Cognitive-Behavioral Therapy for Adolescent Body Dysmorphic Disorder
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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Obsessive-compulsive disorder and body dysmorphic disorder: Pediatric manifestation and treatment
2023, Handbook of Lifespan Cognitive Behavioral Therapy: Childhood, Adolescence, Pregnancy, Adulthood, and AgingApplication of a transdiagnostic treatment for emotional disorders to body dysmorphic disorder: A randomized controlled trial
2019, Journal of Affective DisordersMirror exposure therapy for body image disturbances and eating disorders: A review
2018, Clinical Psychology ReviewCognitive-Behavioral Therapy for Adolescent Body Dysmorphic Disorder: A Pilot Study
2016, Behavior TherapyCitation Excerpt :Depressive symptoms improved significantly from the clinical to subclinical range and these effects were maintained at 3- and 6-month follow-up. Improvement in secondary symptoms, such as depressive symptoms following CBT for BDD, is in line with extant findings from studies in adults (Veale, Gournay, et al., 1996; Veale et al., 2014; Wilhelm, Otto, Lohr, & Deckersbach, 1999; Wilhelm et al., 2011, 2014) and adolescent reports (Greenberg et al., 2010; Krebs et al., 2012), and further suggests that depression, the most common comorbidity in patients with BDD (Gunstad & Phillips, 2003), is often secondary to BDD and may not require separate treatment. Alternatively, it may be that both BDD and depression share common underlying processes that are resolved in the BDD treatment.
A Pilot Randomized Controlled Trial of Cognitive-Behavioral Therapy for Adolescents With Body Dysmorphic Disorder
2015, Journal of the American Academy of Child and Adolescent PsychiatryCitation Excerpt :Existing adult CBT protocols/treatment manuals for BDD24,25 were adapted to ensure developmentally appropriate content for young persons with BDD. These adaptations were guided by the existing pediatric OCD26 and BDD20 literature, as well as by our own previous experience treating these patients.21 For example, language was simplified, and age-appropriate worksheets and handouts were produced.