BDD is often a severe disorder, characterized by distressing or impairing preoccupations with nonexistent or slight defects in appearance and repetitive behaviors performed in response to appearance concerns. Previous research has suggested acute treatment with selective serotonin reuptake inhibitors such as escitalopram can reduce symptoms of BDD, but little is known of the long-term effectiveness of the medications or the risk of relapse when the medications are discontinued.
For the study, 100 adults with BDD received open-label escitalopram for 14 weeks. Patients who responded to escitalopram (defined as greater or equal to 30% reduction in the Yale-Brown Obsessive-Compulsive Scale Modified for Body Dysmorphic Disorder [BDD-YBOCS] score from baseline) were then randomly assigned to six additional months of treatment with continuation monotherapy with escitalopram or discontinuation of escitalopram and substitution with placebo. Relapse of BDD was defined as a 50% or greater loss of BDD-YBOCS improvement that had occurred during the first phase of the study, plus a BDD-YBOCS score of greater than 20 and a rating of “much worse” or “very much worse” on the Clinical Global Impressions Scale for body dysmorphic disorder symptoms.
A total of 81% of the patients who completed the open-label phase of the study achieved BDD symptom response. At the conclusion of the second phase, the time to relapse was significantly longer among patients taking escitalopram than those taking placebo (hazard ratio=2.72); the overall prevalence of relapse was also reduced (18% for escitalopram versus 40% for placebo). Additionally, 35.7% of the escitalopram-treated patients continued to show further improvement in the severity of their BDD symptoms.
“These findings are particularly relevant because body dysmorphic disorder is often chronic,” Katharine Phillips, M.D., the director of the Body Dysmorphic Disorder Program at Rhode Island Hospital, and colleagues wrote. The researchers noted that additional studies are needed to evaluate the effectiveness of escitalopram over longer periods of time as well as “whether treatment with CBT for body dysmorphic disorder will decrease the risk of relapse when an effective medication is discontinued.”
To learn more about BDD, see the Psychiatric News column “How to Recognize, Treat Body Dysmorphic Disorder.”