Pharmacotherapy and other somatic treatments

Although BDD has been said to be 'extremely difficult' to treat, available data suggest that SRIs are often, and perhaps preferentially, effective. (1f,> In a series of 130 patients (who received a total of 316 medications) for whom response was assessed retrospectively, 42 per cent of 65 trials with SRIs resulted in 'much' or 'very much' improvement, compared to 30 per cent of 23 trials with monoamine oxidase inhibitors, 15 per cent of 48 trials with non-SRI tricyclics, 3 per cent with neuroleptics, 6 per cent with a variety of other medications (e.g. mood stabilizers), and 0 per cent of trials involving electroconvulsive treatment. (4) In a retrospective study of 50 patients, 35 SRI trials resulted in much improvement, whereas 18 non-SRI tricyclic trials led to no overall improvement in BDD symptoms. (29 In a study of 45 patients openly treated in a clinical practice, 70 per cent (43 of 61) of SRI trials resulted in much or very much improvement. (4)

Two systematic open-label studies have been published. In one, (21.> 19 (63 per cent) of 30 subjects responded to fluvoxamine (mean dose, 238.3 ± 85.8 mg/day; mean time to response, 6.1 ± 3.7 weeks; range, 1-16 weeks). In another open-label fluvoxamine trial, (22> two-thirds of 15 subjects responded. In a recent double-blind, controlled, crossover trial, clomipramine was more effective than desipramine.(23) Response to medication usually results in a decrease in appearance-related preoccupations, distress, and behaviours, and improvement in functioning. Of interest, available data suggest that delusional patients often respond to SRIs and that insight and referential thinking may improve with SRI treatment. (21,23>

Augmentation of an SRI with buspirone or neuroleptics are promising strategies when an SRI is not adequately effective. (4) Another option is to combine clomipramine with a selective SRI when an adequate trial of one of these medications alone has been ineffective. (Clomipramine blood levels must be monitored with this approach.) Patients who fail one adequate SRI trial may respond to another SRI or venlafaxine. If none of these strategies are effective, a monoamine oxidase inhibitor may be worth trying. All these strategies, while promising, require further research.

Other medications used as single agents have not been well studied, although the previously noted studies found that non-SRIs were rarely effective. An important question is whether antipsychotics alone are effective for treating delusional BDD; retrospective data suggest they are rarely effective, but this question needs to be studied. Medication discontinuation studies have not been done, but clinical experience suggests that most patients relapse after SRI discontinuation and that long-term treatment is often needed, with efficacy usually sustained over time.

Available case series and reports suggest that electroconvulsive treatment is generally ineffective for BDD. One case report noted an improvement in BDD symptoms with a modified leucotomy, and another with a bilateral anterior cingulotomy and subcaudate tractotomy. In one case a capsulotomy was effective, whereas in another an anterior internal capsulotomy was ineffective.

Break Free From Passive Aggression

Break Free From Passive Aggression

This guide is meant to be of use for anyone who is keen on developing a better understanding of PAB, to help/support concerned people to discover various methods for helping others, also, to serve passive aggressive people as a tool for self-help.

Get My Free Ebook


Post a comment