A meta-analysis and systematic review examining efficacy, acceptability and patient retention in psychotherapy studies for the treatment of body dysmorphic disorder

Body Dysmorphic Disorder (BDD) is a distressing mental-health condition, associated with significant impacts to quality of life. As such, treatments for BDD require research attention. In this manuscript we systematically review the present psychotherapeutic treatment literature for BDD with a focus on efficacy and retention. We examine 40 studies, including 27 treatment studies and 13 additional studies that included observational and long-term data, or examined predictors of treatment response. Using meta-analysis, our results suggest that current psychotherapies for BDD achieve reasonable response rates (pooled response rate = 71.9 %), though estimates are more conservative among RCTs (pooled response rate = 69 %) and the available long-term data highlights the strong possibility of relapse following treatment. Our narrative synthesis explores the relationship between treatment and sample characteristics, efficacy and retention, revealing several important considerations when selecting appropriate treatments for BDD, including the incidence of comorbidities, a patient's willingness to engage in exposure response prevention and group-based treatment components, patient age group and the treatment's capacity to retain patients for the treatment course. Based on these findings we provide recommendations aimed at maximising therapist time to achieve efficacy and patient retention, in the context of global pressures on mental health systems.