Psychedelic Therapy for Body Dysmorphic Disorder
This paper (2022) makes the case for using psychedelic-assisted psychotherapy (PAP) for the treatment of body dysmorphic disorder (BDD). Preliminary evidence suggests the safety, feasibility, and potential efficacy of psychedelic treatments in disorders that share similar psychopathological mechanisms with BDD. A Phase II study is suggested with thoughts on how to proceed with this research.
Authors
- Christopher Letheby
Published
Abstract
In this opinion piece, we propose the investigation of psychedelic-assisted psychotherapy for the treatment of body dysmorphic disorder (BDD). BDD is a psychiatric disorder characterised by appearance-based preoccupations and accompanying compulsions. While safe and effective treatments for BDD exist, non-response and relapse rates remain high. Therefore, there is a need to investigate promising new treatment options for this highly debilitating condition. Preliminary evidence suggests safety, feasibility, and potential efficacy of psychedelic treatments in disorders that share similar psychopathological mechanisms with BDD. Drawing on this evidence, as well as on relevant qualitative reports and theoretical proposals, we argue that it would be worthwhile to conduct a phase 2a study aimed at assessing the safety and feasibility of psychedelic-assisted psychotherapy in BDD. We also offer some suggestions for how future research ought to proceed.
Research Summary of 'Psychedelic Therapy for Body Dysmorphic Disorder'
Introduction
Body dysmorphic disorder (BDD) is described as a chronic, severe psychiatric condition marked by preoccupations with perceived bodily or facial defects and repetitive behaviours such as camouflaging, skin picking, and mirror checking. Johnson and colleagues note rising rates of body image disturbance and increasing prevalence of BDD in adolescents and young adults, alongside persistent problems with treatment non-response, relapse, and under‑recognition. Although cognitive–behavioural therapy tailored to BDD (CBT‑BDD) and pharmacotherapies (SSRIs, TCAs) are first‑line treatments, substantial proportions of patients do not remit, many discontinue therapy, and comorbidity and high medication doses contribute to poor adherence and outcomes. Against this clinical backdrop, the authors propose that psychedelic‑assisted psychotherapy merits formal investigation as a potential treatment for BDD. Drawing on a range of preliminary clinical findings, case reports, survey and qualitative data, and theoretical models about self‑representation and perceptual processing, Johnson argues that there is a sufficient circumstantial case to justify a Phase 2a safety and feasibility study of psilocybin‑assisted therapy in people with BDD. The paper therefore outlines the rationale and offers practical suggestions for how early clinical research in this area might be designed and conducted.
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Johnson, S., & Letheby, C. (2022). Psychedelic Therapy for Body Dysmorphic Disorder. Journal of Psychedelic Studies, 6(1), 23-30. https://doi.org/10.1556/2054.2022.00200
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