April O'Grady

Date of Award


Level of Access Assigned by Author

Open-Access Dissertation

Degree Name

Doctor of Philosophy (PhD)




Jeffrey E. Hecker

Second Committee Member

Geoffrey L. Thorpe

Third Committee Member

Bruce Hale


Body dysmorphic disorder (BDD), a psychological disorder characterized by an intense preoccupation with an imagined physical defect, causes extreme distress and leads to depression, divorce, and suicide. Currently, empiricallysupported treatments include cognitive-behavioral therapy (CBT) and selective serotonin-reuptake inhibitors, however, one important component of treatment literature yet to be investigated is the relative efficacy of cognitive or behavior therapy as a sole treatment. In particular, examinations of change processes throughout the course of treatment are needed. Thus, the identification of necessary treatment components in the CBT package and the isolation of specific change processes could lead to a more streamlined and effective treatment approach. The current study utilized a multiple baseline, treatment crossover design to investigate change processes during either behavior therapy (BT) or cognitive therapy (CT) for BDD. Following a diagnostic assessment including a semistructured interview for BDD, six individuals diagnosed with the disorder were invited to participate, five of whom completed the study. Participants received eight sessions of either BT or CT, followed by the same number of sessions of the remaining treatment. BT involved exposure with response prevention (ERP), and required the completion of ERP exercises both at home and in session. CT sessions followed Beck's (I 967, 1976) approach, and involved the identification and challenging of cognitive distortions. In addition to a battery of self-report questionnaires administered at each phase change and at follow-up, daily recordings of compulsive behaviors, appearance-related self-statements, and global distress were gathered, as well as weekly third party assessments of behavior. Visual analysis of daily recordings demonstrated improvement for three of the five participants, with behavior therapy appearing to be most effective in reducing daily BDD symptoms. In addition, following completion of both cognitive and behavioral treatments, three of the five participants met criteria for clinically significant improvement on self-report measures of BDD symptoms and depression. Finally, investigation into the covariation of BDD-related thoughts and behaviors revealed results for two participants. Discussion focused on implications for behavioral and cognitive theories of symptom maintenance, as well as on interpreting current findings within the body of BDD outcome literature and further clinical implications.