This article describes the 2-year treatment of a 14-year-old girl suffering from severe body dysmorphic disorder (BDD) and comorbid major depressive disorder (MDD). Treatment consisted of twice-weekly sessions of exposure with response prevention (ERP), medication (fluoxetine), and a brief hospitalization for crisis stabilization. Continual (weekly) monitoring indicated significant reductions in daily obsessions and time spent in ritual. In addition, school attendance increased and scores on the Yale-Brown Obsessive-Compulsive Scale Modified for Body Dysmorphic Disorder (BDD-YBOCS), Body Dysmorphic Disorder Examination (BDDE), and Children’s Depression Inventory (CDI) decreased. Gains were maintained at follow-up. At termination, the client met criteria for partial remission status as defined by Phillips, Pagano, Menard, and Stout. This case adds to the BDD treatment literature by evaluating the long-term effectiveness of a multicomponent intervention, as implemented in a naturalistic setting with an adolescent, and suggests that combination treatment may be required to reduce distress and to produce lasting changes in functioning.
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