ERP,Medication,and Brief Hospitalization in the Treatment of an Adolescent With Severe BDD

Abstract

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.

Keywords

body dysmorphic disorder ERP behavior therapy fluoxetine adolescent

Get full access to this article

View all access options for this article.

References

Achenbach

T. M.

(1991). Integrative guide for the 1991 CBCL/4-18, YSR, and TRF profiles. Burlington, VT: Department of Psychiatry, University of Vermont.

Albertini

R. S.

Phillips

K. A.

(1999). Thirty-three cases of body dysmorphic disorder in children and adolescents. Journal of the American Academy of Child & Adolescent Psychiatry, 38, 453-459.

Aldea

M. A.

Storch

E. A.

Geffken

G. R.

Murphy

T. K.

(2009). Intensive cognitive-behavioral therapy for adolescents with body dysmorphic disorder. Clinical Case Studies, 8, 113-121.

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders DSM-IV-TR (4th ed., text rev.). Washington, DC: Author.

American Psychiatric Association. (2007). Practice guideline for the treatment of patients with obsessive-compulsive disorder. Arlington, VA: APA.

American Psychological Association. (2002). Ethical principles of psychologists and code of conduct. American Psychologist, 57, 1060-1073.

Brewster

(2011). Body dysmorphic disorder in adolescence: Imagined ugliness. School Psychologist, 65, 13-16.

Chambless

D. L.

(1996). In defense of dissemination of empirically supported psychological interventions. Clinical Psychology: Science and Practice, 3, 230-235.

Eifert

G. H.

Schulte

Zvolensky

M. J.

Lejuez

C. W.

Lau

(1997). Manualized behavior therapy: Merits and challenges. Behavior Therapy, 28, 499-509.

10.

El-khatib

H. E.

Dickey

T. O.

III (1995). Sertraline for body dysmorphic disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 34, 1404-1405.

11.

Faravelli

Salvatori

Galassi

Aiazzi

Drei

Cabras

(1997). Epidemiology of somatoform disorders: A community survey in Florence. Social Psychiatry and Psychiatric Epidemiology, 32, 24-29.

12.

Foa

E. B.

Kozak

M. J.

(1986). Emotional processing of fear: Exposure to corrective information. Psychological Bulletin, 99, 1-20.

13.

Grant

J. E.

Kim

S. W.

Crow

S. J.

(2001). Prevalence and clinical features of body dysmorphic disorder in adolescent and adult psychiatric inpatients. Journal of Clinical Psychiatry, 62, 517-522.

14.

Greenberg

J. L.

Markowitz

Petronko

M. R.

Taylor

C. E.

Wilhelm

Wilson

G. T.

(2010). Cognitive-behavioral therapy for adolescent body dysmorphic disorder. Cognitive and Behavioral Practice, 17, 248-258.

15.

Gunstad

Phillips

K. A.

(2003). Axis I comorbidity in body dysmorphic disorder. Comprehensive Psychiatry, 44, 270-276.

16.

Ipser

J. C.

Sander

Stein

D. J.

(2009). Pharmacotherapy and psychotherapy for body dysmorphic disorder (review). Cochrane Database System Reviews, 1, 1-33.

17.

Keeton

C. P.

Ginsburg

G. S.

(2008). Combining and sequencing medication and cognitive-behaviour therapy for childhood anxiety disorders. International Review of Psychiatry, 20, 159-164.

18.

Koran

L. M.

Abujaoude

Large

M. D.

Serpe

R. T.

(2008). The prevalence of body dysmorphic disorder in the United States adult population. CNS Spectrums, 13, 316-322.

19.

Kovacs

(1992). Children’s Depression Inventory. North Tonawanda, NY: Multi-Health Systems.

20.

Mayville

Katz

R. C.

Gipson

M. T.

Cabral

(1999). Assessing the prevalence of body dysmorphic disorder in an ethnically diverse group of adolescents. Journal of Child and Family Studies, 8, 357-362.

21.

Miller

W. R.

Rollnick

(2002). Motivational interviewing: Preparing people for change. New York, NY: Guilford.

22.

National Advisory Mental Health Council Workgroup on Child and Adolescent Mental Health Intervention Development and Deployment. (2001). Blueprint for change: Research on child and adolescent mental health. Washington, DC: National Institute of Mental Health.

23.

National Collaborating Center for Mental Health. (2006). Obsessive-compulsive disorder: Core interventions in the treatment of obsessive-compulsive disorder and body dysmorphic disorder [Full guideline]. London, England: The British Psychological Society and the Royal College of Psychiatrists.

24.

O’Grady

(2002). A single subject investigation of behavioral and cognitive therapies for body dysmorphic disorder (Unpublished doctoral dissertation). University of Maine, Orono.

25.

Otto

M. W.

Wilhelm

Cohen

L. S.

Harlow

B. L.

(2001). Prevalence of body dysmorphic disorder in a community sample of women. American Journal of Psychiatry, 158, 2061-2063.

26.

Phillips

K. A.

(2005). The broken mirror: Understanding and treating body dysmorphic disorder—Revised and expanded edition. Oxford, UK: Oxford University Press.

27.

Phillips

K. A.

(2009). Understanding body dysmorphic disorder: An essential guide. New York, NY: Oxford University Press.

28.

Phillips

K. A.

Albertini

R. S.

Siniscalchi

J. M.

Khan

Robinson

(2001). Effectiveness of pharmacotherapy for body dysmorphic disorder: A chart review study. Journal of Clinical Psychiatry, 62, 721-727.

29.

Phillips

K. A.

Atala

K. D.

Albertini

R. S.

(1995). Case study: Body dysmorphic disorder in adolescents. Journal of the American Academy of Child & Adolescent Psychiatry, 34, 1216-1220.

30.

Phillips

K. A.

Crino

R. D.

(2001). Body dysmorphic disorder. Current Opinion in Psychiatry, 14, 113-118.

31.

Phillips

K. A.

Didie

E. R.

Feusner

Wilhelm

(2008). Body dysmorphic disorder: Treating an underrecognized disorder. American Journal of Psychiatry, 165, 1111-1118.

32.

Phillips

K. A.

Dwight

M. M.

McElroy

S. L.

(1998). Efficacy and safety of fluvoxamine in body dysmorphic disorder. Journal of Clinical Psychiatry, 59, 165-171.

33.

Phillips

K. A.

Grant

J. E.

Siniscalchi

J. M.

Stout

Price

L. H.

(2005). A retrospective follow-up study of body dysmorphic disorder. Comprehensive Psychiatry, 46, 315-321.

34.

Phillips

K. A.

Hollander

(2008). Treating body dysmorphic disorder with medication: Evidence, misconceptions, and a suggested approach. Body Image, 5, 13-27.

35.

Phillips

K. A.

Hollander

Rasmussen

S. A.

Aronowitz

B. R.

DeCaria

Goodman

W. K.

(1997). A severity rating scale for body dysmorphic disorder: Development, reliability, and validity of a modified version of the Yale-Brown Obsessive Compulsive Scale. Psychopharmacology Bulletin, 33, 17-22.

36.

Phillips

K. A.

McElroy

S. L.

Keck

P. E.

Jr. Pope

H. G.

Jr. Hudson

J. I.

(1993). Body dysmorphic disorder: 30 cases of imagined ugliness. American Journal of Psychiatry, 150, 302-308.

37.

Phillips

K. A.

Menard

(2006). Suicidality in body dysmorphic disorder: A prospective study. American Journal of Psychiatry, 163, 1280-1282.

38.

Phillips

K. A.

Pagano

M. E.

Menard

Stout

R. L.

(2006). A 12-month follow-up study of the course of body dysmorphic disorder. American Journal of Psychiatry, 163, 907-912.

39.

Rosen

J. C.

Reiter

(1996). Development of the body dysmorphic disorder examination. Behaviour Research and Therapy, 34, 755-766.

40.

Rosen

J. C.

Reiter

Orosan

(1995). Cognitive-behavioral body image therapy for body dysmorphic disorder. Journal of Consulting and Clinical Psychology, 63, 263-269.

41.

Schulte

Eifert

G. H.

(2002). What to do when manuals fail? The dual model of psychotherapy. Clinical Psychology: Science and Practice, 9, 312-328.

42.

The Treatment for Adolescents With Depression Study Team. (2007). The Treatment for Adolescents With Depression Study (TADS): Long-term effectiveness and safety outcomes. Archives of General Psychiatry, 10, 1132-1144.

43.

Veale

Boocock

Gournay

Dryden

Shah

Willson

Walburn

(1996). Body dysmorphic disorder: A survey of fifty cases. British Journal of Psychiatry, 169, 196-201.

44.

Veale

Gournay

Dryden

Boocock

Shah

Willson

Walburn

(1996). Body dysmorphic disorder: A cognitive behavioural model and a pilot randomized controlled trial. Behaviour Research and Therapy, 34, 717-729.

45.

Veale

Neziroglu

(2010). Body dysmorphic disorder: A treatment manual. Chichester, UK: John Wiley.

46.

Williams

Hadjistavropoulos

Sharpe

(2006). A meta-analysis of psychological and pharmacological treatments for body dysmorphic disorder. Behaviour Research and Therapy, 44, 99-111.