background Research on the pharmacotherapy of body dysmorphic disorder (BDD) is increasing but still limited. To obtain an effective treatment is very important since BDD occurs frequently with a prevalence around 2% in the population, causes severe distress and functional impairment, and is associated with high suicide attempt rates and poor quality of life. Patients will prefer help from plastic surgeons, dermatologists, dentofacial surgeons and gynaecologists to treat their imagined defects.
aim To summarise evidence from pharmacotherapy trials in patients with BDD.
method English-language literature cited in Medline, PsycINFO (1967-2010) and Embase (1974-2010) was searched for open-label trials and (double-blind) randomised clinical trials (RCTs) using the following keywords: ‘treatment’, ‘pharmacotherapy’, ‘medication’, and ‘body dysmorphic disorder’.
results Available pharmacotherapy research will be reviewed, with a focus on selective serotonin-reuptake inhibitors (SSRIs), which are currently considered the medication of choice for BDD. Practical issues will be discussed like dosing, length of treatment, and potential side-effects associated with the use of srris. Other pharmacotherapy approaches, like addition with antipsychotics and buspirone or antiepileptics, show promising results if srri treatment alone is not adequately helpful.
conclusion SSRIs are the medication of choice for BDD, but the number RCTs is low. Almost two thirds of BDD patients will respond to ssris when SSRIs are highly dosed during 12-16 weeks. Addition with antipsychotics and buspirone or levetiracetam show promising results.