Effectiveness of pharmacotherapy for body dysmorphic disorder: A chart-review study

Background: Research on the pharmacotherapy of body dysmorphic disorder (BD D) is limited. No placebo-controlled, continuation, maintenance, or discont inuation studies have been published. Only one augmentation study has been published. Method: In this chart-review study of 90 patients with DSM-IV BDD treated f or up to 8 years by the first 2 authors (K.A.P., R.S.A.) in their clinical practice, response to a variety of medications, including augmentation stra tegies, was assessed. The relapse rate with medication discontinuation was also determined. Results: All subjects received a serotonin reuptake inhibitor (SRI), with 6 3.2% (55/87) of adequate SRI trials resulting in improvement in BDD symptom s; similar response rates were obtained for each type of SRI. Discontinuati on of an effective SRI resulted in relapse in 83.8% (31/37) of cases. Respo nse rates to selective SRI augmentation were clomipramine, 44.4% (4/9) of t rials; buspirone, 33.3% (12/36) of trials; lithium, 20.0% (1/5); methylphen idate, 16.7% (1/6); and antipsychotics, 15.4% (2/13) of trials. Conclusion: These findings from a clinical setting suggest that a majority of BDD patients improve with an SRI and that all SRIs appear effective. Cer tain SRI augmentation strategies may be beneficial. The high relapse rate w ith SRI discontinuation suggests that long-term treatment is often necessar y. These preliminary findings require confirmation in placebo-controlled ef ficacy studies and effectiveness studies.