New Therapy for Body Image Disorder

Cognitive behavioral therapy was effective for body dysmorphic disorder

/ Author:  / Reviewed by: Joseph V. Madia, MD Beth Bolt, RPh

(RxWiki News) People with serious body image issues can develop unhealthy habits that have serious consequences, but a new therapy could help these people see themselves differently.

People with body dysmorphic disorder (BDD) have an exaggerated sense of flaws in their body and appearance. They can develop habits that try to fix or cover their perceived flaws — such as hiding, skin picking, excessive grooming and having surgery. It can affect family, jobs, school, relationships and friends.

The disease can be so severe that people with BDD become housebound and have a high lifetime rate of suicide and psychiatric hospitalization.

Finding therapy that can help people with BDD develop healthier ways to view their bodies and stop the behaviors associated with BDD was the goal of a recent clinical trial. The research team saw improvement in people with BDD who were treated with a new form of cognitive behavioral therapy.

"Seek help from a therapist for body image issues."

Sabine Wilhelm, PhD, from Massachusetts General Hospital and Harvard Medical School, and her research team conducted this study using a new treatment for body dysmorphic disorder.

The study included 36 participants. Women made up 61 percent of the subjects, and all were age 18 and older. The subjects were divided into two groups — one who received cognitive behavioral therapy (CBT) for 22 sessions over 24 weeks, and one group (waitlisted) who had no CBT for 12 weeks, then had 22 CBT sessions.

The cognitive behavioral therapy was designed to change the way the patients felt about themselves and to reduce anxiety and bad behaviors associated with their perception of their body. The patients learned to see their body in an objective, non-judgmental way while standing in front of a mirror and to hold back from destructive behaviors.

The researchers collected data on the study participants to measure depression, disability, body image beliefs and how severe their BDD symptoms were. They also surveyed the participants’ satisfaction with the treatment.

Results of this study showed that by week 12, 50 percent of the CBT group responded to the treatment, compared to 12 percent of the waitlisted group. The response was measured by a decrease in the severity of the patients' symptoms.

At 12 weeks, the symptoms in the CBT group were not different than those in the waitlist group, meaning that both groups still had behaviors that indicated to the researchers that they still viewed themselves negatively.

Dr. Wilhelm and her team suggested that 12 weeks of treatment may not be enough to treat BDD to the point where a change in symptoms can be seen.

By the end of the study, 81 percent of the total study participants from both groups had responded to the treatment. Improvements were seen in body perception, disability and depression. Improvements were still seen in all participants at a six-month follow-up evaluation.

“Our findings suggest that CBT specifically developed for BDD also improves BDD-related sight and associated symptoms such as depression and disability,” the researchers concluded.

"The benefit of Cognitive-Behavioral Therapy is that it allows an individual to change aspects of both their thoughts (cognitions) and behaviors in relationship to their specific concerns that they are experiencing in life (and in this study, body dysmorphic disorder)," said Daniel Berarducci, MA, a Clinical Professional Counselor at Person-Holistic Innovations in Las Vegas, Nevada.

"Whenever an individual experiences mental health concerns, often the individual will have practiced negative thoughts within themselves, which then affects the individual's behaviors in order to strengthen these negative personal understandings within themselves," Berarducci explained to dailyRx News.

"Through the process of cognitive restructuring (changing one's negative thoughts to healthier/positive thoughts) in combination with positive behavioral exposure (or making positive behavioral decisions), Cognitive-Behavioral Therapy is able to assist an individual with their specific mental health concern by improving their daily functioning by learning and practicing healthier thoughts, feelings, and behaviors," Berarducci said. 

The small number of study subjects was noted as a limitation of this study. Dr. Wilhelm stated, “Follow up controlled studies that include larger samples and compare the efficacy of CBT for BDD to alternative treatment conditions are greatly needed."

Three people in the CBT group left the study and four left from the other group. One person in the group who received no CBT for 12 weeks left because she felt her symptoms were not being treated. Others cited time commitment and other reasons for leaving.

This study was published online in the journal Behavior Therapy.

Dr. Wilhelm disclosed receiving royalties for a publication on body dysmorphic disorder from Guilford Press.

Funding for this research was provided by a grant from the National Institute of Mental of Health.

Review Date: 
February 14, 2014
Last Updated:
February 20, 2014