Exposure and Response Prevention in the Treatment of Body Dysmorphic Disorder: A Case Series

Abstract

This case study series investigates the effect of Exposure and Response Prevention in relation to other components present in behavioral therapy for Body Dysmorphic Disorder (BDD). Treatment components were added one at a time in four consecutive phases: (A₁) Self-Monitoring; (B) Therapist Contact; (C) Exposure and Response Prevention (ERP); and, (A₂) Renewed Self-Monitoring. Client assessment involved (a) a daily self-report diary of BDD symptoms throughout treatment, and (b) periodic completion of standardized self-report measures tapping BDD symptoms and related symptoms of depression and global functioning.  In all, six clients participated in the study. Three clients (Ms. A, Ms. B, and Ms. C) made large or relatively large improvements in their daily self-reported BDD symptoms during the ERP phase. A fourth client (Mr. D) did not make such an improvement during this phase, but made overall progress over the course of treatment. All four of these clients achieved statistically significant improvement over baseline on the standardized BDD measure. One client (Ms. E) dropped out of treatment during the ERP phase, and one (Ms. F) chose not to proceed to the ERP phase after receiving education about it. The results indicate that beneficial effects of treatment occurred during the ERP phase for three of the clients, and thus suggest that this component should, in spite of clients’ almost reflexive, initial skepticism, be considered essential in the behavioral treatment of Body Dysmorphic Disorder. The variety of reactions of the different clients to the treatments is documented and discussed, along with an analysis of the factors that differentiated those clients who found the ERP phase helpful and those who did not.