Cognitive-Behavioral Therapy for Body Dysmorphic Disorder by Proxy

Application of a transdiagnostic treatment for emotional disorders to body dysmorphic disorder: A randomized controlled trial

BACKGROUND

Body dysmorphic disorder (BDD) is a common disorder which is associated with a high rate of comorbidity and functional impairment. Although research shows that cognitive-behavioral therapy can be an efficacious treatment for BDD, there is growing evidence that dysregulated emotion is a core deficit. The Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders (UP) is a transdiagnostic, emotion focused cognitive-behavioral therapy protocol that has been developed to target emotion regulation processes that play an important role in the development and maintenance of many emotional disorders METHODS: : In the present study, 128 patients meeting criteria for BDD were randomized to either the UP (n = 64) or waitlist/treatment-as-usual (WL/TAU) condition. Diagnoses were determined using semi-structural interviews and patients also completed the Brown Assessment of Beliefs Scale (BABS), the Appearance Anxiety Inventory (AAI), the Difficulties in Emotion Regulation Scale (DERS), the Beck Depression Inventory (BDI) and the Clinical Global Impression (CGI).

RESULTS

Repeated measure ANOVA indicated that the UP significantly decreased depression, BDD symptoms and body-related anxiety, as well as significantly improving emotional regulation all with large effect sizes compared to the TAU/WL condition. Treatment gains as well as remission of comorbid conditions were maintained at the three-month follow-up.

LIMITATIONS

Our study limitations include restricted follow-up periods and excluding participants who were actively suicidal.

CONCLUSIONS

To our knowledge, this is the first examination of the UP for BDD, and results suggest that this disorder shares common mechanisms with other disorders of emotion, and that the UP may be an additional efficacious treatment for this condition.

Pharmacological Treatment of Body Dysmorphic Disorder

Body dysmorphic disorder is a challenging disorder that manifests as erroneously perceived flaws in one’s physical appearance and repetitive behaviors in response to appearance concerns. This disorder is also frequently comorbid with other psychiatric disorders, including major depressive disorder and autism spectrum disorder. It is currently understood to arise from a combination of biological, psychological, and environmental factors. Treatment of body dysmorphic disorder typically consists of a combination of pharmacotherapy and cognitive behavioral therapy. However, not all patients respond to treatment, and BDD symptoms remain even in those who do respond. This review outlines current pharmacological and neuromodulation treatments for body dysmorphic disorder and suggests directions for future studies of novel treatments such as augmentation with atypical antipsychotics and the use of intranasal oxytocin in cases of body dysmorphic disorder that show residual symptomatology even with tailored monotherapy. There is emerging evidence suggesting that non-invasive neurostimulatory techniques, such as repetitive transcranial magnetic stimulation, may be of value in treatment-resistant cases.

Does your child's weight influence how you judge yourself as a parent? A cross-sectional study to define and examine parental overvaluation of weight/shape

Parents are integral stakeholders in children's health and development, and yet there is a dearth of research on parental attitudes and parents' personal weight and eating psychopathology, which have the potential to influence pediatric obesity and eating disorder treatments meaningfully. Overvaluation of weight/shape is a core concept in eating-disorder assessment and treatment defined as self-evaluation excessively based on weight/shape, which research has demonstrated to be clinically important psychopathology. A novel and related concept, parental overvaluation of weight/shape, could be defined as parents' self-evaluation unduly based on their child's weight/shape, yet this concept has not been studied and its clinical importance is unknown. The aim of this study was to examine the distinctiveness of parental overvaluation of weight/shape from personal overvaluation of weight/shape, and to examine associations of parental overvaluation with parents' psychopathology and children's weight and eating behaviors. The current study examined differences among parents with (n=134) and without (n=872) parental overvaluation using a cross-sectional design. Parental overvaluation was more common among parents with binge-eating disorder and bulimia than obesity and healthy-weight. Parental overvaluation was modestly associated with personal overvaluation. Parents with and without parental overvaluation differed on personal eating-disorder psychopathology and children's weight and eating behaviors. Importantly, differences remained after adjusting for personal overvaluation and child BMI. This study highlights a novel construct-parental overvaluation-associated with, but distinct from, parental eating disorders and personal overvaluation. Parental overvaluation may warrant clinical attention among parents seeking pediatric obesity or eating-disorder treatment, or treatment for personal eating disorders.

Improving the Detection of Body Dysmorphic Disorder in Clinical Practice

The aim of this article is to raise awareness of the underdiagnosis of body dysmorphic disorder (BDD) in clinical practice and provide suggestions to overcome key barriers to BDD detection. Disclosure of BDD symptoms is uncommon during routine assessments but can be increased by asking specifically about such symptoms. When BDD symptoms are present, it is important to differentiate them from anxiety, depression, obsessive-compulsive disorder, and eating disorders, which may present with some similarities and are commonly comorbid with BDD. Assessment of BDD should be sensitive to issues of poor insight, elevated suicide risk, subthreshold BDD presentations, and the possibility of BDD by proxy. Furthermore, assessment should consider the potential impact of age, gender, ethnicity, and minor physical defects on the presentation of BDD. Improving the assessment of BDD in routine clinical practice will enhance disclosure, improve case conceptualization, and provide the opportunity to deliver appropriate treatment for this underdiagnosed and often serious disorder.