Body dysmorphic disorder in autistic youth: clinical characteristics, treatment outcomes, and clinical adaptations

Body dysmorphic disorder (BDD) is a prevalent and often disabling condition with onset typically occurring during adolescence. To date, little is known about the presentation or treatment of BDD in autistic youth. Using data from two specialist clinics, the current study compared the clinical characteristics and treatment outcomes of autistic (n = 62) and non-autistic (n = 240) youth with BDD. The groups showed broadly similar clinical presentations, with several notable differences. Autistic youth reported fewer areas of appearance concern and were less likely to engage in appearance-based social comparison, but had greater clinician-rated BDD symptom severity, poorer global functioning, and higher levels of school absenteeism. They were also more likely to be prescribed psychotropic medication, including selective serotonin reuptake inhibitors and attention-deficit/hyperactivity disorder (ADHD) medication, despite comparable rates of diagnosed mood and anxiety disorders and ADHD across groups. Outcomes following specialist multimodal treatment - including both cognitive behaviour therapy (CBT) and psychotropic medication, when deemed appropriate - were comparable, with both groups showing significant improvements in BDD, depressive symptoms, and BDD-related psychosocial impairment. Qualitative accounts from therapists highlighted a range of modifications made to optimise CBT for autistic young people with BDD. These findings illustrate the significant level of clinical need among young people with BDD and co-occurring autism but also highlight that tailored evidence-based interventions can be effective for this group.