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An Open-Label Study of Citalopram in Body Dysmorphic Disorder

J Clin Psychiatry 2003;64(6):715-720

Background: Body dysmorphic disorder (BDD), a preoccupation with an imagined or slight defect in appearance, is a relatively common and impairing disorder. While available data suggest that serotonin reuptake inhibitors are effective for BDD, investigation of this disorder's response to pharmacotherapy is limited, and there are no published reports on the efficacy of the selective serotonin reuptake inhibitor citalopram. In addition, there are no published reports on change in quality of life and multiple domains of psychosocial functioning with pharmacologic treatment for patients with BDD.

Method: Fifteen subjects with DSM-IV BDD or its delusional variant were prospectively treated in a 12-week open-label trial of citalopram. Subjects were assessed at regular intervals with the Yale-Brown Obsessive Compulsive Scale Modified for BDD (BDD-YBOCS; the primary outcome measure), the Clinical Global Impressions scale (CGI), the Brown Assessment of Beliefs Scale, measures of quality of life and multiple domains of psychosocial functioning, and other scales. Data were collected from Dec. 28, 1999, to March 1, 2001.

Results: On the BDD-YBOCS, scores decreased from a mean ± SD of 30.7 ± 4.9 at baseline to 15.3 ± 10.6 at endpoint (p < .001), and 73.3% (N = 11) of subjects were responders. On the CGI, 40.0% of patients (N = 6) were very much improved, and 26.7% (N = 4) were much improved. Psychosocial functioning and mental health-related quality of life also significantly (p < .05) improved. The mean dose of citalopram was 51.3 ± 16.9 mg/day, and the mean time to response was 4.6 ± 2.6 weeks. Citalopram was generally well tolerated.

Conclusion: Citalopram appears safe and effective for BDD. Psychosocial functioning and quality of life also significantly improved with citalopram.