Publications by authors named "Georgina Krebs"

Objectives: Should a young person receive psychotherapy or medication for their depression and on what evidence do we base this decision? In this paper, we test the factors across modalities that may influence comparability between medication and psychotherapy trials.

Methods: We included 92 randomised controlled trials (RCTs) of psychotherapy and medication for child and adolescent depression (mean age 4-18 years). Using meta-analyses, we compared (a) participant characteristics and (b) trial characteristics in medication and psychotherapy trials.

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Body dysmorphic disorder (BDD) is an obsessive-compulsive disorder-related psychiatric condition characterized by an intense preoccupation with perceived physical flaws that are not observable by others. BDD affects ~2% of the adult population but is underdiagnosed, partly owing to limited clinician awareness, and undertreated, partly due to limited access to treatment. Research on the aetiology of BDD is scarce but likely involves an interplay between genetic and environmental factors.

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Article Synopsis
  • The study investigates how adverse childhood experiences (ACEs) impact adolescents diagnosed with body dysmorphic disorder (BDD) compared to those with obsessive compulsive disorder (OCD).
  • Results indicate that adolescents with BDD face higher instances of peer victimization (74%) and child maltreatment (44%), with sexual abuse being the most reported type of maltreatment in this group.
  • Despite the prevalence of ACEs among adolescents with BDD, clinical outcomes and treatment effectiveness are similar for those with and without a history of ACEs, emphasizing the need for routine screening for these experiences.
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Body dysmorphic disorder (BDD) is a relatively common and highly impairing mental disorder that is strikingly underdiagnosed and undertreated in Child and Adolescent Mental Health Services (CAMHS). The only clinical guidelines for the management of BDD in youth were published nearly 20 years ago, when empirical knowledge was sparse. Fortunately, there has been a surge in research into BDD over the last 10 years, shedding important insights into the phenomenology, epidemiology, assessment and treatment of the disorder in young people.

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Background: Autism spectrum disorder (ASD) and obsessive compulsive disorder (OCD) are two common and impairing neurodevelopmental conditions with partial symptomatic overlap. The aim of this study is to systematically and meta-analytically examine the following: (i) the prevalence of an OCD diagnosis among young people with ASD, (ii) the prevalence of an ASD diagnosis among young people with OCD, and (iii) the clinical and therapeutic implications of such comorbidity.

Method: A multistep literature search was performed from database inception until 17 November 2023.

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Article Synopsis
  • The study aimed to assess how common body dysmorphic disorder (BDD) is among youth, focusing on prevalence, comorbidity with other mental health issues, and psychosocial impairment.*
  • Findings revealed a prevalence rate of 1.0% for BDD, with higher rates in adolescents (1.9%) compared to children (0.1%), and more frequent in females (1.8%) than males (0.3%).*
  • BDD is linked to significant mental health challenges, with around 70% of affected youths experiencing additional psychiatric disorders, and it highlights the need for better screening and treatment access for young individuals.*
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Greater environmental sensitivity has been associated with increased risk of mental health problems, especially in response to stressors, and lower levels of subjective wellbeing. Conversely, sensitivity also correlates with lower risk of emotional problems in the absence of adversity, and in response to positive environmental influences. Additionally, sensitivity has been found to correlate positively with autistic traits.

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The Appearance Anxiety Inventory (AAI) is a self-report measure assessing the typical cognitions and behaviours of body dysmorphic disorder (BDD). Despite its use in research and clinical settings, its psychometric properties have not been evaluated in young people with BDD. We examined the factor structure, reliability, validity, and sensitivity to change of the AAI in 182 youths with BDD (82.

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Body dysmorphic disorder (BDD) is a prevalent and impairing psychiatric condition that typically debuts in adolescence and is associated with risky behaviours. The disorder can be effectively treated with cognitive behaviour therapy (CBT). However, CBT for BDD is seldom available primarily due to a shortage of trained therapists.

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Introduction: Social media use (SMU) is highly prevalent amongst young people and previous research suggests an association with mental health problems, including poor body image. However, the potential relationship between SMU and body dysmorphic disorder (BDD) has received little attention. Furthermore, little is known about the factors that moderate the potential association between SMU and body dysmorphic symptoms.

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Background: The association between weight and depressive symptoms is well established, but the direction of effects remains unclear. Most studies rely on body mass index (BMI) as the sole weight indicator, with few examining the aetiology of the association between weight indicators and depressive symptoms.

Methods: We analysed data from the Twins Early Development Study (TEDS) and UK Adult Twin Registry (TwinsUK) (7658 and 2775 twin pairs, respectively).

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Background: Emotional symptoms, such as anxiety and depressive symptoms, are common during adolescence, often persist over time, and can precede the emergence of severe anxiety and depressive disorders. Studies suggest that a vicious cycle of reciprocal influences between emotional symptoms and interpersonal difficulties may explain why some adolescents suffer from persisting emotional symptoms. However, the role of different types of interpersonal difficulties, such as social isolation and peer victimisation, in these reciprocal associations is still unclear.

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Diathesis-stress models conceptualise individual differences in propensity for psychopathology as an interaction between environmental risk factors and intra-individual vulnerabilities. In contrast, the differential susceptibility theory and related frameworks view intra-individual differences as variations in sensitivity to the environments rather than merely vulnerability to them. Specifically, they suggest that more sensitive individuals are more affected by the quality of their context, whether positive or negative, than others who are less sensitive.

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Body Dysmorphic Disorder.

Psychiatr Clin North Am

March 2023

This article summarizes current knowledge of body dysmorphic disorder across the life span. An overview of the epidemiology and phenomenology of this condition is provided, as well as clinical perspectives on assessment and treatment. Barriers to accessing treatment are considered, along with recent developments to improve access.

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Background: Despite being considered a measure of environmental risk, reported life events are partly heritable. One mechanism that may contribute to this heritability is genetic influences on sensitivity, relating to how individuals process and interpret internal and external signals. The aim of this study was to explore the genetic and environmental overlap between self-reported life events and measures of sensitivity.

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Background: Anxiety and depressive disorders often co-occur and the order of their emergence may be associated with different clinical outcomes. However, minimal research has been conducted on anxiety-anxiety comorbidity. This study examined factors associated with anxiety comorbidity and anxiety-MDD temporal sequence.

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Article Synopsis
  • A study was conducted to identify new predictors of therapy outcomes for anxiety and depression by analyzing self-reported data from nearly 2,900 participants in the UK over the past decade.
  • The analysis revealed that having a university education and engaging in additional therapeutic activities were linked to better therapy outcomes, while having more episodes of illness and higher personality disorder symptoms were associated with poorer outcomes.
  • The findings suggest that collecting therapy outcome data from large groups via self-reports can be a rapid and cost-effective way to explore factors influencing treatment success and to develop new hypotheses for future research.
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Introduction: Despite remotely-delivered cognitive behavioural therapy (CBT) being an emerging field, the evidence of its efficacy in obsessive-compulsive disorder (OCD) is limited. We aimed to estimate the efficacy of remotely-delivered CBT for OCD, compared to face-to-face CBT and non-CBT control conditions.

Methods: Randomised clinical trials (RCTs) identified through a systematic literature search of PubMed, Ovid/PsychINFO and Web of Science until 21/06/2021.

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Body dysmorphic disorder (BDD) typically originates in adolescence and is associated with considerable adversity. Evidence-based treatments exist but research on clinical outcomes in naturalistic settings is extremely scarce. We evaluated the short- and long-term outcomes of a large cohort of adolescents with BDD receiving specialist multimodal treatment and examined predictors of symptom improvement.

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The Yale-Brown Obsessive-Compulsive Scale Modified for Body Dysmorphic Disorder for Adolescents (BDD-YBOCS-A) is a clinician-rated measure of BDD symptom severity in youth. Despite widespread use in both research and clinical practice, its psychometric properties have not been formally evaluated. The current study examined the factor structure, reliability, validity, and sensitivity to change of the BDD-YBOCS-A in 251 youths with BDD attending two specialist clinics.

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Background: Educational achievement is an independent predictor of many life outcomes and so it is important to understand its causes and correlates. Internalising symptoms, encompassing anxiety and depression symptoms, are one candidate influence.

Methods: Using a prospective and genetically-informative design, the present study investigated the associations between internalising symptoms and educational achievement, controlling for IQ at age 7 years and socioeconomic status, among participants of the Twin and Early Development Study (up to N = 10,791).

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Background: Understanding and improving outcomes for people with anxiety or depression often requires large sample sizes. To increase participation and reduce costs, such research is typically unable to utilise "gold-standard" methods to ascertain diagnoses, instead relying on remote, self-report measures.

Aims: Assess the comparability of remote diagnostic methods for anxiety and depression disorders commonly used in research.

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