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A Pilot Randomized Controlled Trial of Cognitive-Behavioral Therapy for Adolescents With Body Dysmorphic Disorder

Research output: Contribution to journalArticlepeer-review

Original languageEnglish
Pages (from-to)895-904
Number of pages10
JournalJournal of the American Academy of Child and Adolescent Psychiatry
Issue number11
Early online date3 Sep 2015
E-pub ahead of print3 Sep 2015
Published1 Nov 2015


King's Authors


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.
Thirty adolescents aged 12-18 (mean=16.0,SD=1.7) with a primary diagnosis of BDD and their families were randomly assigned to 14 sessions of CBT delivered over four months or a control condition of equivalent duration, consisting of written psycho-education materials and weekly telephone monitoring. Blind evaluators assessed participants at baseline, mid-treatment, post-treatment, and at two-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).
The CBT group showed a significantly greater improvement than the control group, both at post-treatment (time×group interaction coefficient [95%CI]=-11.26 [-17.22 to -5.31]; p=0.000) and at two-month follow-up (time×group interaction coefficient [95%CI]=-9.62 [-15.74 to -3.51]; p=0.002). Six (40%) participants in the CBT group and one (6.7%) in the control condition were classified as responders at both time points (χ2=4.658,p=.031). Improvements were also seen on secondary measures, including insight, depression, and quality of life at post-treatment. Both patients and their families deemed the treatment as highly acceptable.
Developmentally tailored CBT is a promising intervention for young people with BDD, though there is significant room for improvement. Further clinical trials incorporating lessons learned in this pilot and comparing CBT and pharmacological therapies, as well as their combination, are warranted.

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