Cognitive-Behavioral Therapy Reduces Symptoms of Body Dysmorphic Disorder

February 18, 2014

After 22 sessions of modular cognitive-behavioral therapy, adults with body dysmorphic disorder showed significant improvements in obsessive-compulsive behavior, depression, insight, and level of disability. Researchers published their findings recently in the online Behavior Therapy. 

"Body dysmorphic disorder is a common and often debilitating disorder, and there are very few proven effective treatments," said researcher Katharine Phillips, MD, director of the body dysmorphic disorder program at Rhode Island Hospital in Providence. 

"This study suggests that using cognitive-behavioral therapy that specifically targets body dysmorphic disorder symptoms can result in significant improvements in symptoms and ability to function in daily life.” 

For the study, Dr. Phillips and colleagues recruited 36 adults with body dysmorphic disorder, a body-image condition that is characterized by intrusive preoccupations with perceived flaws in appearance and can include symptoms such as obsessive grooming, skin picking, or seeking plastic surgery. Investigators randomly assigned 17 participants to 22 sessions of individual cognitive-behavioral therapy over 24 weeks beginning immediately, and 19 participants to a 12-week waitlist. 

The prescribed cognitive-behavioral therapy, which consisted of core elements such as exposure, response prevention, and perceptual retraining, was designed specifically for patients with body dysmorphic disorder. Patients also had access to optional modules that targeted specific systems, such as skin picking or surgery-seeking behavior. 

Using a variety of scales, researchers conducted patient assessments before treatment, monthly during treatment, immediately after treatment, and at three and six months later. They defined treatment response as a 30% or higher reduction on baseline scores on the Yale-Brown Obsessive-Compulsive Scale Modified for Body Dysmorphic Disorder. 

At 12 weeks, 50% of patients in the immediate-treatment group had achieved response compared to 12% of patients in the wait-list group, researchers found. By the time both groups had completed treatment, 81% had achieved response criteria. Gains were consistent at follow-up appointments three and six months later. 

In addition, participants showed significant improvements on scales measuring depression, insight into inaccurate body-image beliefs, and disability in work and social life. Meanwhile, patient satisfaction post-treatment was high, investigators reported, measuring a mean score of 87.3%. 

“Cognitive-behavioral therapy for body dysmorphic disorder appears to be a feasible, acceptable, and efficacious treatment,” researchers concluded, “that warrants more rigorous investigation.” 

—Jolynn Tumolo 


1. Wilhelm S, Phillips KA, Didie E, et al. Modular cognitive-behavioral therapy for body dysmorphic disorder: a randomized controlled trial. Behavior Therapy. 2013 Dec. 29. [Epub ahead of print]. 

2. RI hospital: cognitive behavioral therapy benefits patients with body dysmorphic disorder [press release]. Washington, DC: EurekAlert!; Feb. 11, 2014.