Mental health articles

Treatment of body dysmorphic disorder include:

Psychological treatment

The most common psychological treatment for body dysmorphic disorder involves CBT. Exposure to avoided situations can include exposure to the sight of the individual’s own body or showing their perceived defect in social situations. Often, exposure programmes follow hierarchies of increasingly diffi cult to cope with body parts or avoided situations. Prevention of checking or self-reassuring behaviours is used to counteract checking rituals. Finally, cognitive restructuring, in which dysfunctional thoughts are identifi ed and then challenged, is a key component of any intervention.

In their systematic review of the relevant literature, Ipser et al. (2009) noted that very few adequately controlled trials of the treatment of body dysmorphic disorder had been conducted, although those that had suggested that exposure-based cognitive behavioural programmes were effective. In one study of this approach, Rosen et al. (1995) followed 54 people with body dysmorphic disorder during a baseline no-treatment phase and then group cognitive behavioural therapy comprising eight 2-hour sessions. Therapy involved modifi cation of intrusive thoughts of body dissatisfaction and overvalued beliefs about physical appearance, exposure to avoided body image situations and elimination of body checking. Body dysmorphic disorder symptoms were ‘eliminated’ in 82 per cent of people in the intervention group immediately following the intervention and in 77 per cent at follow-up. This compared with a 7 per cent improvement reported during the baseline, no-treatment, phase.

Pharmacological treatment

In their review of the relevant three pharmacological trials, Ipser et al. (2009) concluded that treatment with SSRIs and tricyclics is generally successful. Data from the single placebocontrolled trial of fl uoxetine suggested fl uoxetine was more effective than placebo over a period of 12 weeks. Similar effects have also been found in randomized controlled trials evaluating fluoxetine and clomipramine, as well as a more recent small open trial of venlafaxine (an SNRI: Allen et al. 2008). Long-term follow-up data is lacking.

Tags: body dysmorphic disorder, disorder, dysmorphic, treatment