268 J. ROSEN, J. REITER, AND P. OROSANhave benefitted from more individual attention than allowed ingroup therapy. On the other hand, none of the subjects complainedof this, and actually, there seemed to be advantages ofthe group <strong>for</strong>mat. Our impression was that the patients inspiredeach other to complete homework and invest themselves in therapyat times when they felt like dropping out. Moreover, itseemed therapeutic <strong>for</strong> the subjects to observe other womenconquer the same type of maladaptive beliefs about appearanceand self-worth that they held themselves.The successful outcome is consistent with previous reports ofcognitive behavior therapy <strong>for</strong> BDD (Marks & Mishan, 1988;Neziroglu & Yaryura-Tobias, 1993b). The additional contributionsof this study were that a larger series of patients was studied,subjects received no treatment <strong>for</strong> BDD other than cognitivebehavior therapy, therapy was more effective than a controlcondition of repeated assessment, more subjects with weightand shape complaints were included, and outcome was evaluatedwith standardized measures of body image and BDDsymptoms. The effectiveness of this body image therapy alsois similar to the results we obtained earlier with women whoreported less severely disturbed body image than BDD (Rosenet al., 1989, 1990). Thus, it seems that cognitive behavioralbody image therapy is appropriate <strong>for</strong> persons with different degreesof body image disorder.Although this study was very encouraging, we hope it will bejust a beginning to more systematic controlled treatment trials<strong>for</strong> BDD, a disorder that has been surprisingly neglected. Thereare several limitations and new questions in this project thatcould be addressed in future research. One research design limitationwas the lack of experimental control carried out to afollow-up period. Thus, the longer term effect of treatment versusno treatment remains to be evaluated. The length of ourfollow-up was short and because there was some deteriorationin the improvement after treatment; a much longer follow-up isneeded. The experimental design controlled <strong>for</strong> treatment butnot <strong>for</strong> attention and nonspecific aspects of therapy. Thus, aplacebo control in BDD treatment research might be worthevaluating, although we have found this type of intervention tobe ineffective <strong>for</strong> people with body image problems (Rosen etal., 1989). The encouraging results in this study cannot necessarilybe generalized to male BDD patients. Also the effectivenessof this type of cognitive behavioral body image therapy <strong>for</strong>strictly non-weight or shape complaints is unknown. Althoughwe could find no difference in treatment outcome based on typeof appearance complaint, our sample of non-weight/shapecomplainers was too low to give a definitive answer to this question.Finally, the only other treatment <strong>for</strong> BDD that has beenrecommended is pharmacotherapy, especially the use of serotoninreuptake blockers (Phillips, 1991). Thus, it would be usefulto compare these two modalities in a single study and to evaluatethe use of combined treatment.ReferencesAmerican Psychiatric Association. (1987). Diagnostic and statisticalmanual of mental disorders-revised (3rd ed.). Washington, DC:Author.American Psychiatric Association. (1993). DSM-IVdraft. Washington,DC: Author.Bloch, S., & Glue, P. (1988). Psychotherapy and dysmorphophobia: Acase report. British Journal of Psychiatry, 152, 271-274.Braddock, L. E. (1982). Dysmorphophobia in adolescence: A case report.British Journal of Psychiatry, 140, 199-201.Brown, T. A., Cash, T. F, & Mikulka, P. J. (1990). Attitudinal bodyimageassessment: Factor analysis of the <strong>Body</strong> Self-Relations Questionnaire.Journal of Personality Assessment, 35, 134-144.Butters, J. W., & Cash, T. F. (1987). <strong>Cognitive</strong>-behavioral treatment ofwomen's body-image dissatisfaction. Journal of Consulting and ClinicalPsychology, 55, 889-897.Cash, T. F. (1991). <strong>Body</strong> image therapy: A program <strong>for</strong> self-directedchange [Audiocassette series including client workbook]. New York:Guil<strong>for</strong>d.Cooper, Z., & Fairburn, C. G. (1987). The Eating Disorder Examination:A semi-structured interview <strong>for</strong> the assessment of the specificpsychopathology of eating disorders. International Journal of EatingDisorders, 6, 1-8.Cooper, P. J., Taylor, M. J., Cooper, Z., & Fairburn, C. G. (1987). 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