Abstract
Currently, hypochondriasis and body dysmorphic disorder (BDD) are classified as somatoform disorders in DSM-IV-TR (APA, 2000). In ICD-10 (WHO, 1993), BDD is subsumed under hypochondrias. Hypochondriasis and BDD have some similarities with respect to symptomatology (fear and avoidance), cognitive and emotional processing (selective attention to abnormalities of the body), and behavioral factors (bodily preoccupation, compulsive checking, reassurance, seeking medical treatment). In turn, due to their similarities within the spectrum of somatoform disorders on the one hand, and their shared features and high comorbidity with anxiety disorders on the other hand, the APA is recommending the removal of at least BDD from the current category of somatoform disorders and placing it in the new category of anxiety and obsessive–compulsive spectrum disorders (Phillips et al., 2010). Although less clear, there is some evidence that a reconceptualization of hypochondriasis as illness anxiety disorder might also be reasonable (see below). Besides these similarities, however, there are also differences with regard to the focus of concern, with hypochondriasis relating to physical health concerns and BDD to concerns about appearance. This chapter describes diagnostic and summarizes empirical evidence for psychological treatment approaches. Finally, an outlook is given on future development of transdiagnostic interventions in the treatment of hypochondriasis and BDD.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Abramowitz, J. S., Olatunji, B. O., & Deacon, B. J. (2007). Health anxiety, hypochondriasis, and the anxiety disorders. Behavior Therapy, 38, 86–94. doi:10.1016/j.beth.2006.05.001.
American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). American Psychiatric Association: Washington.
American Psychiatric Association. (2010). Obsessive-compulsive and related disorders (DRAFT November 8, 2010). Washington: American Psychiatric Association.
American Psychiatric Association. (2011). Somatic symptom disorders (DRAFT April 18, 2011). Washington: American Psychiatric Association.
Azrin, N. H., & Nunn, R. G. (1973). Habit reversal: A method of eliminating nervous habits and tics. Behavior Research and Therapy, 37, 715–740. doi:10.1016/0005-7967(73)90119-8.
Barsky, A. J., Barnett, M. C., & Cleary, P. D. (1994). Hypochondriasis and panic disorder-boundary and overlap. Archives of General Psychiatry, 51, 918–925.
Barsky, A. J., Klerman, G. L., Wyshak, G., & Latham, K. S. (1990). The prevalence of hypochondriasis in medical outpatients. Social Psychiatry and Psychiatric Epidemiology, 14, 89–94.
Bleichhardt, G., & Hiller, W. (2006). Krankheitsangst bei Patienten in ambulanter Verhaltenstherapie: Psychopathologie, medizinische Inanspruchnahme und Mediennutzung [Pathological features, medical consulting behaviour and media consume in outpatients with health anxiety]. Verhaltenstherapie & Verhaltensmedizin, 27, 29–41.
Bögels, S. M. (2006). Task concentration training versus applied relaxation, in combination with cognitive therapy for social phobia patients with fear of blushing, trembling, and sweating. Behavior Research and Therapy, 44, 1199–1210. doi:10.1016/j.brat.2005.08.010.
Bowe, W. P., Leyden, J. J., Crerand, C. E., Sarwer, D. B., & Margolis, D. J. (2007). Body dysmorphic disorder symptoms among patients with acne vulgaris. Journal of the American Academy of Dermatology, 57, 222–230. doi:10.1016/j.jaad.2007.03.030.
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. doi:10.1016/S0022-3956(03)00107-9.
Clark, D. M., Ehlers, A., Hackmann, A., McManus, F., Fennell, M., Grey, N., et al. (2006). Cognitive therapy versus exposure and applied relaxation in social phobia: A randomized control trial. Journal of Consulting and Clinical Psychology, 74, 568–578. doi:10.1037/0022-006X.74.3.568.
Clark, D. M., Salkovskis, P. M., Hackmann, A., Wells, A., Fennel, M., Ludgate, J., et al. (1998). Two psychological treatments for hypochondriasis—a randomized controlled trial. British Journal of Psychiatry, 173, 218–225. doi:10.1192/bjp.173.3.218
Coles, M. E., Phillips, K. A., Menard, W., Pagano, M. E., Fay, C., Weisberg, R. B., et al. (2006). Body dysmorphic disorder and social phobia: Cross-sectional and prospective data. Depression and Anxiety, 23, 26–33. doi:10.1002/da.20132.
Deckersbach, T., Savage, C. R., Phillips, K. A., Wilhelm, S., Buhlmann, U., Rauch, S. L., et al. (2000). Characteristics of memory dysfunction in body dysmorphic disorder. Journal of International Neuropsychological Society, 6, 673–681. doi:10.1017/S1355617700666055.
Escobar, J. I., Gara, M., Waitzkin, H., Silver, R. C., Holman, A., & Compton, W. (1998). DSM-IV hypochondriasis in primary care. General Hospital Psychiatry, 20, 155–159. doi:10.1016/S0163-8343(98)00018-8.
Faravelli, C., Salvatori, S., Galassi, F., Aiazzi, L., Drei, C., & Cabras, P. (1997). Epidemiology of somatoform disorder: A community survey in Florence. Social Psychiatry and Psychiatric Epidemiology, 32, 24–29. doi:10.1007/BF00800664.
Fava, G. A., Fabbri, S., Sirri, L., & Wise, T. N. (2007). Psychological factors affecting medical condition: A new proposal for DSM-V. Psychosomatics, 48, 103–111. doi:10.1176/appi.psy.48.2.103.
Feusner, J., Townsend, J., Bystritsky, A., & Bookheimer, S. (2007). Visual information processing of faces in body dysmorphic disorder. Archives of General Psychiatry, 64, 1417–1426. doi:10.1001/archpsyc.64.12.1417.
Furer, P., & Walker, J. R. (2005). Treatment of hypochondriasis with exposure. Journal of Contemporary Psychotherapy, 35, 251–267. doi:10.1007/s10879-005-4319-y.
Furer, P., Walker, J. R., & Stein, M. B. (2007). Treating health anxiety and fear of death: A practitioner’s guide. New York: Springer.
Gomez-Perez, J. C., Marks, I. M., & Gutierrez-Fisac, J. L. (1994). Dysmorphophobia: Clinical features and outcome with behaviour therapy. European Psychiatry, 9, 229–235.
Gunstad, J., & Phillips, K. A. (2003). Axis I comorbidity in body dysmorphic disorder. Comprehensive Psychiatry, 44, 270–276. doi:10.1016/S0010-440X(03)00088-9.
Gureje, O., Üstün, T. B., & Simon, G. E. (1997). The syndrome of hypochondriasis: A cross-national study in primary care. Psychological Medicine, 27, 1001–1010. doi:10.1017/S0033291797005345.
Harvey, A. G., Clark, D. A., Ehlers, A., & Rapee, R. M. (2000). Social anxiety and self-impression: Cognitive preparation enhances the beneficial effects of video feedback following a stressful task. Behavior Research and Therapy, 38, 1183–1192. doi:10.1016/S0005-7967(99)00148-5.
Hayes, S. C., Strohsal, K., & Wilson, K. G. (1999). Acceptance and commitment therapy: An experimental approach to behavior change. New York: Guilford Press.
Hiller, W., Leibbrand, R., Rief, W., & Fichter, M. M. (2005). Differentiating hypochondriasis from panic disorder. Journal of Anxiety Disorders, 19, 29–49. doi:10.1016/j.janxdis.2003.10.006.
Holmes, E. A., Arntz, A., & Smucker, M. R. (2007). Imagery rescripting in cognitive behaviour therapy: Images, treatment techniques and outcomes. Journal of Behavior Therapy and Experimental Psychiatry, 38, 297–305. doi:10.1016/j.jbtep.2007.10.007.
Khemlani-Patel, S. (2001). Cognitive and behavioral therapy for body dysmorphic disorder: A comparative investigation. PhD Thesis. Hempstead: Hofstra University.
Koran, L., Abujaoude, E., Large, M., & Serpe, R. (2008). The prevalence of Body dysmorphic disorder in the United States adult population. CNS Spectrums, 13, 316–322.
Lieb, R., Zimmermann, P., Friis, R. H., Höfler, M., Tholen, S., & Wittchen, H.-U. (2002). The natural course of DSM-IV somatoform disorders and syndromes among adolescents and young adults: A prospective-longitudinal community study. European Psychiatry, 17, 321–331. doi:10.1016/S0924-9338(02)00686-7.
Looper, K. J., & Kirmayer, L. J. (2001). Hypochondriacal concerns in a community population. Psychological Medicine, 31, 577–584. doi:10.1017/S0033291701003737.
Marcus, D. K., Gurley, J. R., Marchi, M. M., & Bauer, C. (2007). Cognitive and perceptual variables in hypochondriasis and health anxiety: A systematic review. Clinical Psychology Review, 27, 127–139. doi:10.1016/j.cpr.2006.09.003.
Martin, A., & Jacobi, F. (2006). Features of hypochondriasis and illness worry in the general population in Germany. Psychosomatic Medicine, 68, 770–777. doi:10.1097/01.psy.0000238213.04984.b0.
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 Psychology Review, 30, 467–478. doi:10.1016/j.cpr.2010.01.003.
Muse, K., McManus, F., Hackmann, A., Williams, M., & Williams, M. (2010). Intrusive imagery in severe health anxiety: Prevalence, nature and links with memories and maintenance cycles. Behaviour Research and Therapy, 48, 792–798. doi:10.1016/j.brat.2010.05.008.
Neziroglu, F., Khemlani-Patel, S., & Veale, D. (2008). Social learning theory and cognitive behavioral models of body dysmorphic disorder. Body Image, 5, 28–38. doi:10.1016/j.bodyim.2008.01.002.
Neziroglu, F., McKay, D., Todaro, J., & Yaryura-Tobias, J. A. (1996). Effect of cognitive behaviour therapy on persons with body dysmorphic disorder and comorbid axis II diagnosis. Behaviour Therapy, 27, 67–77. doi:10.1016/S0005-7894(96)80036-0.
Noyes, R. (1999). The relationship of hypochondriasis to anxiety disorders. Psychiatry and Primary Care, 21, 8–17. doi:10.1016/S0163-8343(98)00063-2.
Noyes, R., Carney, C. P., Hillis, S. L., Jones, L. E., & Langbehn, D. R. (2005). Prevalence and correlates of illness worry in the general population. Psychosomatics, 46, 529–539. doi:10.1176/appi.psy.46.6.529.
Noyes, R., Kathol, R. G., Fisher, M., Phillips, B., Suelzer, M., & Woodman, C. (1994). Psychiatric comorbidity among patients with hypochondriasis. General Hospital Psychiatry, 15, 78–87. doi:10.1016/0163-8343(94)90049-3.
Olatunji, B. O., Deacon, B. J., & Abramowitz, J. S. (2009). Is hypochondriasis an anxiety disorder? The British Journal of Psychiatry, 194, 481–482. doi:10.1192/bjp.194.6.578.
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. doi:10.1080/09658210444000043.
Phillips, K. A., Coles, M. E., Menard, W., Yen, S., Fay, C., & Weisberg, R. B. (2005). Suicidal ideation and suicide attempts in body dysmorphic disorder. Journal of Clinical Psychiatry, 66, 717–725.
Phillips, K. A., Didie, E. R., & Menard, W. (2007). Clinical features and correlates of major depressive disorder in individuals with body dysmorphic disorder. Journal of Affective Disorders, 97, 129–135. doi:10.1016/j.jad.2006.06.006.
Phillips, K. A., Dufresne, R. G., Jr., Wilkel, C. S., & Vittorio, C. C. (2000). Rate of dysmorphic disorder in dermatology patients. Journal of the American Academy of Dermatology, 42, 235–243.
Phillips, K. A., Grant, J., Siniscalchi, J., & Albertini, R. S. (2001). Surgical and nonpsychiatric treatment of patients with body dysmorphic disorder. Psychosomatics, 42, 504–510. doi:10.1176/appi.psy.42.6.504.
Phillips, K. A., Stein, D. J., Rauch, S. L., Hollander, E., Fallon, B. A., Barsky, A., et al. (2010). Should an obsessive-compulsive spectrum grouping of disorders be included in DSM-V? Depression and Anxiety, 27, 528–555. doi:10.1002/da.20705.
Rief, W., Buhlmann, U., Wilhelm, S., Borkenhagen, A., & Brähler, E. (2006). The prevalence of body dysmorphic disorder: A population-based survey. Psychological Medicine, 36, 877–885. doi:10.1017/S0033291706007264.
Rief, W., & Hiller, W. (1998). Cognitive aspects of hypochondriasis and the somatization syndrome. Journal of Abnormal Psychology, 107, 587–595. doi:10.1037/0021-843X.107.4.587.
Ritter, V., Gieler, U., Brähler, E., & Stangier, U. (in prep.). Prevalence of body dysmorphic disorder in the German population.
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. doi:10.1037/0022-006X.63.2.263.
Salkovskis, P. M. (1989). Somatic problems. In K. Hawton, P. M. Salkovskis, J. Kirk, & D. M. Clark (Eds.), Cognitive behaviour therapy for psychiatric problems: A practical guide (pp. 235–276). New York: Oxford University Press.
Salkovskis, P. M. (1999). Understanding and treating obsessive compulsive disorder. Behaviour Research and Therapy, 19, 571–583.
Salkovskis, P., & Clark, D. M. (1993). Panic disorder and hypochondriasis. Advances in Behaviour Research and Therapy, 15, 23–48. doi:10.1016/0146-6402(93)90002-J.
Salkovskis, P., Warwick, H. M. C., & Deal, A. C. (2003). Cognitive-behavioral treatment for severe and persistent health anxiety (hypochondriasis). Brief Treatment and Crisis Intervention, 3, 353–367.
Sarwer, D. B., & Crerand, C. E. (2008). Body dysmorphic disorder and appearance enhancing medical treatments. Body Image, 5, 50–58. doi:10.1016/j.bodyim.2007.08.003.
Schmidt, A. T. M. (1994). Bottlenecks in the diagnosis of hypochondriasis. Comprehensive Psychiatry, 35, 306–315. doi:10.1016/0010-440X(94)90024-8.
Silver, A., Sanders, D., Morrison, N., & Cowey, C. (2008). Health anxiety. In J. Bennett-Levy, G. Butler, M. Fennell, A. Hackman, M. Mueller, & D. Westbrook (Eds.), Oxford guide to behavioural experiments in cognitive therapy (pp. 81–99). New York: Oxford University Press.
Sørensen, P., Birket-Smith, M., Wattar, U., Buemann, I., & Salkovskis, P. (2011). A randomized clinical trial of cognitive behavioural therapy versus short-term psychodynamic psychotherapy versus no intervention for patients with hypochondriasis. Psychological Medicine, 41, 431–441. doi:10.1016/0010-440X(94)90024-8.
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. doi:10.1037/0021-843X.117.2.435.
Stangier, U., Janich, C., Adam-Schwebe, S., Berger, P., & Wolter, M. (2003). Screening for body dysmorphic disorder in dermatological outpatients. Dermatology & Psychosomatics, 4, 66–71. doi:10.1159/000072194.
Starcevic, V. (2001). Clinical features and diagnosis of hypochondriasis. In V. Starcevic & D. R. Lipsitt (Eds.), Hypochondriasis: Modern perspectives on an ancient malady (pp. 21–60). Oxford: Oxford University Press.
Thomson, A. B., & Page, L. A. (2007). Psychotherapies for hypochondriasis. Cochrane Database of Systematic Reviews, 4, CD006520. doi: 10.1002/14651858.CD006520.pub2.
Van den Heuvel, O. A., Veltman, D. J., Groenewegen, H. J., Witter, M. P., Merkelbach, J., Cath, D. C., et al. (2005). Disorderspecific neuroanatomical correlates of attentional bias in obsessive-compulsive disorders, panic disorder, and hypochondriasis. Archives of General Psychiatry, 62, 922–933. doi:10.1001/archpsyc.62.8.922.
Veale, D. (2004). Advances in a cognitive behavioural model of body dysmorphic disorder. Body Image, 1, 113–125. doi:10.1016/S1740-1445(03)00009-3.
Veale, D., Boocock, A., Gournay, L., Dryden, W., Shah, F., Willson, R., et al. (1996a). Body dysmorphic disorder. A survey of fifty cases. The British Journal of Psychiatry, 169, 196–201. doi:10.1192/bjp.169.2.196.
Veale, D., Gournay, K., Dryden, W., Boocock, A., Shah, F., Willson, R., et al. (1996b). Body dysmorphic disorder: A cognitive behavioural model and pilot randomised controlled trial. Behaviour Research and Therapy, 34, 717–729. doi:10.1192/bjp.169.2.196.
Veale, D., & Neziroglu, F. (2010). Body dysmorphic disorder. A treatment manual. Chichester: Wiley.
Veale, D., & Riley, S. (2001). Mirror, mirror on the wall, who is the ugliest of them all? The psychopathology of mirror gazing in body dysmorphic disorder. Behaviour Research and Therapy, 39, 1381–1393. doi:10.1016/S0005-7967(00)00102-9.
Vulink, N. C., Sigurdsson, V., Kon, M., Bruijnzeel-Koomen, C. A., Westenberg, H. G., & Denys, D. (2006). Body dysmorphic disorder in 3–8% of patients in outpatient dermatology and plastic surgery clinics [English abstract]. Nederlands Tijdschrift voor Geneeskunde, 150, 97–100.
Walker, J. R., & Furer, P. (2008). Interoceptive exposure in the treatment of health anxiety and hypochondriasis. Journal of Cognitive Psychotherapy: An International Quarterly, 22, 366–378. doi:10.1891/0889-8391.22.4.366.
Wattar, U., Sorensen, P., Buemann, I., Birket-Smith, M., Salkovskis, P. M., Albertsen, M., et al. (2005). Outcome of cognitive-behavioural treatment for health anxiety (hypochondriasis) in a routine clinical setting. Behavioural and Cognitive Psychotherapy, 33, 165–175. doi:10.1017/S1352465804002000.
Weck, F., Bleichhardt, G., Witthöft, M., & Hiller, W. (2011). Explicit and implicit anxiety: Differences between patients with hypochondriasis, patients with anxiety disorders, and healthy controls. Cognitive Therapy and Research, 35, 317–325. doi:10.1007/s10608-010-9303-5.
Weck, F., Harms, G., Neng, J. M. B., & Stangier, U. (2011). Hypochondrische Merkmale bei Patienten einer psychotherapeutischen Ambulanz [Hypochondriacal characteristics in psychotherapeutic outpatients. Prevalence and predisposing factors]. Zeitschrift für Klinische Psychologie und Psychotherapie, 40, 124–132. 10.1007/s10608-010-9303-5
Wells, A. (2005). Detached mindfulness in cognitive therapy: A metacognitive analysis and ten techniques. Journal of Rational-Emotive & Cognitive-Behavior Therapy, 23, 337–355. doi:10.1007/s10942-005-0018-6.
Wells, A. (2009). Meta-cognitive therapy for anxiety and depression. New York: Guilford Press.
Wilhelm, S. (2006). Feeling good about the way you look: A program for overcoming body image problems. New York: Guilford Press.
Williams, J., Hadjistavropoulos, T., & Sharpe, D. (2006). A meta-analysis of psychological and pharmacological treatments for body dysmorphic disorder. Behaviour Research and Therapy, 44, 99–111. doi:10.1016/j.brat.2004.12.006.
World Health Organization. (1993). The ICD-10 classification of mental and behavioural disorders: diagnostic criteria for research. Geneva: World Health Organization.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2012 Springer Science+Business Media, LLC
About this chapter
Cite this chapter
Weck, F., Ritter, V., Stangier, U. (2012). Variants of Exposure in Body Dysmorphic Disorder and Hypochondriasis. In: Neudeck, P., Wittchen, HU. (eds) Exposure Therapy. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-3342-2_13
Download citation
DOI: https://doi.org/10.1007/978-1-4614-3342-2_13
Published:
Publisher Name: Springer, New York, NY
Print ISBN: 978-1-4614-3341-5
Online ISBN: 978-1-4614-3342-2
eBook Packages: Behavioral ScienceBehavioral Science and Psychology (R0)