A Pilot Randomized Controlled Trial of Cognitive-Behavioral Therapy for Adolescents With Body Dysmorphic Disorder.
OBJECTIVE
Body dysmorphic disorder (BDD) typically starts in adolescence, but evidence-based treatments are yet to be developed and formally evaluated in this age group. We designed an age-appropriate cognitive-behavioral therapy (CBT) protocol for adolescents with BDD and evaluated its acceptability and efficacy in a pilot randomized controlled trial.


METHODS
Thirty adolescents aged 12 to 18 years (mean = 16.0, SD = 1.7) with a primary diagnosis of BDD, together with their families, were randomly assigned to 14 sessions of CBT delivered over 4 months or a control condition of equivalent duration, consisting of written psycho-education materials and weekly telephone monitoring. Blinded evaluators assessed participants at baseline, midtreatment, posttreatment, and at 2-month follow-up. The primary outcome measure was the Yale-Brown Obsessive-Compulsive Scale Modified for BDD, Adolescent Version (mean baseline score = 37.13, SD = 4.98, range = 24-43).


RESULTS
The CBT group showed a significantly greater improvement than the control group, both at posttreatment (time × group interaction coefficient [95% CI] = -11.26 [-17.22 to -5.31]; p = .000) and at 2-month follow-up (time × group interaction coefficient [95% CI] = -9.62 [-15.74 to -3.51]; p = .002). Six participants (40%) in the CBT group and 1 participant (6.7%) in the control condition were classified as responders at both time points (χ(2) = 4.658, p = .031). Improvements were also seen on secondary measures, including insight, depression, and quality of life at posttreatment. Both patients and their families deemed the treatment as highly acceptable.


CONCLUSIONS
Developmentally tailored CBT is a promising intervention for young people with BDD, although there is significant room for improvement. Further clinical trials incorporating lessons learned in this pilot study and comparing CBT and pharmacological therapies, as well as their combination, are warranted.


BACKGROUND
Cognitive-Behaviour Therapy for Adolescents With Body Dysmorphic Disorder; http://www.isrctn.com/; ISRCTN67699666.
Child and Adolescent Psychiatry Research Center, Karolinska Institutet, Stockholm; King's College London, Institute of Psychiatry, Psychology and Neuroscience, London; South London and Maudsley National Health Service (NHS) Foundation Trust, London. Electronic address: david.mataix.cols@ki.se.
David
D
Mataix-Cols
Child and Adolescent Psychiatry Research Center, Karolinska Institutet, Stockholm.
Lorena
L
Fernández de la Cruz
Child and Adolescent Psychiatry Research Center, Karolinska Institutet, Stockholm.
Kayoko
K
Isomura
King's College London, Institute of Psychiatry, Psychology and Neuroscience, London; South London and Maudsley National Health Service (NHS) Foundation Trust, London.
Martin
M
Anson
University of Queensland, Brisbane, Australia.
Cynthia
C
Turner
King's College London, Institute of Psychiatry, Psychology and Neuroscience, London.
Benedetta
B
Monzani
Griffith University, Gold Coast, Australia.
Jacinda
J
Cadman
South London and Maudsley National Health Service (NHS) Foundation Trust, London.
Laura
L
Bowyer
King's College London, Institute of Psychiatry, Psychology and Neuroscience, London; Great Ormond Street Hospital, London and Institute of Child Health, University College London.
Isobel
I
Heyman
King's College London, Institute of Psychiatry, Psychology and Neuroscience, London; South London and Maudsley National Health Service (NHS) Foundation Trust, London.
David
D
Veale
King's College London, Institute of Psychiatry, Psychology and Neuroscience, London; South London and Maudsley National Health Service (NHS) Foundation Trust, London.
Georgina
G
Krebs
D000293:Adolescent; D057215:Body Dysmorphic Disorders / Q000628:therapy*; D003071:Cognition; D015928:Cognitive Behavioral Therapy; D003863:Depression; D005260:Female; D006801:Humans; D016015:Logistic Models; D008131:London; D008297:Male; D010865:Pilot Projects; D011569:Psychiatric Status Rating Scales; D011788:Quality of Life / Q000523:psychology; D012720:Severity of Illness Index; D016037:Single-Blind Method; D016896:Treatment Outcome
Body dysmorphic disorder; adolescents; children; cognitive-behavioral therapy; randomized controlled trial