Body Dysmorphic Disorder Literature Review

Wilhelm et al. (2019) found that Cognitive Behavioural Therapy (CBT) works better than supportive therapy at reducing Body Dysmorphic Disorder (BDD) symptoms. They also looked at how it affected understanding of BDD, depression, functional disability, and quality of life (QOL), and whether these changes stick around. They did randomized clinical tests in hospitals on folks diagnosed with BDD. They had 120 patients, split into two groups: one got CBT for BDD (61 people) and the other got supportive therapy (59 people). They had weekly treatments for 24 weeks and then follow-ups at three and six months. Both CBT and supportive therapy helped with BDD symptoms, but CBT showed more consistent improvements in symptom severity and quality of life.

Impact of Body Image Issues in Anxiety Disorders

Aderka et al. (2014) looked at body image issues in 68 outpatients with primary obsessive-compulsive disorder (22 people), social anxiety (25 people), and panic disorder (21 people). The patients filled out self-report surveys about body image issues, feelings about appearance, and anxiety. Body image issues and feelings about appearance didn't really differ between the groups. But, social anxiety symptoms were linked to body image issues, appearance evaluation, and body area satisfaction, while obsessive-compulsive symptoms were linked to beliefs about appearance. This suggests that social anxiety and obsessive-compulsive disorders might relate to different body image factors. They also discussed suggestions for treating anxiety disorders and further research.

Psychological Treatments for Social Anxiety Disorder and BDD

Fang, Sawyer, Aderka, and Hofmann (2013) looked at 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 found that an attention-retraining intervention for SAD reduced BDD symptoms compared to a placebo. These findings support the idea that psychological treatments for SAD can help with co-occurring BDD issues.

Perfectionism and Behavioral Inhibition in BDD

Schieber, Kollei, Zwaan, Müller, and Martin (2013) examined perfectionism, aesthetic sensitivity, and the behavioral inhibition system (BIS) in BDD. They also looked at how these traits related to BDD concerns. They had 58 participants with BDD and 2071 from a representative German population survey. The participants filled out self-report questionnaires on BDD and the other traits. People with BDD reported higher levels of perfectionism and BIS reactivity compared to the control group, but the two groups didn't differ much in aesthetic sensitivity. However, across the whole sample, all these traits were related to BDD concerns. Current BDD models suggest perfectionism and aesthetic sensitivity as vulnerability factors. This study also suggests BIS reactivity is linked to BDD. Aesthetic sensitivity wasn't outwardly expressed in BDD, but it was related to dysmorphic concerns along with perfectionism and BIS reactivity.

Comorbidity and Cognitive Biases in BDD and SAD

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 show similar cognitive biases for interpreting ambiguous social information negatively. Treatment outcome studies showed 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.

Social Anxiety's Role in Functional Impairment in BDD

Kelly, Walters, and Phillips (2010) examined SAD aspects in BDD and the relationship between SAD symptoms and impairment in BDD. They had 108 people 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 did an interview using the Duke Brief Social Phobia Scale (BSPS) to measure social anxiety without BDD. At T1, participants showed high levels of social anxiety on SPIN and subclinical levels on BSPS. Higher social anxiety was linked to poorer psychosocial functioning in both cross-sectional and prospective analyses. This suggests that aspects of social anxiety, especially social fear and avoidance, contribute to functional impairment in BDD.

Case Study on CBT Effectiveness for 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.

Prevalence and Clinical Characteristics of BDD

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 total candidates, 2552 aged 14 to 99 participated in a nationwide German survey. The study also looked at 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.

Social Anxiety and Pharmacological Treatment 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.

Distress Levels in BDD Patients and Treatment Outcomes

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.

Prevalence of BDD in Dermatological Treatment Seekers

Phillips, Dufresne Jr, Wilkel, and Vittorio (2000) looked at 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.