Variants of exposure in body dysmorphic disorder and hypochondriasis

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.