Hostname: page-component-6bf8c574d5-xtvcr Total loading time: 0 Render date: 2025-02-16T20:58:06.388Z Has data issue: false hasContentIssue false
  • English
  • Français

Pharmacologic Treatment of Body Dysmorphic Disorder: Review of the Evidence and a Recommended Treatment Approach

Published online by Cambridge University Press:  07 November 2014

Katharine A. Phillips
Get access Rights & Permissions [Opens in a new window]

Abstract

Research on effective pharmacotherapy for body dysmorphic disorder (BDD) has rapidly increased in recent years, with emerging data consistently indicating that serotonin reuptake inhibitors (SRIs) are often efficacious for this disorder. Although data are limited, it appears that higher SRI doses and longer treatment trials than those used for many other psychiatric disorders are often needed to treat BDD effectively. Approaches to treatment-resistant BDD have received little investigation, but available data indicate that switching to another SRI and several SRI-augmentation strategies may be helpful. This article reviews the empirical literature on BDD and offers a recommended approach to the pharmacotherapy of this distressing and often disabling disorder.

Type
Feature Article
Information
CNS Spectrums , Volume 7 , Issue 6 , June 2002 , pp. 453 - 463
Copyright
Copyright © Cambridge University Press 2002

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

REFERENCES

1.March, JS, Frances, A, Carpenter, D, et al.The expert consensus guideline series: treatment of obsessive-compulsive disorder. J Clin Psychiatry. 1997;58(suppl 4):1–72.Google Scholar
2.Phillips, KA. The Broken Mirror: Understanding and Treating Body Dysmorphic Disorder. New York, NY: Oxford University Press; 1996.Google Scholar
3.Munro, A, Chmara, J. Monosymptomatic hypochondriacal psychosis: a diagnostic checklist based on 50 cases of the disorder. Can J Psychiatry. 1982;27:374–376.CrossRefGoogle ScholarPubMed
4.Cotterill, JA. Body dysmorphic disorder. Dermatol Clin. 1996;14:457–463.CrossRefGoogle ScholarPubMed
5.DeMarco, LM, Li, LC, Phillips, KA, et al.Perceived stress in body dysmorphic disorder. J Nerv Ment Dis. 1998;186:724–726.CrossRefGoogle ScholarPubMed
6.Phillips, KA, McElroy, SL, Keck, PE Jr, et al.Body dysmorphic disorder: 30 cases of imagined ugliness. Am J Psychiatry. 1993;150:302–308.Google ScholarPubMed
7.Phillips, KA, McElroy, SL, Keck, PE Jr, et al.A comparison of delusional and nondelusional body dysmorphic disorder in 100 cases. Psychopharmacol Bull. 1994;30:179–186.Google ScholarPubMed
8.Phillips, KA. Body dysmorphic disorder. In: Phillips, KA, ed. Somatoform and Factitious Disorders. Washington DC: American Psychiatric Publishing; 2001. Oldham JM, Riba MB, series eds. Review of Psychiatry Series, Vol 20, No. 3.Google Scholar
9.Phillips, KA. Quality of life for patients with body dysmorphic disorder. J Nerv Ment Dis. 2000;188:170–175.CrossRefGoogle ScholarPubMed
10.Bienvenu, OJ, Samuels, JF, Riddle, MA, et al.The relationship of obsessive-compulsive disorder to possible spectrum disorders: results from a family study. Biol Psychiatry. 2000;48:287–293.CrossRefGoogle ScholarPubMed
11.Phillips, KA, Nierenberg, AA, Brendel, G, et al.Prevalence and clinical features of body dysmorphic disorder in atypical major depression. J New Ment Dis. 1996;184:125–129.Google ScholarPubMed
12.Grant, JE, Won Kim, S, Crow, SJ. Prevalence and clinical features of body dysmorphic disorder in adolescent and adult psychiatric inpatients. J Clin Psychiatry. 2001;62:517–522.CrossRefGoogle ScholarPubMed
13.McElroy, SL, Phillips, KA, Keck, PE Jr.Obsessive-compulsive spectrum disorders. J Clin Psychiatry. 1994;55(suppl):33–51.Google Scholar
14.Phillips, KA. Body dysmorphic disorder and depression: theoretical considerations and treatment strategies. Psychiatr Q. 1999;70:313–331.CrossRefGoogle ScholarPubMed
15.Barr, LC, Goodman, WK, Price, LH. Acute exacerbation of body dysmorphic disorder during tryptophan depletion [letter]. Am J Psychiatry. 1992;149:1406–1407.Google ScholarPubMed
16.Craven, JL, Rodin, GM. Cyproheptadine dependence associated with an atypical somatoform disorder. Can J Psychiatry. 1987;32:143–145.CrossRefGoogle ScholarPubMed
17.Deckersbach, T, Savage, CR, Phillips, KA, et al.Characteristics of memory dysfunction in body dysmorphic disorder. J Int Neuropsychol Soc. 2000;6:673–681.CrossRefGoogle ScholarPubMed
18.Ames, FR. The Neurological Basis of Body Image. In: Castle, DJ, Phillips, KA, eds. Disorders of Body Image. Hampshire, England: Wrightson Biomedical; 2002.Google Scholar
19.Phillips, KA, Grant, JD, Siniscalchi, J, et al.Surgical and nonpsychiatric medical treatment of patients with body dysmorphic disorder. Psychosomatics, 2001;42:504–510.CrossRefGoogle ScholarPubMed
20.Phillips, KA, McElroy, SL, Lion, JR. Body dysmorphic disorder in cosmetic surgery patients [letter]. J Plastic Reconst Surgery. 1992;90:333–334.Google Scholar
21.Cotterill, JA. Dermatological non-disease: a common and potentially fatal disturbance of cutaneous body image. Br J Dermatol. 1981;104:611–619.CrossRefGoogle ScholarPubMed
22.Cotterill, JA, Cunliffe, WJ. Suicide in dermatological patients. Br J Dermatol. 1997;137:246–250.CrossRefGoogle ScholarPubMed
23.Phillips, KA, Dwight, MM, McElroy, SL. Efficacy and safety of fluvoxamine in body dysmorphic disorder. J Clin Psychiatry. 1998;59:165–171.CrossRefGoogle ScholarPubMed
24.Sondheimer, A. Clomipramine treatment of delusional disorder, somatic type. J Am Acad Child Adolesc Psychiatry. 1988;27:188–192.CrossRefGoogle ScholarPubMed
25.Hollander, E, Liebowitz, MR, Winchel, R, et al.Treatment of body-dysmorphic disorder with serotonin reuptake blockers. Am J Psychiatry. 1989;146:768–770.Google ScholarPubMed
26.Brady, KT, Austin, L, Lydiard, RB. Body dysmorphic disorder: the relationship to obsessive-compulsive disorder. J Nerv Ment Dis. 1990;178:538–540.Google ScholarPubMed
27.Phillips, KA, Atala, KD, Albertini, RS. Body dysmorphic disorder in adolescents. J Am Acad Child Adolesc Psychiatry. 1995;34:1216–122.CrossRefGoogle ScholarPubMed
28.Albertini, R, Phillips, KA, Guvremont, D. Body dysmorphic disorder in a young child [letter]. J Am Acad Child Adolesc Psychiatry. 1996;35:1425–1426.CrossRefGoogle Scholar
29.El-Khatib, HE, Dickey, TO. Sertraline for body dysmorphic disorder [letter]. J Am Acad Child Adolesc Psychiatry. 1995;34:1404–1405.CrossRefGoogle ScholarPubMed
30.Heimann, SW. SSRI for body dysmorphic disorder [letter]. J Am Acad Child Adolesc Psychiatry. 1997;36:868.CrossRefGoogle ScholarPubMed
31.Pallanti, S, Koran, LM. Intravenous, pulse-loaded clomipramine in body dysmorphic disorder: two case reports. CNS Spectrums. 1996;1:54–57.CrossRefGoogle Scholar
32.Phillips, KA. Pharmacologic treatment of body dysmorphic disorder. Psychopharmacol Bull. 1996;32:597–605.Google ScholarPubMed
33.Hollander, E, Cohen, L, Simeon, D, et al.Fluvoxamine treatment of body dysmorphic disorder [letter]. J Clin Psychopharmacol. 1994;14:75–77.Google ScholarPubMed
34.Phillips, KA, Albertini, RS, Siniscalchi, J, et al.Effectiveness of pharmacotherapy for body dysmorphic disorder: a chart-review study. J Clin Psychiatry. 2001;62:721–727.CrossRefGoogle ScholarPubMed
35.Albertini, RS, Phillips, KA. 33 cases of body dysmorphic disorder in children and adolescents. J Am Acad Child Adolesc Psychiatry. 1999;38:453–459.CrossRefGoogle Scholar
36.Phillips, KA, Hollander, E, Rasmussen, SA, et al.A severity rating scale for body dysmorphic disorder: development, reliability, and validity of a modified version of the Yale-Brown Obsessive-Compulsive Scale. Psychopharmacol Bull. 1997;33:17–22.Google ScholarPubMed
37.Perugi, G, Giannotti, D, Di Vaio, S, et al.Fluvoxamine in the treatment of body dysmorphic disorder (dysmorphophobia). Int Clin Psychopharmacol. 1996;11:247–254.CrossRefGoogle ScholarPubMed
38.Hollander, E, Allen, A, Kwon, J, et al.Clomipramine vs desipramine crossover trial in body dysmorphic disorder: selective efficacy of a serotonin reuptake inhibitor in imagined ugliness. Arch Gen Psychiatry. 1999;56:1033–1039.CrossRefGoogle ScholarPubMed
39.Phillips, KA, Albertini, RS, Rasmussen, SA. A randomized placebo-controlled trial of fluoxetine in body dysmorphic disorder. Arch Gen Psychiatry. 2002;59:381–388.CrossRefGoogle ScholarPubMed
40.Phillips, KA, McElroy, SL, Dwight, MM, Eisen, JL, et al.Delusionality and response to open-label fluvoxamine in body dysmorphic disorder. J Clin Psychiatry. 2001;62:87–91.CrossRefGoogle ScholarPubMed
41.Eisen, JL, Phillips, KA, Baer, L, et al.The Brown Assessment of Beliefs Scale: reliability and validity. Am J Psychiatry. 1998;155:102–108.CrossRefGoogle ScholarPubMed
42.Phillips, KA. Body dysmorphic disorder: the distress of imagined ugliness. Am J Psychiatry. 1991;148:1138–1149.Google ScholarPubMed
43.Grant, JE. Successful treatment of nondelusional body dysmorphic disorder with olanzapine: a case report. J Clin Psychiatry. 2001;62:297–298.CrossRefGoogle ScholarPubMed
44.Carroll, BJ. Response of major depression with psychosis and body dysmorphic disorder to ECT [letter]. Am J Psychiatry. 1994;151:288–289.Google ScholarPubMed
45.Hay, GG. Dysmorphophobia. Br J Psychiatry. 1970;116:399–406.CrossRefGoogle ScholarPubMed
46.Joffe, RT, Schuller, DR. An open study of buspirone augmentation of serotonin reuptake inhibitors in refractory depression. J Clin Psychiatry. 1993;54:269–271.Google ScholarPubMed
47.Jenike, MA, Baer, L, Buttolph, L. Buspirone augmentation of fluoxetine in patients with obsessive-compulsive disorder. J Clin Psychiatry. 1991;52:13–16.Google ScholarPubMed
48.Phillips, KA. An open study of buspirone augmentation of serotonin-reuptake inhibitors in body dysmorphic disorder. Psychopharmacol Bull. 1996;32:175–180.Google ScholarPubMed
49.McDougle, CJ, Goodman, WK, Price, LH, et al.Neuroleptic addition in fluvoxamine-refractory obsessive-compulsive disorder. Am J Psychiatry. 1990;147:652–654.Google ScholarPubMed
50.Phillips, KA. Pharmacologic treatment of body dysmorphic disorder: a review of empirical data and a proposed treatment algorithm. Psychiatr Clin North Am. 2000;7:59–82.Google Scholar
51.Body Dysmorphic Disorder (BDD) and the body image program. Butler Hospital Web site. Available at: http://www.butler.org/bdd. Accessed June 1, 1999.Google Scholar
52.Phillips, KA. Body dysmorphic disorder: diagnostic controversies and treatment challenges. Bull Menninger Clin. 2000;64:18–35.Google ScholarPubMed
53.Phillips, KA, McElroy, SL. Treatment response of depression in patients with body dysmorphic disorder. Abstract presented at: New Clinical Drug Evaluation Unit Program (NCDEU) 38th Annual Meeting Abstracts of Poster Presentations; Boca Raton, Fl: National Institute of Mental Health, June 1998: 146.Google Scholar
54.Wagner, HR, Reches, A, Yablonskaya, E, et al.Clonazepam-induced up-regulation of serotonin-1 and serotonin-2 binding sites in rat frontal cortex. Adv Neurol. 1986;43:645–651.Google Scholar
55.Phillips, KA, Castle, DJ. Body dysmorphic disorder. In: Castle, DJ, Phillips, KA, eds. Disorders of Body Image. Hampshire, England: Wrightson Biomedical; 2002.Google Scholar