Neziroglu / Khemlani-Patel Body Dysmorphic Disorder

2022
ISBN: 978-1-61676-500-2
Verlag: Hogrefe Publishing
Format: PDF
Kopierschutz: 1 - PDF Watermark

E-Book, Englisch, 115 Seiten, Format (B × H): 178 mm x 254 mm

Reihe: Advances in Psychotherapy - Evidence-Based Practice

This volume provides a user-friendly, evidence-based guide to the diagnosis, phenomenology, etiology, and treatment of body dysmorphic disorder (BDD). New and seasoned clinicians can learn about the foundations of CBT for BDD as well as the rationale and instructions for modifying the approach to meet the differences in symptoms found in this client group. The book explores techniques for treatment engagement, including adjusting therapeutic style, appropriate utilization of behavioral and cognitive therapy, family involvement, and motivational interviewing techniques. Other issues associated with BDD are also highlighted: poor insight, comorbidity, concerning rates of suicidality, and ambivalence regarding treatment.
The authors outline step-by-step instructions for numerous novel and advanced treatment strategies, including perceptual re-training, attentional training, acceptance and commitment approaches, and ways to manage ongoing desire for cosmetic surgery. Detailed case examples are presented with corresponding treatment guidelines to highlight the variety in clinical presentation and corresponding treatment approaches. Printable tools in the appendices can be used in daily practice.

Zielgruppe

Clinical psychologists, psychiatrists, psychotherapists, and
counselors, as well as students.

Autoren/Hrsg.

Neziroglu, Fugen

Khemlani-Patel, Sony

Fachgebiete

• Sozialwissenschaften Psychologie Psychotherapie / Klinische Psychologie Psychopathologie
• Medizin | Veterinärmedizin Medizin | Public Health | Pharmazie | Zahnmedizin Medizinische Fachgebiete Psychiatrie, Sozialpsychiatrie, Suchttherapie

Inhaltsverzeichnis

1;Body Dysmorphic Disorder;1
1.1;Table of Contents;6
1.2;1 Description;10
1.3;2 Theories and Models;23
1.4;3 Diagnosis and Treatment Indications;33
1.5;4 Treatment;41
1.6;5 Case Vignettes;72
1.7;6 Further Reading;87
1.8;7 References;88
1.9;8 Appendix: Tools and Resources;99

Leseproben

|14|2
Theories and Models

A few theories have been proposed to explain the development and maintenance of body dysmorphic disorder (BDD). Although the biological research is limited, there are some preliminary neurochemical and neuroanatomical theories. This chapter will review established psychological learning theories, with an emphasis on the cognitive behavior model.
2.1  Biological Theories

2.1.1  Neurochemical Theories
Many of the biological models of BDD are derived from treatment responses to the class of medications called selective serotonin reuptake inhibitors (SSRIs), neuroimaging studies, and neuropsychological test findings. Etiology should not be inferred from any of these studies, and functional differences do not necessarily implicate neurological dysfunction as a causal factor. Most of the neurochemical theories of BDD are based on OCD research, because of BDD’s similarity to OCD. In addition, similar to OCD, SSRIs are used to treat BDD, and therefore it is assumed that serotonin is involved in its etiology. However, there are relatively few randomized controlled studies exploring the efficacy of SSRIs. In one study, a serotonin reuptake inhibitor (SRI; clomipramine) was compared with a norepinephrine reuptake inhibitor (NRI; desipramine) and was found to be superior (Hollander et al., 1999). Many anxiety disorders also respond to SRIs better than NRIs, and therefore this difference does not necessarily establish causation. However, there are case examples in the literature that implicate serotonin as a possible etiological factor. These cases suggest that a serotonin receptor agonist or serotonin receptor antagonist can reduce or increase symptoms of BDD. The former involved the use of psilocybin (Hanes, 1996), and the latter chlorophenylpiperazine (m-CPP; Hollander & Wong, 1995) and cyproheptadine (Craven & Rodin, 1987). In another study, 5-hydroxytryptophan, a precursor of serotonin, led to an exacerbation of symptoms (Barr et al., 1992). However, again neither depletion of tryptophan nor use of serotonergic receptor antagonists, both of which increase BDD symptoms, are sufficient to indicate that serotonin is implicated in the etiology of BDD. A wide variety of other psychiatric symptoms also show a response to alterations in serotonin.
|15|2.1.2  Neuroanatomical Theories
The area of the brain known as the extrastriate body area (EBA) is involved in the perception of the body, body parts, and its actions. BDD, a disturbance in body image, thus involves the EBA, which is located at the posterior inferior temporal sulcus/middle temporal gyrus (Downing et al., 2001) and the fusiform body area (FBA) found ventrally in the fusiform gyrus (Peelen & Downing, 2005). Neuroimaging studies should also look into the inferior occipital gyrus, left fusiform gyrus, superior temporal sulcus, hippocampus, amygdala, right inferior frontal gyrus, and orbitofrontal cortex (especially in the right hemisphere), areas involved in emotional reaction to the face (McCurdy-McKinnon & Feusner, 2017; Veale & Neziroglu, 2010).
It has been suggested that the EBA and the FBA can be functionally dissociated, with a more selective activation for local body parts in the EBA relative to more holistic images of the human body in the FBA (Taylor et al., 2007). The EBA and FBA are two brain regions of the extrastriate visual cortex that are highly sensitive to the perception of human bodies and body parts. Functional magnetic resonance imaging (fMRI) demonstrates significant activation in both the EBA and FBA in response to body and body parts stimuli visually presented in different formats such as photos, line drawings, stick figures, and silhouettes, compared with control stimuli such as faces and face parts, tools and tool parts, and landscapes (Downing et al., 2001; Peelen & Downing, 2005; Schwarzlose et al., 2005; Spiridon et al., 2006; Weiner & Grill-Spector, 2010).
Neuroimaging studies have demonstrated that individuals with BDD, as compared with healthy controls, activate left hemisphere hyperactivity in response to normal and low spatial frequency images (Feusner, Townsend, Bystritsky, & Bookheimer, 2007). Controls activate the right hemisphere pattern in general and left hemisphere only when the faces contain high detail. In the studies, individuals with BDD activated left hemisphere hyperactivity regardless of whether the matching photographs of other people’s faces contained high or low detail. In other words, it seems BDD patients were attempting to extract details even when there were none. Several fMRI studies (Feusner et al., 2009) have illustrated lower-than-average activity in the visual cortex regarding low spatial frequency images involving either their own face or the faces of others. Overall, BDD individuals demonstrated imbalances in global versus local or detail visual processing. This abnormality was not only evidenced in faces but also in non-face objects as well. In addition, the amygdala was highly activated for both the low and high spatial frequency images suggesting a heightened emotional response for faces. Activity in the amygdala may lead to emotional arousal (e.g., anxiety), which is positively associated with activity in the ventral visual stream, suggesting that the symptoms of anxiety in BDD might affect activity in ventral visual systems that are responsible for enhanced detailed visual processing. Anxiety might also heighten perceptual distortions in BDD. Alternatively, greater activity in the ventral visual stream might increase anxiety.
In summary, most neuroimaging studies of visual processing have suggested deficiencies in global and configural visual processing. These imbalances in |16|global versus local processing may explain why individuals with BDD detect “flaws.” They are unable to see the flaw within the context of the whole.
2.1.3  Neuropsychological Models
The Rey-Osterrieth Complex Figure is a test of visuospatial construction and memory in which the individual is asked to look at and then draw a complex figure. Individuals with BDD recalled more details of the figure rather than the larger organizational features (Deckersbach et al., 2000; Sidali, 2018). The Inverted Faces Task also looks at holistic versus detailed visual processing (Feusner, Moller, et al., 2010). On this task, individuals are asked to pick the face that is the same as the one they previously saw in an upright or inverted orientation. The latter test is theorized to require detailed rather than holistic visual processing. Again, individuals with BDD exhibit problems with the inverted task when allowed to view it for a long time but not for a short duration (Feusner, Moller, et al., 2010). It may be that, similar to with mirror gazing, when they view something for a long time, they are encoding the details. The Embedded Figures Task also suggested more detailed versus global processing (Kerwin et al., 2014). A global processing defect was also studied looking at the ability to accurately identify emotional expressions in others. Individuals with BDD had significantly more errors in identifying emotional expressions, suggesting abnormalities in visual information processing.
2.2  Psychological Theories

The most prominent psychological theories are evolutionary theory and learning theory. The latter relies on a cognitive model, and some variations of that model have been provided by various researchers (Neziroglu, Roberts, & Yaryura-Tobias, 2004; Veale, 2010; Wilhelm, Phillips, & Steketee, 2013).
2.2.1  Evolutionary Theory
Evolutionary theory is based on the fact that evolution acts to promote reproductive success rather than to enhance the health of the species. Attractiveness may lead to more success in securing a mate, and there is significant literature on sexual attraction as it relates to body symmetry, which has been linked to reproductive health (Hart & Phillips, 2013). Almost 25% of BDD individuals report concerns with symmetry, such as a crooked nose, asymmetrical eyebrows, upper lip too thin in relation to lower lip, etc. Traits that are adaptive in some ways may be pathological when taken to an extreme. Grooming may be adaptive, but excess use of it, as in BDD, may be maladaptive. Body image concerns, ...