Exploring the Relevance of Perceived Barriers to Treatment in Adults With Body Dysmorphic Disorder Symptoms: Comparing Psychotherapy and Online Interventions

Although individuals facing Body Dysmorphic Disorder (BDD) endure considerable levels of distress, they often do not engage in empirically effective cognitive-behavioral therapy. Identified barriers to seeking treatment include logistical challenges, shame and stigmatization, and pessimistic expectations of mental health interventions associated with a lack of insight into having a psychological issue. This study investigates the relevance of these perceived treatment barriers for face-to-face therapy and for online interventions as a potentially accessible alternative or entry to traditional psychotherapy. Through an online survey involving 321 participants (comprising 239 with elevated BDD symptoms and 82 with self-reported probable BDD), we utilize the Barriers to Treatment Questionnaire to assess different perceived barriers. A comparative analysis is conducted to contrast the perceived relevance of barriers to psychotherapy with those reported for online interventions. As a result, perceived barriers to psychotherapy are most prominent in feelings of shame and fear of stigmatization, followed by logistical challenges and negative treatment expectations, and again followed by format-related concerns. Overall perceived barriers to online interventions are lower, though concerns related to the intervention format, such as data security concerns, become more pronounced. Notably, shame and stigmatization remain central factors in both contexts. When offering psychological help to individuals with BDD, the aspects of shame and negative attitudes toward seeking psychological help should be primarily addressed. Considering all their advantages, online interventions should continue to be utilized for BDD, to improve the treatment situation, but it should be noted that this treatment format is not without challenges.