Obsessions and compulsions are both common in adults with high-functioning ASD and are associated with significant levels of distress.

Background: The evidence base for the efficacy of cognitive behaviour therapy (CBT) for treating body dysmorphic disorder (BDD) is weak. Aims: To determine whether CBT is more effective than anxiety management (AM) in an outpatient setting. Method: This was a single-blind stratified parallel-group randomised controlled trial. The primary endpoint was at 12 weeks, and the Yale-Brown Obsessive Compulsive Scale for BDD (BDD-YBOCS) was the primary outcome measure. Secondary measures for BDD included the Brown Assessment of Beliefs Scale (BABS), the Appearance Anxiety Inventory (AAI) and the Body Image Quality of Life Inventory (BIQLI). The outcome measures were collected at baseline and week 12. The CBT group, unlike the AM group, had 4 further weekly sessions that were analysed for their added value. Both groups then completed measures at their 1-month follow-up. Forty-six participants with a DSM-IV diagnosis of BDD, including those with delusional BDD, were randomly allocated to either CBT or AM. Results: At 12 weeks, CBT was found to be significantly superior to AM on the BDD-YBOCS [β = -7.19; SE (β) = 2.61; p < 0.01; 95% CI = -12.31 to -2.07; d = 0.99] as well as the secondary outcome measures of the BABS, AAI and BIQLI. Further benefits occurred by week 16 within the CBT group. There were no differences in outcome for those with delusional BDD or depression. Conclusions: CBT is an effective intervention for people with BDD even with delusional beliefs or depression and is more effective than AM over 12 weeks.

Objective: Body dysmorphic disorder (BDD) typically starts in adolescence, but evidence-based treatments are yet to be developed and formally evaluated in this age group. We designed an age-appropriate cognitive-behavioral therapy (CBT) protocol for adolescents with BDD and evaluated its acceptability and efficacy in a pilot randomized controlled trial.Method: Thirty adolescents aged 12-18 (mean=16.0,SD=1.7) with a primary diagnosis of BDD and their families were randomly assigned to 14 sessions of CBT delivered over four months or a control condition of equivalent duration, consisting of written psycho-education materials and weekly telephone monitoring. Blind evaluators assessed participants at baseline, mid-treatment, post-treatment, and at two-month follow-up. The primary outcome measure was the Yale-Brown Obsessive-Compulsive Scale Modified for BDD, adolescent version (mean baseline score=37.13,SD=4.98; range=24-43). Results:The CBT group showed a significantly greater improvement than the control group, both at post-treatment (time×group interaction coefficient [95%CI]=-11.26 [-17.22 to -5.31]; p=0.000) and at two-month follow-up (time×group interaction coefficient [95%CI]=-9.62 [-15.74 to -3.51]; p=0.002).Six (40%) participants in the CBT group and one (6.7%) in the control condition were classified as responders at both time points (χ 2 =4.658,p=.031). Improvements were also seen on secondary measures, including insight, depression, and quality of life at post-treatment. Both patients and their families deemed the treatment as highly acceptable. Conclusion:Developmentally tailored CBT is a promising intervention for young people with BDD, though there is significant room for improvement. Further clinical trials incorporating lessons learned in this pilot and comparing CBT and pharmacological therapies, as well as their combination, are warranted.