The aim of this study is to describe the case of a client named Alex who had Body Dysmorphic Disorder by Proxy. He has preoccupation that his wife, Andrea, has a fat buttocks and he insisted that his wife wear clothes that will hide his flat buttocks and for them to avoid public places where people will notice Andrea’s flat buttocks. Alex was treated using Pharmacotherapy and Cognitive Behavioral Therapy (CBT). Body Dysmorphic Disorder by Proxy according to DSM 5 is preoccupation with one or more deficits or flaws in physical appearance in another person that are not observable or appear slight to others which at some point during the course of the disorder, the other person has performed repetitive behaviors or mental acts in response to appearance concerns and the preoccupation causes clinically significant distress or impairment in interpersonal and other areas of functioning.
Severity of the symptoms was assessed using Yale-Brown Obsessive Compulsive Scale (BDD-YBOCS) and Symptoms Checklist. Through the calculation of Reliable Change Indices (RCI), the data revealed that CBT significantly reduced BDD by proxy symptomatology in anxiety, obsession, and depression (RCI = 10.6). On the other hand, Alex was given SSRI (Citalopram; 20mg daily). This case description was the first study to suggest the potentiality of CBT for BDD by proxy.
I think giving pharmacotherapy such as SSRI is in question because according to the article, the client, Alex, is not manifesting depression, in fact, he still perform occupational duties and he executes well his daily life activities. As a result, he decided to terminate the SSRI (Citalopram) because he believed that he can manage to reach his goal in the Cognitive Behavioral Therapy (CBT) without the support of medication. I believe CBT works with BDD by proxy by exposing the couples to public places and to reassure Alex that people barely notice Andrea’s flat buttocks, also, giving homework that the couple must do together such as seeking activities together like playing sports. In that way, the negative thoughts will be restructured, the warm feelings of the couple towards each other may ignite and the compulsive acts of Alex may be modified.
Jennifer Francia P. Villanueva, RPm