A review of cognitive behavioral and pharmacological treatment of body dysmorphic disorder.
Early case stories say ERP, cognitive therapy, and SSRIs help body dysmorphic disorder, but we still lack controlled trials.
01Research in Context
What this study did
Johnston et al. (1997) read every paper they could find on body dysmorphic disorder. They looked for studies that used exposure plus response prevention, cognitive therapy, or SSRI pills.
Most reports were single-case stories, not big experiments. The team wrote a plain summary of what each case claimed.
What they found
All three tools—ERP, cognitive talk, and SSRIs—looked helpful, but proof was thin. Every study had only one or a few clients and no control group.
The authors said, "Promising, but we need real trials."
How this fits with other research
Zemestani et al. (2022) later ran a real RCT: ERP plus SSRI beat pills alone for adults with OCD. Their controlled numbers back up the early guess F et al. made.
McLennan et al. (2008) stretched ERP even further. One 12-year-old boy with autism and OCD got better with ERP, showing the trick works outside adult BDD.
Lang et al. (2010) scanned 16 small skin-picking studies and hit the same wall: behavioral ideas help, but samples are tiny. The evidence gap F et al. flagged still stands today.
Why it matters
You can treat body-focused repetitive problems with ERP, cognitive coaching, or SSRIs, but track your own data. Use single-case charts and share them. We still need your numbers to turn "promising" into "proven."
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02At a glance
03Original abstract
Body dysmorphic disorder (BDD) first appeared in the diagnostic nomenclature in 1987 with the Diagnostic and Statistical Manual of Mental Disorders, 3rd Edition Revised (DSM-III-R) (APA, 1987). Currently in DSM-IV (APA, 1994), the criterion of impairment in functioning was added to the already existing criteria of preoccupation with an imagined defect in appearance not accounted for by another mental disorder. The body parts most often perceived as defective are the nose, hair, and complexion. Behavioral and pharmacological studies consist primarily of case reports. Systematic desensitization, exposure and response prevention, and cognitive therapy are promising approaches that need further investigation. Pharmacological agents noted to be beneficial are the selective serotonin reuptake inhibitors. Controlled studies in this area are also needed.
Behavior modification, 1997 · doi:10.1177/01454455970213004