Cognitive-behavioral therapy for body dysmorphic disorder in adolescents: Development of a treatment protocol

A brief cognitive-behavioral therapy (CBT) protocol for pediatric body dysmorphic disorder (BDD) was developed and evaluated in an adolescent female. A 17-year old female with BDD received 12 sessions over 8 weeks of individual CBT with family involvement. Assessments were conducted at three time points: pretreatment, posttreatment and 3-month follow-up. Primary outcomes included scores on the Yale-Brown Obsessive-Compulsive Scale, Modified for Body Dysmorphic Disorder-Adolescent Version and ratings on the target ritual monitoring form. Secondary outcomes included the Beck Depression Inventory-II, Rosenberg Self-Esteem Scale, Quality of Life and Satisfaction Questionnaire-Short Form, Child Behavior Checklist and Youth Self-Report. Scores from the BDD-YBOCS and target ritual form showed that the participant reached remission status and near zero levels of her target ritual by post-treatment. The participant had also eliminated or nearly eliminated other BDD rituals, regardless of whether they had been targeted directly during the treatment. The participant rated the intervention as socially acceptable, and in addition to marked improvement on BDD severity, secondary anxious and depressive symptoms were significantly improved at posttreatment. Gains were partially maintained over time. At 3-month follow-up the participant was rated as moderately improved as compared with her baseline score (i.e., meeting criteria for extremely severe BDD). This case demonstrates that a brief, 12-session, cognitive-behavioral therapy may be a useful treatment for BDD in an adolescent population. Controlled treatment outcome studies are needed to evaluate the potential efficacy of CBT for BDD.