Efficacy and safety of cognitive and behavioral interventions in treating body dysmorphic disorder: A systematic review and meta-analysis of randomized controlled trials.

BACKGROUND

Body dysmorphic disorder (BDD) is characterized by excessive preoccupation with perceived flaws, which leads to distress and psychosocial impairment. Researchers have proposed various cognitive and behavioral interventions for treating BDD-for example, cognitive behavioral therapy, mindfulness-based cognitive therapy, cognitive therapy, and cognitive bias modification.

OBJECTIVE

This systematic review and meta-analysis evaluated the efficacy and safety of the aforementioned cognitive and behavioral interventions for BDD.

METHODS

This study adhered to the PRISMA guidelines. PubMed, Embase, and the Cochrane Library were systematically searched for relevant articles published until February 2025. We included randomized control trials comparing patients receiving and those not receiving (control) cognitive and behavioral interventions. The primary outcome was BDD severity, measured using the Yale-Brown Obsessive-Compulsive Scale modified for BDD. The secondary outcomes were depression, anxiety, beliefs, quality of life, remission rate, dropout rate, and adverse events.

RESULTS

This study included 13 trials (691 participants). The interventions lasted 2 to 36 weeks (4-22 sessions). Meta-analysis revealed significant reductions in BDD severity in the cognitive and behavioral interventions group (standardized mean difference [SMD]: 2.09; 95 % confidence interval [CI]: 1.28-2.90; p < 0.0001), with sustained benefits at follow-up (SMD: 2.21; 95 % CI: 0.92-3.51; p = 0.0008). Cognitive and behavioral interventions mitigated depression and anxiety; enhanced beliefs and quality of life; and increased the remission rate (odds ratio: 5.94; 95 % CI:1.92-18.34; p = 0.002). Dropout rates and adverse events were similar between the cognitive and behavioral interventions and control groups.

CONCLUSION

Our findings support the efficacy and safety of cognitive and behavioral interventions in mitigating BDD symptoms and improving psychological measures.