Good news for people with body dysmorphic disorder (BDD) as a new study validates that sustained use of pharmaceutical therapy can reduce symptoms and prevent relapse.
BDD is an often-chronic mental illness in which people focus intensively on perceived physical flaws, which to others appear minor or even nonexistent.
Cognitive-behavioral therapy (CBT) that is tailored to BDD and certain types of antidepressant medication called serotonin-reuptake inhibitors (SRIs) often alleviate symptoms.
Researchers from Rhode Island Hospital and Massachusetts General Hospital say the study is the first to verify that medication was effective in preventing a relapse of symptoms after medication is suspended. In addition, previous studies regarding the efficacy of medications were short-term.
People with BDD fare better and are less likely to relapse when treated with medication on a long-term basis, according to the researchers.
“This research yielded clinically important data about BDD, a common, often-chronic and understudied illness in need of more evidence-based treatment,” said Katharine Phillips, M.D., director of the BDD program at Rhode Island Hospital.
“We showed that the risk of relapse can be substantially reduced by continuing effective medication and also that the continuation of medication after the acute period can further improve symptoms.”
Phillips and co-author, Sabine Wilhelm, Ph.D., director of the OCD and related disorders program at Massachusetts General Hospital, found that 81 percent of adults with BDD who took Lexapro (escitalopram) for a full 14 weeks experienced substantial improvement in BDD symptoms.
The responders who continued to take the medication for another six months tended to further improve.
Furthermore, those who responded to Lexapro and continued taking the medication were less likely to experience worsening of BDD symptoms in comparison to those who were switched from Lexapro to placebo (for example, a sugar pill).
The study appears in The American Journal of Psychiatry.
Approximately two percent of the American population suffers from BDD, and it affects men and women about equally.
People with BDD obsess about perceived flaws in their appearance and perform repetitive and time-consuming behaviors, such as mirror checking and comparing with others, in response to their appearance concerns.
A majority receive cosmetic treatment, such as surgery and dermatologic treatment, which is rarely effective for BDD concerns. SRI medications can help relieve the obsessive and compulsive symptoms of BDD as well as accompanying symptoms such as depression and anxiety.
This research study found that six months of additional treatment following initial response to the medication did positively affect outcomes. In the study, 74 people completed phase one, which involved Lexapro treatment during the 14-week, acute period.
During phase two, the relapse prevention efficacy phase, 58 participants were randomized to double-blind continuation treatment with Lexapro or were changed to placebo treatment.
“Among patients who responded to acute-phase escitalopram (Lexapro), continued pharmacological treatment significantly delayed time to relapse compared to patients in the placebo group,” said Wilhelm.
“Further, more than twice as many placebo-treated patients relapsed than escitalopram-treated patients. This is important data for providers treating patients with BDD. Research studies are also needed that investigate whether treatment with CBT for BDD will decrease the risk of relapse when an effective medication is stopped.”
Phillips and Wilhelm are currently conducting a study that is comparing the effectiveness of two different kinds of therapy for people with BDD: CBT and supportive talk therapy.