Skip to main content Accessibility help

We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.

Close cookie message
×
Hostname: page-component-cd9895bd7-gxg78 Total loading time: 0 Render date: 2024-12-26T18:39:57.710Z Has data issue: false hasContentIssue false

15 - A Cognitive Behavioral Approach to Body Dysmorphic Disorder:

Assessment, Treatment, and New Developments

from Part Three - Cognitive Behavioral Therapy for Obsessive-Compulsive Disorder and Associated Disorders

Published online by Cambridge University Press:  06 January 2022

By
Oliver Sündermann  and
David Veale
Edited by
Gillian Todd  and
Rhena Branch
Gillian Todd
Affiliation:
University of East Anglia
Rhena Branch
Affiliation:
University of East Anglia
Get access

Summary

Cognitive behavior therapy (CBT) is the treatment of choice for people with body dysmorphic disorder (BDD). The first part of the chapter describes the clinical features and processes of BDD, and introduces an updated CBT model of the self as an aesthetic object that evolves around the notion that people with BDD experience distressing mental imagery of their disliked features, maintained by self-focused attention and safety-seeking behaviors. In the second part of the chapter, we present an updated assessment and treatment protocol to BDD. We use case material to illustrate how to engage clients and socialize them into a psychological way of working to overcome their appearance concerns. We illustrate assessment and formulation, how to set up effective behavioral experiments, how to conduct mirror retraining, imagery rescripting, and compassion-focused techniques. BDD screening and diagnostic measures are also presented.

Keywords

body dysmorphic disorderCBTinhibitory learningTheory A/Theory Bbehavioral experimentsimagery rescripting
Type
Chapter
Information
Evidence-Based Treatment for Anxiety Disorders and Depression
A Cognitive Behavioral Therapy Compendium
 , pp. 295 - 315
Publisher: Cambridge University Press
Print publication year: 2022

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Recommended Reading

Phillips, K. A. (2005). The broken mirror: Understanding and treating body dysmorphic disorder. Oxford University Press.Google Scholar
Phillips, K. A. (2017). Body dysmorphic disorder: Advances in research and clinical practice. Oxford University Press.Google Scholar
Sündermann, O., & Veale, D. (2017). Complexity in obsessive-compulsive and body dysmorphic disorder: A functional approach to complex difficulties. The Cognitive Behaviour Therapist, 10.CrossRefGoogle Scholar
Veale, D., & Gilbert, P. (2014). Body dysmorphic disorder: The functional and evolutionary context in phenomenology and a compassionate mind. Journal of Obsessive-Compulsive and Related Disorders, 3(2), 150–160.CrossRefGoogle Scholar
Veale, D., Gilbert, P., Wheatley, J., & Naismith, I. (2014). A new therapeutic community: Development of a compassion-focussed and contextual behavioural environment. Clinical Psychology and Psychotherapy, 22(4), 285–303.CrossRefGoogle ScholarPubMed
Veale, D., & Neziroglu, F. (2010). Body dysmorphic disorder: A treatment manual. John Wiley and Sons.Google Scholar
Veale, D., Willson, R., & Clark, A. (2009). Overcoming body image problems including body dysmorphic disorder. Constable Robinson.Google Scholar
Wilhelm, S., Phillips, K. A., & Steketee, G. (2012). Cognitive-behavioral therapy for body dysmorphic disorder: A treatment manual. Guilford Press.Google Scholar

References

Angelakis, I., Gooding, P. A., & Panagioti, M. (2016). Suicidality in body dysmorphic disorder (BDD): A systematic review with meta-analysis. Clinical Psychology Review, 49, 55–66.Google Scholar
Arntz, A. (2011). Imagery rescripting for personality disorders. Cognitive and Behavioral Practice, 18(4), 466–481.Google Scholar
Arntz, A., & Weertman, A. (1999). Treatment of childhood memories: Theory and practice. Behaviour Research and Therapy, 37(8), 715–740. doi:10.1016/S0005-7967(98)00173-9Google Scholar
Baldock, E., & Veale, D. (2017). The self as an aesthetic object: Body image, beliefs about the self, and shame in a cognitive-behavioural model of body dysmorphic disorder. In Body dysmorphic disorder: Advances in research and clinical practice. Oxford University Press.Google Scholar
Bjornsson, A. S., Didie, E. R., Grant, J. E., Menard, W., Stalker, E., & Phillips, K. A. (2013). Age at onset and clinical correlates in body dysmorphic disorder. Comprehensive Psychiatry, 54(7), 893–903.CrossRefGoogle ScholarPubMed
Bohne, A., Keuthen, N. J., Wilhelm, S., Deckersbach, T., & Jenike, M. A. (2002). Prevalence of symptoms of body dysmorphic disorder and its correlates: A cross-cultural comparison. Psychosomatics, 43(6), 486–490.CrossRefGoogle ScholarPubMed
Buhlmann, U., Etcoff, N. L., & Wilhelm, S. (2006). Emotion recognition bias for contempt and anger in body dysmorphic disorder. Journal of Psychiatric Research, 40(2), 105–111.Google Scholar
Buhlmann, U., Marques, L. M., & Wilhelm, S. (2012). Traumatic experiences in individuals with body dysmorphic disorder. The Journal of Nervous and Mental Disease, 200(1), 95–98.Google Scholar
Buhlmann, U., McNally, R. J., Etcoff, N. L., Tuschen-Caffier, B., & Wilhelm, S. (2004). Emotion recognition deficits in body dysmorphic disorder. Journal of Psychiatric Research, 38(2), 201–206.CrossRefGoogle ScholarPubMed
Buhlmann, U., McNally, R. J., Wilhelm, S., & Florin, I. (2002). Selective processing of emotional information in body dysmorphic disorder. Journal of Anxiety Disorders, 16(3), 289–298.Google Scholar
Buhlmann, U., Reese, H. E., Renaud, S., & Wilhelm, S. (2008). Clinical considerations for the treatment of body dysmorphic disorder with cognitive-behavioral therapy. Body Image, 5(1), 39–49.Google Scholar
Cansever, A., Uzun, Ö., Dönmez, E., & Özşahin, A. (2003). The prevalence and clinical features of body dysmorphic disorder in college students: A study in a Turkish sample. Comprehensive Psychiatry, 44(1), 60–64.CrossRefGoogle Scholar
Cash, T. F., & Fleming, E. C. (2002). The impact of body image experiences: Development of the Body Image Quality of Life Inventory. International Journal of Eating Disorders, 31(4), 455–460.CrossRefGoogle ScholarPubMed
Cash, T. F., Phillips, K. A., Santos, M. T., & Hrabosky, J. I. (2004). Measuring ‘negative body image’: Validation of the Body Image Disturbance Questionnaire in a nonclinical population. Body Image, 1(4), 363–372.CrossRefGoogle Scholar
Cassiello-Robbins, C., & Barlow, D. H. (2016). Anger: The unrecognized emotion in emotional disorders. Clinical Psychology: Science and Practice, 23(1), 66–85. doi:10.1111/cpsp.12139Google Scholar
Craske, M. G., Treanor, M., Conway, C. C., Zbozinek, T., & Vervliet, B. (2014). Maximizing exposure therapy: An inhibitory learning approach. Behaviour Research and Therapy, 58, 10–23.Google Scholar
Deckersbach, T., Savage, C. R., Phillips, K. A., Wilhelm, S., Buhlmann, U., Rauch, S. L., … & Jenike, M. A. (2000). Characteristics of memory dysfunction in body dysmorphic disorder. Journal of the International Neuropsychological Society, 6(6), 673–681.Google Scholar
Didie, E. R., Loerke, E. H., Howes, S. E., & Phillips, K. A. (2012). Severity of interpersonal problems in individuals with body dysmorphic disorder. Journal of Personality Disorders, 26(3), 345.Google Scholar
Eisen, J. L., Phillips, K. A., Baer, L., Beer, D. A., Atala, K. D., & Rasmussen, S. A. (1998). The Brown Assessment of Beliefs Scale: Reliability and validity. American Journal of Psychiatry, 155(1), 102–108.Google Scholar
First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. (2002). Structured clinical interview for DSM-IV-TR axis I disorders, research version, patient edition. SCID-I/P.Google Scholar
Fontenelle, L. F., Telles, L. L., Nazar, B. P., De Menezes, G. B., Do Nascimento, A. L., Mendlowicz, M. V., & Versiani, M. (2006). A sociodemographic, phenomenological, and long-term follow-up study of patients with body dysmorphic disorder in Brazil. The International Journal of Psychiatry in Medicine, 36(2), 243–259.Google Scholar
Greenberg, J. L., Reuman, L., Hartmann, A. S., Kasarskis, I., & Wilhelm, S. (2014). Visual hot spots: An eye tracking study of attention bias in body dysmorphic disorder. Journal of Psychiatric Research, 57, 125–132.CrossRefGoogle ScholarPubMed
Harrison, A., de la Cruz, L. F., Enander, J., Radua, J., & Mataix-Cols, D. (2016). Cognitive-behavioral therapy for body dysmorphic disorder: A systematic review and meta-analysis of randomized controlled trials. Clinical Psychology Review, 48, 43–51.Google Scholar
Ipser, J. C., Sander, C., & Stein, D. J. (2009). Pharmacotherapy and psychotherapy for body dysmorphic disorder. Cochrane Database of Systematic Reviews, (1).Google Scholar
Lambrou, C., Veale, D., & Wilson, G. (2011). The role of aesthetic sensitivity in body dysmorphic disorder. Journal of Abnormal Psychology, 120(2), 443.CrossRefGoogle ScholarPubMed
Lambrou, C., Veale, D., & Wilson, G. (2012). Appearance concerns comparisons among persons with body dysmorphic disorder and nonclinical controls with and without aesthetic training. Body Image, 9(1), 86–92.CrossRefGoogle ScholarPubMed
Mancuso, S. G., Knoesen, N. P., & Castle, D. J. (2010). The Dysmorphic Concern Questionnaire: A screening measure for body dysmorphic disorder. Australian and New Zealand Journal of Psychiatry, 44(6), 535–542.Google Scholar
Marques, L., LeBlanc, N., Weingarden, H., Greenberg, J. L., Traeger, L. N., Keshaviah, A., & Wilhelm, S. (2011). Body dysmorphic symptoms: Phenomenology and ethnicity. Body Image, 8(2), 163–167. doi:10.1016/j.bodyim.2010.12.006Google Scholar
Osman, S., Cooper, M., Hackmann, A., & Veale, D. (2004). Spontaneously occurring images and early memories in people with body dysmorphic disorder. Memory, 12(4), 428–436.Google Scholar
Öst, L.-G., Havnen, A., Hansen, B., & Kvale, G. (2015). Cognitive behavioral treatments of obsessive-compulsive disorder. A systematic review and meta-analysis of studies published 1993–2014. Clinical Psychology Review, 40, 156–169.Google Scholar
Phillips, K. (2017). Body dysmorphic disorder: Advances in research and clinical practice. Oxford University Press.Google Scholar
Phillips, K., & Menard, W. (2006). Suicidality in body dysmorphic disorder: A prospective study. American Journal of Psychiatry, 163(7), 1280–1282.Google Scholar
Phillips, K. A. (2005). The broken mirror: Understanding and treating body dysmorphic disorder. Oxford University Press.Google Scholar
Phillips, K. A. (1996). Instruments for assessing BDD: The BDDQ: A self-report screening instrument for BDD. The Broken Mirror, 321–333.Google Scholar
Phillips, K. A., Didie, E. R., Menard, W., Pagano, M. E., Fay, C., & Weisberg, R. B. (2006). Clinical features of body dysmorphic disorder in adolescents and adults. Psychiatry Research, 141(3), 305–314.Google Scholar
Phillips, K. A., Hart, A. S., & Menard, W. (2014). Psychometric evaluation of the Yale–Brown Obsessive-Compulsive Scale Modified for Body Dysmorphic Disorder (BDD-YBOCS). Journal of Obsessive-Compulsive and Related Disorders, 3(3), 205–208.CrossRefGoogle Scholar
Stott, R., Mansell, W., Salkovskis, P., Lavender, A., & Cartwright-Hatton, S. (2010). Oxford guide to metaphors in CBT: Building cognitive bridges. Oxford University Press.Google Scholar
Sündermann, O., & Veale, D. (2017). Complexity in obsessive-compulsive and body dysmorphic disorder: A functional approach to complex difficulties. The Cognitive Behaviour Therapist, 10.Google Scholar
Sündermann, O., Wheatley, J., & Veale, D. (2016). ‘If you have good skin, you are god. If you have bad skin, you are a piece of rubbish.’ Mastery of shame and anger in treatment-resistant body dysmorphic disorder: A single case study. The Cognitive Behaviour Therapist, 9.Google Scholar
Veale, D. (2004). Advances in a cognitive behavioural model of body dysmorphic disorder. Body Image, 1(1), 113–125. doi:10.1016/S1740-1445(03)00009-3CrossRefGoogle Scholar
Veale, D., Ellison, N., Werner, T. G., Dodhia, R., Serfaty, M. A., & Clarke, A. (2012). Development of a cosmetic procedure screening questionnaire (COPS) for body dysmorphic disorder. Journal of Plastic, Reconstructive and Aesthetic Surgery, 65(4), 530–532.Google Scholar
Veale, D., Eshkevari, E., Kanakam, N., Ellison, N., Costa, A., & Werner, T. (2014). The Appearance Anxiety Inventory: Validation of a process measure in the treatment of body dysmorphic disorder. Behavioural and Cognitive Psychotherapy, 42(5), 605–616.Google Scholar
Veale, D., & Gilbert, P. (2014). Body dysmorphic disorder: The functional and evolutionary context in phenomenology and a compassionate mind. Journal of Obsessive-Compulsive and Related Disorders, 3(2), 150–160.Google Scholar
Veale, D., Gilbert, P., Wheatley, J., & Naismith, I. (2014). A new therapeutic community: Development of a compassion-focussed and contextual behavioural environment. Clinical Psychology and Psychotherapy, 22(4), 285–303.Google Scholar
Veale, D., Gledhill, L. J., Christodoulou, P., & Hodsoll, J. (2016). Body dysmorphic disorder in different settings: A systematic review and estimated weighted prevalence. Body Image, 18, 168–186.CrossRefGoogle ScholarPubMed
Veale, D., & Matsunaga, H. (2014). Body dysmorphic disorder and olfactory reference disorder: Proposals for ICD-11. Revista Brasileira de Psiquiatria, 36, 14–20.Google Scholar
Veale, D., Miles, S., & Anson, M. (2015). Long-term outcome of cognitive behavior therapy for body dysmorphic disorder: A naturalistic case series of 1 to 4 years after a controlled trial. Behavior Therapy, 46(6), 775–785.CrossRefGoogle ScholarPubMed
Veale, D., & Neziroglu, F. (2010). Body dysmorphic disorder: A treatment manual. John Wiley and Sons.Google Scholar
Veale, D., & Riley, S. (2001). Mirror, mirror on the wall, who is the ugliest of them all? The psychopathology of mirror gazing in body dysmorphic disorder. Behaviour Research and Therapy, 39(12), 1381–1393.Google Scholar
Veale, D., Willson, R., & Clarke, A. (2009). Overcoming body image problems including body dysmorphic disorder. Constable and Robinson.Google Scholar
Weingarden, H., Renshaw, K. D., Davidson, E., & Wilhelm, S. (2017). Relative relationships of general shame and body shame with body dysmorphic phenomenology and psychosocial outcomes. Journal of Obsessive-Compulsive and Related Disorders, 14, 1–6.Google Scholar
Wilhelm, S., Phillips, K. A., & Steketee, G. (2012). Cognitive-behavioral therapy for body dysmorphic disorder: A treatment manual. Guilford Press.Google Scholar
Williams, J., Hadjistavropoulos, T., & Sharpe, D. (2006). A meta-analysis of psychological and pharmacological treatments for body dysmorphic disorder. Behaviour Research and Therapy, 44(1), 99–111.Google Scholar
Willson, R., Veale, D., & Freeston, M. (2016). Imagery rescripting for body dysmorphic disorder: A multiple-baseline single-case experimental design. Behavior Therapy, 47(2), 248–261.CrossRefGoogle ScholarPubMed
Windheim, K., Veale, D., & Anson, M. (2011). Mirror gazing in body dysmorphic disorder and healthy controls: Effects of duration of gazing. Behaviour Research and Therapy, 49(9), 555–564.Google Scholar

Save book to Kindle

To save this book to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about saving to your Kindle.

Note you can select to save to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

Find out more about the Kindle Personal Document Service.

Available formats
×

Save book to Dropbox

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Dropbox.

Available formats
×

Save book to Google Drive

To save content items to your account, please confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account. Find out more about saving content to Google Drive.

Available formats
×