Efficacy of App-Based Cognitive Behavioral Therapy for Body Dysmorphic Disorder with Coach Support: Initial Randomized Controlled Clinical Trial.

INTRODUCTION: Body dysmorphic disorder (BDD) is severe, chronic, and undertreated. Apps could substantially improve treatment access. OBJECTIVE: We provide an initial test of the usability and efficacy of coach-supported app-based cognitive behavioral therapy (CBT) for BDD. The Perspectives app covers core treatment components: psychoeducation, cognitive restructuring, exposure with response prevention, mindfulness, attention retraining, and relapse prevention. METHODS: A randomized waitlist-controlled trial was conducted. Adults (N = 80) with primary BDD were assigned to 12 weeks of Perspectives or waitlist. Coaches promoted engagement and answered questions via in-app messaging and phone calls. BDD severity was measured at baseline, mid-treatment, and end of treatment by blinded independent evaluators (Yale-Brown Obsessive Compulsive Scale Modified for BDD; BDD-YBOCS). Secondary outcomes included BDD-related insight, depression, quality of life, and functioning. RESULTS: App uptake and satisfaction were high. In intent-to-treat analyses, Perspectives app-based CBT was associated with significantly lower BDD-YBOCS severity at end of treatment (M [SD]: 16.8 [7.5]) compared to the waitlist (26.7 [6.2]; p < 0.001, d = 1.44). App-based CBT was associated with greater improvements across all secondary measures, with medium to large effects. CONCLUSIONS: Perspectives, supported by a bachelor's-level coach, is an efficacious, scalable treatment for adults with BDD.

An Internet-based controlled trial of interpretation bias modification versus progressive muscle relaxation for body dysmorphic disorder.

OBJECTIVE: The current study extended upon previous research efforts by evaluating the utility and feasibility of an 8-session Internet-based interpretation bias modification (IBM) training protocol targeting evaluation- and appearance-related threat biases characteristic of the disorder compared to a progressive muscle relaxation (PMR) condition for treatment of body dysmorphic disorder (BDD). METHOD: Fifty participants with BDD were recruited from across the United States and randomly assigned to eight sessions of either IBM or PMR. Assessments of interpretation bias, BDD symptoms, depression, and anxiety were administered at pretreatment, 1-week posttreatment, and 3-month follow-up. RESULTS: Compared to the PMR group, individuals in the IBM condition reported less negative/threat interpretation biases and greater positive/benign interpretation biases at posttreatment and follow-up. There were no significant differences between groups with regard to BDD symptoms, depression, or anxiety. Clinically significant improvement was common in both conditions (IBM = 64.0%; PMR = 52.0%), though it did not differ between them. CONCLUSIONS: Contrary to our hypothesis, IBM did not outperform PMR with regard to BDD symptom reduction, though both treatments yielded significant improvements on symptom outcomes. Findings suggest that IBM and/or PMR may be promising treatment strategies for BDD, perhaps adjunctively. Overall, these findings provide helpful future directions for IBM research and provide an additional lens through which to examine its potential effectiveness for BDD. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

The Health Threat Posed by the Hidden Epidemic of Anabolic Steroid Use and Body Image Disorders Among Young Men.

CONTEXT: The prevalence of body image disorders and anabolic-androgenic steroid (AAS) use is increasing, despite the evidence of their serious adverse health effects and despite the passage of laws regulating their sales. Here we review the evolution of the dual emerging epidemics of body image disorders and AAS use, adverse health effects of AASs, and the need for an integrated health policy and regulatory response. EVIDENCE ACQUISITION: We searched for studies published prior to June 2018. Quality of evidence was low to moderate because of its observational nature; heterogeneity of eligibility criteria; variable doses; reliance on retrospective self-reported data in many studies; and variable quality of outcome ascertainment. EVIDENCE SYNTHESIS: Most AAS users are nonathlete young men, who use these substances to look lean and more muscular. Some of these men suffer from "muscle dysmorphia," a form of body dysmorphic disorder. AASs has been associated with cardiovascular disorders, psychiatric disorders, AAS-withdrawal hypogonadism, infertility, neurotoxic effects, musculoskeletal injuries, liver toxicity, and needle-borne infections. Potential adverse effects may be compounded by the use of other substances (e.g., opioids) and high-risk behaviors. Unregulated Internet sales of AASs and selective androgen receptor modulators, which are easily purchased without a prescription, are of concern because of their potential to fuel the epidemic among adolescents and the military. CONCLUSIONS: Integrated nationwide efforts are necessary to raise public awareness of this epidemic, to study long-term health effects of AASs and treatment strategies, and to reform regulations to stem the epidemics of AAS use and body image disorders.

"You look great!": The effect of viewing appearance-related Instagram comments on women's body image.

Instagram is an increasingly popular social networking site where users post and share photos. The aim of the present study was to experimentally investigate the effect of viewing appearance-related comments accompanying Instagram images on women's body image. Participants were 128 female undergraduate students who viewed a set of attractive images paired with a brief positive comment. For half the participants, comments were related to appearance; the other half viewed the same images with place-related comments. As predicted, exposure to appearance comments led to greater body dissatisfaction than exposure to place comments. There was no significant effect on state self-objectification, but trait self-objectification predicted increase in body dissatisfaction regardless of experimental condition. It was concluded that comments form an important and integral part of Instagram imagery, one that has implications for body image in its own right.

A prospective study of adolescents' body dysmorphic symptoms: Peer victimization and the direct and protective roles of emotion regulation and mindfulness.

In this study, we examined whether peer appearance-related victimization was associated with adolescents' increasing body dysmorphic disorder (BDD) symptoms over 12 months. Also, given emotion regulation and mindfulness have been associated with less body dissatisfaction, we expected that they would protect against the negative impact of peer victimization on BDD symptoms. Participants were 367 Australian adolescents (Mage=13years). In multiple regressions, two aspects of emotion regulation, strategies and clarity, and two components of mindfulness, acting with awareness and being non-judgmental, were uniquely associated with fewer BDD symptoms at T2 relative to T1. There was evidence that one mindfulness component, observing, was a risk factor for more BDD symptoms. Further, acting with awareness and observing moderated the prospective relationship between victimization and BDD symptoms; low acting with awareness and high observing were risks for symptoms regardless of victimization, whereas high acting with awareness and low observing appeared protective of BDD symptoms, but only for adolescents who reported lower victimization.

Body dysmorphic disorder: Latest neuroanatomical and neuropsychological findings.

Body dysmorphic disorder (BDD) is characterized by a preoccupation with a perceived defect or flaw in physical appearance that is not observable or appears slight to others. It leads to severe distress and functional impairment. Cognitive-behavioural and neurobiological similarities to obsessive compulsive disorder (OCD) have led to its newly conceived classification as an obsessive compulsive related disorder (OCRD). In the process of investigating the neurobiology of BDD, neuroimaging and neuropsychological studies have been conducted. This review presents the most recent research findings and their connection with BDD clinical features. Imaging studies have shown increased total white matter volume and caudate volume asymmetry in BDD patients. These findings are consistent with the striatal topography model of OCRDs. Other studies have showed perfusion deficits in bilateral anterior-medial temporal and occipital regions and asymmetric perfusion in parietal lobes. In addition, correlation between symptom severity and left inferior frontal gyrus volume reflects the degree of detailed, analytic encoding that occurs on day-to-day basis when viewing others and themselves, and that likely underlies their symptoms. Finally, positive correlation between right amygdala volume and symptom severity signifies pathological fear circuitry engagement, hypervigilance and heightened sensitivity to social situations. Neuropsychological studies of BDD reveal deficits in strategic organization, learning and free recall after short and long delays. Executive function deficits are related to spatial working memory and subsequent thinking speed as well as impaired higher level planning ability. BDD patients' organizational strategies tend to focus on detail rather than on larger, global clustering features. They are characterized by abnormal visual processing of both details and global elements, inaccurate processing of global elements and reduced flexibility in switching visual attention between global and local features. Moreover, BDD patients seem to have deficits in identifying facial emotional expressions and they tend to misinterpret expressions of disgust (and others) as anger. Poor insight and ideas of reference, common in BDD, might be related to emotion recognition biases for angry expressions. These findings have been supplemented by combined neuroimaging and neuropsychological studies. Left hemisphere hyperactivity for low and normal spatial frequency face tasks and abnormal activation of the amygdala for high and low spatial frequency face tasks suggests detail encoding and analysis in BDD. Patients may primarily perceive details but they are impaired in their ability to contextualize them holistically.

Cognitive-behavioural therapy and recovery of a delusional dysmorphophobia case.

BACKGROUND: We present the application of cognitive-behavioural therapy in a clinical case diagnosed with delusional dysmorphophobia. METHOD: The psychometric scales used for evaluation were the Positive and Negative Syndrome Scale for Schizophrenia, Beck Anxiety and Depression inventories, the Rosenberg Self-Esteem Scale along with the degree of conviction in the delusional belief and in alternative explanations, and social functioning measured by patient reporting. The therapy included cognitive and behavioural techniques: evidence analysis, search for alternative explanations, logical and functional analysis, reality testing, progressive relaxation techniques, in vivo and imaginal exposure therapy. Evaluations were performed before and after the treatment and then at follow-up after 12 and 24 months. RESULTS: Progressively, the delusional conviction disappeared. There were significant improvements at an emotional level and the patient recovered social and work  functioning. CONCLUSIONS: The need to use psychological treatments for people with delusional disorder as first choice treatment must be considered.

Research-to-policy translation for prevention of disordered weight and shape control behaviors: A case example targeting dietary supplements sold for weight loss and muscle building.

New approaches to universal eating disorders prevention and interventions targeting macro-environmental change are greatly needed, and research-to-policy translation efforts hold promise for advancing both of these goals. This paper describes as a policy-translation case example an academic-community-government partnership of the Strategic Training Initiative for the Prevention of Eating Disorders, Multi-Service Eating Disorders Association, and the office of Massachusetts Representative Kay Khan, all based in Massachusetts, USA. The partnership's research-to-policy translation project focused on dietary supplements sold for weight loss and muscle building, which have been linked with serious injury and death in consumers. Youth and people of all ages with eating disorders and body dysmorphic disorder may be especially vulnerable to use these products due to deceptive promises of fast and safe weight loss and muscle gain. The research-to-policy translation project was informed by a triggers-to-action framework to establish the evidentiary base of harm to consumers, operationalize policy solutions to mitigate harm through legislation, and generate political will to support action through legislation introduced in the Massachusetts legislature to restrict sales of weight-loss and muscle-building dietary supplements. The paper concludes with lessons learned from this unique policy translation effort for the prevention of disordered weight and shape control behaviors and offers recommendations for next steps for the field to advance research and practice for universal, macro-environmentally targeted prevention.

Body Image and Body Dysmorphic Concerns.

Most people would like to change something about their bodies and the way that they look, but for some it becomes an obsession. A healthy skin plays an important role in a person's physical and mental wellbeing, whereas a disfiguring appearance is associated with body image concerns. Skin diseases such as acne, psoriasis and vitiligo produce cosmetic disfigurement and patients suffering these and other visible skin conditions have an increased risk of depression, anxiety, feelings of stigmatization and self-harm ideation. Body image affects our emotions, thoughts, and behaviours in everyday life, but, above all, it influences our relationships. Furthermore, it has the potential to influence our quality of life. Promotion of positive body image is highly recommended, as it is important in improving people's quality of life, physical health, and health-related behaviors. Dermatologists have a key role in identifying body image concerns and offering patients possible treatment options.

Prevalence of Body Dysmorphic Disorder and Muscle Dysmorphia Among Entry-Level Military Personnel.

OBJECTIVE: To determine the prevalence of body dysmorphic disorder (BDD) and muscle dysmorphia (MD) in enlisted U.S. military personnel; and secondarily, to determine supplement use and relationship with BDD and MD. METHODS: A survey of advanced individual training of tri-service personnel at Fort Sam Houston, Texas, was performed combining the dysmorphia concern questionnaire, the MD symptom questionnaire, a supplement questionnaire, and demographic factors. RESULTS: Of the 1,320 service members approached, 1,150 (87.1%) completed the survey. The majority of participants were male, 62.8% (n = 722) and Army soldiers 59.0% (n = 679). The prevalence rate of BDD was 13.0% in males and 21.7% in females. The prevalence of MD was 12.7% in males and 4.2% in females. There was a strong correlation between having BDD and using supplements to get thinner (odds ratio 5.1; 95% confidence interval 3.4-7.8; p < 0.001) and MD to get more muscular (odds ratio 5.4; 95% confidence interval 3.5-8.3; p < 0.001). CONCLUSIONS: Our study shows a higher than expected prevalence rate of BDD and MD in service members. This indicates a need for increased awareness of dysmorphias in mental health providers, primary care providers, and commanders and justifies further military specific BDD and MD research.

Evaluación diagnóstica de la Dismorfia Muscular: una revisión sistemática / Muscle Dysmorphia Diagnostic evaluation: a systematic review

El objetivo de este estudio fue examinar las investigaciones realizadas sobre la evaluación diagnóstica de la Dismorfia Muscular (DM). Se realizó una búsqueda sistemática en las bases PsycINFO y Medline de 1997 a 2012, los descriptores fueron: "muscle dysmorphic disorder" "vigorexia" y "male". 17 estudios cumplieron los criterios de inclusión, de éstos, todos utilizaron los criterios diagnósticos propuestos por Pope et al. (1997). Aquellos con DM están preocupados por el tamaño corporal, levantan pesas de 3 a 7 días por semana, realizan dietas hiperproteicas y en ocasiones utilizan suplementos alimentarios y esteroides. En conclusión, los criterios de Pope et al. (1997) son la base para el diagnóstico de DM y el DSM-5 los retoma al reconocer e incluir a la DM como una patología

The aim of this study was to examine the actual state of the Muscle Dysmorphia (MD) diagnostic evaluation. A systematic search of the Medline and PsycINFO databases was conducted, from 1997-2012, descriptors were "muscle dysmorphic disorder" "vigorexia" and "male". 17 studies met the inclusion criteria, of these, the diagnostic criteria proposed by Pope et al. (1997) were used by all. Those with MD are concerned about body size, lift weights 3-7 days a week, performed protein diets, sometimes they uses food supplements and steroids. In conclusion, Pope et al. (1997) criteria are the basis for the MD diagnosis and the DSM-5 take it to account to recognize and include the MD as a pathology

Imagery Rescripting for Body Dysmorphic Disorder: A Multiple-Baseline Single-Case Experimental Design.

Individuals with body dysmorphic disorder (BDD) often experience negative distorted images of their appearance, and research suggests these may be linked to memories of adverse events such as bullying or teasing. This study evaluates imagery rescripting (ImR) as an intervention for BDD. In this article, we present a multiple-baseline single-case experimental design testing imagery rescripting as a brief, stand-alone intervention, with six individuals with BDD that related to aversive memories. The impact of the intervention was assessed by self-reported daily measures of symptom severity (preoccupation with appearance, appearance-related checking behaviors, appearance-related distress, and strength of belief that their main problem is their appearance) and standardized clinician ratings of BDD severity (Yale-Brown Obsessive Compulsive Scale modified for BDD). Four out of six of the participants responded positively to the intervention, with clinically meaningful improvement in symptomatology. Overall response was rapid; improvements began within the first week post-ImR intervention. From a small sample it is cautiously concluded that imagery rescripting may show promise as a module in cognitive-behavioral therapy for BDD, and is worthy of further investigation.

Seeing in the Mind's eye: Imagery rescripting for patients with body dysmorphic disorder. A single case series.

BACKGROUND: Intrusive images of appearance play an important role in the maintenance of body dysmorphic disorder (BDD) and are often linked to negative autobiographical experiences. However, to date there is no study examining the use and efficacy of imagery rescripting in BDD. METHOD: This study investigated imagery rescripting in six patients with BDD, using a single case series A-B design. The intervention consisted of two treatment sessions (T1, T2). BDD and depressive symptoms were evaluated prior to (T1), post (T2) and two weeks after intervention (FU), using the Yale -Brown Obsessive Compulsive Scale for BDD (BDD-YBOCS), the Body Dysmorphic Symptoms Inventory, and the Beck Depression Inventory. RESULTS: At post-treatment, significant reductions in negative affect, distress, vividness and encapsulated beliefs associated with images and memories as well as an increased control were observed for five of six patients. These were maintained or decreased at two weeks follow-up. Scores on the BDD-YBOCS indicated a significant 26% improvement in BDD severity at follow-up for the whole group. Considering response as a ≥ 30% reduction in BDD-YBOCS score, four of six patients were classified as treatment responders. At follow-up, significant improvements in BDD and depressive symptoms were observed for the whole group. LIMITATIONS: The small sample size and the lack of a control group limit the generalizability of our results. CONCLUSIONS: The findings indicate the potential efficacy of imagery rescripting, and highlight the need for further controlled trials. Imagery rescripting should be considered as a treatment technique within the cognitive framework of BDD.

What is and what is not positive body image? Conceptual foundations and construct definition.

A decade ago, research on positive body image as a unique construct was relatively nonexistent, and now this area is flourishing. How and why did positive body image scholarship emerge? What is known about this contemporary construct? This article situates and contextualizes positive body image within Cash's scholarship, eating disorder prevention efforts, feminist influences, strength-based disciplines within psychology, and Buddhism. Extracting insights from quantitative and qualitative research, this article demonstrates that positive body image is (a) distinct from negative body image; (b) multifaceted (including body appreciation, body acceptance/love, conceptualizing beauty broadly, adaptive investment in appearance, inner positivity, interpreting information in a body-protective manner); (c) holistic; (d) stable and malleable; (e) protective; (f) linked to self-perceived body acceptance by others; and (g) shaped by social identities. Complementing what positive body image is, this article further details what positive body image is not to provide a more nuanced understanding of this construct.

Phenomenology of men with body dysmorphic disorder concerning penis size compared to men anxious about their penis size and to men without concerns: a cohort study.

Men with body dysmorphic disorder (BDD) may be preoccupied with the size or shape of the penis, which may be causing significant shame or impairment. Little is known about the characteristics and phenomenology of such men and whether they can be differentiated from men with small penis anxiety (SPA) (who do not have BDD), and men with no penile concerns. Twenty-six men with BDD, 31 men with SPA, and 33 men without penile concerns were compared on psychopathology, experiences of recurrent imagery, avoidance and safety-seeking behaviours. Men with BDD had significantly higher scores than both the SPA group and no penile concern group for measures of imagery, avoidance, safety seeking and general psychopathology. The groups differed on the phenomenology of BDD specific to penile size preoccupation clearly from the worries of SPA, which in turn were different to those of the men without concerns. The common avoidance and safety seeking behaviours were identified in such men that may be used clinically.

Accept, distract, or reframe? An exploratory experimental comparison of strategies for coping with intrusive body image thoughts in anorexia nervosa and body dysmorphic disorder.

Negative body image is the hallmark of anorexia nervosa (AN) and body dysmorphic disorder (BDD). One aspect of body image, appearance-related thoughts, have shown to be a major contributor to relapse, thus further investigation of successful treatment strategies targeting these maladaptive thoughts are warranted. The present study tested an acceptance/mindfulness (AC), a cognitive restructuring (CR), and a distraction strategy with regard to their short-term effectiveness of reducing the frequency of thought occurrence and associated outcomes in participants with AN (n=20), BDD (n=21), and healthy controls (HC; n=22). Although all strategies led to a significant reduction of thought frequency, there was no group × strategy interaction effect in their reduction. Positive affect increased in the BDD group through the AC strategy, but decreased in healthy controls. Acceptance of the thought increased in the CR strategy in AN, whereas that strategy seemed to work least for BDD. Healthy controls showed most acceptance when using distraction. Taken together, the study suggests that all strategies might have their benefits and that it might be worthwhile further investigating differential indication of the strategies with regard to diagnosis and individual factors.

[The development of the body schema]. / Le développement du schéma corporel.

The body schema as an acquired structure enables individuals to gain a representation of the different parts of their body without relying on external stimulations. When its development is disrupted a certain number of disorders can arise which have significant repercussions on the patients' daily lives. These dysfunctions can be managed in the framework of psychomotor rehabilitation.

[Body image disturbance, nursing objectives and interventions]. / L'image corporelle perturbée, quels objectifs et interventions en soins infirmiers?

Faced with a changed body, several nursing care interventions are possible in order to restore self-esteem. Relational and personal care techniques or other forms of body mediation are all tools which can be used in order to reposition the patients at the centre of the care.

Paralyzed by desire: a new type of body integrity identity disorder.

BACKGROUND: Body incongruity in body integrity identity disorder (BIID) manifests in the desire to have a healthy limb amputated. We describe a variant of the disorder: the desire to become paralyzed (paralysis-BIID). METHOD: Sixteen otherwise healthy participants, recruited through Internet-based forums, websites, or word of mouth, completed questionnaires about details of their desire and accompanying symptoms. RESULTS: Onset of the desire for paralysis typically preceded puberty. All participants indicated a specific level for desired spinal cord injury. All participants simulated paralysis through mental imagery or physical pretending, and 9 (56%) reported erotic interest in paraplegia and/or disability. Our key new finding was that 37.5% of paralysis-BIID participants were women, compared with 4.4% women in a sample of 68 individuals with amputation-BIID. CONCLUSIONS: BIID reflects a disunity between self and body, usually with a prominent sexual component. Sex-related differences are emerging: unlike men, a higher proportion of women desire paralysis than desire amputation, and, while men typically seek unilateral amputation, women typically seek bilateral amputation. We propose that these sex-related differences in BIID manifestation may relate to sex differences in cerebral lateralization, or to disruption of representation and/or processing of body-related information in right-hemisphere frontoparietal networks.