April 1st, 2012

Hospital studies CBT for treatment of body dysmorphic disorder

A new five-year study at Rhode Island Hospital – in collaboration with the Massachusetts General Hospital/Harvard Medical School in Boston – will for the first time test psychosocial treatment for body dysmorphic disorder (BDD), an often chronic disorder that clinicians leading the study say affects 1.7-2.4 percent of the U.S. population, and over the course of their lifetime can cause suicidal ideation in some 80 percent of those diagnosed. With suicide attempts in roughly 25 percent of BDD patients, its statistics are higher than most other mental disorders.

Katharine A. Phillips, M.D., is the director of the BDD Program at Rhode Island Hospital and professor of psychiatry at the Warren Alpert Medical School of Brown University. Internationally known as a BDD expert and the principal investigator for the study, under Phillips’ guidance the study will evaluate the effectiveness of cognitive behavioral therapy (CBT) that is specifically tailored to BDD versus supportive psychotherapy (SPT).

“SPT appears to be the most widely used therapy in the community to treat BDD and related problems, such as low self-esteem or problems with family members,” says Ashley S. Hart, Ph.D., a licensed clinical psychologist in the BDD program and also an assistant professor of psychiatry at Brown. Hart is the project coordinator and CBT therapist for the study and spoke on Phillips’ and the study’s behalf. “It will find out whether CBT or SPT help people who have BDD by improving their preoccupation with their appearance, as well as their mood, other symptoms, daily functioning and quality of life.”

The National Institute of Mental Health is funding the study for what are two notable reasons: “BDD is an under-recognized and under-diagnosed psychiatric disorder,” says Hart. It is characterized by a distressing or impairing preoccupation with non-existent or slight defects in appearance. For example, if a slight physical defect or anomaly is present, Hart says a person’s concern is markedly excessive and can lead to a life filled with multiple daily hours obsessing over his/her body’s defects and deformities. The obsessing often leads the person to try to decrease distress and improve appearance by frequent mirror checking, excessive grooming, surgery seeking or skin picking.

According to Hart, supportive psychotherapy has not been tested or compared to CBT, although the latter is thought to be a promising treatment for the disorder. “CBT for BDD is a manualized treatment that targets BDD’s unique symptoms, which are not adequately treated by CBT for other mental disorders,” she says. “The study will compare the effectiveness of CBT for BDD to that of supportive psychotherapy for BDD.” When considering the difference between the two treatment forms, Hart explains that CBT offers a practical “here and now” treatment that focuses on changing problematic thoughts and behaviors, and teaching the patient practical skills that can help a person cope with and overcome the disorder.

Supportive psychotherapy focuses on establishing and maintaining a good relationship with the patient, supporting adaptive coping skills, improving self-esteem and expressing emotions.

A total of 60 participants may be enrolled in this study through Rhode Island Hospital while Massachusetts General Hospital/Harvard Medical School, as a participating and collaborating site, will also enroll 60. Eligible participants are ages 18 and older who have BDD, live within driving distance of Providence and meet further qualifications for the study. Participants are randomly assigned to receive either CBT or supportive psychotherapy, and have an equal chance of receiving either treatment, which is provided at no cost. Participation in the study lasts about 12 months and comprises 22 one-hour treatment sessions over 24 weeks. If participants benefit from the treatment to which they are assigned, they will also receive a booster session (a session that helps them maintain what they learned during therapy) one month and three months after treatment ends. They also have follow-up evaluations one, three and six months after the treatment ends.

By Jennifer E Chase

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