Body dysmorphic disorder a treatment manual pdf

Individuals with BDD often spend significant periods of time worrying about and evaluating a particular aspect of their appearance. Large amounts of time may be spent checking their appearance in the mirror, comparing their appearance with others, and engaging in behaviours designed to try to hide or conceal the area of concern. Overcoming Body Dysmorphia: This information package is designed to provide you with some information about body dysmorphic disorder - how it develops, how it is maintained and how to address this problem.

It is organised into modules that are designed to be worked through in sequence. We recommend that you complete one module before moving onto the next. Each module contains information, worksheets, and suggested exercises or activities. This module provides some general information about body image and Body Dysmorphic Disorder, considers how this problem might develop, and discusses some of the negative consequences of the disorder. Concerns about one's appearance are recognized and accepted in most cultures as an aspect of normal human behavior.

However, if these concerns are excessive and are either significantly distressing or having an impact on the individual's quality of life, the person may be suffering from BDD.

This review will outline the clinical characteristics, prevalence, cultural considerations, and treatment for BDD to further clinician's knowledge of BDD and to improve the identification and initiation of appropriate treatment for BDD. Individuals experience excessive self-consciousness, often with ideas of reference i. Individuals with BDD obsess over certain aspects of their appearance. The preoccupations are intrusive, unwanted, and associated with distressing emotions such as shame, disgust, anxiety, and sadness.

Insight regarding the appearance beliefs is often poor, i. At circumscribed times e. The lack of insight exhibited by the individual does not vary markedly as a function of anxiety level. As a consequence of the preoccupation, the associated distress and concerns that others may reject them, there is almost always associated impairment in one or more areas of social, occupational, academic, and role functioning. BDD is also associated with high rates of suicidality.

A recent meta-analysis concluded that patients with BDD were four times more likely to experience suicidal ideation and 2. Many psychiatric illnesses have been reported to cooccur with BDD, the most common being major depressive disorder, social phobia, obsessive-compulsive disorder, and substance misuse disorders.

A recent systematic review[ 2 ] highlighted the prevalence of BDD within different settings. They found the weighted prevalence of BDD in adults in the community was estimated to be 1. This finding highlights one challenging aspect of diagnosing BDD, i. Indeed, the evidence suggests that BDD is underdiagnosed and that presentation to nonpsychiatric specialties is just one factor.

A number of studies have highlighted that even within psychiatric settings, the diagnosis of BDD is suboptimal. Three studies within inpatient units[ 22 , 23 , 24 ] and two studies set in outpatient psychiatric settings[ 25 , 26 ] have highlighted that when patients are systematically screened for the presence of BDD and the diagnosis is made, almost none of the patients had a BDD diagnosis within their medical records.

In fact, only in one study was a single patient out of a total of 14 patients diagnosed with BDD by both the researchers and within the clinical records. In the remaining studies, no patients were. A study by Conroy et al. This was despite one quarter reporting that BDD was a major reason or somewhat of a reason for their current hospitalization.

Reasons for not disclosing, including feeling too embarrassed, being afraid of negative judgment, feeling that their clinician would not understand their concerns, not knowing that there is treatment for BDD, not being asked about BDD, feeling that BDD was not a big problem, not wanting to know that their body image concerns were a problem, and thinking that other people did not have this problem.

The lack of spontaneous disclosure highlights the need for psychiatrists to specifically ask about BDD symptoms when assessing patients. Using specific screening instruments may also be helpful, particularly when assessing patients with disorders that can be comorbid with BDD or may mask the true diagnosis of BDD, such as depression, obsessive-compulsive disorder, or an anxiety disorder. BDD usually begins in adolescence though it can be 10 years or more before diagnosis and appropriate treatment.

This data suggests that men are affected by BDD though likely not as commonly as women. There is a lack of research comparing the clinical features of BDD between and within countries among different populations and cultures. However, it is likely that manifestations of BDD may be influenced by cultural ideas around beauty.

For example, Japanese case reports discuss eyelids as the feature focus, which is a rare physical complaint in the Western culture. SRI medication refers to all of the selective SRI SSRI class of antidepressants fluoxetine, sertraline, paroxetine, citalopram, escitalopram, and fluvoxamine and one antidepressant from the tricycle class, clomipramine, which is a potent SRI. Phillips et al.

The third randomized controlled trial examined what happened when patients with BDD who had responded to escitalopram were either switched to a placebo or continued on escitalopram for a further 6 months. This study highlights that escitalopram is an effective treatment for BDD compared to placebo and additionally that there is a risk of relapse when an efficacious SRI medication is stopped.

There is an absence of dose-finding studies of SRI medications in BDD; however, the clinical experts in the field have suggested that higher doses are required as compared to depression and that some patients may need more than the maximum regulated dose. CBT for BDD aims to help patients build an alternative understanding of their difficulties, reduce self-focused attention, and ruminating and self-defeating coping strategies.

Patients are guided through graded exposure or behavioral experiments to test out their fears. Fifty-four percentage of participants were classified as having a delusional BDD. At 12 weeks, CBT was found to be significantly superior to AM in reducing symptom severity and on improving the secondary outcome measures such as quality of life and level of insight. This effect was also seen for those individuals with delusional beliefs or depression suggesting that CBT is just as effective as reducing BDD severity in these more impaired groups.

There still remain a number of areas within the treatment of BDD which require further investigation. Module 1: Understanding Body Dysmorphic Disorder This module provides some general information about body image and Body Dysmorphic Disorder, considers how this problem might develop, and discusses some of the negative consequences of the disorder.

Module 2: What keeps BDD going? Module 3: Reducing Appearance Preoccupation This module explores ways you can start to decrease the amount of time spent focused on your appearance, and thus start to break the vicious cycle of BDD.

Module 6: Adjusting Appearance Assumptions In this module we will focus on challenging the unhelpful rules and assumptions that can keep you caught in the vicious cycle of BDD. Module 7: Self-Management Planning This final module brings all the concepts of this information package together, presents a new model for you to operate by, and includes a self-management plan to help you to stay on track in the future.

Download the entire workbook Click the link above to download all modules in this workbook at once, as a zip file. Phillips MD, Gail Steke in the extra times greater than chatting or gossiping. Presenting an effective treatment approach specifically tailored to the unique challenges of body dysmorphic disorder BDD , this book is grounded in state-of-the-art research. The authors are experts on BDD and related conditions. They describe ways to engage patients who believe they have defects or flaws in their appearance.

Provided are clear-cut strategies for helping patients overcome the self-defeating thoughts, impairments in functioning, and sometimes dangerous ritualistic behaviors that characterize BDD. Clinician-friendly features include step-by-step instructions for conducting each session and more than 50 reproducible handouts and forms; the large-size format facilitates photocopying. See also the related self-help guide by Dr. Review "BDD entails substantial suffering and requires skilled therapeutic intervention.

This unique treatment manual lives up to the stellar reputations of Wilhelm, Phillips, and Steketee. Their systematic treatment is science based, clinically informed, and practitioner friendly. It is next to impossible to think of a better qualified group of authors for this definitive treatment manual. Sarwer, PhD, Departments of Psychiatry and Surgery, Perelman School of Medicine at the University of Pennsylvania "BDD is a common and often crippling psychiatric disorder, yet too frequently it is not diagnosed or not competently treated.

This book fills a critical niche by providing concrete, hands-on guidance for conducting state-of-the-art cognitive-behavioral therapy for BDD. The guidelines in this book will be accessible and useful for a wide range of readers, from students just beginning their training in behavioral therapies to seasoned professionals who are already experienced with BDD. An invaluable addition to the field. Pope Jr. The manual also provides a concise review of the scientific basis for the approach.

All clinicians who treat patients with BDD or other clinically meaningful body image disturbances now have a go-to guide to add to their clinical bookshelves.