Delusionality and response to open-label fluvoxamine in body dysmorphic disorder

Background: Available data suggest that the delusional variant of body dysm orphic disorder (BDD), a type of delusional disorder, may respond to seroto nin reuptake inhibitors (SRIs) and that delusionality (lack of insight) in BDD may improve with SRI treatment. However, this research has been hampere d by the lack of a reliable and valid scale to assess delusionality. Method: Thirty subjects (21 women, 9 men; mean age = 33.3 +/- 9.0 years) wi th DSM-IV BDD were prospectively treated with open-label fluvoxamine for 16 weeks. Subjects were assessed at regular intervals with the Brown Assessme nt of Beliefs Scale (BABS), the Yale-Brown Obsessive Compulsive Scale Modif ied for BDD (BDD-YBOCS; a measure of BDD severity), and other instruments. The BABS is a reliable and valid 7-item, semistructured, clinician-administ ered scale that assesses current delusionality. Results: In this prospective, open-label study, 63% of BDD subjects respond ed to fluvoxamine. Delusional and nondelusional subjects had similar improv ement in BDD symptoms. In addition, insight significantly improved in both delusional and nondelusional subjects. Baseline BABS scores did not contrib ute significantly to endpoint BDD-YBOCS scores in a regression analysis. Conclusion: Degree of delusionality did not predict fluvoxamine response, a nd delusionality significantly improved. These findings are preliminary and require confirmation in controlled trials. The implications of these findi ngs for other types of delusions requires investigation.