Body Dysmorphic Disorder Literature Review

Effectiveness of Cognitive Behavioral Therapy in Treating Body Dysmorphic Disorder

Wilhelm et al. (2019) found that Cognitive Behavioral Therapy (CBT) is more effective than supportive therapy in reducing symptoms of Body Dysmorphic Disorder (BDD). Their study also evaluated the impact on understanding BDD, depression, functional disability, and quality of life (QOL), and whether these improvements are sustained over time. The research involved randomized clinical trials in hospitals with individuals diagnosed with BDD. The study comprised 120 patients, divided into two groups: 61 received CBT for BDD, while 59 underwent supportive therapy. Participants received weekly treatments for 24 weeks, followed by assessments at three and six months. Both CBT and supportive therapy alleviated BDD symptoms, but CBT demonstrated more consistent enhancements in symptom severity and quality of life. (Wilhelm et al., 2019)

Body Dysmorphic Disorder Literature Review

Body Image Issues and Anxiety Disorders

Aderka et al. (2014) explored body image issues in 68 outpatients with primary obsessive-compulsive disorder (22 individuals), social anxiety (25 individuals), and panic disorder (21 individuals). Patients completed self-report surveys regarding body image issues, appearance-related feelings, and anxiety. The results indicated no significant differences in body image issues and appearance-related feelings between the groups. However, social anxiety symptoms were associated with body image issues, appearance evaluation, and body area satisfaction, while obsessive-compulsive symptoms correlated with beliefs about appearance. This suggests that social anxiety and obsessive-compulsive disorders may involve distinct body image factors. The study provided recommendations for treating anxiety disorders and directions for future research. (Aderka et al., 2014)

Psychological Treatments for Social Anxiety Disorder and BDD

Fang, Sawyer, Aderka, and Hofmann (2013) investigated the effects of psychological treatments for Social Anxiety Disorder (SAD) on BDD concerns. In one study, they found that 12 weekly group sessions of CBT significantly reduced BDD symptom severity. Another study demonstrated that an attention-retraining intervention for SAD reduced BDD symptoms compared to a placebo. These findings support the notion that psychological treatments for SAD can alleviate co-occurring BDD issues. This indicates a potential therapeutic overlap between treatments for SAD and BDD, suggesting that addressing one may benefit the other. (Fang et al., 2013)

Perfectionism, Aesthetic Sensitivity, and BDD

Schieber, Kollei, Zwaan, Müller, and Martin (2013) examined perfectionism, aesthetic sensitivity, and the behavioral inhibition system (BIS) in BDD. They also explored how these traits related to BDD concerns. The study involved 58 participants with BDD and 2071 from a representative German population survey. Participants completed self-report questionnaires on BDD and other traits. Individuals with BDD reported higher levels of perfectionism and BIS reactivity compared to the control group, although aesthetic sensitivity did not significantly differ. Across the entire sample, these traits were related to BDD concerns. Current BDD models suggest that perfectionism and aesthetic sensitivity are vulnerability factors. This study also highlights BIS reactivity as a potential link to BDD. While aesthetic sensitivity wasn't overtly expressed in BDD, it was related to dysmorphic concerns alongside perfectionism and BIS reactivity. (Schieber et al., 2013)

Comparative Analysis of SAD and BDD

Fang and Hofmann (2010) compared Social Anxiety Disorder (SAD) and Body Dysmorphic Disorder (BDD) in terms of comorbidity, symptoms, cognitive biases, treatment outcomes, and cultural aspects. They found that SAD and BDD are highly comorbid, have similar ages of onset, and exhibit comparable cognitive biases, particularly in interpreting ambiguous social information negatively. Treatment outcome studies indicated that improvements in SAD were closely related to improvements in BDD. Cross-cultural research suggests that BDD might be considered a subtype of SAD in some Eastern cultures, further emphasizing the complex relationship between these disorders. (Fang & Hofmann, 2010)

Social Anxiety and Functional Impairment in BDD

Kelly, Walters, and Phillips (2010) examined aspects of SAD in BDD and the relationship between SAD symptoms and impairment in BDD. They studied 108 individuals with DSM-IV diagnosed BDD without comorbid social phobia. Participants completed measures of social anxiety and psychosocial functioning at baseline (T1) and a 12-month follow-up (T2). Social anxiety severity was measured using the Social Phobia Inventory (SPIN). Participants also underwent an interview using the Duke Brief Social Phobia Scale (BSPS) to measure social anxiety without BDD. At T1, participants exhibited high levels of social anxiety on SPIN and subclinical levels on BSPS. Higher social anxiety correlated with poorer psychosocial functioning in both cross-sectional and prospective analyses, suggesting that aspects of social anxiety, particularly social fear and avoidance, contribute to functional impairment in BDD. (Kelly et al., 2010)

CBT Case Study in BDD

Wilhelm, Buhlmann, Hayward, Greenberg, and Dimaite (2010) presented a case study detailing the CBT process for a patient with BDD. The patient underwent 10 weeks of 50-minute sessions focusing on psychoeducation, cognitive restructuring, exposure-response prevention, and perceptual retraining exercises. The patient's BDD symptoms significantly improved throughout the treatment. This case study provides clinical insights and further supports CBT as an effective treatment for BDD, offering a comprehensive approach to addressing the disorder's multifaceted nature. (Wilhelm et al., 2010)

Prevalence and Characteristics of BDD in the General Population

Rief, Buhlmann, Wilhelm, Borkenhagen, and Brähler (2006) aimed to uncover the prevalence rates of BDD in the general population and evaluate associated clinical characteristics. Out of 4152 candidates, 2552 aged 14 to 99 participated in a nationwide German survey. The study also explored suicidal ideation related to the belief of being physically unattractive and the tendency towards cosmetic surgeries. The prevalence of BDD in the sample was 1.7%. Individuals with BDD reported higher rates of suicidal ideation and attempts. BDD was also associated with lower income, lower rates of living with someone, and higher unemployment. The study concludes that self-reported BDD is relatively common and associated with significant comorbidity, highlighting the disorder's profound impact on individuals' lives. (Rief et al., 2006)

Pharmacological Treatment and Social Anxiety in BDD

Pinto and Phillips (2005) examined social anxiety in 81 BDD sufferers and changes in their social anxiety with pharmacological treatment. Participants completed the Social Avoidance and Distress Scale (SADS) and were assessed for BDD symptoms. Participants in a placebo-controlled fluoxetine trial were assessed at baseline and endpoint. Social anxiety was significantly correlated with BDD severity. Social anxiety did not improve with fluoxetine compared to placebo, but it did improve significantly more in fluoxetine responders than in non-responders. This suggests that while pharmacological treatment may not directly alleviate social anxiety, it can be beneficial for individuals who respond positively to medication. (Pinto & Phillips, 2005)

Severity of BDD Symptoms and Response to Fluvoxamine

Phillips, Siniscalchi, and McElroy (2004) had 75 outpatients with DSM-IV BDD complete the Symptom Questionnaire, which included standardized self-report scales covering various aspects related to BDD. The results were compared to published norms for normal subjects and psychiatric outpatients. Participants in an open-label fluvoxamine trial completed the Symptom Questionnaire at baseline and endpoint. Compared to normal controls, BDD patients had significantly higher scores on all scales, indicating severe distress and psychological pathology. Scores on all scales significantly decreased with fluvoxamine. The study concluded that people with BDD experience high levels of distress and poor well-being in areas of depression, anxiety, somatic symptoms, and anger hostility. These symptoms significantly improved with fluvoxamine, underscoring its potential effectiveness in treating BDD. (Phillips et al., 2004)

Prevalence of BDD Among Dermatological Patients

Phillips, Dufresne Jr, Wilkel, and Vittorio (2000) investigated the percentage of patients seeking dermatological treatments who tested positive for BDD. They used self-report questionnaires and defect severity scales to determine the rate of BDD in 268 participants. Results showed that 11.9% of participants tested positive for BDD. The study concluded that BDD is common among patients seeking dermatological treatments, suggesting a need for increased awareness and screening in dermatological settings. (Phillips et al., 2000)