Treating body dysmorphic disorder with medication: evidence, misconceptions, and a suggested approach.
Body dysmorphic disorder (BDD) is a relatively common and often disabling disorder with high morbidity and mortality. Both psychotropic medication and cognitive behavioral therapy (CBT) are considered first-line treatments for BDD, and medication treatment is often essential for more severely ill and suicidal patients. In this practical overview of the pharmacotherapy of BDD, we briefly describe BDD's clinical features, associated morbidity, and how to recognize and diagnose BDD. We describe the importance of forming a therapeutic alliance with the patient, the need for psychoeducation, and other essential groundwork for successful treatment of BDD. We review available pharmacotherapy research, with a focus on serotonin-reuptake inhibitors (SSRIs, or SRIs), which are currently considered the medication of choice for BDD. Many patients have substantial improvement in core BDD symptoms, psychosocial functioning, quality of life, suicidality, and other aspects of BDD when treated with appropriate pharmacotherapy that targets BDD symptoms. We also discuss practical issues such as dosing, length of treatment, and potential side effects associated with the use of SRIs. In addition, we discuss pharmacotherapy approaches that can be tried if SRI treatment alone is not adequately helpful. Finally, some misconceptions about pharmacotherapy, gaps in knowledge about BDD's treatment, and the need for additional research are discussed.
Phillips
Katharine A
KA
Butler Hospital and The Warren Alpert Medical School of Brown University, 345 Blackstone Boulevard, Providence, RI 02906, USA. Katharine_Phillips@Brown.edu
Hollander
Eric
E
D001828:Body Image; D002065:Buspirone / Q000627:therapeutic use; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D004565:Electroconvulsive Therapy; D006801:Humans; D010868:Pimozide / Q000627:therapeutic use; D017366:Serotonin Receptor Agonists / Q000627:therapeutic use; D017367:Selective Serotonin Reuptake Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D013001:Somatoform Disorders / Q000188:drug therapy / Q000523:psychology / Q000628:therapy*; D013406:Suicide, Attempted / Q000523:psychology
D002065:Buspirone; D010868:Pimozide; D017366:Serotonin Receptor Agonists; D017367:Selective Serotonin Reuptake Inhibitors