic review and updating commensurate with advances in clinical research. We hope that this international initiative constitutes a significant step forward to inform and advance evidence-based specialized treatment and training for OCD.
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Affiliation(s)
- Debbie Sookman
- Department of Psychology, McGill University Health Center, 1025 Pine Ave W, Montreal, Quebec, H3A 1A1, Canada; Department of Psychiatry, McGill University, 845 Sherbrooke St W, Montreal, Quebec, H3A 0G4, Canada.
| | - Katharine A Phillips
- Department of Psychiatry, Weill Cornell Medical College, 1300 York Ave, New York, NY 10065, United States.
| | - David Mataix-Cols
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Stockholm, Sweden.
| | - David Veale
- South London and the Maudsley NHS Foundation Trust & King's College London, Denmark Hill, London, SE5 8AZ, United Kingdom.
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18
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Castle D, Beilharz F, Phillips KA, Brakoulias V, Drummond LM, Hollander E, Ioannidis K, Pallanti S, Chamberlain SR, Rossell SL, Veale D, Wilhelm S, Van Ameringen M, Dell’Osso B, Menchon JM, Fineberg NA. Body dysmorphic disorder: a treatment synthesis and consensus on behalf of the International College of Obsessive-Compulsive Spectrum Disorders and the Obsessive Compulsive and Related Disorders Network of the European College of Neuropsychopharmacology. Int Clin Psychopharmacol 2021; 36:61-75. [PMID: 33230025 PMCID: PMC7846290 DOI: 10.1097/yic.0000000000000342] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 10/13/2020] [Indexed: 11/25/2022]
Abstract
Body dysmorphic disorder (BDD) is characterized by a preoccupation with a perceived appearance flaw or flaws that are not observable to others. BDD is associated with distress and impairment of functioning. Psychiatric comorbidities, including depression, social anxiety, and obsessive-compulsive disorder are common and impact treatment. Treatment should encompass psychoeducation, particularly addressing the dangers associated with cosmetic procedures, and may require high doses of selective serotonin reuptake inhibitors* (SSRI*) and protracted periods to establish full benefit. If there is an inadequate response to SSRIs, various adjunctive medications can be employed including atypical antipsychotics*, anxiolytics*, and the anticonvulsant levetiracetam*. However, large-scale randomized controlled trials are lacking and BDD is not an approved indication for these medications. Oxytocin* may have a potential role in treating BDD, but this requires further exploration. Cognitive-behavioural therapy has good evidence for efficacy for BDD, and on-line and telephone-assisted forms of therapy are showing promise. CBT for BDD should be customized to address such issues as mirror use, perturbations of gaze, and misinterpretation of others' emotions, as well as overvalued ideas about how others view the individual.
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Affiliation(s)
- David Castle
- Department of Psychiatry, University of Melbourne and St Vincent’s Hospital
| | | | - Katharine A. Phillips
- New York-Presbyterian Hospital and Professor of Psychiatry, Weill Cornell Medical College, New York, New York, USA
| | - Vlasios Brakoulias
- School of Medicine, Western Sydney University and Western Sydney Local Health District, Sydney, Australia
| | - Lynne M. Drummond
- National Services for OCD/BDD, SW London and St George’s NHS Trust, London, UK
| | - Eric Hollander
- Albert Einstein College of Medicine, Bronx, New York, USA
| | - Konstantinos Ioannidis
- Department of Psychiatry, University of Cambridge, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Stefano Pallanti
- Albert Einstein College of Medicine, Bronx, New York, USA
- Istituto di Neuroscienze University of Florence, Florence, Italy
| | - Samuel R. Chamberlain
- Department of Psychiatry, University of Southampton
- Southern Health NHS Foundation Trust, Southampton
- Department of Psychiatry, University of Cambridge
- Department of Psychiatry, Cambridgeshire and Peterborough NHS Foundation Trust, Cambridge, UK
| | - Susan L. Rossell
- Centre for Mental Health, Swinburne University and St Vincent’s Hospital, Melbourne, Australia
| | - David Veale
- Department of Psychology, King’s College London and the South London and Maudsley NHS Foundation Trust, London, UK
| | - Sabine Wilhelm
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Cambridge, Massachusetts, USA
| | - Michael Van Ameringen
- Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario, Canada
| | - Bernardo Dell’Osso
- Department of Biomedical and Clinical Sciences Luigi Sacco, University of Milan, Luigi Sacco Hospital, Milan, Italy
| | - Jose M. Menchon
- Department of Psychiatry, Bellvitge University Hospital-IDIBELL, University of Barcelona, Cibersam, Barcelona, Spain
| | - Naomi A. Fineberg
- Department of Clinical and Pharmaceutical Sciences, University of Hertfordshire and Hertfordshire Partnership University NHS Foundation Trust, Hatfield, UK
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20
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Fernández de la Cruz L, Enander J, Rück C, Wilhelm S, Phillips KA, Steketee G, Sarvode Mothi S, Krebs G, Bowyer L, Monzani B, Veale D, Mataix-Cols D. Empirically defining treatment response and remission in body dysmorphic disorder. Psychol Med 2021; 51:83-89. [PMID: 31662124 PMCID: PMC7190405 DOI: 10.1017/s0033291719003003] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 09/02/2019] [Accepted: 10/01/2019] [Indexed: 11/06/2022]
Abstract
BACKGROUND The number of clinical trials in body dysmorphic disorder (BDD) has steadily increased in recent years. As the number of studies grows, it is important to define the most empirically useful definitions for response and remission in order to enhance field-wide consistency and comparisons of treatment outcomes across studies. In this study, we aim to operationally define treatment response and remission in BDD. METHOD We pooled data from three randomized controlled trials of cognitive-behavior therapy (CBT) for BDD (combined n = 153) conducted at four academic sites in Sweden, the USA, and England. Using signal detection methods, we examined the Yale-Brown Obsessive Compulsive Scale modified for BDD (BDD-YBOCS) score that most reliably identified patients who responded to CBT and those who achieved remission from BDD symptoms at the end of treatment. RESULTS A BDD-YBOCS reduction ⩾30% was most predictive of treatment response as defined by the Clinical Global Impression (CGI) - Improvement scale (sensitivity 0.89, specificity 0.91, 91% correctly classified). At post-treatment, a BDD-YBOCS score ⩽16 was the best predictor of full or partial symptom remission (sensitivity 0.85, specificity 0.99, 97% correctly classified), defined by the CGI - Severity scale. CONCLUSION Based on these results, we propose conceptual and operational definitions of response and full or partial remission in BDD. A consensus regarding these constructs will improve the interpretation and comparison of future clinical trials, as well as improve communication among researchers, clinicians, and patients. Further research is needed, especially regarding definitions of full remission, recovery, and relapse.
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Affiliation(s)
- Lorena Fernández de la Cruz
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Jesper Enander
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
| | - Christian Rück
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
| | - Sabine Wilhelm
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Katharine A. Phillips
- New York-Presbyterian Hospital and Weill Cornell Medical College, New York, NY, USA
- Rhode Island Hospital and the Alpert Medical School of Brown University, Providence, RI, USA
| | - Gail Steketee
- Boston University, School of Social Work, Boston, MA, USA
| | | | - Georgina Krebs
- The National and Specialist OCD, BDD and Related Disorders Team, Child and Adolescent Mental Health Services, South London and Maudsley NHS Foundation Trust, London, UK
- MRC Social, Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Laura Bowyer
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Benedetta Monzani
- The National and Specialist OCD, BDD and Related Disorders Team, Child and Adolescent Mental Health Services, South London and Maudsley NHS Foundation Trust, London, UK
| | - David Veale
- Department of Psychology, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Centre for Anxiety Disorders and Trauma, South London and Maudsley NHS Foundation Trust, London, UK
| | - David Mataix-Cols
- Department of Clinical Neuroscience, Centre for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden
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Fang A, Steketee G, Keshaviah A, Didie E, Phillips KA, Wilhelm S. Mechanisms of Change in Cognitive Behavioral Therapy for Body Dysmorphic Disorder. Cognit Ther Res 2020; 44:596-610. [PMID: 38031584 PMCID: PMC10686577 DOI: 10.1007/s10608-020-10080-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Although cognitive-behavioral therapy (CBT) is highly efficacious for body dysmorphic disorder (BDD), not all patients benefit, and mechanisms underlying response remain unknown. In this first report of the mechanisms underlying improvement with CBT for BDD, we examined whether cognitive (maladaptive beliefs, perfectionism, schemas) and behavioral (checking, grooming, avoidance behaviors) changes mediate the effect of CBT on BDD symptom reduction. Forty-five participants with BDD who enrolled in a CBT for BDD treatment development study were included in two sets of analyses: (1) between-subject mediation of the effect of 12 weeks of CBT versus waitlist, and (2) within-subject mediation of longitudinal change in BDD symptom severity during 24 weeks of CBT. No significant mediators emerged in the between-subject analysis. Checking, grooming, avoidance behaviors, and maladaptive beliefs mediated within-subject improvements over time. Findings suggest that BDD symptom reduction occurs through the very mechanisms that have been hypothesized to maintain BDD in CBT models. Targeting certain cognitive (beliefs about appearance) and behavioral (checking, grooming, and avoidance behaviors) mechanisms in future treatment trials may enhance symptom improvement during CBT. National Clinical Trials Registration Identifier # NCT00106223.
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Affiliation(s)
- Angela Fang
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Gail Steketee
- School of Social Work, Boston University, Boston, MA, USA
| | | | - Elizabeth Didie
- Butler Hospital and Alpert Medical School of Brown University, Providence, RI, USA
| | - Katharine A. Phillips
- Butler Hospital and Alpert Medical School of Brown University, Providence, RI, USA
- New York-Presbyterian Hospital and Weill Cornell Medical College, New York, NY, USA
| | - Sabine Wilhelm
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Simches Research Building, 185 Cambridge Street, Suite 2000, Boston, MA 02114, USA
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22
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Sofko C, Tremont G, Tan JE, Westervelt H, Ahern DC, Menard W, Phillips KA. Olfactory and Neuropsychological Functioning in Olfactory Reference Syndrome. Psychosomatics 2020; 61:261-267. [PMID: 32107040 PMCID: PMC7211111 DOI: 10.1016/j.psym.2019.12.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 12/20/2019] [Accepted: 12/23/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Olfactory reference syndrome (ORS) is an underrecognized, understudied, and often severe psychiatric disorder characterized by a prominent and distressing or impairing preoccupation with a false belief of emitting an offensive body odor. As this condition has only recently been recognized in the International Classification of Diseases (the 11th Edition), no empirical evidence exists about the underlying features and etiology of the disorder. OBJECTIVE To examine the neuropsychological and olfactory functioning of individuals with ORS and address whether there is central nervous system or sensory dysfunction associated with the condition. METHODS In this preliminary investigation, 9 consecutive participants with ORS completed a structured clinical interview and neuropsychological and olfaction evaluations. RESULTS A proportion of individuals with ORS displayed deficits in aspects of cognitive functioning (i.e., processing speed, executive functioning, recognition memory bias for ORS-related words), olfaction functioning (i.e., odor detection and discrimination), and emotional processing. CONCLUSIONS Based on these preliminary findings of cognitive, olfaction, and emotional processing deficits in individuals with ORS, further neuropsychological and olfaction studies are needed that better characterize this understudied patient group and address this study's limitations.
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Affiliation(s)
- Channing Sofko
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI; Department of Psychiatry, Rhode Island Hospital, Providence, RI; Department of Psychiatry, The Miriam Hospital, Providence, RI; Division of Mental Health and Behavioral Sciences, Bay Pines Veterans Affairs Health Care System, Bay Pines, Florida.
| | - Geoffrey Tremont
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI; Department of Psychiatry, Rhode Island Hospital, Providence, RI
| | - Jing Ee Tan
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI; Department of Psychiatry, Rhode Island Hospital, Providence, RI; Division of Neurology, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Holly Westervelt
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI; Department of Psychiatry, Rhode Island Hospital, Providence, RI; Department of Neurology, Vanderbilt University Medical Center, Nashville, TN
| | - David C Ahern
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI; Department of Psychiatry, The Miriam Hospital, Providence, RI
| | - William Menard
- Department of Psychiatry, Rhode Island Hospital, Providence, RI; Department of Neurology, Butler Hospital, Providence, RI
| | - Katharine A Phillips
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI; Department of Psychiatry, Rhode Island Hospital, Providence, RI; Department of Psychiatry, Weill Cornell Medical College, New York, NY; Department of Psychiatry, New York-Presbyterian Hospital, New York, NY
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23
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Wilhelm S, Phillips KA, Greenberg JL, O’Keefe SM, Hoeppner SS, Keshaviah A, Sarvode-Mothi S, Schoenfeld DA. Efficacy and Posttreatment Effects of Therapist-Delivered Cognitive Behavioral Therapy vs Supportive Psychotherapy for Adults With Body Dysmorphic Disorder: A Randomized Clinical Trial. JAMA Psychiatry 2019; 76:363-373. [PMID: 30785624 PMCID: PMC6450292 DOI: 10.1001/jamapsychiatry.2018.4156] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Cognitive behavioral therapy (CBT), the best-studied treatment for body dysmorphic disorder (BDD), has to date not been compared with therapist-delivered supportive psychotherapy, the most commonly received psychosocial treatment for BDD. OBJECTIVE To determine whether CBT for BDD (CBT-BDD) is superior to supportive psychotherapy in reducing BDD symptom severity and associated BDD-related insight, depressive symptoms, functional impairment, and quality of life, and whether these effects are durable. DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial conducted at Massachusetts General Hospital and Rhode Island Hospital recruited adults with BDD between October 24, 2011, and July 7, 2016. Participants (n = 120) were randomized to the CBT-BDD arm (n = 61) or the supportive psychotherapy arm (n = 59). Weekly treatments were administered at either hospital for 24 weeks, followed by 3- and 6-month follow-up assessments. Measures were administered by blinded independent raters. Intention-to-treat statistical analyses were performed from February 9, 2017, to September 22, 2018. INTERVENTIONS Cognitive behavioral therapy for BDD, a modular skills-based treatment, addresses the unique symptoms of the disorder. Supportive psychotherapy is a nondirective therapy that emphasizes the therapeutic relationship and self-esteem; supportive psychotherapy was enhanced with BDD-specific psychoeducation and treatment rationale. MAIN OUTCOMES AND MEASURES The primary outcome was BDD symptom severity measured by the change in score on the Yale-Brown Obsessive-Compulsive Scale Modified for BDD from baseline to end of treatment. Secondary outcomes were the associated symptoms and these were assessed using the Brown Assessment of Beliefs Scale, Beck Depression Inventory-Second Edition, Sheehan Disability Scale, and Quality of Life Enjoyment and Satisfaction Questionnaire-Short Form. RESULTS Of the 120 participants, 92 (76.7%) were women, with a mean (SD) age of 34.0 (13.1) years. The difference in effectiveness between CBT-BDD and supportive psychotherapy was site specific: at 1 site, no difference was detected (estimated mean [SE] slopes, -18.6 [1.9] vs -16.7 [1.9]; P = .48; d growth-modeling analysis change, -0.25), whereas at the other site, CBT-BDD led to greater reductions in BDD symptom severity, compared with supportive psychotherapy (estimated mean [SE] slopes, -18.6 [2.2] vs -7.6 [2.0]; P < .001; d growth-modeling analysis change, -1.36). No posttreatment symptom changes were observed throughout the 6 -months of follow-up (all slope P ≥ .10). CONCLUSIONS AND RELEVANCE Body dysmorphic disorder severity and associated symptoms appeared to improve with both CBT-BDD and supportive psychotherapy, although CBT-BDD was associated with more consistent improvement in symptom severity and quality of life. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT01453439.
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Affiliation(s)
- Sabine Wilhelm
- Department of Psychiatry, Massachusetts General Hospital, Boston,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Katharine A. Phillips
- Department of Psychiatry, Rhode Island Hospital, Providence,Department of Psychiatry, New York-Presbyterian Hospital, New York,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, Rhode Island,Department of Psychiatry, Weill Cornell Medical College, New York, New York
| | - Jennifer L. Greenberg
- Department of Psychiatry, Massachusetts General Hospital, Boston,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Sheila M. O’Keefe
- Department of Psychiatry, Massachusetts General Hospital, Boston,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | - Susanne S. Hoeppner
- Department of Psychiatry, Massachusetts General Hospital, Boston,Department of Psychiatry, Harvard Medical School, Boston, Massachusetts
| | | | | | - David A. Schoenfeld
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts,Department of Biostatistics, Massachusetts General Hospital, Boston
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24
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Phillips KA, Citrome L. Inaccurate Prescribing Warnings in Electronic Medical Record Systems: Results From an American Society of Clinical Psychopharmacology Membership Survey. J Clin Psychiatry 2018; 80. [PMID: 30549488 DOI: 10.4088/jcp.18ac12536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Katharine A Phillips
- Weill Cornell Psychiatry Specialty Center, 315 E 62nd St, New York, NY 10065. .,New York-Presbyterian Hospital and Weill Cornell Medical College, New York, New York, USA.,Rhode Island Hospital and Alpert Medical School of Brown University, Providence, Rhode Island, USA
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25
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Keogh LA, Steel E, Weideman P, Butow P, Collins IM, Emery JD, Mann GB, Bickerstaffe A, Trainer AH, Hopper LJ, Phillips KA. Consumer and clinician perspectives on personalising breast cancer prevention information. Breast 2018; 43:39-47. [PMID: 30445378 DOI: 10.1016/j.breast.2018.11.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 10/23/2018] [Accepted: 11/03/2018] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Personalised prevention of breast cancer has focused on women at very high risk, yet most breast cancers occur in women at average, or moderately increased risk (≤moderate risk). OBJECTIVES To determine; 1) interest of women at ≤ moderate risk (consumers) in personalised information about breast cancer risk; 2) familial cancer clinicians' (FCCs) perspective on managing women at ≤ moderate risk, and; 3) both consumers' and FCCs reactions to iPrevent, a personalised breast cancer risk assessment and risk management decision support tool. METHODS Seven focus groups on breast cancer risk were conducted with 49 participants; 27 consumers and 22 FCCs. Data were analysed thematically. RESULTS Consumers reported some misconceptions, low trust in primary care practitioners for breast cancer prevention advice and frustration that they often lacked tailored advice about breast cancer risk. They expressed interest in receiving personalised risk information using iPrevent. FCCs reported an inadequate workforce to advise women at ≤ moderate risk and reacted positively to the potential of iPrevent to assist. CONCLUSIONS While highlighting a potential role for iPrevent, several outstanding issues remain. For personalised prevention of breast cancer to extend beyond women at high risk, we must harness women's interest in receiving tailored information about breast cancer prevention and identify a workforce willing to advise women.
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Affiliation(s)
- L A Keogh
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Australia.
| | - E Steel
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Australia
| | - P Weideman
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Australia
| | - P Butow
- Centre for Medical Psychology and Evidence-based Decision-Making (CeMPED) and the Psycho-Oncology Cooperative Research Group (PoCoG), The University of Sydney, Sydney, Australia
| | - I M Collins
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; The Greater Green Triangle Clinical School, Deakin University School of Medicine, Warrnambool, Australia
| | - J D Emery
- Department of General Practice, The University of Melbourne, Melbourne, Australia
| | - G B Mann
- The Breast Service, Royal Melbourne and Royal Women's Hospital, Melbourne, Australia; Department of Surgery, The University of Melbourne, Melbourne, Australia
| | - A Bickerstaffe
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Australia
| | - A H Trainer
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; Department of Medicine, The University of Melbourne, Melbourne, Australia
| | - L J Hopper
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Australia
| | - K A Phillips
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
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Ager B, Jansen J, Porter D, Phillips KA, Glassey R, Butow P. Development and pilot testing of a Decision Aid (DA) for women with early-stage breast cancer considering contralateral prophylactic mastectomy. Breast 2018; 40:156-164. [PMID: 29857282 DOI: 10.1016/j.breast.2018.05.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2018] [Revised: 04/23/2018] [Accepted: 05/18/2018] [Indexed: 01/11/2023] Open
Abstract
OBJECTIVE Describe the development, acceptability and feasibility of a Decision Aid (DA) for women with early-stage breast cancer (BC) at average contralateral breast cancer (CBC) risk considering contralateral prophylactic mastectomy (CPM). METHODS The DA was developed using the International Patient Decision Aid Standards (IPDAS) and the Ottawa Decision Support Framework. It provides evidence-based information about CPM in a booklet format combining text, graphs and images of surgical options. Twenty-three women with a history of early-stage breast cancer were interviewed in person or over the phone using a 'think aloud approach'. Framework analysis was used to code and analyse data. RESULTS Twenty-three women participated in the study. Mean age of participants was 58.6 years and time since diagnosis ranged from 14 months to 21 years. Five women had CPM and eighteen had not. Women strongly endorsed the DA. Many felt validated by a section on appearance and found information on average risk of recurrence and metastases helpful, however, noted the importance of discussing personal risk with their surgeon. Many requested more information on surgery details (time taken, recovery) and costs of the different options. CONCLUSION The DA was acceptable to women, including the format, content and proposed implementation strategies. Practical and financial issues are important to women in considering treatment options. PRACTICE IMPLICATIONS Women appreciate information about CPM at diagnosis and emphasised the importance of discussing potential downsides of the procedure in addition to benefits. The DA was considered acceptable to facilitate such discussions.
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Affiliation(s)
- B Ager
- School of Psychology, The University of Sydney, Australia
| | - J Jansen
- Sydney Medical School, The University of Sydney, Australia; Psycho-Oncology Co-Operative Research Group (PoCoG), The University of Sydney, Australia
| | - D Porter
- Department of Medical Oncology, Auckland Hospital, Auckland, New Zealand; Faculty of Medical and Health Sciences, The University of Auckland, New Zealand
| | - K A Phillips
- Division of Cancer Medicine, Peter MacCallum Cancer Centre, Victoria, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Victoria, Australia
| | - R Glassey
- Medical School, The University of Western Australia, Perth, Australia
| | | | - P Butow
- Psycho-Oncology Co-Operative Research Group (PoCoG), The University of Sydney, Australia; Centre for Medical Psychology and Evidence Based Decision-Making, The University of Sydney, Australia.
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Zeinomar N, Phillips KA, Liao Y, MacInnis RJ, Dite GS, Daly MB, John EM, Andrulis IL, Buys SS, Hopper JL, Terry MB. Abstract P6-09-04: Benign breast disease and breast cancer risk across the spectrum of familial risk using a prospective family study cohort (ProF-SC). Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p6-09-04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Benign breast disease (BBD) is one of the strongest risk factors for breast cancer but it is unclear whether the strength of the association with BBD and breast cancers varies by breast cancer family history. Few studies of BBD enrich specifically for putative genetic factors by over-sampling based on family history let alone evaluate potential interactions with measures of underlying familial risk. The aim of this study was to evaluate how risk associated with BBD is modified by underlying familial risk so as to guide clinical management and risk assessment of women with BBD.
Methods: Using a prospective family study cohort of 17,154 women unaffected with breast cancer at baseline and followed by questionnaire at regular intervals, we examined the association between BBD and breast cancer risk using Cox Proportional Hazards models. We classified women as having BBD if they reported at baseline having been told by a doctor that they had BBD, such as a non-cancerous cyst or breast lump. We did not have information on histologic sub-type. We confirmed self-reported diagnosis of BBD with pathology reports in a subset of the New York cohort and found high agreement between self-reported and pathologically confirmed BBD (93.5%). We assessed multiplicative and additive interactions with underlying familial risk profile (FRP) defined as either fixed-time horizon of 1-year, or total lifetime risk, estimated from the Breast Ovarian Analysis of Disease Incidence and Carrier Estimation Algorithm (BOADICEA) model.
Results: During 176,756 person-years of follow-up (mean 10.2, maximum 23.7 years), we observed 968 incident breast cancers cases with an average age at diagnosis of 55.8 years and average age at enrollment into the cohort of 46.8 years. At baseline, 4,704 (27%) women reported having a previous diagnosis of BBD. Compared to women with no history of BBD, breast cancer risk was increased in women of all ages (HR: 1.37, 95% CI: 1.19,1.56), and in women up to age 45 years (using attained age models) (HR: 1.40, 95% CI: 1.01,1.93). In terms of recency of BBD, we found that the increased risk associated with BBD remained 21 years or more after the initial BBD diagnosis (HR: 1.37, 95% CI: 1.11, 1.68). We found no evidence for multiplicative interactions with FRP, which implies that the increase in absolute risk associated with BBD depends on a woman's FRP (Table 1).
Conclusions: Women with a history of BBD have an increased risk of breast cancer that multiplies their underlying familial risk (FRP). These results could prove to be valuable for risk counseling and clinical management.
Table 1: Cumulative Incidence of Breast Cancer to age 45, 55, and 65 by BBD and underlying FRP as measured by 10-year BOADICEA score.AgeNo BBD, <3.4 %BBD, <3.4%No BBD, ≥3.4%BBD, ≥3.4%454.6 (3.8, 5.6)6.1(4.7, 8.0)12.1 (10.2, 14.5)16.1 (13.1, 19.7)557.4 (6.3, 8.7)9.8 (7.5, 12.8)19.1 (16.6, 22.0)25.0 (21.7, 28.9)659.7 (8.2, 11.5)12.8 (9.9, 16.5)24.5 (21.8, 27.6)31.8 (28.3, 35.7)
Citation Format: Zeinomar N, Phillips KA, Liao Y, MacInnis RJ, Dite GS, Daly MB, John EM, Andrulis IL, Buys SS, Hopper JL, Terry MB. Benign breast disease and breast cancer risk across the spectrum of familial risk using a prospective family study cohort (ProF-SC) [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-09-04.
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Affiliation(s)
- N Zeinomar
- Columbia University Mailman School of Public Health, New York, NY; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY; The University of Melbourne, Melbourne, Australia; School of Population and Global Health, The University of Melbourne, Melbourne, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia; Fox Chase Cancer Center, Philadelphia, PA; Cancer Prevention Institute of California, Fremont, CA; Stanford University School of Medicine, Stanford, CA; Lunenfeld-Tanenbaum Research Institute, University of Toronto, Toronto, ON, Canada; Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT
| | - KA Phillips
- Columbia University Mailman School of Public Health, New York, NY; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY; The University of Melbourne, Melbourne, Australia; School of Population and Global Health, The University of Melbourne, Melbourne, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia; Fox Chase Cancer Center, Philadelphia, PA; Cancer Prevention Institute of California, Fremont, CA; Stanford University School of Medicine, Stanford, CA; Lunenfeld-Tanenbaum Research Institute, University of Toronto, Toronto, ON, Canada; Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT
| | - Y Liao
- Columbia University Mailman School of Public Health, New York, NY; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY; The University of Melbourne, Melbourne, Australia; School of Population and Global Health, The University of Melbourne, Melbourne, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia; Fox Chase Cancer Center, Philadelphia, PA; Cancer Prevention Institute of California, Fremont, CA; Stanford University School of Medicine, Stanford, CA; Lunenfeld-Tanenbaum Research Institute, University of Toronto, Toronto, ON, Canada; Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT
| | - RJ MacInnis
- Columbia University Mailman School of Public Health, New York, NY; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY; The University of Melbourne, Melbourne, Australia; School of Population and Global Health, The University of Melbourne, Melbourne, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia; Fox Chase Cancer Center, Philadelphia, PA; Cancer Prevention Institute of California, Fremont, CA; Stanford University School of Medicine, Stanford, CA; Lunenfeld-Tanenbaum Research Institute, University of Toronto, Toronto, ON, Canada; Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT
| | - GS Dite
- Columbia University Mailman School of Public Health, New York, NY; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY; The University of Melbourne, Melbourne, Australia; School of Population and Global Health, The University of Melbourne, Melbourne, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia; Fox Chase Cancer Center, Philadelphia, PA; Cancer Prevention Institute of California, Fremont, CA; Stanford University School of Medicine, Stanford, CA; Lunenfeld-Tanenbaum Research Institute, University of Toronto, Toronto, ON, Canada; Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT
| | - MB Daly
- Columbia University Mailman School of Public Health, New York, NY; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY; The University of Melbourne, Melbourne, Australia; School of Population and Global Health, The University of Melbourne, Melbourne, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia; Fox Chase Cancer Center, Philadelphia, PA; Cancer Prevention Institute of California, Fremont, CA; Stanford University School of Medicine, Stanford, CA; Lunenfeld-Tanenbaum Research Institute, University of Toronto, Toronto, ON, Canada; Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT
| | - EM John
- Columbia University Mailman School of Public Health, New York, NY; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY; The University of Melbourne, Melbourne, Australia; School of Population and Global Health, The University of Melbourne, Melbourne, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia; Fox Chase Cancer Center, Philadelphia, PA; Cancer Prevention Institute of California, Fremont, CA; Stanford University School of Medicine, Stanford, CA; Lunenfeld-Tanenbaum Research Institute, University of Toronto, Toronto, ON, Canada; Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT
| | - IL Andrulis
- Columbia University Mailman School of Public Health, New York, NY; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY; The University of Melbourne, Melbourne, Australia; School of Population and Global Health, The University of Melbourne, Melbourne, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia; Fox Chase Cancer Center, Philadelphia, PA; Cancer Prevention Institute of California, Fremont, CA; Stanford University School of Medicine, Stanford, CA; Lunenfeld-Tanenbaum Research Institute, University of Toronto, Toronto, ON, Canada; Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT
| | - SS Buys
- Columbia University Mailman School of Public Health, New York, NY; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY; The University of Melbourne, Melbourne, Australia; School of Population and Global Health, The University of Melbourne, Melbourne, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia; Fox Chase Cancer Center, Philadelphia, PA; Cancer Prevention Institute of California, Fremont, CA; Stanford University School of Medicine, Stanford, CA; Lunenfeld-Tanenbaum Research Institute, University of Toronto, Toronto, ON, Canada; Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT
| | - JL Hopper
- Columbia University Mailman School of Public Health, New York, NY; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY; The University of Melbourne, Melbourne, Australia; School of Population and Global Health, The University of Melbourne, Melbourne, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia; Fox Chase Cancer Center, Philadelphia, PA; Cancer Prevention Institute of California, Fremont, CA; Stanford University School of Medicine, Stanford, CA; Lunenfeld-Tanenbaum Research Institute, University of Toronto, Toronto, ON, Canada; Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT
| | - MB Terry
- Columbia University Mailman School of Public Health, New York, NY; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY; The University of Melbourne, Melbourne, Australia; School of Population and Global Health, The University of Melbourne, Melbourne, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia; Fox Chase Cancer Center, Philadelphia, PA; Cancer Prevention Institute of California, Fremont, CA; Stanford University School of Medicine, Stanford, CA; Lunenfeld-Tanenbaum Research Institute, University of Toronto, Toronto, ON, Canada; Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT
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Terry MB, Phillips KA, Daly MB, Andrulis IL, Liao Y, Ma X, Zeinomar N, MacInnis RJ, Dite GS, John EM, Buys SS, Hopper JL. Abstract P6-09-01: Risk-reducing oophorectomy and breast cancer risk across the spectrum of familial risk using a prospective family study cohort (ProF-SC). Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p6-09-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Whether risk-reducing salpingo oophorectomy (RRSO) reduces breast cancer risk in addition to reducing ovarian cancer risk is controversial with some arguing that the previous evidence of a reduction in breast cancer risk from RRSO was due to bias. Evidence from independent prospective cohorts of high-risk women is needed to resolve this controversy.
Methods: Using a prospective family study cohort of 17,810 women unaffected with breast cancer at baseline, we examined the association between RRSO and breast cancer risk using Cox Proportional Hazards models. We compared results estimating RRSO as a non-time-dependent variable to results treating RRSO as a time-dependent variable, because failing to account for the time-varying nature of a covariate person- time prior to RRSO, should it exist, will incorrectly attribute the cancer-free person-time to RRSO. We separately examined the association with RRSO in BRCA1 and BRCA2 mutation carriers and non-carriers, and further performed gene-stratified analyses in women with BRCA1 and BRCA2 only. We also assessed multiplicative interactions with underlying familial risk profile (FRP), defined as total lifetime risk estimated from the Breast Ovarian Analysis of Disease Incidence and Carrier Estimation Algorithm (BOADICEA) model.
Results: During a median 10.7 years of follow-up (maximum 23.7 years), we observed 1,040 incident cases of breast cancer with an average age at diagnosis of 55.8 years and average age at enrollment into the cohort of 46.8 years. A total of 2434 (14%) women reported at baseline having a RRSO. We observed decreased risk of breast cancer associated with RRSO for both BRCA1(N= 650) and BRCA2(N=557) mutation carriers when RRSO was treated as a fixed covariate (HR= 0.60, 95% CI=0.40-0.92 and HR= 0.40, 95%CI = 0.23-0.69, respectively). In contrast, when we treated RRSO as a time-varying covariate, for both BRCA1 and BRCA2 carriers, we no longer observed a decreased risk for BRCA1 and BRCA2 carriers (HR= 1.67, 95% CI=1.05-2.67 and HR= 0.97, 95%CI = 0.53-1.80, respectively). There was no association between RRSO and breast cancer risk for non-carriers (N=16,603), whether we treated RRSO as a fixed or time varying covariate (HR= 0.88, 95% CI=0.72-1.08 and HR= 1.06, 95%CI = 0.85-1.30, respectively).
Conclusions: Our findings provide an independent replication that the reduced risk of breast cancer previously observed in BRCA1 and BRCA2 mutation carrier women may be from bias in counting person-time. Clinical management of high-risk women should counsel based on the reduced risk of ovarian cancer from RRSO, but not breast cancer.
Citation Format: Terry MB, Phillips KA, Daly MB, Andrulis IL, Liao Y, Ma X, Zeinomar N, MacInnis RJ, Dite GS, John EM, Buys SS, Hopper JL. Risk-reducing oophorectomy and breast cancer risk across the spectrum of familial risk using a prospective family study cohort (ProF-SC) [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-09-01.
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Affiliation(s)
- MB Terry
- Columbia University Mailman School of Public Health, New York, NY; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY; The University of Melbourne, Melbourne, Australia; School of Population and Global Health, The University of Melbourne, Melbourne, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia; Fox Chase Cancer Center, Philadelphia, PA; Cancer Prevention Institute of California, Fremont, CA; Stanford University School of Medicine, Stanford, CA; Lunenfeld-Tanenbaum Research Institute, University of Toronto, Toronto, ON, Canada; Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT
| | - KA Phillips
- Columbia University Mailman School of Public Health, New York, NY; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY; The University of Melbourne, Melbourne, Australia; School of Population and Global Health, The University of Melbourne, Melbourne, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia; Fox Chase Cancer Center, Philadelphia, PA; Cancer Prevention Institute of California, Fremont, CA; Stanford University School of Medicine, Stanford, CA; Lunenfeld-Tanenbaum Research Institute, University of Toronto, Toronto, ON, Canada; Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT
| | - MB Daly
- Columbia University Mailman School of Public Health, New York, NY; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY; The University of Melbourne, Melbourne, Australia; School of Population and Global Health, The University of Melbourne, Melbourne, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia; Fox Chase Cancer Center, Philadelphia, PA; Cancer Prevention Institute of California, Fremont, CA; Stanford University School of Medicine, Stanford, CA; Lunenfeld-Tanenbaum Research Institute, University of Toronto, Toronto, ON, Canada; Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT
| | - IL Andrulis
- Columbia University Mailman School of Public Health, New York, NY; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY; The University of Melbourne, Melbourne, Australia; School of Population and Global Health, The University of Melbourne, Melbourne, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia; Fox Chase Cancer Center, Philadelphia, PA; Cancer Prevention Institute of California, Fremont, CA; Stanford University School of Medicine, Stanford, CA; Lunenfeld-Tanenbaum Research Institute, University of Toronto, Toronto, ON, Canada; Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT
| | - Y Liao
- Columbia University Mailman School of Public Health, New York, NY; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY; The University of Melbourne, Melbourne, Australia; School of Population and Global Health, The University of Melbourne, Melbourne, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia; Fox Chase Cancer Center, Philadelphia, PA; Cancer Prevention Institute of California, Fremont, CA; Stanford University School of Medicine, Stanford, CA; Lunenfeld-Tanenbaum Research Institute, University of Toronto, Toronto, ON, Canada; Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT
| | - X Ma
- Columbia University Mailman School of Public Health, New York, NY; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY; The University of Melbourne, Melbourne, Australia; School of Population and Global Health, The University of Melbourne, Melbourne, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia; Fox Chase Cancer Center, Philadelphia, PA; Cancer Prevention Institute of California, Fremont, CA; Stanford University School of Medicine, Stanford, CA; Lunenfeld-Tanenbaum Research Institute, University of Toronto, Toronto, ON, Canada; Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT
| | - N Zeinomar
- Columbia University Mailman School of Public Health, New York, NY; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY; The University of Melbourne, Melbourne, Australia; School of Population and Global Health, The University of Melbourne, Melbourne, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia; Fox Chase Cancer Center, Philadelphia, PA; Cancer Prevention Institute of California, Fremont, CA; Stanford University School of Medicine, Stanford, CA; Lunenfeld-Tanenbaum Research Institute, University of Toronto, Toronto, ON, Canada; Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT
| | - RJ MacInnis
- Columbia University Mailman School of Public Health, New York, NY; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY; The University of Melbourne, Melbourne, Australia; School of Population and Global Health, The University of Melbourne, Melbourne, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia; Fox Chase Cancer Center, Philadelphia, PA; Cancer Prevention Institute of California, Fremont, CA; Stanford University School of Medicine, Stanford, CA; Lunenfeld-Tanenbaum Research Institute, University of Toronto, Toronto, ON, Canada; Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT
| | - GS Dite
- Columbia University Mailman School of Public Health, New York, NY; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY; The University of Melbourne, Melbourne, Australia; School of Population and Global Health, The University of Melbourne, Melbourne, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia; Fox Chase Cancer Center, Philadelphia, PA; Cancer Prevention Institute of California, Fremont, CA; Stanford University School of Medicine, Stanford, CA; Lunenfeld-Tanenbaum Research Institute, University of Toronto, Toronto, ON, Canada; Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT
| | - EM John
- Columbia University Mailman School of Public Health, New York, NY; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY; The University of Melbourne, Melbourne, Australia; School of Population and Global Health, The University of Melbourne, Melbourne, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia; Fox Chase Cancer Center, Philadelphia, PA; Cancer Prevention Institute of California, Fremont, CA; Stanford University School of Medicine, Stanford, CA; Lunenfeld-Tanenbaum Research Institute, University of Toronto, Toronto, ON, Canada; Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT
| | - SS Buys
- Columbia University Mailman School of Public Health, New York, NY; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY; The University of Melbourne, Melbourne, Australia; School of Population and Global Health, The University of Melbourne, Melbourne, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia; Fox Chase Cancer Center, Philadelphia, PA; Cancer Prevention Institute of California, Fremont, CA; Stanford University School of Medicine, Stanford, CA; Lunenfeld-Tanenbaum Research Institute, University of Toronto, Toronto, ON, Canada; Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT
| | - JL Hopper
- Columbia University Mailman School of Public Health, New York, NY; Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY; The University of Melbourne, Melbourne, Australia; School of Population and Global Health, The University of Melbourne, Melbourne, Australia; Peter MacCallum Cancer Centre, Melbourne, Australia; Fox Chase Cancer Center, Philadelphia, PA; Cancer Prevention Institute of California, Fremont, CA; Stanford University School of Medicine, Stanford, CA; Lunenfeld-Tanenbaum Research Institute, University of Toronto, Toronto, ON, Canada; Huntsman Cancer Institute, University of Utah School of Medicine, Salt Lake City, UT
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Phillips KA, Trosman JR, Weldon CB, Douglas MP. New Medicare Coverage Policy for Next-Generation Tumor Sequencing: A Key Shift in Coverage Criteria With Broad Implications Beyond Medicare. JCO Precis Oncol 2018; 2. [PMID: 31073549 DOI: 10.1200/po.18.00206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Affiliation(s)
- K A Phillips
- University of California at San Francisco, Department of Clinical Pharmacy.,Center for Translational and Policy Research on Personalized Medicine (TRANSPERS).,UCSF Philip R. Lee Institute for Health Policy.,UCSF Helen Diller Family Comprehensive Cancer Center
| | - J R Trosman
- University of California at San Francisco, Department of Clinical Pharmacy.,Center for Translational and Policy Research on Personalized Medicine (TRANSPERS).,Center for Business Models in Healthcare
| | - C B Weldon
- Center for Translational and Policy Research on Personalized Medicine (TRANSPERS).,Center for Business Models in Healthcare
| | - M P Douglas
- University of California at San Francisco, Department of Clinical Pharmacy.,Center for Translational and Policy Research on Personalized Medicine (TRANSPERS)
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Phillips KA. New Insights on the Treatment of Hypochondriasis. Am J Psychiatry 2017; 174:719-720. [PMID: 28760014 DOI: 10.1176/appi.ajp.2017.17050515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Katharine A Phillips
- From Rhode Island Hospital and Warren Alpert Medical School of Brown University, Providence, R.I
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Phillips KA, Keshaviah A, Dougherty D, Stout RL, Menard W, Wilhelm S. Pharmacotherapy Relapse Prevention in Body Dysmorphic Disorder: A Double-Blind, Placebo-Controlled Trial. Am J Psychiatry 2016; 173:887-95. [PMID: 27056606 PMCID: PMC5009005 DOI: 10.1176/appi.ajp.2016.15091243] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Body dysmorphic disorder is common, distressing, and often severely impairing. Serotonin reuptake inhibitors appear efficacious, but the few existing pharmacotherapy studies were short term (≤4 months), and no relapse prevention studies or continuation phase studies have been conducted to the authors' knowledge. The authors report results from the first relapse prevention study in body dysmorphic disorder. METHOD Adults (N=100) with DSM-IV body dysmorphic disorder received open-label escitalopram for 14 weeks (phase 1); 58 responders were then randomized to double-blind continuation treatment with escitalopram versus switch to placebo for 6 months (phase 2). Reliable and valid outcome measures were utilized. RESULTS In phase 1, 67.0% of treated subjects and 81.1% of subjects who completed phase 1 responded to escitalopram. Body dysmorphic disorder severity (in both the intent-to-treat and the completer groups) and insight, depressive symptoms, psychosocial functioning, and quality of life significantly improved from baseline to end of phase 1. In phase 2, time to relapse was significantly longer with escitalopram than with placebo treatment (hazard ratio=2.72, 95% CI=1.01-8.57). Phase 2 relapse proportions were 18% for escitalopram and 40% for placebo. Among escitalopram-treated subjects, body dysmorphic disorder severity significantly decreased over time during the continuation phase, with 35.7% of subjects showing further improvement. There were no significant group differences in body dysmorphic disorder severity or insight, depressive symptoms, psychosocial functioning, or quality of life. CONCLUSIONS Continuation-phase escitalopram delayed time to relapse, and fewer escitalopram-treated subjects relapsed than did placebo-treated subjects. Body dysmorphic disorder severity significantly improved during 6 additional months of escitalopram treatment following acute response; more than one-third of escitalopram-treated subjects experienced further improvement.
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Affiliation(s)
- Katharine A. Phillips
- Rhode Island Hospital and Butler Hospital, Providence, RI,Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI
| | | | - Darin Dougherty
- Massachusetts General Hospital, Boston MA,Department of Psychiatry, Harvard Medical School, Boston MA
| | - Robert L. Stout
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI,Decision Sciences Institute, Pawtucket, RI
| | - William Menard
- Rhode Island Hospital and Butler Hospital, Providence, RI
| | - Sabine Wilhelm
- Massachusetts General Hospital, Boston MA,Department of Psychiatry, Harvard Medical School, Boston MA
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Affiliation(s)
- P Butow
- Centre for Medical Psychology and Evidence-Based Medicine (CeMPED) Psycho-Oncology Co-operative Research Group (PoCoG), University of Sydney, Sydney
| | - K A Phillips
- Division of Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne Sir Peter MacCallum Department of Oncology Centre for Molecular, Environmental, Genetic and Analytic Epidemiology, School of Population Health Department of Medicine, St Vincent's Hospital, The University of Melbourne, Melbourne, Australia
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Kelly MM, Zhang J, Phillips KA. The prevalence of body dysmorphic disorder and its clinical correlates in a VA primary care behavioral health clinic. Psychiatry Res 2015; 228:162-5. [PMID: 25935375 DOI: 10.1016/j.psychres.2015.04.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Revised: 02/08/2015] [Accepted: 04/05/2015] [Indexed: 11/28/2022]
Abstract
We examined the prevalence of body dysmorphic disorder (BDD) in a Veterans Affairs (VA) primary care behavioral health clinic. Of 100 Veterans, 11% (95% CI = 6.3-18.6%) had current BDD and 12% (95% CI = 7.0-19.8%) had lifetime BDD. However, only 8.3% of these Veterans had been diagnosed with BDD. BDD was significantly associated with a substantially elevated rate of suicide attempts, major depression, and obsessive-compulsive disorder. This severe disorder appears to be underdiagnosed in VA settings.
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Affiliation(s)
- Megan M Kelly
- Psychology Service, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA; Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA; Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA, USA.
| | - Jinxin Zhang
- Psychology Service, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, USA; Center for Psychological Studies, Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Katharine A Phillips
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA; Rhode Island Hospital, Providence, RI, USA
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Phillips KA. Body dysmorphic disorder: common, severe and in need of treatment research. Psychother Psychosom 2015; 83:325-9. [PMID: 25322928 DOI: 10.1159/000366035] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 07/19/2014] [Indexed: 11/19/2022]
Affiliation(s)
- Katharine A Phillips
- Rhode Island Hospital, and Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, R.I., USA
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Fineberg NA, Reghunandanan S, Simpson HB, Phillips KA, Richter MA, Matthews K, Stein DJ, Sareen J, Brown A, Sookman D. Obsessive-compulsive disorder (OCD): Practical strategies for pharmacological and somatic treatment in adults. Psychiatry Res 2015; 227:114-25. [PMID: 25681005 DOI: 10.1016/j.psychres.2014.12.003] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 11/26/2014] [Accepted: 12/04/2014] [Indexed: 12/18/2022]
Abstract
This narrative review gathers together a range of international experts to critically appraise the existing trial-based evidence relating to the efficacy and tolerability of pharmacotherapy for obsessive compulsive disorder in adults. We discuss the diagnostic evaluation and clinical characteristics followed by treatment options suitable for the clinician working from primary through to specialist psychiatric care. Robust data supports the effectiveness of treatment with selective serotonin reuptake inhibitors (SSRIs) and clomipramine in the short-term and the longer-term treatment and for relapse prevention. Owing to better tolerability, SSRIs are acknowledged as the first-line pharmacological treatment of choice. For those patients for whom first line treatments have been ineffective, evidence supports the use of adjunctive antipsychotic medication, and some evidence supports the use of high-dose SSRIs. Novel compounds are also the subject of active investigation. Neurosurgical treatments, including ablative lesion neurosurgery and deep brain stimulation, are reserved for severely symptomatic individuals who have not experienced sustained response to both pharmacological and cognitive behavior therapies.
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Affiliation(s)
- Naomi A Fineberg
- Highly Specialized Obsessive Compulsive and Related Disorders Service, Hertfordshire Partnership University NHS Foundation Trust, Rosanne House,Parkway ,Welwyn Garden City, Hertfordshire, AL8 6HG, UK; Postgraduate Medical School, University of Hertfordshire, College Lane, Hatfield, UK; University of Cambridge School of Clinical Medicine, Addenbrooke׳s Hospital, Box 189, Cambridge CB2 2QQ, UK.
| | - Samar Reghunandanan
- Highly Specialized Obsessive Compulsive and Related Disorders Service, Hertfordshire Partnership University NHS Foundation Trust, Rosanne House,Parkway ,Welwyn Garden City, Hertfordshire, AL8 6HG, UK
| | - Helen B Simpson
- College of Physicians and Surgeons at Columbia University, New York, NY, USA; Anxiety Disorders Clinic and the Centre for OCD and Related Disorders at the New York State Psychiatric Institute, New York, NY, USA
| | - Katharine A Phillips
- Rhode Island Hospital and the Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Margaret A Richter
- Frederick W. Thompson Anxiety Disorders Centre, Sunnybrook Health Sciences Centre and Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Keith Matthews
- Division of Neuroscience, Ninewells Hospital and Medical School, University of Dundee, Dundee DD1 9SY, UK
| | - Dan J Stein
- Department of Psychiatry, University of Cape Town, Cape Town, South Africa
| | - Jitender Sareen
- Departments of Psychiatry, Psychology and Community Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Angus Brown
- Highly Specialized Obsessive Compulsive and Related Disorders Service, Hertfordshire Partnership University NHS Foundation Trust, Rosanne House,Parkway ,Welwyn Garden City, Hertfordshire, AL8 6HG, UK
| | - Debbie Sookman
- Obsessive Compulsive Disorder Clinic, Department of Psychology, McGill University Health Centre, and Department of Psychiatry, McGill University, Montreal, PQ, Canada
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Crerand CE, Phillips KA. Reply to: ‘Patients with mild to moderate body dysmorphic disorder may benefit from rhinoplasty’. J Plast Reconstr Aesthet Surg 2014; 67:1754-5. [DOI: 10.1016/j.bjps.2014.06.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Accepted: 06/09/2014] [Indexed: 10/25/2022]
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Stein DJ, Craske MA, Friedman MJ, Phillips KA. Anxiety disorders, obsessive-compulsive and related disorders, trauma- and stressor-related disorders, and dissociative disorders in DSM-5. Am J Psychiatry 2014; 171:611-3. [PMID: 24880507 DOI: 10.1176/appi.ajp.2014.14010003] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Kelly MM, Didie ER, Phillips KA. Personal and appearance-based rejection sensitivity in body dysmorphic disorder. Body Image 2014; 11:260-5. [PMID: 24958661 PMCID: PMC4519841 DOI: 10.1016/j.bodyim.2014.03.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 03/03/2014] [Accepted: 03/13/2014] [Indexed: 10/25/2022]
Abstract
Although rejection sensitivity may be an important feature of body dysmorphic disorder (BDD), no studies have examined rejection sensitivity in a clinical sample and compared types of rejection sensitivity in individuals with BDD. Personal and appearance-based rejection sensitivity scores in forty-six patients diagnosed with BDD were compared with published norms. Associations between rejection sensitivity, BDD severity, and other clinical variables were examined. Personal and appearance-based rejection sensitivity scores were 0.6 and 1.1 standard deviation units above published norms, respectively. Greater personal rejection sensitivity was associated with more severe BDD and depressive symptoms, poorer mental health, general health, and physical and social functioning. Greater appearance-based rejection sensitivity was associated with more severe BDD and depressive symptoms, and poorer general health. Appearance-based rejection sensitivity contributed more unique variance to BDD severity than personal rejection sensitivity did; however, personal rejection sensitivity contributed more unique variance to general health than appearance-based rejection sensitivity did.
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Affiliation(s)
- Megan M. Kelly
- Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, University of Massachusetts Medical School, Alpert Medical School of Brown University
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Wilhelm S, Phillips KA, Didie E, Buhlmann U, Greenberg JL, Fama JM, Keshaviah A, Steketee G. Modular cognitive-behavioral therapy for body dysmorphic disorder: a randomized controlled trial. Behav Ther 2014; 45:314-27. [PMID: 24680228 PMCID: PMC4283214 DOI: 10.1016/j.beth.2013.12.007] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 11/13/2013] [Accepted: 12/20/2013] [Indexed: 11/17/2022]
Abstract
There are few effective treatments for body dysmorphic disorder (BDD) and a pressing need to develop such treatments. We examined the feasibility, acceptability, and efficacy of a manualized modular cognitive-behavioral therapy for BDD (CBT-BDD). CBT-BDD utilizes core elements relevant to all BDD patients (e.g., exposure, response prevention, perceptual retraining) and optional modules to address specific symptoms (e.g., surgery seeking). Thirty-six adults with BDD were randomized to 22 sessions of immediate individual CBT-BDD over 24 weeks (n=17) or to a 12-week waitlist (n=19). The Yale-Brown Obsessive-Compulsive Scale Modified for BDD (BDD-YBOCS), Brown Assessment of Beliefs Scale, and Beck Depression Inventory-II were completed pretreatment, monthly, posttreatment, and at 3- and 6-month follow-up. The Sheehan Disability Scale and Client Satisfaction Inventory (CSI) were also administered. Response to treatment was defined as ≥30% reduction in BDD-YBOCS total from baseline. By week 12, 50% of participants receiving immediate CBT-BDD achieved response versus 12% of waitlisted participants (p=0.026). By posttreatment, 81% of all participants (immediate CBT-BDD plus waitlisted patients subsequently treated with CBT-BDD) met responder criteria. While no significant group differences in BDD symptom reduction emerged by Week 12, by posttreatment CBT-BDD resulted in significant decreases in BDD-YBOCS total over time (d=2.1, p<0.0001), with gains maintained during follow-up. Depression, insight, and disability also significantly improved. Patient satisfaction was high, with a mean CSI score of 87.3% (SD=12.8%) at posttreatment. CBT-BDD appears to be a feasible, acceptable, and efficacious treatment that warrants more rigorous investigation.
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Affiliation(s)
- Sabine Wilhelm
- Massachusetts General Hospital and Harvard Medical School.
| | - Katharine A. Phillips
- Rhode Island Hospital and the Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University
| | - Elizabeth Didie
- Rhode Island Hospital and the Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University
| | - Ulrike Buhlmann
- Institute of Psychology, Humboldt-Universität zu Berlin, Germany
| | | | - Jeanne M. Fama
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School
| | - Aparna Keshaviah
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School
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Abstract
The core feature of body dysmorphic disorder (BDD) is distressing or impairing preoccupation with nonexistent or slight defects in one's physical appearance. BDD beliefs are characterized by varying degrees of insight, ranging from good (ie, recognition that one's BDD beliefs are not true) through "absent insight/delusional" beliefs (ie, complete conviction that one's BDD beliefs are true). The Diagnostic and Statistical Manual of Mental Disorders, 3rd ed., rev. (DSM-III-R) and The Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV) classified BDD's nondelusional form in the somatoform section of the manual and its delusional form in the psychosis section, as a type of delusional disorder, somatic type (although DSM-IV allowed double-coding of delusional BDD as both a psychotic disorder and BDD). However, little or no evidence on this issue was available when these editions were published. In this article, we review the classification of BDD's delusional and nondelusional variants in earlier editions of DSM and the limitations of their approaches. We then review empirical evidence on this topic, which has become available since DSM-IV was developed. Available evidence indicates that across a range of validators, BDD's delusional and nondelusional variants have many more similarities than differences, including response to pharmacotherapy. Based on these data, we propose that BDD's delusional and nondelusional forms be classified as the same disorder and that BDD's diagnostic criteria include an insight specifier that spans a range of insight, including absent insight/delusional BDD beliefs. We hope that this recommendation will improve care for patients with this common and often-severe disorder. This increased understanding of BDD may also have implications for other disorders that have an "absent insight/delusional" form.
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Affiliation(s)
- Katharine A. Phillips
- Body Dysmorphic Disorder Program, Rhode Island Hospital, Providence, Rhode Island, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Ashley S. Hart
- Body Dysmorphic Disorder Program, Rhode Island Hospital, Providence, Rhode Island, USA
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
| | - Helen Blair Simpson
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York, USA
- Anxiety Disorders Clinic and the Center for OCD and Related Disorders, New York State Psychiatric Institute, New York, New York, USA
| | - Dan J. Stein
- Department of Psychiatry, University of Cape Town, Cape Town, South Africa
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Bjornsson AS, Phillips KA. Do obsessions and compulsions play a role in social anxiety disorder? Harv Rev Psychiatry 2014. [PMID: 24394222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Affiliation(s)
- Andri S Bjornsson
- From the Department of Psychology, University of Iceland (Dr. Bjornsson); Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University (Dr. Phillips); Rhode Island Hospital, Providence, RI (Dr. Phillips)
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Bjornsson AS, Didie ER, Grant JE, Menard W, Stalker E, Phillips KA. Age at onset and clinical correlates in body dysmorphic disorder. Compr Psychiatry 2013; 54:893-903. [PMID: 23643073 PMCID: PMC3779493 DOI: 10.1016/j.comppsych.2013.03.019] [Citation(s) in RCA: 103] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2011] [Revised: 03/04/2013] [Accepted: 03/19/2013] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE Age at onset is an important clinical feature of all disorders. However, no prior studies have focused on this important construct in body dysmorphic disorder (BDD). In addition, across a number of psychiatric disorders, early age at disorder onset is associated with greater illness severity and greater comorbidity with other disorders. However, clinical correlates of age at onset have not been previously studied in BDD. METHODS Age at onset and other variables of interest were assessed in two samples of adults with DSM-IV BDD; sample 1 consisted of 184 adult participants in a study of the course of BDD, and sample 2 consisted of 244 adults seeking consultation or treatment for BDD. Reliable and valid measures were used. Subjects with early-onset BDD (age 17 or younger) were compared to those with late-onset BDD. RESULTS BDD had a mean age at onset of 16.7 (SD=7.3) in sample 1 and 16.7 (SD=7.2) in sample 2. 66.3% of subjects in sample 1 and 67.2% in sample 2 had BDD onset before age 18. A higher proportion of females had early-onset BDD in sample 1 but not in sample 2. On one of three measures in sample 1, those with early-onset BDD currently had more severe BDD symptoms. Individuals with early-onset BDD were more likely to have attempted suicide in both samples and to have attempted suicide due to BDD in sample 2. Early age at BDD onset was associated with a history of physical violence due to BDD and psychiatric hospitalization in sample 2. Those with early-onset BDD were more likely to report a gradual onset of BDD than those with late-onset in both samples. Participants with early-onset BDD had a greater number of lifetime comorbid disorders on both Axis I and Axis II in sample 1 but not in sample 2. More specifically, those with early-onset BDD were more likely to have a lifetime eating disorder (anorexia nervosa or bulimia nervosa) in both samples, a lifetime substance use disorder (both alcohol and non-alcohol) and borderline personality disorder in sample 1, and a lifetime anxiety disorder and social phobia in sample 2. CONCLUSIONS BDD usually began during childhood or adolescence. Early onset was associated with gradual onset, a lifetime history of attempted suicide, and greater comorbidity in both samples. Other clinical features reflecting greater morbidity were also more common in the early-onset group, although these findings were not consistent across the two samples.
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Affiliation(s)
- Andri S Bjornsson
- Department of Psychology, University of Iceland, Aragata 14, 101 Reykjavik, Iceland.
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Abstract
Symmetry obsessions are a common symptom of obsessive-compulsive disorder (OCD) and have several demographic and clinical correlates. Appearance-related symmetry concerns appear common in body dysmorphic disorder (BDD); however, no published studies have examined this topic. This study examined the clinical features, prevalence, and correlates of symmetry concerns involving physical appearance in two BDD samples (N=160 and N=115). More than 25% of participants in each sample reported symmetry concerns for a body part with which they were preoccupied (total of 18 body parts in sample 1 and 18 in sample 2). In sample 1, BDD participants with appearance-related symmetry concerns were older than those without appearance-related symmetry concerns. In sample 2, those with appearance-related symmetry concerns reported poorer mental health-related quality of life, were more likely to have experienced lifetime suicidal ideation, had better BDD-related insight, and were less likely to have a lifetime eating disorder. In both samples, participants with appearance-related symmetry concerns were more likely to have lifetime OCD but not OCD-related symmetry obsessions. Thus, symmetry is a common appearance concern in BDD that is associated with comorbid OCD but not with OCD symmetry concerns specifically, suggesting that symmetry concerns may have a different mechanism/pathophysiology in BDD versus OCD.
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Affiliation(s)
- Ashley S. Hart
- Rhode Island Hospital, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
| | - Katharine A. Phillips
- Rhode Island Hospital, Providence, RI, USA
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
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46
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Abstract
The revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM) provides a useful opportunity to revisit debates about the nature of psychiatric classification. An important debate concerns the involvement of mental health consumers in revisions of the classification. One perspective argues that psychiatric classification is a scientific process undertaken by scientific experts and that including consumers in the revision process is merely pandering to political correctness. A contrasting perspective is that psychiatric classification is a process driven by a range of different values and that the involvement of patients and patient advocates would enhance this process. Here we draw on our experiences with input from the public during the deliberations of the Obsessive Compulsive-Spectrum Disorders subworkgroup of DSM-5, to help make the argument that psychiatric classification does require reasoned debate on a range of different facts and values, and that it is appropriate for scientist experts to review their nosological recommendations in the light of rigorous consideration of patient experience and feedback.
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Affiliation(s)
- Dan J Stein
- Department of Psychiatry, University of Cape Town and Groote Schuur Hospital J2, Anzio Rd, Observatory 7925, Cape Town, South Africa.
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47
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Phillips KA, Menard W, Quinn E, Didie ER, Stout RL. A 4-year prospective observational follow-up study of course and predictors of course in body dysmorphic disorder. Psychol Med 2013; 43:1109-1117. [PMID: 23171833 DOI: 10.1017/s0033291712001730] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND This report prospectively examines the 4-year course, and predictors of course, of body dysmorphic disorder (BDD), a common and often severe disorder. No prior studies have prospectively examined the course of BDD in individuals ascertained for BDD. Method The Longitudinal Interval Follow-Up Evaluation (LIFE) assessed weekly BDD symptoms and treatment received over 4 years for 166 broadly ascertained adults and adolescents with current BDD at intake. Kaplan-Meier life tables were constructed for time to remission and relapse. Full remission was defined as minimal or no BDD symptoms, and partial remission as less than full DSM-IV criteria, for at least 8 consecutive weeks. Full relapse and partial relapse were defined as meeting full BDD criteria for at least 2 consecutive weeks after attaining full or partial remission respectively. Cox proportional hazards regression examined predictors of remission and relapse. RESULTS Over 4 years, the cumulative probability was 0.20 for full remission and 0.55 for full or partial remission from BDD. A lower likelihood of full or partial remission was predicted by more severe BDD symptoms at intake, longer lifetime duration of BDD, and being an adult. Among partially or fully remitted subjects, the cumulative probability was 0.42 for subsequent full relapse and 0.63 for subsequent full or partial relapse. More severe BDD at intake and earlier age at BDD onset predicted full or partial relapse. Eighty-eight percent of subjects received mental health treatment during the follow-up period. CONCLUSIONS In this observational study, BDD tended to be chronic. Several intake variables predicted greater chronicity of BDD.
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Affiliation(s)
- K A Phillips
- Rhode Island Hospital, Providence, RI 02903, USA.
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Phythian CJ, Phillips KA, Wall R. Farmer perceptions of the prevalence and management of Psoroptes ovis infestation in sheep flocks in southwest England. Vet Rec 2013; 172:290. [PMID: 23396535 DOI: 10.1136/vr.101412] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- C J Phythian
- School of Veterinary Science, University of Bristol, Dolberry Building, Langford, Bristol BS40 5DU, UK.
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Kelly MM, Dalrymple K, Zimmerman M, Phillips KA. A comparison study of body dysmorphic disorder versus social phobia. Psychiatry Res 2013; 205:109-16. [PMID: 22999105 PMCID: PMC3552120 DOI: 10.1016/j.psychres.2012.08.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Revised: 08/08/2012] [Accepted: 08/11/2012] [Indexed: 01/10/2023]
Abstract
Body dysmorphic disorder (BDD) shares many characteristics with social phobia (SP), including high levels of social anxiety and avoidance, but to our knowledge no studies have directly compared these disorders' demographic and clinical features. Demographic and clinical features were compared in individuals with BDD (n=172), SP (n=644), and comorbid BDD/SP (n=125). SP participants had a significantly earlier age of onset and lower educational attainment than BDD participants. BDD participants were significantly less likely to ever be married than SP participants, had a greater likelihood of ever being psychiatrically hospitalized, and had significantly lower mean GAF scores than SP participants. The two groups had different comorbidity patterns, which included a greater likelihood for BDD participants to have comorbid obsessive-compulsive disorder (OCD) or an eating disorder, vs. a greater likelihood for SP participants to have a comorbid non-OCD anxiety disorder. The comorbid BDD/SP group had significantly greater morbidity across several domains than the SP only group, but not the BDD only group. In summary, although BDD and SP were similar across many demographic and clinical features, they had important differences. Future studies are needed to confirm these findings and address similarities and differences between these disorders across a broader range of variables.
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Affiliation(s)
- Megan M Kelly
- Alpert Medical School of Brown University, Providence, RI, USA.
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Phillips KA, Pinto A, Hart AS, Coles ME, Eisen JL, Menard W, Rasmussen SA. A comparison of insight in body dysmorphic disorder and obsessive-compulsive disorder. J Psychiatr Res 2012; 46:1293-9. [PMID: 22819678 PMCID: PMC3432724 DOI: 10.1016/j.jpsychires.2012.05.016] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Revised: 05/25/2012] [Accepted: 05/31/2012] [Indexed: 11/19/2022]
Abstract
Insight/delusionality of beliefs is an important dimension of psychopathology across psychiatric disorders. This construct is of increasing interest in obsessive-compulsive and related disorders, including obsessive-compulsive disorder (OCD) and body dysmorphic disorder (BDD). Even though OCD and BDD are considered closely related, no prior study has compared these disorders across a range of categories of global insight (excellent, good, fair, poor, absent/delusional), and only one study has compared these disorders on individual components of insight. Using the reliable and valid Brown Assessment of Beliefs Scale (BABS), this study examined insight/delusionality of OCD- or BDD-related beliefs in 211 individuals with primary OCD versus 68 individuals with primary BDD. In both disorders, levels of insight spanned the full range, from excellent to absent (i.e., delusional beliefs). However, the distribution of BABS scores across insight categories differed significantly by disorder, with the majority of OCD subjects showing excellent or good insight, and the majority of BDD subjects showing poor or absent insight. Compared to OCD subjects, BDD subjects had significantly poorer insight both overall (total BABS score) and on all individual BABS items. BABS score was significantly correlated with BDD and OCD severity, but in regressions it accounted for only 21% of the variance in OCD and 28% in BDD. In summary, both global insight and its individual components are poorer in BDD than in OCD, which has implications for research and clinical care, as well as understanding of the relationship between these disorders. Disorder severity is associated with but not equivalent to insight/delusionality.
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