Skip to main content
Search
Search
    Quick Search anywhere
    Quick search in Citations
Advanced Search
Skip main navigationClose Drawer MenuOpen Drawer Menu
Previous article
Next article
Originalia

Kognitive Therapie bei körperdysmorpher Störung

Published Online:September 06, 2013https://doi.org/10.1026/1616-3443/a000214

Abstract

In den letzten Jahren ist die Erkenntnis gewachsen, dass die Körperdysmorphe Störung (KDS) viele Gemeinsamkeiten hinsichtlich klinischer Charakteristika und aufrechterhaltender Prozesse mit Zwangsstörungen (z. B. ritualisierte Kontrollhandlungen, wiederkehrende persistierende Gedanken) und sozialer Angststörung (z. B. exzessive Selbstaufmerksamkeit, mentale Vorstellungsbilder) aufweist. Neuere Behandlungsansätze bei KDS fokussieren insbesondere auf die Veränderung der gemeinsamen aufrechterhaltenden Prozesse. Diese Ansätze verbinden klassische kognitiv-behaviorale Techniken (Exposition mit Reaktionsverhinderung und kognitive Umstrukturierung) mit Interventionen aus der Kognitiven Therapie (Aufmerksamkeitstraining, Imagery Rescripting, Videofeedback, Verhaltensexperimente). Im vorliegenden Artikel werden die unterschiedlichen Behandlungsbausteine vorgestellt und die Vorgehensweise detailliert beschrieben. Die Interventionen aus der Kognitiven Therapie haben sich aus klinischer Erfahrung bei der Behandlung als hilfreich erwiesen, wurden bislang jedoch noch nicht für die KDS evaluiert.


Cognitive therapy in body dysmorphic disorder

It is now increasingly recognized that body dysmorphic disorder (BDD) shares many clinical features and maintaining processes with obsessive-compulsive disorders (e. g., ritualistic compulsive behaviors, recurrent persistent thoughts) and social anxiety disorder (e. g., excessive self-focused attention, mental imagery). More recent treatment approaches of BDD focus on the modification of the common maintaining processes. These approaches combine traditional cognitive-behavioral techniques (exposure with response prevention and cognitive restructuring) with cognitive therapy interventions (attentional training, imagery rescripting, videofeedback, behavioral experiments). In the present article, these treatment components are described in detail. The interventions of cognitive therapy have proven to be efficient in clinical practice, but are not yet empirically evaluated for BDD.

Literatur

  • Arntz, A. & Weertman, A. (1999). Treatment of childhood memories: Theory and practice. Behavior Research and Therapy, 37, 715 – 740. First citation in articleCrossref, Google Scholar

  • Azrin, N. H. & Nunn, R. G. (1973). Habit reversal: A method of eliminating nervous habits and tics. Behavior Research and Therapy, 11, 619 – 628. First citation in articleCrossref, Google Scholar

  • Buhlmann, U. (2011). Treatment barriers for individuals with body dysmorphic disorder: An internet survey. Journal of Nervous and Mental Disease, 199, 268 – 271. First citation in articleCrossref, Google Scholar

  • Buhlmann, U. , McNally, R. J. , Etcoff, N. L. , Tuschen-Caffier, B. & Wilhelm, S. (2004). Emotion recognition deficits in body dysmorphic disorder. Journal of Psychiatric Research, 38, 201 – 206. First citation in articleCrossref, Google Scholar

  • Buhlmann, U. , Wilhelm, S. , Glaesmer, H. , Mewes, R. , Brähler, E. & Rief, W. (2011). Perveived appearance-related teasing in body dysmorphic disorder: A population-based survey. International Journal of Cognitive Therapy, 4, 342 – 348. First citation in articleCrossref, Google Scholar

  • Clark, D. M. , Ehlers, A. , Hackmann, A. , McManus, F. , Fennell, M. , Grey, N. , Waddington, L. & Wild, J. (2006). Cognitive therapy versus exposure and applied relaxation in social phobia: A randomized control trial. Journal of Consulting and Clinical Psychology, 74, 568 – 578. First citation in articleCrossref, Google Scholar

  • Deckersbach, T. , Savage, C. R. , Phillips, K. A. , Wilhelm, S. , Buhlmann, U. , Rauch, S. L. , Baer, L. & Jenike, M. A. (2000). Characteristics of memory dysfunction in body dysmorphic disorder. Journal of International Neuropsychological Society, 6, 673 – 681. First citation in articleCrossref, Google Scholar

  • Fang, A. & Hofmann, S. G. (2010). Relationship between social anxiety disorder and body dysmorphic disorder. Clinical Psychology Review, 30, 1040 – 1048. First citation in articleCrossref, Google Scholar

  • Feusner, J. D. , Neziroglu, F. , Wilhelm, S. , Mancusi, L. & Bohon, C. (2010). What causes BDD: Research findings and a proposed model. Psychiatric Annals, 40, 349 – 355. First citation in articleCrossref, Google Scholar

  • Feusner, J. D. , Townsend, J. , Bystritsky, A. & Bookheimer, S. (2007). Visual information processing of faces in body dysmorphic disorder. Archives of General Psychiatry, 64 (12),1417 – 1426. First citation in articleGoogle Scholar

  • Grocholewski, A. , Kliem, S. & Heinrichs, N. (2012). Selective attention to imagined facial ugliness is specific to body dysmorphic disorder. Body Image, 9, 261 – 269. First citation in articleGoogle Scholar

  • Gunstad, J. & Phillips, K. A. (2003). Axis I comorbidity in body dysmorphic disorder. Comprehensive Psychiatry, 44, 270 – 276. First citation in articleCrossref, Google Scholar

  • Harvey, A. G. , Clark, D. M. , Ehlers, A. & Rapee, R. M. (2000). Social anxiety and self-impression. Cognitive Therapy, 38, 1138 – 1192. First citation in articleGoogle Scholar

  • Hautzinger, M. (2010). Akute Depression (Fortschritte der Psychotherapie). Göttingen: Hogrefe. First citation in articleGoogle Scholar

  • Hayes, S. C. , Strohsal, K. & Wilson, K. G. (2004). Acceptance and Commitment Therapy: An Experimental Approach to Behavior Change. New York: Guilford Press. First citation in articleGoogle Scholar

  • Hackmann, A. , Clark, D. M. & McManus, F. (2000). Recurrent images and early memories in social phobia. Behaviour Research and Therapy, 38, 601 – 610. First citation in articleCrossref, Google Scholar

  • Kollei, I. , Brunhoeber, S. , Rauh, E. , de Zwaan, M. & Martin, A. (2012). Body image, emotions and thought control strategies in body dysmorphic disorder compared to eating disorders and healthy controls. Journal of Psychosomatic Research, 72, 321 – 327. First citation in articleCrossref, Google Scholar

  • Marques, L. , Weingarden, H. M. , LeBlanc, N. J. & Wilhelm, S. (2011). Treatment utilization and barriers to treatment engagement among people with body dysmorphic symptoms. Journal of Psychosomatic Research, 70, 286 – 293. First citation in articleCrossref, Google Scholar

  • McKay, D. , Todaro, J. , Neziroglu, F. , Campisi, T. , Moritz, E. K. & Yaryura-Tobias, J. A. (1997). Body dysmorphic disorder: A preliminary evaluation of treatment and maintenance using exposure with response prevention. Behaviour Research and Therapy, 35, 67 – 70. First citation in articleCrossref, Google Scholar

  • McMillan, D. & Lee, R. (2010). A systematic review of behavioral experiments vs. exposure alone in the treatment of anxiety disorders: A case of exposure while wearing the emperor’s new clothes? Clinical Psychological Review, 30, 467 – 478. First citation in articleCrossref, Google Scholar

  • Miller, W. R. & Rollnick, S. (2004). Motivierende Gesprächsführung. Freiburg: Lambertus. First citation in articleGoogle Scholar

  • Neziroglu, F. , Khemlani-Patel, S. & Veale, D. (2008). Social learning theory and cognitive behavioral models of body dysmorphic disorder. Body Image, 5, 28 – 38. First citation in articleCrossref, Google Scholar

  • Neziroglu, F. & Yaryura-Tobias, J. A. (1993). Body dysmorphic disorder: Phenomenology and case descriptions. Behavioral Psychotherapy, 21, 27 – 36. First citation in articleCrossref, Google Scholar

  • Osman, S. , Cooper, M. , Hackmann, A. & Veale, D. (2004). Spontaneously occurring images and early memories in people with body dysmorphic disorder. Memory, 12, 428 – 436. First citation in articleCrossref, Google Scholar

  • Phillips, K. A. (2005). The Broken Mirror. Understanding and Treating Body Dysmorphic Disorder. New York: Oxford University Press. First citation in articleGoogle Scholar

  • Phillips, K. A. (2000). Body dysmorphic disorder: Diagnostic controversies and treatment challenges. Bulletin of the Menninger Clinic, 64, 18 – 35. First citation in articleGoogle Scholar

  • Phillips, K. A. , Dufresne, R. G. , Wilkel, C. S. & Vittorio, C. C. (2000). Rate of dysmorphic disorder in dermatology patients. Journal of the American Academy of Dermatology, 42, 436 – 441. First citation in articleCrossref, Google Scholar

  • Rosen, J. C. , Reiter, J. , Orosan, P. (1995). Cognitive behavioral body image therapy for body dysmorphic disorder. Journal of Consulting and Clinical Psychology, 63, 263 – 269. First citation in articleCrossref, Google Scholar

  • Sarwer, D. B. & Crerand, C. E. (2008). Body dysmorphic disorder and appearance enhancing medical treatments. Body Image, 5, 50 – 58. First citation in articleCrossref, Google Scholar

  • Smucker, M. R. & Dancu, C. V. (1999). Cognitive Behavioral Treatment for Adult Survivors of Childhood Trauma: Rescripting and Reprocessing. Northvale, NJ: Jason Aronson. First citation in articleGoogle Scholar

  • Spurr, J. M. & Stopa, L. (2002). Self-focused attention in social phobia and social anxiety. Clinical Psychology Review, 22, 947 – 975. First citation in articleCrossref, Google Scholar

  • Stangier, U. (2002). Hautkrankheiten und Körperdysmorphe Störung. Fortschritte der Psychotherapie. Göttingen: Hogrefe. First citation in articleGoogle Scholar

  • Stangier, U. , Adam-Schwebe, S. , Müller, T. & Wolter, M. (2008). Discrimination of facial appearance related stimuli in body dysmorphic disorder. Journal of Abnormal Psychology, 117, 435 – 443. First citation in articleCrossref, Google Scholar

  • Stangier, U. , Clark, D. M. & Ehlers, A. (2006). Soziale Phobie. Fortschritte der Psychotherapie. Göttingen: Hogrefe. First citation in articleGoogle Scholar

  • Stangier, U. & Gieler, U. (1997). Somatoforme Störungen in der Dermatologie. Psychotherapie in Psychiatrie, Psychotherapeutischer Medizin und Klinischer Psychologie, 2, 91 – 101. First citation in articleGoogle Scholar

  • Teismann, T. & Ertle, A. (2011). Verhaltensexperimente in der kognitiven Therapie. Verhaltenstherapie, 21, 117 – 124. First citation in articleCrossref, Google Scholar

  • Teismann, T. , Hanning, S. , von Brachel, R. & Willutzki, U. (2012). Kognitive Verhaltenstherapie depressiven Grübelns. Berlin: Springer. First citation in articleGoogle Scholar

  • Twohig, M. P. , Hayes, S. C. & Masuda, A. (2006b). A preliminary investigation of acceptance and commitment therapy as a treatment for chronic skin picking. Behaviour Research and Therapy, 44 (10), 1513 – 1522. First citation in articleGoogle Scholar

  • Teng, E. J. , Woods, D. W. & Twohig, M. P. (2006a). Treatment of skin picking and its psychological correlates: A comparison of Habit Reversal to wait-list. Behavior Modification, 30, 411 – 422. First citation in articleCrossref, Google Scholar

  • Veale, D. (2004). Advances in a cognitive behavioural model of body dysmorphic disorder. Body Image, 1, 113 – 125. First citation in articleCrossref, Google Scholar

  • Veale, D. , Gournay, K. , Dryden, W. , Boocock, A. , Shah, F. , Wilson, R. & Walburn, J. (1996). Body dysmorphic disorder: A cognitive behavioral model and pilot randomised controlled trial. Behavior Research and Therapy, 34, 717 – 729. First citation in articleCrossref, Google Scholar

  • Veale, D. & Neziroglu, F. (2010). Body dysmorphic disorder. A treatment manual. Chichester: Wiley. First citation in articleGoogle Scholar

  • Vocks, S. & Legenbauer, T. (2010). Körperbildtherapie bei Anorexia und Bulimia nervosa. Ein kognitiv-verhaltenstherapeutisches Behandlungsprogramm. Göttingen: Hogrefe. First citation in articleGoogle Scholar

  • Wells, A. (2009). Meta-Cognitive Therapy for Anxiety and Depression. New York: Guilford Press. First citation in articleGoogle Scholar

  • Wells, A. (2005). Detached mindfulness in cognitive therapy: A metacognitive analysis and ten techniques. Journal of Rational-Emotive and Cognitive-Behavior Therapy, 23, 337 – 355. First citation in articleCrossref, Google Scholar

  • Wild, J. & Clark, D. M. (2011). Imagery rescripting of early traumatic memories in social phobia. Cognitive and Behavioral Practice, 18, 433 – 443. First citation in articleCrossref, Google Scholar

  • Wilhelm, S. , Phillips, K. A. , Fama, J. M. , Greenberg, J. L. & Steketee, G. (2011). Modular cognitive-behavioral therapy for body dysmorphic disorder. Behavior Therapy, 42, 624 – 633. First citation in articleCrossref, Google Scholar

  • Wilhelm, S. , Phillips, K. A. & Steketee, G. (2013). Cognitive-Behavioral Therapy in Body Dysmorphic Disorder. A Treatment Manual. New York: Guilford Press. First citation in articleGoogle Scholar

  • Williams, J. , Hadjistavropoulos, T. , Sharpe, D. (2006). A meta-analysis of psychological and pharmacological treatments for body dysmorphic disorder. Behavior Research and Therapy, 44, 99 – 111. First citation in articleCrossref, Google Scholar

  • Windheim, K. , Veale, D. & Anson, M. (2011). Mirror gazing in body dysmorphic disorder and healthy controls: effects of duration of gazing. Behavior Research and Therapy, 49, 555 – 564. First citation in articleCrossref, Google Scholar