Cognitive-Behavioral Therapy for Adolescent Body Dysmorphic Disorder

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Abstract

The onset of appearance-related concerns associated with body dysmorphic disorder (BDD) typically occurs in adolescence, and these concerns are often severe enough to interfere with normal development and psychosocial functioning. Cognitive behavioral therapy (CBT) is an effective treatment for adults with BDD. However, no treatment studies focusing on adolescents with BDD have been conducted. The need for an effective treatment in this population led to the development of a brief CBT protocol with family involvement. The treatment focuses on enhancing an adolescent's quality of life through the reduction of maladaptive thoughts and behaviors, and incorporates skills training and parent training. Similar treatment packages have already been shown to be efficacious for children and adolescents with similar disorders, such as obsessive-compulsive disorder and social phobia. The following case illustrates the application of this brief CBT protocol for BDD in an adolescent, and highlights clinical considerations needed when adapting CBT for a pediatric population. Treatment was associated with clinically significant improvement in symptoms of BDD, self-esteem, depression, and quality of life. This report extends extant literature by suggesting that CBT may be a helpful treatment for adolescents with BDD.

Section snippets

Adapting CBT for BDD for Adolescents

Although CBT for adolescent BDD shares the same overarching goals with the adult treatment, modifications are necessary to ensure a developmentally appropriate treatment. In particular, adapting a CBT approach for youth with BDD requires taking into account theories of human development and psychological change. Unique psychosocial challenges that adolescents face through various stages of their development must be addressed throughout treatment.

Adolescence is characterized by significant

Case Characteristics and History

Marcy1 is a 17-year-old Caucasian female in her junior year of high school and living at home with her parents and younger brother. Marcy's parents brought her to treatment at a university anxiety disorders clinic due to her excessive appearance concerns. Although Marcy was an attractive, average weight teenager, she reported feeling horrified by her stomach (“flabby”), hair (“bushy eyebrows,”

Initial Evaluation

Marcy and her parents came to the clinic for an initial evaluation, during which they filled out several self-report questionnaires and participated in a clinical interview (KSADS-PL; Kaufman et al., 1997). Marcy met diagnoses for primary BDD with current comorbid obsessive-compulsive disorder, conduct disorder and attention-deficit/hyperactivity disorder. She had a significant psychiatric history including past major depressive disorder, eating disorder not otherwise specified and five

Treatment Overview

Treatment consisted of 12, fifty-minute sessions of individual CBT with family involvement for BDD. Treatment components are described below; additional detail regarding the treatment can be found in the treatment protocol (Greenberg, 2009). The treatment occurred twice weekly for 4 weeks followed by 4 weekly sessions of CBT.

The cognitive-behavioral treatment developed for this study was based on a cognitive behavioral model of BDD (e.g., Veale et al., 1996, Wilhelm, 2006) and was adapted for

Results

Prior to treatment, Marcy reported spending more than 8 hours per day thinking about and 3 to 8 hours per day engaging in rituals related to her BDD (total BDD-YBOCS-A score = 36). Her symptoms caused her severe distress and affected her daily, social, and school performance. Marcy believed with full conviction that her appearance concerns were physically as opposed to psychologically related (delusional BDD). At the end of 12 sessions (8 weeks) of CBT for adolescent BDD, Marcy was spending less

Discussion

In this preliminary examination of CBT for adolescent BDD, a 17-year-old female with severe, delusional BDD and complex comorbidity responded favorably to a brief CBT adapted for adolescents. Following 12 sessions of CBT with family involvement, Marcy's BDD and global functioning were significantly improved. Moreover, Marcy and her parents reported the treatment to be highly acceptable and Marcy maintained sufficient motivation throughout treatment. By posttreatment, Marcy also reported an

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