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Cognitive Behavioral Therapy for Body Dysmorphic Disorder

The Diagnostic and Statistical Manual- Fifth Edition (DSM-5) has classified Body Dysmorphic Disorder (BDD) under obsessive-compulsive related disorders as BDD shares many similarities to Obsessive Compulsive Disorder (OCD).  Body Dysmorphic Disorder (BDD) is defined as a preoccupation with a perceived or imagined defect in one’s physical appearance. The preoccupation is associated with a distorted body image with many time consuming safety behaviors such as mirror gazing, camouflaging, ruminating, skin picking or constant comparing of oneself to others. Such patients have a poor quality of life, are socially isolated, very depressed and are at high risk of committing suicide. They often have needless dermatological treatment and cosmetic surgery. In the past ten years effective pharmacological and cognitive behavioral treatments have been developed for BDD.  Despite more awareness of the disorder, it is still under recognized and often misdiagnosed.  Specific evidence based treatment strategies have been developed.  Although there are some similarities to obsessive compulsive disorder treatment there are also many distinct approaches.  This workshop will describe the symptoms of BDD, explain cognitive behavioral models of BDD, and teach assessment and treatment strategies. These strategies include the process of engagement and developing a formulation; imagery rescripting; attentional training; ceasing ruminating; habit reversal, exposure and response prevention; and behavioral experiments.
By the end of the workshop, participants will 

  1. Recognize and diagnose various forms of BDD
  2. Understand a cognitive behavioral model of BDD and the factors that maintain the symptoms of BDD and psychogenic excoriation
  3. Devise strategies for engagement and change in BDD with a focus on ceasing ruminating and comparing, dropping of avoidance and safety behaviours, re-scripting imagery and behavioural experiments

This workshop is aimed at those with moderate experience in CBT (i.e. not beginners), and will involve a mixture of didactic material and an exercise to develop a formulation



Good Practices in the Treatment of BDD

Body Dysmorphic Disorder (BDD) is defined as a preoccupation with a perceived or imagined defect in one’s physical appearance. Although awareness of the disorder continues to grow larger, BDD is often misdiagnosed and under recognized in clinical practice. However, there are specific evidence based strategies that have been developed for the treatment of BDD. In short, assessment and treatment strategies include attentional training; imagery rescripting; ceasing ruminating; habit reversal; and exposure and response prevention (ERP). Individuals can be taught to modify the attentional biases, and to stop cognitive processes such as ruminating, self-attacking, and comparing. One hope with attentional training may be to increase the degree of attention away from self-referent information towards tasks or towards the environment.  Additionally, imagery rescripting strategy is to develop a different relationship with the image so that it is no longer regarded as truth but just a "picture in one’s mind” that was constructed over time. ERP involves exposing patients to situations frequently avoided or feared while preventing the person from engaging in compulsive behaviors that artificially reduce the anxiety.  Understanding the role of overvalued ideation, disgust, shame, self-consciousness, and feelings of anxiety and depression helps to target treatment strategies to specific emotions and cognitions.  Overall, these treatment strategies may aid in reduction of symptoms and abnormal perceptions.