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Zhao F, Guo Z, Bo Y, Feng L, Zhao J. Is cognitive behavioral therapy an efficacious treatment for psychological interventions in body dysmorphic disorders? A meta-analysis based on current evidence from randomized controlled trials. J Affect Disord 2024; 352:237-249. [PMID: 38369262 DOI: 10.1016/j.jad.2024.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Revised: 01/27/2024] [Accepted: 02/06/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND Clinical guidelines and some studies recommend cognitive-behavioral therapy (CBT) as the most effective treatment for body dysmorphic disorder (BDD). However, owing to the lack of randomized controlled trials (RCTs), the research evidence is insufficient. This study aimed to explore the effectiveness of CBT in the treatment of BDD using RCTs. This meta-analysis was registered in PROSPERO (CRD42023410577). METHODS After a literature search and screening, 11 RCTs with 667 patients were included. The ROB 2.0 tool, funnel plots, sensitivity analysis, and meta-regression analysis were used to assess the quality, publication bias, and sources of heterogeneity. RESULTS After CBT intervention, the severity of BDD (SMD = -1.73, 95 % CI (confidence interval) = [-2.90; -0.57]), depression symptoms (SMD = -1.72, 95 % CI = [-3.16; -0.28]), and anxiety levels were all reduced in the patients of the experimental group; the remission of BDD (OR = 7.37, 95 % CI = [2.17; 24.98]) and the response of BDD (OR = 8.86, 95 % CI = [4.85; 16.18]) were all increased; incorrect beliefs such as disability and BABS were also reduced; the quality of life was improved. The difference between the groups was statistically significant (p < 0.01). Meta-regression analysis showed that age and sample size were the predictive factors of the effectiveness of CBT. LIMITATIONS The heterogeneity of most meta-analyses was high (I2 > 75 %). CONCLUSIONS Although CBT is effective in treating BDD, there is insufficient evidence to suggest that it is the best psychological intervention for BDD. More high-quality evidence is still needed in the future.
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Affiliation(s)
- Fei Zhao
- Key Laboratory of Environmental Ecology and Population Health in Northwest Minority Areas, Medical College of Northwest Minzu University, Lanzhou, China
| | - Zhong Guo
- Key Laboratory of Environmental Ecology and Population Health in Northwest Minority Areas, Medical College of Northwest Minzu University, Lanzhou, China
| | - Yan Bo
- Key Laboratory of Environmental Ecology and Population Health in Northwest Minority Areas, Medical College of Northwest Minzu University, Lanzhou, China
| | - LiJuan Feng
- Students' Counseling and Psychological Education Center, Northwest Minzu University, Lanzhou, China.
| | - Jin Zhao
- Key Laboratory of Environmental Ecology and Population Health in Northwest Minority Areas, Medical College of Northwest Minzu University, Lanzhou, China.
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Loewen Á, Blasco-Fontecilla H, Li C, Bella-Fernández M, Ruiz-Antorán B. Prevalence of Body Dysmorphic Disorder in the Spanish Population: Cross-Sectional Web-Based Questionnaire Study. JMIR Form Res 2024; 8:e46515. [PMID: 38175692 PMCID: PMC10797500 DOI: 10.2196/46515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 10/30/2023] [Accepted: 11/20/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND Body dysmorphic disorder (BDD) is defined as excessive concern with mild or nonexistent defects in personal physical appearance, which are not perceived by others. The worldwide prevalence of BDD ranges between 0.5% and 3.2%, with no differences across genders. The mean age of onset of BDD is 16.9 years. BDD is typically associated with young age, psychiatric disorders, and dermatological procedures. Patients with BDD typically display poorer mental health status than patients diagnosed with other mental disorders. OBJECTIVE The aim of this study was to estimate the prevalence of BDD in Spain and to identify the variables associated with BDD. METHODS We performed a cross-sectional descriptive study by collecting data through an anonymous web-based survey targeting the Spanish population aged 18 years or older. The measures in this study were (1) sociodemographic variables, (2) variables associated with dermatological and psychiatric disorders and cosmetic procedures, (3) scales measuring quality of life (12-item Short Form health survey, version 2) and (4) BDD (BDD Questionnaire). Statistical analysis was performed with SPSS software version 21. P values less than .05 were considered significant. RESULTS Of the 2091 participants who took the survey, 322 (15.2%) met the criteria of having BDD. The mean age of the participants with BDD was 23.5 (SD 9.6) years. In terms of BDD prevalence, women accounted for 19.9% (284/1421), men accounted for 5.2% (34/653), and students accounted for 25.2% (263/1043). Approximately 46.6% (150/322) of the participants with BDD reported a history of psychiatric comorbidities, including anxiety disorders, depressive disorders, and eating disorders. BDD was significantly associated with female gender, younger age (18-24 years), students, monthly income of less than €500 (€1=US $1.11), and the presence of dermatological and some psychiatric disorders such as depression, anxiety, and eating disorders (P<.05). The number of body parts of concern in participants with BDD was significantly higher than that in those without BDD (4.6 vs 2.2, respectively; P<.001). Regarding the body parts of concern, body fat was the most common concern for both groups with BDD and without BDD, followed by thighs, face, hips, and skin in the BDD group and thighs, teeth, and hair in the non-BDD group. Participants with BDD showed a significantly poorer self-perception of their mental health, irrespective of the presence of any mental disorder (P<.001). CONCLUSIONS Our findings showed that the prevalence of BDD in Spain was higher than expected. Further, BDD is frequently associated with other psychiatric disorders, particularly depressive disorder, anxiety disorder, and eating disorder. Participants with BDD had a poorer perception of quality of life associated with mental but not physical health problems. Finally, the perception of quality of mental health life in participants with BDD was independent of diagnosis of any mental disorder.
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Affiliation(s)
- Álvaro Loewen
- Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain
| | - Hilario Blasco-Fontecilla
- Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain
- Servicio de Psiquiatría Infanto-juvenil, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Spain
- Centro de Investigación Biomédica en Red - Salud Mental, Madrid, Spain
- Facultad de Ciencias de la Salud y Centro Médico, Universidad Internacional de La Rioja, Madrid, Spain
| | - Chao Li
- Facultad de Medicina, Universidad Autónoma de Madrid, Madrid, Spain
| | - Marcos Bella-Fernández
- Servicio de Psiquiatría Infanto-juvenil, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Spain
- Facultad de Psicología, Universidad Autónoma de Madrid, Madrid, Spain
- Departamento de Psicología, Universidad Pontificia de Comillas, Madrid, Spain
| | - Belén Ruiz-Antorán
- Servicio de Farmacología Clínica, Hospital Universitario Puerta de Hierro Majadahonda, Majadahonda, Spain
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Monzani B, Fallah D, Rautio D, Gumpert M, Jassi A, Fernández de la Cruz L, Mataix-Cols D, Krebs G. Psychometric Evaluation of the Yale-Brown Obsessive-Compulsive Scale Modified for Body Dysmorphic Disorder for Adolescents (BDD-YBOCS-A). Child Psychiatry Hum Dev 2023; 54:1799-1806. [PMID: 35678889 PMCID: PMC10582126 DOI: 10.1007/s10578-022-01376-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Revised: 05/09/2022] [Accepted: 05/12/2022] [Indexed: 11/03/2022]
Abstract
The Yale-Brown Obsessive-Compulsive Scale Modified for Body Dysmorphic Disorder for Adolescents (BDD-YBOCS-A) is a clinician-rated measure of BDD symptom severity in youth. Despite widespread use in both research and clinical practice, its psychometric properties have not been formally evaluated. The current study examined the factor structure, reliability, validity, and sensitivity to change of the BDD-YBOCS-A in 251 youths with BDD attending two specialist clinics. A principal component analysis identified two factors, explaining 56% of the variance. The scale showed good internal consistency (Cronbach's alpha = 0.87) and adequate convergent and divergent validity. In a subgroup of participants receiving BDD treatment (n = 175), BDD-YBOCS-A scores significantly decreased over time, demonstrating sensitivity to change. BDD-YBOCS-A change scores over treatment were highly correlated with severity changes measured by the Clinical Global Impression - Severity scale (r = .84). The study provides empirical support for the use of the BDD-YBOCS-A in children and adolescents with BDD.
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Affiliation(s)
- Benedetta Monzani
- National and Specialist OCD and Related Disorders Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK.
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
| | - Deanna Fallah
- National and Specialist OCD and Related Disorders Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK
| | - Daniel Rautio
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Martina Gumpert
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Amita Jassi
- National and Specialist OCD and Related Disorders Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Lorena Fernández de la Cruz
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - David Mataix-Cols
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Georgina Krebs
- National and Specialist OCD and Related Disorders Clinic for Young People, South London and Maudsley NHS Foundation Trust, London, UK
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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4
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Pikoos TD, Rossell SL, Tzimas N, Buzwell S. Is the needle as risky as the knife? The prevalence and risks of body dysmorphic disorder in women undertaking minor cosmetic procedures. Aust N Z J Psychiatry 2021; 55:1191-1201. [PMID: 33636988 DOI: 10.1177/0004867421998753] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Body dysmorphic disorder is commonly considered a contraindication for major cosmetic surgery, but whether body dysmorphic disorder relates to poorer outcomes from minor cosmetic treatment remains unknown. This study aimed to explore the prevalence of body dysmorphic disorder in clients seeking non-surgical cosmetic procedures and to examine whether body dysmorphic disorder clients are vulnerable in minor cosmetic settings. Vulnerability was explored in terms of psychological distress, unrealistic expectations and motivations for treatment outcome, and reduced satisfaction with past cosmetic procedures. METHOD A cross-sectional online survey was completed by 154 women seeking minor cosmetic procedures which included the Body Dysmorphic Disorder Questionnaire - Dermatology Version to screen for body dysmorphic disorder, and measures of cosmetic treatment motivation, expectations and satisfaction. RESULTS Roughly 25% of women in the current sample screened positive for a potential body dysmorphic disorder diagnosis. Participants with suspected body dysmorphic disorder demonstrated higher levels of psychological distress and more unrealistic expectations and motivations for cosmetic treatment, such as improving social or romantic relationships. However, body dysmorphic disorder participants reported similar levels of satisfaction with past minor cosmetic treatments to the non-body dysmorphic disorder group. CONCLUSION While the relationship between body dysmorphic disorder and treatment outcome warrants further investigation in prospective research tracking satisfaction and adverse reactions over time, this preliminary evidence suggests clients with suspected body dysmorphic disorder display several vulnerabilities in non-surgical cosmetic settings. Given the rapidly increasing accessibility of minor cosmetic procedures, further research is needed to determine their safety for clients with body dysmorphic disorder. Detection of body dysmorphic disorder in non-surgical cosmetic settings could facilitate earlier psychological intervention, promoting superior long-term outcomes.
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Affiliation(s)
- Toni D Pikoos
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Susan L Rossell
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia.,Psychiatry, St Vincent's Hospital, Melbourne, VIC, Australia
| | - Nicky Tzimas
- Cosmetic Professional Development Institute of Australia, Melbourne, VIC, Australia
| | - Simone Buzwell
- Centre for Mental Health, Swinburne University of Technology, Hawthorn, VIC, Australia
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5
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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] [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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6
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Lee RC, Aulisio M, Liu RW. Exploring the Ethics of Stature Lengthening as Treatment for Height Dysphoria. Strategies Trauma Limb Reconstr 2020; 15:163-168. [PMID: 34025797 PMCID: PMC8121106 DOI: 10.5005/jp-journals-10080-1502] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
AIM To promote a discussion on the ethics and justifications of stature lengthening in patients without skeletal deformity. BACKGROUND Stature lengthening for height gain in patients without skeletal deformity has stirred controversy within the orthopedic community. However, current literature does not delineate the ethical issues surrounding this procedure. Improvements in the techniques, technology, and safety profile of stature lengthening warrant an ethical discussion to challenge, justify, and guide the use of this surgical procedure. REVIEW RESULTS Examination of ethical issues leads to the distinction between the dual roles of stature lengthening as a treatment vs an enhancement. The primary focus on stature lengthening as treatment allows for exploration of "height dysphoria"-a psychological burden caused by a dissatisfaction with one's height-as the primary pathology that may justify surgical intervention. CONCLUSION In our opinion, additional work is required to establish "height dysphoria" as a true pathology in order to ethically justify stature lengthening as a legitimate form of treatment. Further discussion is needed to address the ethics of stature lengthening as an enhancement. CLINICAL SIGNIFICANCE This paper addresses salient ethical issues of stature lengthening in patients without skeletal deformity by exploring historical, contemporary, and comparative contexts. HOW TO CITE THIS ARTICLE Lee RC, Aulisio M, Liu RW. Exploring the Ethics of Stature Lengthening as Treatment for Height Dysphoria. Strategies Trauma Limb Reconstr 2020;15(3):163-168.
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Affiliation(s)
- Richard C Lee
- Department of Bioethics, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States
| | - Mark Aulisio
- Department of Bioethics, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States
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7
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Schulte J, Schulz C, Wilhelm S, Buhlmann U. Treatment utilization and treatment barriers in individuals with body dysmorphic disorder. BMC Psychiatry 2020; 20:69. [PMID: 32070300 PMCID: PMC7027080 DOI: 10.1186/s12888-020-02489-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Accepted: 02/10/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Although effective treatments are available, most individuals with body dysmorphic disorder (BDD) do not receive an appropriate diagnosis or treatment. We aimed to examine treatment utilization and barriers to treatment, and to identify associated socio-demographic and clinical characteristics. METHODS German individuals completed an online self-report survey of appearance concerns. A sample of N = 429 individuals met criteria for BDD. We examined the frequency of treatment utilization and barriers, analyzed comparisons between treated and untreated individuals and assessed the relationships of socio-demographic and clinical features with mental health treatment utilization and treatment barriers, respectively. RESULTS Only 15.2% of the individuals with BDD had been diagnosed with BDD, and lifetime rates of mental health treatment were low (39.9%). Individuals endorsed multiple barriers to mental health treatment, especially shame, low perceived need and a preference for cosmetic and medical treatments. Associated features were identified, including age, a BDD diagnosis, body dysmorphic symptom severity, a likely major depressive disorder, prior cosmetic surgery, and insight. CONCLUSIONS The results of this largest study to date highlight that BDD is still underrecognized and undertreated even in a country with extensive mental health care and few financial barriers. We discuss modifiable factors and strategies to foster awareness of BDD in sufferers and professionals to improve treatment dissemination and to reduce treatment barriers.
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Affiliation(s)
- Johanna Schulte
- grid.5949.10000 0001 2172 9288Institute of Psychology, University of Münster, Fliednerstraße 21, 48149 Münster, Germany
| | - Claudia Schulz
- grid.5949.10000 0001 2172 9288Institute of Psychology, University of Münster, Fliednerstraße 21, 48149 Münster, Germany ,Present address: AMEOS Hospital Osnabrück, Knollstraße 31, Osnabrück, Germany
| | - Sabine Wilhelm
- Department of Psychiatry, Massachusetts General Hospital/Harvard Medical School, Simches Research Building, 185 Cambridge Street, Boston, MA 02114 USA
| | - Ulrike Buhlmann
- Institute of Psychology, University of Münster, Fliednerstraße 21, 48149, Münster, Germany.
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8
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Rossell SL, Labuschagne I, Castle DJ, Toh WL. Delusional themes in Body Dysmorphic Disorder (BDD): Comparisons with psychotic disorders and non-clinical Controls. Psychiatry Res 2020; 284:112694. [PMID: 31785950 DOI: 10.1016/j.psychres.2019.112694] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 11/15/2019] [Accepted: 11/16/2019] [Indexed: 01/08/2023]
Abstract
The prevailing nosological classification of body dysmorphic disorder (BDD) encompasses an optional specifier "with absent insight/delusional beliefs" for patients who hold high conviction of the veracity of their disorder-specific beliefs. Yet limited research has examined the explicit nature of delusional beliefs in BDD. The current study therefore aimed to compare themes of delusional ideation in BDD relative to schizophrenia (SCZ) and healthy controls (HCs). Participants had a primary diagnosis of BDD (n = 44) or SCZ (n = 55), or were HCs (n = 55) with no personal or immediate family history of a diagnosable mental health disorder. Assessment of multidimensional delusional ideation was based on the Peters Delusional Inventory (PDI). Results showed that BDD and SCZ groups endorsed significantly more items, and had significantly elevated preoccupation and conviction than the HC group. Only the SCZ group exhibited significantly elevated distress relative to HC participants. In addition, BDD (akin to SCZ) participants were more likely to endorse somatic (appearance-related), control and thought alienation themes than the HC group. These findings suggest that delusional beliefs in BDD may not be strictly appearance-related, but rather span broader themes. This conveys therapeutic implications in terms of designing and administering targeted treatments aimed at delusional thinking in BDD.
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Affiliation(s)
- Susan L Rossell
- Centre for Mental Health, Swinburne University, Australia; Department of Psychiatry, St. Vincent's Mental Health, Australia.
| | - Izelle Labuschagne
- Cognition and Emotion Research Centre, School of Psychology, Australian Catholic University, Fitzroy, VIC, Australia
| | - David J Castle
- Department of Psychiatry, St. Vincent's Mental Health, Australia; Departments of Psychological Sciences and Psychiatry, University of Melbourne, Australia
| | - Wei Lin Toh
- Centre for Mental Health, Swinburne University, Australia; Departments of Psychological Sciences and Psychiatry, University of Melbourne, Australia
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9
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Grace SA, Labuschagne I, Castle DJ, Rossell SL. Intranasal oxytocin alters amygdala-temporal resting-state functional connectivity in body dysmorphic disorder: A double-blind placebo-controlled randomized trial. Psychoneuroendocrinology 2019; 107:179-186. [PMID: 31146138 DOI: 10.1016/j.psyneuen.2019.05.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 05/21/2019] [Accepted: 05/21/2019] [Indexed: 12/21/2022]
Abstract
The aetiology of body dysmorphic disorder (BDD) is poorly understood. Recent evidence from functional brain imaging studies suggests that BDD is associated with aberrant task-based functional connectivity and that intranasal oxytocin (OXT) may improve network connectivity in BDD patients. Thus, the aim of this study was to investigate the effect of intranasal OXT on amygdala resting-state functional connectivity (rsFC) in BDD. In a randomized, double-blind, cross-over design, 19 BDD participants and 17 demographically matched healthy control participants received intranasal OXT (24 IU) or placebo prior to resting-state functional magnetic resonance imaging. The left and right amygdala were seeded as regions of interest, and temporal correlations between the amygdalae and all other voxels comprising cortical and subcortical grey matter were investigated. Compared to healthy controls, BDD patients showed greater baseline (placebo) rsFC between the left amygdala and two clusters within the left temporal lobe and one cluster within the superior frontal gyrus which was reversed following OXT administration. The control group also showed significantly greater rsFC between the left amygdala and anterior prefrontal cortex in the OXT session compared to placebo. Whilst preliminary, these findings suggest that BDD patients exhibit abnormal amygdala-temporal connectivity at rest, and OXT might have a role in changing this functional relationship.
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Affiliation(s)
- Sally A Grace
- Centre for Mental Health, Swinburne University, Melbourne, Australia; School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Australia.
| | - Izelle Labuschagne
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Australia
| | - David J Castle
- Psychiatry, St Vincent's Hospital, Melbourne, Australia; Psychiatry, University of Melbourne, Melbourne, Australia
| | - Susan L Rossell
- Centre for Mental Health, Swinburne University, Melbourne, Australia; Psychiatry, St Vincent's Hospital, Melbourne, Australia
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10
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Beilharz F, Castle DJ, Phillipou A, Rossell SL. Visual training program for body dysmorphic disorder: protocol for a novel intervention pilot and feasibility trial. Pilot Feasibility Stud 2018; 4:189. [PMID: 30598835 PMCID: PMC6302469 DOI: 10.1186/s40814-018-0384-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 12/07/2018] [Indexed: 01/08/2023] Open
Abstract
Background Body dysmorphic disorder (BDD) is a characterised by perceived defects or flaws in appearance which are associated with distressing thoughts, repetitive or obsessive behaviours, and significant impairment in social and occupational functioning. A core feature of BDD involves abnormalities of visual processing, although this is not typically a focus of psychological and psychiatric treatments. While current treatments generally show moderate effectiveness in the short-term, those with BDD can have high relapse rates, as they still 'see' their flaws or defects. The current research trials a visual training program designed to remediate visual abnormalities and reduce symptom severity of BDD. Methods This is a single-group open-label pilot study assessing the feasibility and potential efficacy of a 10-week visual training program. This pilot trial will be conducted at Swinburne University of Technology, Melbourne, Australia, and will recruit up to 20 participants diagnosed with BDD. These participants will complete pre- and post-assessments and a 10-week visual training program encompassing three phases of basic visual processing, face and emotion recognition, and self-perception. The primary outcomes focus on feasibility and acceptability of the intervention, with secondary outcomes exploring clinical outcomes related to symptom severity, quality of life and eye movements. Discussion This pilot trial will translate the empirical findings of abnormalities in visual processing among those diagnosed with BDD, to an innovative treatment method across a range of visual processing levels. This trial will assess the feasibility and potential efficacy of such a visual training program, paving the way for further research including a future definitive randomised control trial. Trial registration Australian New Zealand Clinical Trial Registry, ACTRN 12618000274279, Registered 22nd February 2018.
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Affiliation(s)
- Francesca Beilharz
- 1Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
| | - David J Castle
- 1Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia.,2Department of Psychiatry, St Vincent's Hospital, Melbourne, Australia.,3Psychiatry, Faculty of Medicine, University of Melbourne, Melbourne, Australia
| | - Andrea Phillipou
- 1Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia.,2Department of Psychiatry, St Vincent's Hospital, Melbourne, Australia.,3Psychiatry, Faculty of Medicine, University of Melbourne, Melbourne, Australia
| | - Susan L Rossell
- 1Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia.,2Department of Psychiatry, St Vincent's Hospital, Melbourne, Australia
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Abstract
Shame is a distressing emotion experienced when individuals judge themselves in a broadly negative and critical manner. Clinical descriptions of body dysmorphic disorder (BDD) emphasize the centrality of shame, yet research on shame in BDD remains scarce. This study is the largest investigation of shame in clinically diagnosed individuals with BDD, and it is the first to examine whether shame changes with treatment. Eighty-three adults with BDD were treated with 14 weeks of open-label escitalopram. Shame was measured using the Young Schema Questionnaire-Short Form. Shame was significantly higher in individuals with BDD than in previously reported healthy control and psychiatric outpatient samples. Shame was significantly, moderately correlated with greater suicidal thoughts and hopelessness and marginally significantly correlated with greater BDD severity. Shame decreased significantly with treatment. Reductions in shame with escitalopram were significantly associated with reductions in suicidal thoughts and hopelessness, even when accounting for reductions in BDD and depression severity.
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12
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Toh WL, Castle DJ, Mountjoy RL, Buchanan B, Farhall J, Rossell SL. Insight in body dysmorphic disorder (BDD) relative to obsessive-compulsive disorder (OCD) and psychotic disorders: Revisiting this issue in light of DSM-5. Compr Psychiatry 2017. [PMID: 28651226 DOI: 10.1016/j.comppsych.2017.06.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
INTRODUCTION In DSM-5, body dysmorphic disorder (BDD) was reclassified under the obsessive-compulsive and related disorders (OCRDs), but little is known about the nature of BDD beliefs. This study aimed to compare level of insight in BDD and consider related implications for DSM-5 classification. METHOD Participants were 27 BDD, 19 obsessive-compulsive disorder (OCD), and 20 psychosis (SZ) participants as well as 42 non-clinical controls (NC), who completed the Brown Assessment of Beliefs Scale (BABS) and Peters Delusions Inventory (PDI). RESULTS For total (and most individual) BABS items, BDD and SZ participants scored significantly higher than OCD and NC participants. On the PDI, there were significant group differences in number of questions endorsed, with clinical groups scoring significantly higher than the NC group on dimensions of distress and preoccupation, but not conviction. CONCLUSION These findings suggest appearance-related concerns in BDD somewhat resemble delusions seen in psychosis (and not OCD), and convey important nosological and therapeutic implications.
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Affiliation(s)
- Wei Lin Toh
- Centre for Mental Health, Swinburne University, Australia; Cognitive Neuropsychiatry, Monash Alfred Psychiatry Research Centre, Alfred Hospital and Monash University School of Psychology and Psychiatry, Australia; Departments of Psychological Sciences and Psychiatry, University of Melbourne, Australia.
| | - David J Castle
- Departments of Psychological Sciences and Psychiatry, University of Melbourne, Australia; Department of Psychiatry, St. Vincent's Mental Health, Australia
| | - Rachel L Mountjoy
- Mental Health Clinical Services Unit, Austin Health, Australia; The Melbourne Clinic, Australia; Department of Psychology and Counselling, La Trobe University, Australia
| | - Ben Buchanan
- Cognitive Neuropsychiatry, Monash Alfred Psychiatry Research Centre, Alfred Hospital and Monash University School of Psychology and Psychiatry, Australia
| | - John Farhall
- Department of Psychology and Counselling, La Trobe University, Australia
| | - Susan L Rossell
- Centre for Mental Health, Swinburne University, Australia; Cognitive Neuropsychiatry, Monash Alfred Psychiatry Research Centre, Alfred Hospital and Monash University School of Psychology and Psychiatry, Australia; Departments of Psychological Sciences and Psychiatry, University of Melbourne, Australia; Department of Psychiatry, St. Vincent's Mental Health, Australia
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13
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Beilharz F, Castle DJ, Grace S, Rossell SL. A systematic review of visual processing and associated treatments in body dysmorphic disorder. Acta Psychiatr Scand 2017; 136:16-36. [PMID: 28190269 DOI: 10.1111/acps.12705] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/12/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Recent advances in body dysmorphic disorder (BDD) have explored abnormal visual processing, yet it is unclear how this relates to treatment. The aim of this study was to summarize our current understanding of visual processing in BDD and review associated treatments. METHOD The literature was collected through PsycInfo and PubMed. Visual processing articles were included if written in English after 1970, had a specific BDD group compared to healthy controls and were not case studies. Due to the lack of research regarding treatments associated with visual processing, case studies were included. RESULTS A number of visual processing abnormalities are present in BDD, including face recognition, emotion identification, aesthetics, object recognition and gestalt processing. Differences to healthy controls include a dominance of detailed local processing over global processing and associated changes in brain activation in visual regions. Perceptual mirror retraining and some forms of self-exposure have demonstrated improved treatment outcomes, but have not been examined in isolation from broader treatments. CONCLUSION Despite these abnormalities in perception, particularly concerning face and emotion recognition, few BDD treatments attempt to specifically remediate this. The development of a novel visual training programme which addresses these widespread abnormalities may provide an effective treatment modality.
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Affiliation(s)
- F Beilharz
- Brain and Psychological Sciences Research Centre, Swinburne University of Technology, Melbourne, Vic., Australia
| | - D J Castle
- Department of Psychiatry, St Vincent's Hospital, Melbourne, Vic., Australia.,Psychiatry, Faculty of Medicine, University of Melbourne, Melbourne, Vic., Australia
| | - S Grace
- Brain and Psychological Sciences Research Centre, Swinburne University of Technology, Melbourne, Vic., Australia
| | - S L Rossell
- Brain and Psychological Sciences Research Centre, Swinburne University of Technology, Melbourne, Vic., Australia.,Department of Psychiatry, St Vincent's Hospital, Melbourne, Vic., Australia.,Monash Alfred Psychiatry Research Centre (MAPrc), The Alfred Hospital and Monash University Central Clinical School, Melbourne, Vic., Australia
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14
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Beilharz F, Rossell SL. Treatment Modifications and Suggestions to Address Visual Abnormalities in Body Dysmorphic Disorder. J Cogn Psychother 2017; 31:272-284. [PMID: 32755901 DOI: 10.1891/0889-8391.31.4.272] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Recent psychophysical and neurocognitive findings implicate abnormal visual processing for a range of stimuli in body dysmorphic disorder (BDD); such abnormalities differentiate BDD from other mental health disorders. Current treatments most commonly involve cognitive behavior therapy with or without accompanying antidepressant medications. These are moderately successful yet appear to overlook the core phenomenological aspect of abnormal perception in BDD. The following text summarizes the current literature of perceptual abnormalities within BDD and how these findings may be applied and incorporated into treatment options. Possible modifications of cognitive behavioral therapy (CBT) based on the widespread visual abnormalities within BDD include making perceptual mirror retraining a compulsory component of therapy and implementing self-exposure tasks within exposure and response prevention. Alternative options such as a visual training program to remediate visual abnormalities across a range of visual stimuli are also explored, which may be included as an adjunctive treatment alongside CBT.
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Affiliation(s)
- Francesca Beilharz
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
| | - Susan L Rossell
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia.,The Alfred Hospital and Monash University Central Clinical School, Melbourne, Australia.,Department of Psychiatry, St. Vincent's Hospital, Melbourne, Australia
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15
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Schneider SC, Storch EA. Improving the Detection of Body Dysmorphic Disorder in Clinical Practice. J Cogn Psychother 2017; 31:230-241. [PMID: 32755898 DOI: 10.1891/0889-8391.31.4.230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
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.
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Affiliation(s)
- Sophie C Schneider
- Department of Pediatrics, University of South Florida, St. Petersburg, Florida
| | - Eric A Storch
- University of South Florida, St. Petersburg, Florida.,Rogers Behavioral Health, Tampa, Florida.,Johns Hopkins All Children's Hospital, St. Petersburg, Florida
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16
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Introduction to the Special Issue on Body Dysmorphic Disorder. J Cogn Psychother 2017; 31:227-229. [PMID: 32755897 DOI: 10.1891/0889-8391.31.4.227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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17
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Cunningham ML, Griffiths S, Mitchison D, Mond JM, Castle D, Murray SB. Muscle Dysmorphia: An Overview of Clinical Features and Treatment Options. J Cogn Psychother 2017; 31:255-271. [DOI: 10.1891/0889-8391.31.4.255] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
An increasing public and empirical focus on male body image indicates that muscularity is a preeminent concern among boys and men. For some, these concerns develop into a complex and disabling psychiatric disorder termedmuscle dysmorphia(MD), the hallmark of which is an intense preoccupation regarding one’s (subjectively) insufficient muscularity. Treatment of MD is critical; however, evidence to inform treatment approaches is sorely lacking. The purpose of this article is twofold. First, we provide an overview of the clinical features of MD, drawing particular attention to the preoccupation, functional impairment and psychiatric comorbidity associated with the disorder. Second, we discuss and recommend potential treatment directions for MD, including techniques that have demonstrated efficacy in the treatment of related disorders, namely, body dysmorphic disorder and eating disorders (and anorexia nervosa in particular). Psychotherapeutic techniques, including cognitive restructuring of deleterious perfectionistic and egosyntonic beliefs, and dialectical behavioral techniques to improve the repertoire of emotion regulation skills available to afflicted individuals, are discussed, in addition to psychopharmacological approaches.
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18
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Turner C, Cadman J. When Adolescents Feel Ugly: Cognitive Behavioral Therapy for Body Dysmorphic Disorder in Youth. J Cogn Psychother 2017; 31:242-254. [PMID: 32755899 DOI: 10.1891/0889-8391.31.4.242] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Adolescence is a critical time for physical development and maturation, and with these important physiological changes comes greater awareness of body image and appearance, which, for a proportion of young people can become excessive, signaling the onset of body dysmorphic disorder (BDD). BDD in adolescence is associated with significant impairment and suicidality, is poorly understood, and currently there is limited evidence for the effectiveness of psychological therapy. Cognitive behavioral therapy (CBT) is currently the most promising and best available psychological therapy for BDD in youth. The aim of this article is to provide clinicians with information on CBT treatment for BDD in young people and to provide guidance based on clinical experience of working with this complex population group. The article will include discussion of strategies including maximizing psychoeducation with parental involvement, the use of cognitive therapy techniques, exposure with response prevention, and perceptual visual training techniques, including attention training and mirror retraining.
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Affiliation(s)
- Cynthia Turner
- School of Psychology, Australian Catholic University, Brisbane, Australia
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