Pharmacologic treatment of body dysmorphic disorder

Compared to other psychiatric disorders, pharmacologic treatment research for body dysmorphic disorder (BDD) is in the early stages. Consequently, there are no medications with a Food and Drug Administration indication for the treatment of BDD. Evidence from case reports, retrospective reviews, open-label studies, and a growing number of controlled trials have consistently demonstrated seoronin reuptake inhibitor (SRI) superiority over other psychotropic medications for the treatment of BDD. Thus, SRIs are usually the first-line choice of pharmacologic treatment for BDD. In general, higher doses than used for treating other disorders are needed to treat BDD. Also, a longer time interval of treatment may be required before a clinical response to the SRI is evident. In fact, some BDD experts suggest that up to 12 weeks of SRI treatment with at least 2-4 weeks of the total treatment at the highest recommended dose (and tolerated by the patient) should be given before determining that an SRI is ineffective. Use of SRIs for treatment of BDD along with comorbid mood, anxiety, eating, substance abuse, or impulse-control disorders can be challenging. Choice and dose of a particular SRI may be affected by the other medications used to target comorbidity. If BDD symptoms remain refractory to SRI pharmacotherapy, reported strategies for achieving symptom reduction include augmenting the SRI with another psychotropic medication (or cognitive-behavioral therapy), or switching to a different SRI or psychotropic medication.