Skip to content
Contents

BDD in Talking Therapies

Reference: 24-25394

Date response sent: 18/12/2024

Details of enquiry

  1. Please identify the Talking Therapies service that you are answering on behalf of.
  2. Please may you inform us whether Body Dysmorphic Disorder (BDD) appears on your drop-down menu as a diagnosis/ problem descriptor on for example
  3. IAPTus or PC-MIS software for measuring outcomes? (If not, what descriptor, do you use?)
  4. If it is not on the drop-down menu, can you identify people with BDD in a different way (for example, the number who have completed the Body Image Questionnaire for BDD)?
  5. Do you use a digital front door like Limbic to screen clients? If yes, which one do you use, and does it directly screen for BDD?
  6. Please inform us whether your staff ask the recommended screening question to help identify people with BDD? (The “Talking Therapies manual for anxiety and depression” recommends a question “Have you worried a lot about your appearance or the way a bodily feature looked and wish you could think about it less?”. ) If you do not use the recommended question, do you routinely screen for BDD with a different question or leave it up to therapists to identify if it appears clinically relevant? (if yes, what is the question)?
  7. If you use a screening question to try to identify people with BDD, at what stage do you ask the question. e.g., (a) first contact/triage, (b) at assessment at step 2 guided self-help (c) at assessment for step 3 (high intensity)?
  8. Please inform us if you use the recommended Anxiety Disorder Specific Measure (ADSM) “The Body Image Questionnaire” (BIQ) in people with BDD to determine outcomes during therapy?  If not, do you use the PHQ9 and GAD7 for BDD or something else?
  9. For people discharged in the year 1st April 2023 – 31st March 2024, please inform us of the total number of people you discharged (all diagnoses, at least one contact) and the total number of people discharged for BDD as the main problem.
  10. For people discharged in the year 1st April 2023 – 31st March 2024, please inform us of the total number of people you took on for therapy (all diagnoses, at least 2 contacts) and the total number of people with BDD that you took on for therapy (at least 2 contacts) that were discharged.
  11. Of those that you took on for therapy, what proportion / numbers of people with BDD received treatment at Step 2 with a PWP? If treatment is with a PWP, what proportion and number is a generic CBT for anxiety/ depression or other approach, and what proportion and number received a specific computer program or workbook for BDD?  Please specify which one you use.
  12. Of those with BDD who received treatment at Step 2 with a PWP, what was the average number of sessions for generic CBT for anxiety/ depression and for a specific computer program or workbook for BDD?
  13. For people discharged from the 1st April 2023 to 31st March 2024 with the last treatment type being step 3, what was the average number of sessions in the episode for those treated with BDD and the average for all other diagnoses in the service?
  14. For people discharged in the year 1st April 2023 – 31st March 2024, please inform us of the number of people with BDD who had 2 Body Image Questionnaires completed prior to discharge (and the number who had the GAD7 instead of the BIQ) at Step 2 and at Step 3 (high intensity)?
  15. For people discharged in the year 1st April 2023 – 31st March 2024, what percentage and number of people with BDD in the treated sample achieve reliable improvement at Step 2 and Step 3? (Note the reliable change on the BIQ is ≥10 – please state if you are using the GAD7 for reliable improvement). How does that compare to the percentage and number who achieve reliable improvement on all the other diagnoses in the service?
  16. For people discharged in the year 1st April 2023 – 31st March 2024, what was the mean and standard deviation and number of clients of the Body Image Questionnaire in those taken on for treatment at Step 2 and at Step 3?
  17. For people discharged in the year 1st April 2023 – 31st March 2024, what was the mean and standard deviation and number of clients with BDD on the Body Image Questionnaire after treatment at Step 2 and at Step 3?
  18. For people discharged in the year 1st April 2023 – 31st March 2024, what proportion and number achieve reliable improvement and recovery after treatment (≤ 40 is no longer a case) with BDD on the Body Image Questionnaire at Step 2 and Step 3?
  19. How many of your CBT therapists have attended a top up workshop or any other training in treating BDD?
  20. Please can you do a survey of your CBT therapists in your service and ask them.

“How much of a priority do you think is training in BDD compared to other problems in your service?”

  1. – Not a priority
  2. – Low priority
  3. – Medium priority
  4. – High priority
  5. – Essential

When you report the results, please provide the number of respondents and the individual scores (e.g. n=6 who scored 1,2,2,3,4,4) so we can calculate a mean across the whole of England.

Response sent

The Tavistock and Portman NHS Foundation Trust is a small specialist mental health Trust, and not a hospital. We do not provide acute services, nor inpatient patient services, and do not have an A&E department, nor a dedicated service dealing with diagnosis and treatment of BDD nor use the Body Image Questionnaire.

We provide outpatient, and mainly psychological services via Talking Therapies for anxiety, trauma, phobias, and we would work with adult patients with BDD problems as part of their overall mental health presentation.

Our Trust would not be the referral pathway for BDD as the presenting condition for adults, as we do not provide any dedicated BDD services for adults to which this information would apply, and your request for information in respect of this, is not applicable to our Trust

The population for which we may receive referrals for BDD are children and young people (CYP) aged under 18 years of age at the point of referral. Any case notes of patients’ secondary conditions triggered by BDD would be recorded as free text notes within the electronic patient records, and are not in an electronically retrievable format, i.e., there is no automated mechanism for the extraction/collation of the required data.

Our staff use a range of recommended screening questions and measures for CYP, including the Body Dysmorphic Disorder Questionnaire (BDDQ), the Appearance Anxiety Inventory (AAI), the Body Image Questionnaire (BIQ) and the Yale-Brown Obsessive Compulsive Scale Adolescents for BDD (YBOCS-A BDD).

If the young person turns 18 years of age whilst being seen within a CYP service, they may continue to be seen whilst supported to discharge and transition to the appropriate adult services outside of our organisation. Such CYP would complete the same child outcome measures described previously to ensure there is a matched pair of outcomes prior to their discharge to monitor their progress.

Further to your request to carry out a survey of the CBT therapists in our service, such staff only work within our CYP service. As such, bearing in mind that we do not offer a BDD service for adults, we asked those CBT therapists working with CYP “How much of a priority do you think is training in BDD compared to other problems in your service?”, who provided the following ratings:

  1. – Not a priority  – 0
  2. – Low priority  – 2
  3. – Medium priority – 3
  4. – High priority – 0
  5. – Essential  – 3

Of the eight staff surveyed, all responded.

 

 

Back to top