Impact of sleep disruption on BDD symptoms and treatment response.

Background: Body dysmorphic disorder (BDD) is severe, undertreated, and relatively common. Although gold-standard cognitive behavioral therapy (CBT) for BDD has strong empirical support, a significant number of patients do not respond. More work is needed to understand BDD's etiology and modifiable barriers to treatment response. Given its high prevalence and impact on the development, maintenance, and treatment of related, frequently comorbid disorders, sleep disruption is a compelling, but not-yet studied factor.
Methods: Data were drawn from a randomized controlled trial of guided smartphone app-based CBT for BDD. Included participants were offered 12-weeks of treatment, immediately (n = 40) or after a 12-week waitlist (n = 37). Sleep disruption and BDD symptom severity were assessed at baseline, week-6, and week-12.
Results: Hypotheses and analysis plan were pre-registered. Two-thirds of patients reported significant insomnia symptoms at baseline. Baseline severity of sleep disruption and BDD symptoms were not related (r = 0.02). Pre-treatment sleep disruption did not predict BDD symptom reduction across treatment, nor did early sleep improvements predict greater BDD symptom improvement. Early BDD symptom improvement also did not predict later improvements in sleep.
Limitations: Limitations include the small sample, restricted ranges of BDD symptom severity and treatment response, and few metrics of sleep disruption.
Conclusions: Although insomnia was disproportionately high in this sample and both BDD symptoms and sleep improved in treatment, results suggest sleep and BDD symptoms may function largely independent of one another. More work is encouraged to replicate and better understand findings as well as potential challenges and benefits of addressing sleep in BDD.
Competing Interests: Declaration of competing interest Dr. Bernstein receives salary support from Koa Health. Dr. Bernstein is a presenter for the Massachusetts General Hospital Psychiatry Academy in educational programs supported through independent medical education grants from pharmaceutical companies. Dr. Bernstein has a consulting agreement with Otsuka Pharmaceutical Development & Commercialization, Inc. Mr. Klare has no potential conflicts to disclose. Dr. Weingarden receives salary support from Koa Health and the National Institute of Mental Health (NIMH) (K23MH119372) and is a presenter for the Massachusetts General Hospital Psychiatry Academy in educational programs supported through independent medical education grants from pharmaceutical companies. Dr. Weingarden has a consulting agreement with Hello Therapeutics, Inc. Dr. Greenberg has received salary support from Koa Health and is a presenter for the Massachusetts General Hospital Psychiatry Academy in educational programs supported through independent medical education grants from pharmaceutical companies. She has received speaking honoraria from L'Oreal (for a presentation at a SkinCeuticals cosmetic surgery and dermatology conference) and RBC Consultants for the CeraVe Psychodermatology Advisory Board. Dr. Snorrason has received salary support from Koa Health. Dr. Hoeppner has received salary support from Koa Health. Dr. Vanderkruik receives salary support from the Marriott Foundation and has a consulting agreement with the World Health Organization. Dr. Harrison is Founder/CEO of Koa Health, a digital mental health company that collaborated with Dr. Wilhelm and her team at MGH to build Perspectives. Dr. Harrison also serves on the WHO Roster of Experts for Digital Health, sits on the Board of EMPOWER (a non-profit organization promoting the training of community health workers to provide mental healthcare), and is a member of the Expert Panel for implementing the Wellcome Trust's mental health strategy. Dr. Wilhelm is a presenter for the Massachusetts General Hospital Psychiatry Academy in educational programs supported through independent medical education grants from pharmaceutical companies; she has received royalties from Elsevier Publications, Guilford Publications, New Harbinger Publications, Springer, and Oxford University Press. Dr. Wilhelm has also received speaking honoraria from various academic institutions and foundations, including the International Obsessive Compulsive Disorder Foundation, the Tourette Association of America and the Centers for Disease Control and Prevention. In addition, she received payment from the Association for Behavioral and Cognitive Therapies for her role as Associate Editor for the Behavior Therapy journal, as well as from John Wiley & Sons, Inc. for her role as Associate Editor on the journal Depression & Anxiety. Dr. Wilhelm has also received honoraria from One-Mind for her role in PsyberGuide Scientific Advisory Board. Dr. Wilhelm is also on the Scientific Advisory Board for Koa Health, Inc. and for Noom, Inc. Dr. Wilhelm has received research and salary support from Koa Health, Inc. Additionally, Dr. Wilhelm has a consulting agreement with Noom, Inc.
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