Cognitive Behaviour Therapy (CBT) for Body Dysmorphic Disorder (BDD)

Efficacy of Cognitive Behaviour Therapy -v- Anxiety Management for Body Dysmorphic Disorder: a Randomised Controlled Trial

The aim of the research is to determine if Cognitive Behaviour Therapy (CBT) specific for BDD is more effective than a credible non-specific form of CBT for treating BDD and its delusional variant in adults aged 17 or over. This will be done in a single centre randomised controlled trial that compares specific CBT for BDD versus non-specific CBT over 12 weeks. The hypotheses to be tested are that: (1) specific CBT for BDD will be more effective than non-specific CBT at 12 weeks (2) Treatment effects from Specific CBT will be maintained at 1 month follow up. The main study end-point is at 12 weeks and the secondary end-point is at 1 month follow up. A secondary aim is to explore whether delusionality (insight) as measured by the Brown Assessment of Beliefs and co-morbid depressed mood predicts response to treatment.

Inclusion Criteria:

• BDD is the main psychological problem. We will use DSMIV criteria as BDD does not exist as a separate diagnosis in ICD10. They may have an additional diagnosis of Delusional Disorder when it refers to beliefs about being ugly or defective.
• They must have a total of 24 or more on the twelve-item YBOCS modified for BDD (Phillips et al., 1997).
• They may be of either gender but must be 17 years or above.
• They are willing to travel to the treatment centre for weekly sessions.
• They are wiling to complete regular questionnaires and be audiotaped for supervision and for listening to enhance their learning.
• They may be taking psychotropic medication so long as it is stabilised and there are no plans to increase the dose.

Exclusion Criteria:

• They have a current or past diagnosis of schizophrenia, bipolar affective disorder.
• They have current suicidal intent or severe self-neglect that requires hospitalisation.
• They have a current alcohol or substance dependence or anorexia nervosa or borderline personality disorder that requires treatment in its own right.
• They are currently receiving any other form of psychotherapy,
• They have received CBT for BDD in the past 6 months, which is judged as competently delivered and did not respond.
• They cannot speak sufficient English for CBT. (Assistance will be provided for those who speak English but are unable to read questionnaires).