Clomipramine vs desipramine crossover trial in body dysmorphic disorder - Selective efficacy of a serotonin reuptake inhibitor in imagined ugliness

Background: Body dysmorphic disorder (preoccupation with an imagined or sli ght defect in appearance) is a common and disabling disorder associated wit h high rates of delusional symptoms and suicide attempts. Although prelimin ary studies suggest that serotonin reuptake inhibitors may be effective for body dysmorphic disorder, to date no controlled treatment studies have bee n published. Methods: Forty patients were enrolled and 29 were randomized into a 16-week , double-blind, crossover-design study of clomipramine, a potent serotonin reuptake inhibitor, and active control desipramine, a selective norepinephr ine reuptake inhibitor. Outcome measures included specific ratings of body dysmorphic disorder se verity, delusionality, and functional impairment. Results: Clomipramine was superior to desipramine in the acute treatment of body dysmorphic disorder symptoms as measured by assessment of patients' o bsessive preoccupation with perceived body defects, repetitive behaviors in response to this preoccupation, and global ratings of symptom severity. Tr eatment efficacy was independent of the presence or severity of comorbid di agnoses of obsessive-compulsive disorder, depression, or social phobia. Lik ewise, clomipramine was equally effective regardless of whether the patient s had insight or held their dysmorphic misperception with delusional intens ity. Clomipramine was also superior to desipramine in improving functional disability. Conclusions: Clomipramine is more effective than desipramine in the treatme nt of body dysmorphic disorder and is effective even among those patients w ho are delusional.