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Body Dysmorphic Disorder
The MGH Body Dysmorphic Disorder Clinic & Research Unit provides state-of-the-art care, both inside and outside of the research setting, for people with Body Dysmorphic Disorder (BDD) and related disorders. Treatments offered include cognitive-behavioral therapy and pharmacotherapy. The program also provides consultations, evaluations, and follow-up care. Treatment delivered in the context of research studies is usually provided at no cost to our patients.
COGNITIVE-BEHAVIORAL THERAPY
In recent years, cognitive-behavioral therapy (CBT) has become the preferred form of treatment for BDD and has shown promising results when delivered in either individual or group formats. CBT combines a number of cognitive and behavioral treatment strategies. By combining cognitive and behavioral treatment elements into CBT, we can better target the multiple issues and challenges faced by an individual with BDD. Treatment elements often include:
Informational Interventions: Describing the nature of BDD, the impact thoughts have on one’s feelings, and the role of avoidance in symptom maintenance.
Self Monitoring: Patients self-monitor their BDD-related thoughts and behaviors (e.g., “no one is talking to me because of my thin hair”, comparing self to others, mirror checking, attempting to gain reassurance, camouflaging/disguising flaws, skin picking).
Cognitive Interventions: Cognitive strategies address a person’s negative thoughts. They teach an individual how certain ways of thinking impact their symptoms. Cognitive therapy also focuses on exploring beliefs that support and strengthen a person’s perception about his or her body image. Negative thoughts are evaluated with respect to their usefulness (“Is this thought helpful right now?”) and validity (“Is this thought true?”). If thoughts are not valid or useful, patients learn to develop alternative thoughts and beliefs. Cognitive errors (e.g., the patient unreasonably assumes that someone is reacting negatively to him/her without having any proof to support this assumption) are also identified and challenged.
Behavioral Interventions: Behavioral strategies include exposure, response prevention, mirror retraining, and activity scheduling. They help the individual to decrease avoidance behaviors, resist the compulsions associated with BDD, and increase healthier behaviors.
Exposure: Patients will learn to encounter situations they usually avoid (e.g., social situations, mirrors). To minimize anxiety, this is usually done in a gradual fashion, moving from less anxiety-provoking situations to more challenging ones at a rate the patient feels comfortable with.
Response Prevention: Prevention of ritualistic behaviors such as skin picking, mirror checking, excessive exercise, repeated cosmetic surgery, and comparing oneself to others.
Mirror Retraining: BDD patients tend to only focus on their perceived flaws when looking in the mirror, and tend to think about their flaws in negative terms (e.g., “my huge, disgusting pimple” or “my disfigured scar”). In mirror retraining patients learn to look at their appearance in a more holistic way. They also learn how to change their negative evaluations of their appearance into more objective and nonjudgmental descriptions.
Activity Scheduling: Planning of enjoyable events and achievement-oriented activities.
Homework Assignments: Clinician assigns tasks to reinforce therapy sessions.
Candidates receive a thorough diagnostic assessment prior to treatment. Such detailed assessment results in a treatment plan that accurately reflects one’s own individual needs. The course of treatment varies for each patient and depends on the patient’s symptoms and the rate at which he or she is progressing. CBT patients can frequently complete their treatment in a relatively brief amount of time - often within just weeks or months.
PHARMACOTHERAPY
Recent research has demonstrated the efficacy of medications, specifically selective serotonin reuptake inhibitors (SSRI’s), in the treatment of BDD, even for those patients who are delusional. Successful medication treatment can result in a decrease in time preoccupied with one’s appearance, less time spent on associated ritualistic behaviors, less distress, and a decrease in depressive symptoms. Patients often gain better insight into their BDD problems. Patients should be on medication for 12-16 weeks before assessing their response. If one SSRI fails, another should be attempted. Medication may be used alone or as an adjunct to cognitive-behavioral therapy.
INEFFECTIVE TREATMENTS
Supportive or insight oriented therapy has not been found to be effective in treating BDD. Natural remedies, surgery, dermatological treatments, diet, hypnosis, reassurance, trying harder, or uncovering a presumed trauma have also all proven ineffective in relieving BDD symptoms.
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