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Effectiveness of Multimodal Treatment for Young People With Body Dysmorphic Disorder in Two Specialist Clinics

Rautio, Daniel ; Gumpert, Martina ; Jassi, Amita ; Krebs, Georgina ; Flygare, Oskar ; Andrén, Per LU ; Monzani, Benedetta ; Peile, Lauren ; Jansson-Fröjmark, Markus and Lundgren, Tobias , et al. (2022) In Behavior Therapy 53(5). p.1037-1049
Abstract

Body dysmorphic disorder (BDD) typically originates in adolescence and is associated with considerable adversity. Evidence-based treatments exist but research on clinical outcomes in naturalistic settings is extremely scarce. We evaluated the short- and long-term outcomes of a large cohort of adolescents with BDD receiving specialist multimodal treatment and examined predictors of symptom improvement. We followed 140 young people (age range 10–18) with a diagnosis of BDD treated at two national and specialist outpatient clinics in Stockholm, Sweden (n = 96) and London, England (n = 44), between January 2015 and April 2021. Participants received multimodal treatment consisting of cognitive behavior therapy and, in 72% of cases,... (More)

Body dysmorphic disorder (BDD) typically originates in adolescence and is associated with considerable adversity. Evidence-based treatments exist but research on clinical outcomes in naturalistic settings is extremely scarce. We evaluated the short- and long-term outcomes of a large cohort of adolescents with BDD receiving specialist multimodal treatment and examined predictors of symptom improvement. We followed 140 young people (age range 10–18) with a diagnosis of BDD treated at two national and specialist outpatient clinics in Stockholm, Sweden (n = 96) and London, England (n = 44), between January 2015 and April 2021. Participants received multimodal treatment consisting of cognitive behavior therapy and, in 72% of cases, medication (primarily selective serotonin reuptake inhibitors). Data were collected at baseline, posttreatment, and 3, 6, and 12 months after treatment. The primary outcome measure was the clinician-rated Yale-Brown Obsessive-Compulsive Scale Modified for BDD, Adolescent version (BDD-YBOCS-A). Secondary outcomes included self-reported measures of BDD symptoms, depressive symptoms, and global functioning. Mixed-effects regression models showed that BDD-YBOCS-A scores decreased significantly from baseline to posttreatment (coefficient [95% confidence interval] = -16.33 [-17.90 to -14.76], p<0.001; within-group effect size (Cohen's d) = 2.08 (95% confidence interval, 1.81 to 2.35). At the end of the treatment, 79% of the participants were classified as responders and 59% as full or partial remitters. BDD symptoms continued to improve throughout the follow-up. Improvement was also seen on all secondary outcome measures. Linear regression models identified baseline BDD symptom severity as a predictor of treatment outcome at posttreatment, but no consistent predictors were found at the 12-month follow-up. To conclude, multimodal treatment for adolescent BDD is effective in both the short- and long-term when provided flexibly within a specialist setting. Considering the high personal and societal costs of BDD, specialist care should be made more widely available.

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publishing date
type
Contribution to journal
publication status
published
subject
keywords
adolescents, body dysmorphic disorder, cognitive-behavior therapy, dysmorphophobia, treatment outcomes
in
Behavior Therapy
volume
53
issue
5
pages
1037 - 1049
publisher
Elsevier
external identifiers
  • scopus:85131841752
  • pmid:35987534
ISSN
0005-7894
DOI
10.1016/j.beth.2022.04.010
language
English
LU publication?
no
additional info
Publisher Copyright: © 2022
id
7916bbff-eabd-4b13-bb2f-7bac17bb15b1
date added to LUP
2023-07-14 11:30:03
date last changed
2024-06-15 04:36:55
@article{7916bbff-eabd-4b13-bb2f-7bac17bb15b1,
  abstract     = {{<p>Body dysmorphic disorder (BDD) typically originates in adolescence and is associated with considerable adversity. Evidence-based treatments exist but research on clinical outcomes in naturalistic settings is extremely scarce. We evaluated the short- and long-term outcomes of a large cohort of adolescents with BDD receiving specialist multimodal treatment and examined predictors of symptom improvement. We followed 140 young people (age range 10–18) with a diagnosis of BDD treated at two national and specialist outpatient clinics in Stockholm, Sweden (n = 96) and London, England (n = 44), between January 2015 and April 2021. Participants received multimodal treatment consisting of cognitive behavior therapy and, in 72% of cases, medication (primarily selective serotonin reuptake inhibitors). Data were collected at baseline, posttreatment, and 3, 6, and 12 months after treatment. The primary outcome measure was the clinician-rated Yale-Brown Obsessive-Compulsive Scale Modified for BDD, Adolescent version (BDD-YBOCS-A). Secondary outcomes included self-reported measures of BDD symptoms, depressive symptoms, and global functioning. Mixed-effects regression models showed that BDD-YBOCS-A scores decreased significantly from baseline to posttreatment (coefficient [95% confidence interval] = -16.33 [-17.90 to -14.76], p&lt;0.001; within-group effect size (Cohen's d) = 2.08 (95% confidence interval, 1.81 to 2.35). At the end of the treatment, 79% of the participants were classified as responders and 59% as full or partial remitters. BDD symptoms continued to improve throughout the follow-up. Improvement was also seen on all secondary outcome measures. Linear regression models identified baseline BDD symptom severity as a predictor of treatment outcome at posttreatment, but no consistent predictors were found at the 12-month follow-up. To conclude, multimodal treatment for adolescent BDD is effective in both the short- and long-term when provided flexibly within a specialist setting. Considering the high personal and societal costs of BDD, specialist care should be made more widely available.</p>}},
  author       = {{Rautio, Daniel and Gumpert, Martina and Jassi, Amita and Krebs, Georgina and Flygare, Oskar and Andrén, Per and Monzani, Benedetta and Peile, Lauren and Jansson-Fröjmark, Markus and Lundgren, Tobias and Hillborg, Maria and Silverberg-Mörse, Maria and Clark, Bruce and Fernández de la Cruz, Lorena and Mataix-Cols, David}},
  issn         = {{0005-7894}},
  keywords     = {{adolescents; body dysmorphic disorder; cognitive-behavior therapy; dysmorphophobia; treatment outcomes}},
  language     = {{eng}},
  number       = {{5}},
  pages        = {{1037--1049}},
  publisher    = {{Elsevier}},
  series       = {{Behavior Therapy}},
  title        = {{Effectiveness of Multimodal Treatment for Young People With Body Dysmorphic Disorder in Two Specialist Clinics}},
  url          = {{http://dx.doi.org/10.1016/j.beth.2022.04.010}},
  doi          = {{10.1016/j.beth.2022.04.010}},
  volume       = {{53}},
  year         = {{2022}},
}