Medication, psychotherapy, or a combination of both, in treating body dysmorphic disorder
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Body dysmorphic disorder BDD is a condition characterised by a distressing and disabling preoccupation with an imagined or slight defect in appearance. This causes people with this disorder either significant distress or disrupts their daily functioning or both. There has been a growing recognition that BDD is common, and is associated with significant illness and disability.
There is also some evidence that it may respond to pharmacotherapy and psychotherapy. Our systematic review of randomised controlled trials assesses the effects of drug treatment or psychotherapy when used on their own or in combination.
We found five eligible trials, including three of psychotherapy cognitive behavioural therapy CBT and exposure and response prevention ERP and two of medication the serotonin reuptake inhibitors SRIs fluoxetine and clomipramine. Symptoms became less severe after treatment with both medication and psychotherapy. Adverse events were mild to moderate in severity and none of the people in the active treatment groups were reported to have dropped out of the studies because of treatment-emergent adverse events.
Treatment response in the medication trials was not effected by the degree to which people had insight into their condition. Although few controlled trials have been done, and those that have been conducted were small, indicating that our findings should be used with caution unless confirmed by larger studies some of which are ongoingthe results suggest that treatment with both medication or psychotherapy can be effective in treating the symptoms of body dysmorphic disorder.
The findings of these studies need to be replicated. In addition, future controlled studies in other samples, such as adolescents, and using other selective SRIs, as well as a range of psychological therapy approaches and modalities alone and in combinationare essential in supplementing the sparse data currently available. Body dysmorphic disorder BDD is a prevalent and disabling preoccupation with a slight or imagined defect in appearance.
To assess the efficacy of pharmacotherapy, psychotherapy or a combination of both treatment modalities for body dysmorphic disorder. Additional studies were located through study reference lists. Randomised controlled trials RCTs of patients meeting DSM or ICD diagnostic criteria for BDD, in which the trials compare pharmacotherapy, psychotherapy or multi-modal treatment groups with active or non-active control groups.
Short or long-term trials were eligible. Two review authors independently assessed RCTs for inclusion in the reviewcollated trial dataand assessed trial quality. Investigators were contacted to obtain missing data. Summary effect sizes for dichotomous and continuous outcomes were calculated using a random effects model and heterogeneity was assessed.
Two pharmacotherapy and three psychotherapy trials were eligible for inclusion in the reviewwith data from four short-term RCTs participants available for analysis. Response data from a single placebo - controlled trial of fluoxetine suggested overall superiority of medication relative to placebo relative risk RR 3. Medication, psychotherapy, or a combination of both, in treating body dysmorphic disorder Body dysmorphic disorder BDD is a condition characterised by a distressing and disabling preoccupation with an imagined or slight defect in appearance.
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