Krebs, Georgina;
Rifkin-Zybutz, Raphael;
Clark, Bruce;
Jassi, Amita;
(2023)
Access to evidence-based treatments for young people with body dysmorphic disorder.
Archives of Disease in Childhood
10.1136/archdischild-2023-325444.
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Abstract
INTRODUCTION: Body dysmorphic disorder (BDD) typically emerges during adolescence, affects approximately 2% of the general population and is highly impairing. Despite its prevalence and impact, awareness of BDD remains poor and the condition often goes undiagnosed and untreated.1 Cognitive–behavioural therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs) are effective treatments for BDD and recommended as the first-line interventions.2 However, little is known about the accessibility of these treatments within the UK or among young people specifically. We conducted a case note review to examine the treatment histories of young people referred to a tertiary care outpatient clinic for BDD and obsessive-compulsive disorder (OCD) in the UK. We hypothesised that: (a) contrary to the National Institute for Health and Care Excellence guidelines2, a substantial proportion of those with BDD would not have accessed first-line treatment prior to referral to the specialist clinic; (b) fewer patients with BDD would have accessed first-line treatments compared with patients with OCD, despite similar prevalence and morbidity of the two conditions. METHODS: We reviewed consecutive referrals to the National and Specialist OCD, BDD and Related Disorders Clinic at the Maudsley Hospital, received between January 2015 and May 2022, with a primary diagnosis of BDD (n=83) or OCD (n=413). All data were collected as part of routine assessment, which included systematic recording of whether patients had ever previously received CBT for their primary diagnosis, an SSRI medication or any other psychological treatment. Statistical comparisons of the BDD versus OCD group were made using t-tests for continuous data and χ2 test for categorical data. RESULTS: As shown in table 1, the BDD group reported a significantly later onset, were older at assessment and had a greater female preponderance than the OCD group. The two groups had substantial, but comparable, levels of global functioning, as indicated by scores on the Children’s Global Assessment Scale. The majority of both the BDD and OCD groups had received SSRIs prior to referral. However, fewer than half of the BDD group had received CBT for BDD prior to referral, whereas three-quarters of the OCD group had received CBT for OCD, representing a significant group difference. Conversely, a significantly larger proportion of the BDD group had received other forms of therapy, relative to the OCD group. The most common ‘other therapy’ received by the BDD group was counselling or CBT for another condition (see table 2).
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