Body dysmorphic disorder (BDD) is an often severe, chronic, and disabling disorder, and although some controlled trials of cognitive behavior therapy (CBT) have shown efficacy, the body of evidence is still limited. The condition is generally considered difficult to treat, and further research to determine the effectiveness of psychological treatments for BDD is needed. The present study is the first to evaluate an acceptance-based therapy for BDD. In total, 21 patients received a 12-week group treatment consisting of weekly sessions of psychoeducation, acceptance and defusion practice, and exposure exercises to foster acceptance of internal discomfort and to strengthen the patients’ committed purposeful actions. The primary outcome was BDD symptomatology (measured on the BDD-YBOCS) assessed by a psychiatrist before and after treatment and at 6 months follow-up. The secondary outcomes were self-rated BDD symptoms, psychological flexibility, depressive symptoms, quality of life, and disability. Reductions in BDD symptomatology from pre- to posttreatment were significant and showed a large effect size, d = 1.93 (95% CI 0.82–3.04). At posttreatment, 68% of the participants showed clinically significant improvement in the primary outcome variable. Treatment gains were maintained at 6 months follow-up. The treatment also resulted in significant improvements in all secondary outcomes. The dropout rate was low; 90.5% of the participants completed treatment. This study suggests that acceptance-based exposure therapy may be an efficacious and acceptable treatment for BDD that warrants further investigation in larger controlled trials.
Body dysmorphic disorder (BDD) is a severe, chronic, and disabling disorder characterized by a preoccupation with one or more perceived defects in appearance that are not observable or appear only slight to others (American Psychiatric Association, 2013). The disorder is marked by intrusive thoughts concerning these perceived flaws in appearance and feelings of anxiety, disgust, or shame, particularly in situations where the body parts can be viewed (Veale & Neziroglu, 2010). In attempts to reduce internal discomfort, those afflicted by the disorder engage in ritualistic behaviors aimed at checking, concealing, or improving the perceived flaws (Phillips, Gunderson, Mallya, McElroy, & Carter, 1998). Insight is usually poor or absent. More than one-third of patients have delusional appearance beliefs (Phillips, Menard, Pagano, Fay, & Stout, 2006), i.e., a complete conviction that they appear disfigured.
The prevalence of BDD in the general population has been estimated to be between 1.7 % and 2.4 %, and the rate of spontaneous remission appears to be low (Buhlmann et al., 2010, Koran et al., 2008, Phillips et al., 2006b and Rief et al., 2006). BDD is associated with decreased quality of life (Phillips, 2000) and impairment in interpersonal and social functioning (Rabinowitz, Neziroglu, & Roberts, 2007). Additionally, lifetime incidence rates of undergoing psychiatric hospitalization, being suicidal, or becoming housebound are high (Phillips et al., 2005a and Phillips and Menard, 2006). Comorbidity with other disorders, particularly depression, social phobia, obsessive-compulsive disorder, and personality disorders, is high (Gunstad and Phillips, 2003, Phillips and McElroy, 2000 and Phillips et al., 2005b).
