Hollander D (1993): Introduction. In: Hollander E, editor. Obsessive-Compulsive Related Disorders . Washington, DC: American Psychiatric Press, 1-16 Hollander E, Neville D, Frenkel M, et al: Body dysmorphic disorder: diagnostic issues and related disorders. Psychosomatics 33: 156-165, 1992 Bienvenu OJ, Samuels JF, Riddle MA , et al. The relationship of obsessive-compulsive disorder to possible spectrum disorders: results from a family study. Biol Psychiatry. 2000 Aug 15;48(4):287-93 Implications: many of same strategies, both for primary treatments and augmentation
Classical Conditioning:Acquisition of BDD CS UCS UCR Body part abuse disgust teasing anxiety acne shame puberty depression
Be aware of the agenda / goals of patient have they been sent by cosmetic surgeon or relative shut them up. Make the diagnosis - don’t say imagined defect- we try to give an alternative explanation for their symptoms with the CBT model. We emphasise the the role of selective attention and impossible ideals If depressed start on SSRI??
Body Dysmorphic Disorder, Hypochondriasis, Hoarding, and other OCD Spectrum Disorders; Comparing and Contrasting Treatments with OCD Fugen Neziroglu Ph.D., ABBP, ABPP Bio-Behavioral Institute Great Neck, NY www.biobehavioralinstitute.com
Information Processing Biases : Looking in the mirror and focusing immediately on the nose. Selective attention to details, rather than the whole.
Neurobiological Defect : Serotonin alteration; orbito-frontal cortex, temporal, occipital and parietal lobe involvement; genetically or ethologically transmitted.
How Do All These Aspects Interrelate? Based on genetically and/or ethologically transmitted need for symmetry or aestheticism, maladaptive beliefs and values are learned which influences information processing and perception.
Phillips KA et al. (2006), Compr Psychiatry 47(2):77-87
Frequency and Percentage of Abuse in BDD and OCD Abuse Type BDD (N=50) OCD (N=50) Any Abuse 19 (38%) 7 (14%) Sexual 11 (22%) 3 (6%) Physical 7 (14%) 4 (8%) Emotional 14 (28%) 1 (2%) Neziroglu F, Khemlani-Patel, S & Yaryura-Tobias. (2006). Body Image 3: 189-193
CBT Working Model Operant Conditioning Biological Predisposition Operant Conditioning Social Learning + CS UCS CR UCR Information Processing Bias Classical/Evaluative Conditioning Body Dysmorphic Disorder Neziroglu et al. (2004), Psychiatr Ann 34(12):915-920
CR is removed through avoidance behaviors (e.g., camouflaging, mirror checking, excessive makeup)
Positive intermittent reinforcement
Maintains avoidance behaviors
Operant Conditioning: Maintenance Of BDD Mood/CR Avoidance Behaviors Negative Reinforcement CBT Working Model (Cont.) Neziroglu et al. (2004), Psychiatr Ann 34(12):915-920
CBT Working Model (Cont.) Operant Conditioning Biological Predisposition Operant Conditioning Social Learning + Body Dysmorphic Disorder Neziroglu et al. (2004), Psychiatr Ann 34(12):915-920 CS UCS CR UCR Information Processing Bias Classical Conditioning