Katharine A Phillips’s research while affiliated with New York Presbyterian Hospital and other places

This meta-analysis and trial sequential analysis (TSA) of randomized controlled trials (RCTs) on the psychological treatment of body dysmorphic disorder (BDD) was conducted to evaluate the intervention effects and robustness of the evidence. This study included 15 RCTs up until 15 June 2024, with 905 participants. Results showed significant improvements in BDD symptoms ( g = −0.97), depression ( g = −0.51), anxiety ( g = −0.72), insight/delusion ( g = −0.57), psychosocial functioning ( g = 0.45), and quality of life ( g = 0.44), with effects sustained from 1 to 6 months follow-up. RCTs with a waitlist/inactive control reported larger effect sizes for post-intervention BDD symptoms compared to those with a placebo/active control group. In addition, studies with low risk of bias demonstrate larger effect sizes for post-intervention psychosocial functioning compared to studies with some concerns. Notably, the presence of exposure and response prevention in the treatment, as well as the mode of delivery (face-to-face or digital), did not have a significant impact on the intervention outcomes. Females exhibited greater effect sizes in post-intervention BDD symptoms and psychosocial functioning than males. With increasing age, the effect size for insight/delusion symptoms diminished. Longer session duration was associated with larger effect sizes for BDD symptoms, depression at post-treatment, and depression at follow-up. TSA indicated robust evidence for depression at post-treatment and BDD symptoms, while the remaining outcome variables did not meet the desired level of evidence. In conclusion, this study underscores the effectiveness of psychological treatments in reducing BDD symptoms and improving related outcomes, highlighting the need for further research to confirm the impact of these therapies on other outcomes.

Serotonin reuptake inhibitors (SRIs) are the first-line medication treatment for body dysmorphic disorder (BDD). They usually substantially improve BDD symptoms and many co-occurring disorders and symptoms. SRIs must be optimized in terms of dose and trial duration. High doses are often needed to effectively treat BDD (as for obsessive-compulsive disorder). Excellent adherence to the medication is also required for a good outcome. Treatment with an SRI alone is as effective for patients with delusional BDD beliefs as for those with nondelusional beliefs. These medications also usually improve co-occurring depressive symptoms, anxiety, anger/hostility, suicidality, psychosocial functioning, and quality of life. An SRI may be used regardless of BDD severity but is always recommended for severe BDD and for more highly suicidal patients. Unfortunate myths about these medications abound; with competent prescribing, most SRIs are usually well tolerated. If an optimized SRI trial insufficiently improves symptoms, certain medications, such as atypical neuroleptics (perhaps in particular aripiprazole) and buspirone can improve treatment outcomes when added to an SRI. This chapter reviews the evidence for the efficacy of SRIs, SRI augmentation and switching strategies, and alternatives to an SRI. It also discusses how to effectively implement medication treatment for BDD.

Dermatologists routinely see patients with inflammatory skin conditions and aesthetic concerns that involve substantial psychological comorbidity. However, most dermatologists do not receive formal training in this area, and many are unsure how to best help treat certain patients holistically. Body dysmorphic disorder (BDD) is a common and distressing psychiatric condition that disproportionately impacts dermatology patients, including patients living with chronic inflammatory skin conditions such as acne and atopic dermatitis. BDD is characterized by preoccupation with nonexistent or minimally noticeable flaws in physical appearance that cause clinically significant distress or impairment in functioning. Adolescent populations may be particularly vulnerable to clinically significant body image dissatisfaction, including BDD, due to the high prevalence of acne and the pervasive role of social media platforms. The rise of social media may exacerbate body image issues through repetitive exposure to idealized and often unrealistic beauty standards. Though screening questionnaires can assist dermatologists in recognizing BDD, dermatologists must collaborate with mental health providers to provide comprehensive care to vulnerable patients, including adolescents.J Drugs Dermatol. 2024;23(7):545-550. doi:10.36849/JDD.8156.

Obsessive-compulsive and related disorders include obsessive-compulsive disorder, hoarding disorder, body dysmorphic disorder, trichotillomania (hair-pulling disorder), and excoriation (skin-picking) disorder. This volume reviews the phenomenology and epidemiology of each of the disorders. Next, it reviews how the disorders are maintained, from biological (including genetic and neuroanatomical) and psychological (including information-processing, personality, behavioral, and cognitive) perspectives. Detailed instructions for the assessment and treatment of each disorder are provided, including somatic (such as pharmacotherapy, neurosurgery, and neuromodulation) and psychosocial (including exposure-based and cognitive) approaches as well as an exploration of the efficacy of combining pharmacotherapy and psychological approaches). The volume concludes with reviews of the obsessive-compulsive and related disorders in special populations including older adults, children and adolescents, and cross-cultural issues).

Obsessive-compulsive and related disorders include obsessive-compulsive disorder, hoarding disorder, body dysmorphic disorder, trichotillomania (hair-pulling disorder), and excoriation (skin-picking) disorder. This volume reviews the phenomenology and epidemiology of each of the disorders. Next, it reviews how the disorders are maintained, from biological (including genetic and neuroanatomical) and psychological (including information-processing, personality, behavioral, and cognitive) perspectives. Detailed instructions for the assessment and treatment of each disorder are provided, including somatic (such as pharmacotherapy, neurosurgery, and neuromodulation) and psychosocial (including exposure-based and cognitive) approaches as well as an exploration of the efficacy of combining pharmacotherapy and psychological approaches). The volume concludes with reviews of the obsessive-compulsive and related disorders in special populations including older adults, children and adolescents, and cross-cultural issues).