Predicting response to a smartphone-based cognitive-behavioral therapy for body dysmorphic disorder

BACKGROUND

Body dysmorphic disorder (BDD) is a severe, chronic disorder if untreated. Smartphone cognitive behavioral therapy (CBT) for BDD is efficacious and can reduce key treatment barriers (e.g., lack of clinicians, cost, stigma). While promising, little is known about who is more or less likely to benefit from this approach.

METHODS

This is a secondary data analysis of a randomized, waitlist-controlled trial of smartphone CBT for BDD. Participants (N = 80) were recruited nationally and randomized to receive a 12-week, coach-guided CBT for BDD app, either immediately or after a 12-week waitlist. The main outcome for this analysis was BDD severity (BDD-YBOCS) over time (baseline, week 6, week 12) during the active app use phase in each randomized group (n = 74). Secondary outcomes included treatment response (≥30 % reduction in BDD-YBOCS) and remission (total BDD-YBOCS ≤16) at end-of-treatment.

RESULTS

Immediate (vs. delayed) CBT predicted better outcomes (symptom improvement), as did gender identity (symptom improvement), higher baseline treatment credibility and expectancy (response, remission), lower baseline BDD severity (remission), and sexual minority status (vs. heterosexual; response, remission).

LIMITATIONS

Limitations include the relatively small sample, drop-out rate of 22 %, and limited gender and racial-ethnic diversity.

CONCLUSIONS

These results highlight a potential advantage of smartphone CBT in historically marginalized populations, and the importance of efforts to hasten treatment access, bolster confidence in the treatment at treatment onset, and develop stratified care models to optimize treatment allocation and efficacy.

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

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.

Psychometric evaluation of the appearance anxiety inventory in adolescents with body dysmorphic disorder

The Appearance Anxiety Inventory (AAI) is a self-report measure assessing the typical cognitions and behaviours of body dysmorphic disorder (BDD). Despite its use in research and clinical settings, its psychometric properties have not been evaluated in young people with BDD. We examined the factor structure, reliability, validity, and sensitivity to change of the AAI in 182 youths with BDD (82.9% girls; Mage = 15.56, SD = 1.37) consecutively referred to two specialist outpatient clinics in Stockholm, Sweden (n = 97) and London, England (n = 85). An exploratory factor analysis identified three factors, namely "threat monitoring", "camouflaging", and "avoidance", explaining 48.15% of the variance. The scale showed good internal consistency (McDonalds omega = 0.83) and adequate convergent validity with the Yale-Brown Obsessive-Compulsive Scale Modified for Body Dysmorphic Disorder for Adolescents (BDD-YBOCS-A; rs = 0.42) and the Clinical Global Impression-Severity Scale (rs = 0.32). Sensitivity to change was adequate, with AAI total scores and individual factor scores significantly decreasing over time in the subgroup of participants receiving multimodal treatment for BDD (n = 79). Change of AAI scores over treatment showed a positive statistically significant moderate-to-good correlation (r = 0.55) with changes in BDD symptom severity, measured by the BDD-YBOCS-A. The study provides empirical support for the use of the AAI in young people with BDD in clinical settings.

Enhancing self-esteem in adults with body dysmorphic symptoms: experimental testing and initial evaluation of a brief internet-based training

BACKGROUND

Low self-esteem is an important factor associated with body dysmorphic concerns. In treatment, self-esteem cannot always be adequately addressed. Internet-based interventions offer a low-threshold and cost-efficient possibility for treating body dysmorphic disorder (BDD).

AIMS

For this reason, we conducted two studies to explore the effectiveness of an internet-based intervention targeting improving self-esteem in adults with BDD symptoms.

METHOD

The first study investigated the differential effects of a 1-week self-esteem training compared with a 1-week attention-focus training. Two hundred twenty adults with elevated body dysmorphic symptoms were randomly assigned to one of the two trainings. Our second study (n = 58 adults with body dysmorphic symptoms) evaluated an extended 2-week stand-alone self-esteem training.

RESULTS

In the first study, self-esteem in different domains (appearance, performance and social), self-focused attention, and BDD symptom severity improved in both groups. Other-focused attention only increased in the attention training group. Participants' overall adherence was high. In the second study we observed significant improvements in self-esteem, BDD symptom severity, and other secondary outcomes, with additional improvements in most outcomes in the second week. Adherence was again high.

CONCLUSIONS

Together, these findings show that a brief internet-based intervention may be a highly accepted and effective way of improving self-esteem in people suffering from BDD symptoms.

Time to Response in Therapy for Body Dysmorphic Disorder: A Comparison of Cognitive Behavioral Therapy and Supportive Psychotherapy

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.

A randomized controlled trial of mindfulness-based cognitive therapy for body dysmorphic disorder: Impact on core symptoms, emotion dysregulation, and executive functioning

BACKGROUND AND OBJECTIVES

Mindfulness-based cognitive therapy (MBCT) is garnering increasing empirical interest as an intervention for Body Dysmorphic Disorder (BDD), although no studies of mindfulness as a standalone treatment have included a sample composed entirely of patients with BDD or a comparison group. The aim of this study was to investigate the improvement of MBCT intervention on the core symptoms, emotional dysfunction, and executive function of BDD patients, as well as the feasibility and acceptability of MBCT training.

METHOD

Patients with BDD were randomized into an 8-week MBCT group (n = 58) or treatment-as-usual (TAU) control group (n = 58) and were assessed at pre-treatment, post-treatment, and 3-month follow-up.

RESULTS

Participants who received MBCT showed greater improvement on self-reported and clinician ratings of BDD symptoms, self-reported emotion dysregulation symptoms and executive function compared with TAU participants. Improvement for executive function tasks was partially supported. In addition, feasibility and acceptability of MBCT training were positive.

LIMITATIONS

There is no systematic assessment of the severity of key potential outcome variables associated with BDD.

CONCLUSION

MBCT may be a useful intervention for patients with BDD, improving patients' BDD symptoms, emotion dysregulation, and executive functioning.

[Towards perfection: the ethical downside of the ideal of beauty]

Beauty, it seems, is a fascination inherent in human nature. Research shows that an attractive face plays a significant factor in human life, such as in the areas of appreciation and judgment.The growing demand for cosmetic treatments is amplified by social media and influencer marketing. However, there are possible negative effects, such as addiction and dissatisfaction with treatment outcome in people with Body Dysmorphic Disorder. It remains important to recognize that risks are inherent in medical procedures.

Appearance-related safety behaviors predict symptoms of body dysmorphic disorder following internet-based treatment

Recent experimental evidence has found that appearance related safety behaviors (i.e., practices meant to avoid a perceived feared outcome) likely play a crucial role in maintaining symptoms of body dysmorphic disorder (BDD). The present study sought to determine if these behaviors predicted BDD symptom severity following treatment. Participants (N = 50) with BDD were randomized to either eight sessions of interpretation bias modification or progressive muscle relaxation. Both treatments led to reductions in BDD symptom severity and appearance-related safety behaviors, though moderate levels of safety behaviors persisted at both posttreatment and follow-up. Importantly, post-treatment appearance related safety behaviors significantly predicted BDD symptom severity at three-month follow-up. Taken together, the present findings suggest appearance related safety behaviors maintain BDD symptoms following effective computerized treatments and provide further evidence for their importance in the treatment of BDD.

Internet-Based Treatment of Body Dysmorphic Disorder: Feasibility, Evaluation, and Self-Report Data

ABSTRACT

Initial findings indicate the effectiveness of internet-based interventions for body dysmorphic disorder (BDD). In order to substantiate these findings, a seven-module guided internet-based intervention was created and examined. We report the mixed data of participants with clinical and subclinical BDD of the treatment group (n = 18). We investigated the feasibility, the quality of the program content, the design and usability, and its effects on symptom severity and related psychopathology. Adherence to the intervention was low and dropout rate high (55.6%). The program content, perceived website usability, and visual aesthetic were rated high. Credibility and expectancy were on a medium level. Satisfaction with appearance improved significantly in the intention-to-treat analysis (d = 0.58). In sum, symptom-related outcomes and program evaluation showed a positive trend albeit the study conduction was difficult. Future programs should investigate the role of additional motivation strategies and more flexible support addressing the known treatment barriers.

Mechanisms of cognitive-behavioral therapy effects on symptoms of body dysmorphic disorder: a network intervention analysis

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.

Mechanisms of cognitive behavioral therapy vs. supportive psychotherapy in body dysmorphic disorder: An exploratory mediation analysis

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.

Cognitive training via a mobile application to reduce some forms of body dissatisfaction in young females at high-risk for body image disorders: A randomized controlled trial

Body dissatisfaction has been related to Body Image Disorders (BIDs) such as Eating Disorders (EDs) and Body Dysmorphic Disorder (BDD). This study investigates the efficacy of a mHealth app in reducing body dissatisfaction, BDD/ED symptoms and related features. Ninety-five women who were identified as high-risk of developing BIDs (using the Structured Clinical Interview for DSM-5) were randomized into: immediate-use App (iApp group; n = 47) and delayed-use App (dApp group; n = 48). The iApp group started using the app at baseline for 16 days (T1). The dApp group started using the app at T1 for 16 days. Participants completed questionnaires at baseline (T0), 16 days from baseline (T1), and 32 days from baseline (T2). Repeated measure Multivariate Analysis of Variance (MANOVA) showed Group (iApp vs. dApp) × Time (T0 vs. T1) interactions indicating decrease in BDD symptoms and body dissatisfaction related to EDs in the iApp group at T1. The Reliable Change Index indicated changes on extreme body dissatisfaction/BDD symptoms for 34.74% of participants. Although preliminary, these findings highlight that a mHeatlh app might reduce BDD symptoms and body dissatisfaction related to EDs in women at high-risk for BIDs. Effects on ED symptoms and associated features seem more limited.

Efficacy of App-Based Cognitive Behavioral Therapy for Body Dysmorphic Disorder with Coach Support: Initial Randomized Controlled Clinical Trial

INTRODUCTION

Body dysmorphic disorder (BDD) is severe, chronic, and undertreated. Apps could substantially improve treatment access.

OBJECTIVE

We provide an initial test of the usability and efficacy of coach-supported app-based cognitive behavioral therapy (CBT) for BDD. The Perspectives app covers core treatment components: psychoeducation, cognitive restructuring, exposure with response prevention, mindfulness, attention retraining, and relapse prevention.

METHODS

A randomized waitlist-controlled trial was conducted. Adults (N = 80) with primary BDD were assigned to 12 weeks of Perspectives or waitlist. Coaches promoted engagement and answered questions via in-app messaging and phone calls. BDD severity was measured at baseline, mid-treatment, and end of treatment by blinded independent evaluators (Yale-Brown Obsessive Compulsive Scale Modified for BDD; BDD-YBOCS). Secondary outcomes included BDD-related insight, depression, quality of life, and functioning.

RESULTS

App uptake and satisfaction were high. In intent-to-treat analyses, Perspectives app-based CBT was associated with significantly lower BDD-YBOCS severity at end of treatment (M [SD]: 16.8 [7.5]) compared to the waitlist (26.7 [6.2]; p < 0.001, d = 1.44). App-based CBT was associated with greater improvements across all secondary measures, with medium to large effects.

CONCLUSIONS

Perspectives, supported by a bachelor's-level coach, is an efficacious, scalable treatment for adults with BDD.

Body dysmorphic disorder (BDD) in the orthodontic and orthognathic setting: A systematic review

General prevalence of Body Dysmorphic Disorder (BDD), a psychiatric disorder in which patients focus on an imagined body defect not visible to others, varies between 0.7 and 2.5%. Up to 86% present with complaints in the area of teeth or face. Patients with BDD pursue an aesthetic rather than functional recovery, making BDD a possible contraindication to treatment. The aim of this systematic review was to review prevalence of BDD within the orthodontic and/or orthognathic population, to describe diagnostic tools for early detection of patients with BDD and to assess the outcome after treatment. A systematic search was conducted up to November 2020 using PubMed, Embase, Web of Science Core Collection and Cochrane Library. Following the screening of 1423 articles, 5 prospective studies were included. Prevalence of BDD within the orthodontic and orthognathic population varied from 5.2% to 13% (average of 6.2%). Literature showed a trend of higher BDD prevalence within younger, female and single patient population, although results are not conclusive. Questionnaires can be useful for preliminary detection of BDD. General anamnesis with questioning medical or psychiatric history, medication and personal expectations remains very important. Red flags could be previous consultations for the same problem or presence of psychiatric comorbidities. Prospective studies are necessary to map satisfaction of these patients and need for re-interventions after treatment.

Body dysmorphic disorder of female genitalia: a qualitative study of Swiss obstetrician-gynecologists' experiences and practices

Purpose

This work focuses on the experiences and practices of obstetrician–gynecologists (ob–gyns) with patients suffering from body dysmorphic disorder (BDD) and issues with their aesthetics, specifically focusing on female genitalia. Ob–gyns are likely to play an important role in the recognition and treatment of women facing such issues.

Methods

This study took a qualitative, explorative approach. Semi-structured interviews were conducted with 11 ob–gyns about their experiences with patients who presented symptoms of BDD of female genitalia, their treatments, and interest in further education and supportive material. Interviews were analyzed through qualitative content analysis.

Results

A categorization system was created. The results showed that the participating ob–gyns are often confronted with genital dissatisfaction of patients. The study sample demonstrated a lack of mental health literacy concerning BDD. The treatments that the ob–gyns of this sample suggested for BDD of female genitalia were not in line with what evidence suggests. Finally, interest in further education and supportive material for consultation was evidenced in this sample.

Conclusions

The findings encourage further studies to identify the recognition of BDD concerning genitalia or etiological factors. Furthermore, practical implications (e.g., need of supportive material) can be derived from the results.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00404-021-06270-w.

Empirically Defining Treatment Response and Remission in Body Dysmorphic Disorder Using a Short Self-Report Instrument

Determining response or remission status in body dysmorphic disorder (BDD) usually requires a lengthy interview with a trained clinician. This study sought to establish empirically derived cutoffs to define treatment response and remission in BDD using a brief self-report instrument, the Appearance Anxiety Inventory (AAI). Results from three clinical trials of BDD were pooled to create a sample of 123 individuals who had received cognitive-behavioral therapy for BDD, delivered via the Internet. The AAI was compared to gold-standard criteria for response and remission in BDD, based on the clinician-administered Yale-Brown Obsessive Compulsive Scale, modified for BDD (BDD-YBOCS), and evaluated using signal detection analysis. The results showed that a ≥ 40% reduction on the AAI best corresponded to treatment response, with a sensitivity of 0.71 and a specificity of 0.84. A score ≤ 13 at posttreatment was the optimal cutoff in determining full or partial remission from BDD, with a sensitivity of 0.75 and a specificity of 0.88. These findings provide benchmarks for using the AAI in BDD treatment evaluation when resource-intensive measures administered by clinicians are not feasible.

Empirically defining treatment response and remission in body dysmorphic disorder

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.

[Body dysmorphic disorder: One Hundred Years of Solitude]

Body dysmorphic disorder is a common psychiatric disease; its respective prevalence is 2% in the general population, 3.3% in tertiary students, 7.4% among adolescent and adult psychiatric in-patients, and above 10% in patients of cosmetic surgery or dermatology. The most important symptom of the disease is the distorted perception of bodily appearance that leads to low self-esteem, anxiety, depression, social isolation and compulsive behaviours. The disease usually begins during adolescence (average age at onset: 16.7 years), the symptoms have a rather deleterious impact on social relationships, education, work and family life. Comorbidity with affective disorders, anxiety disorders, personality disorders, eating disorders, alcoholism, and substance use disorders is common. The life quality of the affected patients is bad, the risk of suicide is high, and the occurrence of heteroaggressive behaviour is not infrequent either. Despite the great prevalence and the serious consequences, body dysmorphic disorder is diagnosed only in 15% of the cases, and it occurs relatively rarely that the individuals affected by the disease get an adequate treatment. The patients do not usually ask for help because they feel ashamed, or they look for help in wrong places because of lack of insight. In addition, quite many experts working in the health service are not sufficiently familiar with the pheno - mena of this disorder. The authors' objective is to provide a thorough review about body dysmorphic disorder with special regard to the results of the past decade. A substantial recent change is the fact that the disorder, previously categorized in the group of somatoform disorders, has been placed in the group of obsessive-compulsive and related disorders in DSM-5. A complex interplay of biological, psychological and sociocultural factors underlies the etio - patho genesis. Pharmacotherapy with serotonin reuptake inhibitors and cognitive-behavioural therapy are still regarded as the most effective treatments for body dysmorphic disorder. The modifications of the latter developed to target misperception of appearance, emotional dysfunction or perfectionism seem to represent promising therapeutic measures in addition to the application of novel methods of information technology.

Mental Disorders: Obsessive-Compulsive Disorder and Body Dysmorphic Disorder

Obsessive-compulsive disorder (OCD) is characterized by recurrent intrusive thoughts, images, or urges (ie, obsessions) and repetitive mental acts or behaviors (ie, compulsions). Body dysmorphic disorder (BDD) is a chronic preoccupation with perceived flaws in physical appearance that leads to repetitive behaviors (ie, rituals). The Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-5) places both disorders under a new category, obsessive-compulsive and related disorders, along with hoarding disorder, excoriation disorder, and trichotillomania. Both OCD and BDD cause marked distress and functional impairment in patients. They share similarities in terms of risk factors and comorbid conditions. Management of these disorders involves a thorough assessment of symptoms, suicidal ideation, and comorbid medical and mental health conditions. Cognitive behavioral therapy (CBT) is the most effective therapy option for OCD. Pharmacotherapy with selective serotonin reuptake inhibitors (SSRIs) can be added for patients who do not improve with CBT only, or used as an initial treatment with or without CBT for patients with severe symptoms. For patients with BDD, initial treatments for monotherapy or combination therapy are SSRIs and/or CBT tailored to BDD. For patients with severe BDD or signs of suicidality, combination therapy should be used.

Prevalence and impact of insomnia in children and adolescents with body dysmorphic disorder undergoing multimodal specialist treatment

Pediatric body dysmorphic disorder (BDD) is challenging to treat. This study aimed to establish the prevalence of insomnia in youth with BDD and explore its impact on clinical outcomes. Sixty-six children and adolescents with BDD consecutively referred to a specialist clinic completed a range of clinical measures, including the Yale-Brown Obsessive-Compulsive Scale Modified for BDD-Adolescent Version (BDD-YBOCS-A), and the Insomnia Severity Index (ISI). Patients with clinical insomnia (ISI score ≥ 9) were compared to the rest of the sample on socio-demographic and clinical features. Fifty-six patients who received multimodal treatment were re-assessed post-treatment. A mixed-model ANOVA was performed to compare treatment outcomes between the insomnia vs. no insomnia groups, and Chi-squared tests were used to compare response and remission rates. According to the ISI, 48% of the sample qualified as having insomnia at baseline. These participants showed significantly higher self-reported BDD symptom severity, more depressive symptoms, and more functional impairment in daily activities. Patients with insomnia improved less on the BDD-YBOCS-A than those without insomnia, although the difference did not reach statistical significance. The rates of responders and remitters were lower in the insomnia group, compared to the non-insomnia group. Insomnia is prevalent in pediatric BDD, and is associated with more severe psychopathology and worse functioning in daily activities. Furthermore, youth experiencing BDD and insomnia may benefit from multimodal treatment to a lesser extent than those without insomnia. If these results are replicated in larger samples, treatment refinements for pediatric BDD could include specific modules to directly target insomnia.

[Body Dysmorphic Disorder - Balance between Beauty Mania and Illness]

Body Dysmorphic Disorder - Balance between Beauty Mania and Illness Abstract. The body dysmorphic disorder (BDD) belongs to the somatoform disorders and is characterized by an excessive concern about a slight or not apparent defect in appearance. Typical areas of concern include the face, for example the skin texture or form and symmetry of a particular feature. Besides behavioral pecularities such as excessive checking of the defect in a mirror, the preoccupation causes clinically significant distress and impairment in social functioning. Given a prevalence of up to 20 % among patients seeking plastic surgery, it is perhaps the most relevant psychiatric condition for plastic surgeons. Moreover, aesthetic treatments might even lead to a worsening of symptoms. Thus, we recommend close observation of all patients seeking aesthetic operations cautiously with regard to typical symptoms and behavior. Particular questions from well-known screening questionnaires might further help to identify patients with BDD.

[Body Dysmorphic Disorder: Diagnosis, Treatment and Challenges in the General Practice]

Body Dysmorphic Disorder: Diagnosis, Treatment and Challenges in the General Practice Abstract. Body dysmorphic disorder (point prevalence: 1.7-2.4 %) is characterized by excessive preoccupation with one or more subjectively perceived blemishes of the appearance, as a result of which those affected show a high burden of disease due to avoidance behavior and time-consuming rituals, and often secondary problems (including depression, suicidal tendencies). The disorder is often accompanied by pronounced shame and is therefore associated with challenges in diagnostics, which is why the indication and specialist treatment (first-line treatment: cognitive-behavioural therapy) are usually only carried out with great latency. Family doctors can play a key role in diagnosis and treatment because of the often long-standing relationship of trust with their patients. Targeted screening, active and at the same time prudent discussion, as well as knowledge of treatment options and special features of the disease pattern (e.g. fluctuating understanding of the disease, desire for plastic surgery measures) are necessary. Against this background, the article provides an overview of the clinic, diagnostics and therapy and concludes with specific challenges and practical recommendations for family practice.

Opening a Pandora's Box that can't be salvaged: Health professionals' perceptions of appearance-related care in an Australian pediatric specialist hospital

Many children and young people struggle adjusting to the psychosocial consequences (e.g., body dissatisfaction, social anxiety, and stigmatisation) of visible differences (or disfigurement). As appearance-affecting conditions often require specialist multidisciplinary team care, health professionals are in a unique position to offer psychosocial support and intervention. However, there is a dearth of literature on how appearance-related concerns are managed in pediatric hospital settings. Sixteen Australian specialist health professionals participated in semi-structured qualitative interviews to address this gap. Interviews explored current appearance-related psychosocial service provision, barriers in accessing appearance-related care, and perceptions of online platforms to deliver specialist support and intervention. Thematic analysis demonstrated four themes: We can do it better, Capability versus availability, Online generation, and Putting appearance on the agenda. This research highlighted the potential value of online platforms to increase accessibility to specialist appearance-related care, the need for more psychosocial resources to be integrated into appearance-related specialities, prioritising the development of low to medium appearance-related support and intervention, increasing the appearance-related knowledge of health professionals and families, and the need for more holistic approaches in routine care.

Internet-based, therapist-guided, cognitive-behavioural therapy for body dysmorphic disorder with global eligibility for inclusion: an uncontrolled pilot study

OBJECTIVES

Cognitive-behavioural therapy (CBT) has been shown to be an effective treatment for body dysmorphic disorder (BDD), but access to treatment around the world is limited. One way to increase access is to administer CBT remotely via the internet. This study represents the first effort to remotely deliver a therapist-supported, internet-based CBT treatment with no restrictions on enrolment based on geographical location, and it aims to assess whether this treatment can be delivered safely across international borders, with outcomes comparable to previous BDD-NET trials.

DESIGN

Uncontrolled clinical trial.

PARTICIPANTS

Patients (n=32) in nine different countries were recruited primarily through internet advertisements.

INTERVENTION

BDD-NET is a 12-week treatment, consisting of eight treatment modules previously shown to be effective in a Swedish version.

SETTING

Therapists based at a single, secondary care centre in Sweden provided active guidance and feedback throughout the treatment via asynchronous electronic messages.

MAIN OUTCOME MEASURE

The clinician-administered Yale-Brown Obsessive Compulsive Scale for BDD (BDD-YBOCS). Symptom severity was assessed pretreatment, mid-treatment (6 weeks), post-treatment and at the 3-month follow-up.

RESULTS

There were significant improvements on BDD-YBOCS scores (F(3, 71.63)=31.79, p<0.001), that were maintained at 3-month follow-up. Mean differences from baseline in BDD-YBOCS scores were -8.12 (week 6), -12.63 (post-treatment) and -11.71 (3-month follow-up). 47% and 50% of participants were considered treatment responders at post-treatment and 3-month follow-up, respectively. Additionally, remission rates were 28% at post-treatment and 44% at 3-month follow-up. The treatment was also deemed acceptable by patients.

CONCLUSIONS

The results suggest that BDD-NET can be safely and effectively delivered across international borders to a culturally diverse sample. Larger scale randomised controlled trials with more participants from non-Western cultures are warranted to further validate the cross-cultural generalisability of this treatment.

TRIAL REGISTRATION NUMBER

NCT03517384.

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.

Long-term outcome of therapist-guided internet-based cognitive behavioural therapy for body dysmorphic disorder (BDD-NET): a naturalistic 2-year follow-up after a randomised controlled trial

OBJECTIVES

Most patients with body dysmorphic disorder (BDD) do not receive evidence-based treatment. A randomised controlled trial (RCT) has found that a therapist-guided internet-based cognitive-behavioural therapy (CBT) programme for BDD (BDD-NET) can be delivered safely via the internet with significant improvements in BDD symptom severity in the short term. The purpose of this study was to evaluate if the therapeutic gains of BDD-NET are maintained 2 years after treatment.

SETTING

Academic medical centre.

PARTICIPANTS

A naturalistic 2-year follow-up study of the 88 self-referred adult outpatients with a diagnosis of BDD that had received BDD-NET within the context of the RCT.

PRIMARY AND SECONDARY OUTCOMES

The primary outcome was the BDD-Yale-Brown Obsessive-Compulsive Scale (YBOCS). Responder status was defined as a ≥30% reduction in symptoms. Remission was defined as no longer meeting Diagnostic and Statistical Manual of Mental Disorders 5th edition criteria for BDD. Secondary outcomes included measures of depression, global functioning and quality of life.

RESULTS

The efficacy of BDD-NET was sustained long- term, with further improvements observed on the BDD-YBOCS during the follow-up period. At follow-up, 69% (95% CI 57% to 80%) were classified as responders and 56% (95% CI 43% to 69%) were in remission. Gains on depressive symptoms and global functioning were also sustained but not quality of life. A majority of participants reported that the main reason for seeking help for their BDD was the possibility to access the treatment from home.

CONCLUSION

BDD-NET is an effective treatment for BDD, and the patients' gains are maintained in the long term. BDD-NET has the potential to increase access to CBT and may lower the threshold for BDD sufferers to seek help in the first place.

TRIAL REGISTRATION NUMBER

NCT02010619.

Recent advances in understanding and managing body dysmorphic disorder

Body dysmorphic disorder (BDD) is a relatively common and disabling psychiatric disorder characterised by excessive and persistent preoccupation with perceived defects or flaws in one's appearance, which are unnoticeable to others, and associated repetitive behaviours (eg, mirror checking). The disorder generally starts in adolescence, but often goes unnoticed and is severely underdiagnosed. Left untreated, BDD typically persists and causes marked functional impairment in multiple domains. This clinical review considers recent advances in the epidemiology and classification of BDD, including its reclassification in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders under the new 'Obsessive-Compulsive and Related Disorders' chapter. Key issues in assessment are outlined including the use of validated screening instruments to minimise misdiagnosis and the importance of risk assessment in this population given the high rates of suicidality and inappropriate use of cosmetic treatments. In addition, current knowledge regarding the causes and mechanisms underlying BDD are summarised. The recommended treatments for BDD are outlined, namely cognitive behavioural therapy (CBT) and antidepressants, such as selective serotonin reuptake inhibitors. Both CBT and pharmacotherapy have been shown to be efficacious treatments for BDD in adult populations, and evidence is emerging to support their use in young people. Although the majority of patients improve with existing evidence-based treatment, a large proportion are left with clinically significant residual symptoms. Priorities for future research are therefore discussed including the need to further refine and evaluate existing interventions with the goal of improving treatment outcomes and to increase their availability.

Psychocutaneous disease: Clinical perspectives

Psychocutaneous disease, defined in this review as primary psychiatric disease with skin manifestations, is commonly encountered in dermatology. Dermatologists can play an important role in the management of psychocutaneous disease because patients visit dermatology for treatment of their skin problems but often refuse psychiatric intervention. This review describes common psychocutaneous syndromes, including delusional, factitious, obsessive-compulsive and related, and eating disorders, as well as psychogenic pruritus, cutaneous sensory (pain) syndromes, posttraumatic stress disorder, and sleep-wake disorders. The updated classification of these disorders in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition is included. Strategies for management are reviewed.

Cognitive-behavioural therapy and recovery of a delusional dysmorphophobia case

BACKGROUND

We present the application of cognitive-behavioural therapy in a clinical case diagnosed with delusional dysmorphophobia.

METHOD

The psychometric scales used for evaluation were the Positive and Negative Syndrome Scale for Schizophrenia, Beck Anxiety and Depression inventories, the Rosenberg Self-Esteem Scale along with the degree of conviction in the delusional belief and in alternative explanations, and social functioning measured by patient reporting. The therapy included cognitive and behavioural techniques: evidence analysis, search for alternative explanations, logical and functional analysis, reality testing, progressive relaxation techniques, in vivo and imaginal exposure therapy. Evaluations were performed before and after the treatment and then at follow-up after 12 and 24 months.

RESULTS

Progressively, the delusional conviction disappeared. There were significant improvements at an emotional level and the patient recovered social and work&nbsp; functioning.

CONCLUSIONS

The need to use psychological treatments for people with delusional disorder as first choice treatment must be considered.

Understanding and Treating Women's Body Image and Eating Disorders

This article provides an overview of the etiology of eating disorders, screening recommendations, and evidence-based treatment options. These disorders are a noteworthy concern among girls and women in the United States, especially given the resulting medical comorbidities and high mortality rates.

[Body dysmorphic disorder: clinical aspects, nosological dimensions and controversies with anorexia nervosa]

There is strong evidence about the co-existence of body dysmorphic disorder (BDD) and eating disorders (ED), particularly with anorexia nervosa (AN). An exhaustive review of the specialised literature regarding these disorders was carried out. The results show that their co-occurrence implies a more complex diagnosis and treatment, a more severe clinical symptomatology and a worse prognosis and outcome. Both disorders display common similarities, differences and comorbidities, which allow authors to classify them in different nosological spectra (somatomorphic, anxious, obsessive-compulsive, affective and psychotic). Their crossover involves higher levels of body dissatisfaction and body image distortion, depression, suicidal tendency, personality disorders, substance use/abuse, obsessive-compulsive disorder, social phobia, alexithymia and childhood abuse or neglect background. Treatment including cognitive-behavioral psychotherapy and selective reuptake serotonin inhibitors are effective for both, BDD and ED; nevertheless, plastic surgery could exacerbate BDD. Clinical traits of BDD must be systematically detected in patients suffering from ED and vice versa.

Body Image and Body Dysmorphic Concerns

Most people would like to change something about their bodies and the way that they look, but for some it becomes an obsession. A healthy skin plays an important role in a person's physical and mental wellbeing, whereas a disfiguring appearance is associated with body image concerns. Skin diseases such as acne, psoriasis and vitiligo produce cosmetic disfigurement and patients suffering these and other visible skin conditions have an increased risk of depression, anxiety, feelings of stigmatization and self-harm ideation. Body image affects our emotions, thoughts, and behaviours in everyday life, but, above all, it influences our relationships. Furthermore, it has the potential to influence our quality of life. Promotion of positive body image is highly recommended, as it is important in improving people's quality of life, physical health, and health-related behaviors. Dermatologists have a key role in identifying body image concerns and offering patients possible treatment options.

Obsession with perfection: Body dysmorphia

The deeply rooted fascination with beauty penetrates society worldwide. The indulgence to look and feel beautiful pervades all ages, genders, and nationalities, with research conferring a remarkable tendency to agree on measures of attractiveness among these disparate groups. Research has found that beautiful people do, in fact, receive more desirable outcomes in life and job satisfaction, family formation, and overall happiness. Humans have a tendency to respond to attractive persons more favorably, driving many patients to our clinics. Although some dissatisfaction with one's appearance is common and normal, excessive concern with certain facial or body attributes can be sign of an underlying disorder. Body dysmorphic disorder (BDD) is a disorder of self-perception. It is the obsession with perfection. Defined as the impairing preoccupation with a nonexistent or minimal flaw in appearance, BDD affects 0.7-2.4% of the general population and a much larger percentage of those attempting to receive aesthetic treatments. Clinicians should be aware of this disorder and remain vigilant because such patients will not be satisfied with corrective procedures. Although not involving cosmetic intervention, the treatment of BDD does involve psychiatric referral and psychopharmacologic therapy, with patients receiving these having a much better prognosis.

Imagery Rescripting for Body Dysmorphic Disorder: A Multiple-Baseline Single-Case Experimental Design

Individuals with body dysmorphic disorder (BDD) often experience negative distorted images of their appearance, and research suggests these may be linked to memories of adverse events such as bullying or teasing. This study evaluates imagery rescripting (ImR) as an intervention for BDD. In this article, we present a multiple-baseline single-case experimental design testing imagery rescripting as a brief, stand-alone intervention, with six individuals with BDD that related to aversive memories. The impact of the intervention was assessed by self-reported daily measures of symptom severity (preoccupation with appearance, appearance-related checking behaviors, appearance-related distress, and strength of belief that their main problem is their appearance) and standardized clinician ratings of BDD severity (Yale-Brown Obsessive Compulsive Scale modified for BDD). Four out of six of the participants responded positively to the intervention, with clinically meaningful improvement in symptomatology. Overall response was rapid; improvements began within the first week post-ImR intervention. From a small sample it is cautiously concluded that imagery rescripting may show promise as a module in cognitive-behavioral therapy for BDD, and is worthy of further investigation.

Therapist guided internet based cognitive behavioural therapy for body dysmorphic disorder: single blind randomised controlled trial

OBJECTIVES

To evaluate the efficacy of therapist guided internet based cognitive behavioural therapy (CBT) programme for body dysmorphic disorder (BDD-NET) compared with online supportive therapy.

DESIGN

A 12 week single blind parallel group randomised controlled trial.

SETTING

Academic medical centre.

PARTICIPANTS

94 self referred adult outpatients with a diagnosis of body dysmorphic disorder and a modified Yale-Brown obsessive compulsive scale (BDD-YBOCS) score of ≥ 20. Concurrent psychotropic drug treatment was permitted if the dose had been stable for at least two months before enrolment and remained unchanged during the trial.

INTERVENTIONS

Participants received either BDD-NET (n=47) or supportive therapy (n=47) delivered via the internet for 12 weeks.

MAIN OUTCOME MEASURES

The primary outcome was the BDD-YBOCS score after treatment and follow-up (three and six months from baseline) as evaluated by a masked assessor. Responder status was defined as a ≥ 30% reduction in symptoms on the scale. Secondary outcomes were measures of depression (MADRS-S), global functioning (GAF), clinical global improvement (CGI-I), and quality of life (EQ5D). The six month follow-up time and all outcomes other than BDD-YBOCS and MADRS-S at 3 months were not pre-specified in the registration at clinicaltrials.gov because of an administrative error but were included in the original trial protocol approved by the regional ethics committee before the start of the trial.

RESULTS

BDD-NET was superior to supportive therapy and was associated with significant improvements in severity of symptoms of body dysmorphic disorder (BDD-YBOCS group difference -7.1 points, 95% confidence interval -9.8 to -4.4), depression (MADRS-S group difference -4.5 points, -7.5 to -1.4), and other secondary measures. At follow-up, 56% of those receiving BDD-NET were classed as responders, compared with 13% receiving supportive therapy. The number needed to treat was 2.34 (1.71 to 4.35). Self reported satisfaction was high.

CONCLUSIONS

CBT can be delivered safely via the internet to patients with body dysmorphic disorder. BDD-NET has the potential to increase access to evidence based psychiatric care for this mental disorder, in line with NICE priority recommendations. It could be particularly useful in a stepped care approach, in which general practitioner or other mental health professionals can offer treatment to people with mild to moderate symptoms at low risk of suicide.Trial registration ClinicalTrials.gov ID: NCT02010619.

[A Case with Multiple Comorbidities of Obsessive-Compulsive and Related Disorders]

Obsessive-compulsive and related disorders (OCRDs) have been introduced in a revision to DSM-5 as a novel category that is distinct from other anxiety disorders in DSM-IV. OCRDs consist of 5 primary disorders: obsessive-compulsive disorder (OCD), body dysmorphic disorder (BDD), hoarding disorder (HD), skin picking disorder (SPD), and hair pulling disorder (HPD), which share core clinical features such as preoccupation or recurrent thoughts and/or repetitive behaviors. Repetitive behaviors in BDD and HD can be differentially characterized by the presence of cognitive components associated with preceding anxiety from those in SPD or HPD, which are only observed as motoric components that regulate emotions or alleviate tension. Thus, the validity of the OCRD category and specific interrelationships between each OCRD remain uncertain. In the present study, therefore, we presented a case of multiple comorbidities of OCRDs in order to discuss the nature of the OCRD category. Our patient was a 20-year-old female university student. At the age of 11 years old, she started picking at acne on her face. The psychopathological, and treatment features observed in this case indicated possible interrelationships among OCRDs, especially between cognitive and motoric OCRDs, which supported the clinical utility and continuous nature of this category.

Therapist-guided, Internet-based cognitive-behavioural therapy for body dysmorphic disorder (BDD-NET): a feasibility study

OBJECTIVES

Cognitive-behavioural therapy (CBT) is an effective treatment for body dysmorphic disorder (BDD). However, most sufferers do not have access to this treatment. One way to increase access to CBT is to administer treatment remotely via the Internet. This study piloted a novel therapist-supported, Internet-based CBT program for BDD (BDD-NET).

DESIGN

Uncontrolled clinical trial.

PARTICIPANTS

Patients (N=23) were recruited through self-referral and assessed face to face at a clinic specialising in obsessive-compulsive and related disorders. Suitable patients were offered secure access to BDD-NET.

INTERVENTION

BDD-NET is a 12-week treatment program based on current psychological models of BDD that includes psychoeducation, functional analysis, cognitive restructuring, exposure and response prevention, and relapse prevention modules. A dedicated therapist provides active guidance and feedback throughout the entire process.

MAIN OUTCOME MEASURE

The clinician-administered Yale-Brown Obsessive Compulsive Scale for BDD (BDD-YBOCS). Symptom severity was assessed pretreatment, post-treatment and at the 3-month follow-up.

RESULTS

BDD-NET was deemed highly acceptable by patients and led to significant improvements on the BDD-YBOCS (p=<0.001) with a large within-group effect size (Cohen's d=2.01, 95% CI 1.05 to 2.97). At post-treatment, 82% of the patients were classified as responders (defined as≥30% improvement on the BDD-YBOCS). These gains were maintained at the 3-month follow-up. Secondary outcome measures of depression, global functioning and quality of life also showed significant improvements with moderate to large effect sizes. On average, therapists spent 10 min per patient per week providing support.

CONCLUSIONS

The results suggest that BDD-NET has the potential to greatly increase access to CBT, at least for low-risk individuals with moderately severe BDD symptoms and reasonably good insight. A randomised controlled trial of BDD-NET is warranted.

TRIAL REGISTRATION NUMBER

Clinicaltrials.gov registration ID NCT01850433.

Body dysmorphic disorder

Body dysmorphic disorder (BDD) can be a severe and often debilitating psychiatric disorder that has been largely under-recognized and underdiagnosed. Pharmacologic and nonpharmacologic treatment options are available but limited. This review aims to provide an updated overview of the psychopathology and epidemiology of BDD, with an emphasis on current pharmacologic and nonpharmacologic treatment options for BDD.

Body dysmorphic disorder: beyond skin deep

Body dysmorphic disorder (BDD) is a psychiatric illness that primarily affects adolescents and young adults of both sexes. Patients have a distorted self-image, which manifests as a preoccupation with slight or imagined defects in the face, nose, skin, hair or any part of the body that ultimately interferes with daily functioning. It is a relatively common yet long unrecognized problem. Patients often seek multiple physician assessments for their perceived defects and request cosmetic procedures. Early intervention can prevent a cycle of multiple surgeries, as the outcome is usually poor and may lead to exacerbation of symptoms, anger and litigation. BDD is a disabling, and even life-threatening, condition; it can lead to major depression and suicidal ideation. Selective serotonin reuptake inhibitors and cognitive behavioral therapy are the mainstay of treatment and are beneficial in most patients. A multidisciplinary approach is strongly recommended.

Association Splitting: feasibility study of a novel technique to reduce weight and shape concerns

Weight and shape concerns are core aspects of eating disorders and can have an intrusive and obsessive character. Such thoughts play an important role in the development and maintenance of eating disorders and seem to be a result of dysfunctional cognitive networks. Association Splitting, a novel intervention for obsessive-compulsive disorders, targets such dysfunctional networks.

AIMS

To adapt Association Splitting for the reduction of weight- and shape-related cognitions in students with high weight and shape concerns.

METHODS

Thirteen students with high weight and shape concerns were recruited and ten completed assessments before and after using the Association Splitting approach. Self-reported weight and shape concerns, eating behaviours and obsessive thinking were assessed. Changes between the two time points were analysed.

RESULTS

After using Association Splitting, participants reported lower weight and shape concerns, reduced drive for thinness and body dissatisfaction and lower levels of eating disorder-related behaviours. The technique was perceived as helpful by 70% of the participants.

CONCLUSION

Association Splitting is a feasible approach to reducing weight and shape concerns and might be a useful addition to the treatment or prevention of eating disorders.

Managing body image difficulties of adult cancer patients

BACKGROUND

Body image is a critical psychosocial issue for patients with cancer because they often undergo significant changes to appearance and functioning. The primary purpose of this review article was to identify empirically-supported approaches to treat body image difficulties of adult cancer patients that can be incorporated into high-quality comprehensive cancer care.

METHODS

An overview was provided of theoretical models of body image relevant to cancer patients, and findings were presented from published literature on body image and cancer from 2003 to 2013. These data were integrated with information from the patient-doctor communication literature to delineate a practical approach for assessing and treating body image concerns of adult cancer patients.

RESULTS

Body image difficulties were found across patients with diverse cancer sites, and were most prevalent in the immediate postoperative and treatment period. Age, body mass index, and specific cancer treatments have been identified as potential risk factors for body image disturbance in cancer patients. Current evidence supports the use of time-limited cognitive behavioral therapy interventions for addressing these difficulties. Other intervention strategies also show promise but require further study. Potential indicators of body image difficulties were identified to alert health care professionals when to refer patients for psychosocial care, and a framework was proposed for approaching conversations about body image that can be used by the oncologic treatment team.

CONCLUSIONS

Body image issues affect a wide array of cancer patients. Providers can use available evidence combined with information from the health care communication literature to develop practical strategies for treating body image concerns of patients with cancer.