Effectiveness of Pharmacotherapy for Body Dysmorphic Disorder: A Chart-Review Study
J Clin Psychiatry 2001;62(9):721-727
© Copyright 2017 Physicians Postgraduate Press, Inc.
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Background: Research on the
pharmacotherapy of body dysmorphic disorder (BDD) is limited. No
placebo-controlled, continuation, maintenance, or discontinuation
studies have been published. Only one augmentation study has been
Method: In this chart-review study of 90
patients with DSM-IV BDD treated for up to 8 years by the first 2
authors (K.A.P., R.S.A.) in their clinical practice, response to
a variety of medications, including augmentation strategies, was
assessed. The relapse rate with medication discontinuation was
Results: All subjects received a
serotonin reuptake inhibitor (SRI), with 63.2% (55/87) of
adequate SRI trials resulting in improvement in BDD symptoms;
similar response rates were obtained for each type of SRI.
Discontinuation of an effective SRI resulted in relapse in 83.8%
(31/37) of cases. Response rates to selective SRI augmentation
were clomipramine, 44.4% (4/9) of trials; buspirone, 33.3%
(12/36) of trials; lithium, 20.0% (1/5); methylphenidate, 16.7%
(1/6); and antipsychotics, 15.4% (2/13) of trials.
Conclusion: These findings from a
clinical setting suggest that a majority of BDD patients improve
with an SRI and that all SRIs appear effective. Certain SRI
augmentation strategies may be beneficial. The high relapse rate
with SRI discontinuation suggests that long-term treatment is
often necessary. These preliminary findings require confirmation
in placebo-controlled efficacy studies and effectiveness studies.