Overview of Evidence-Based Treatment: Medication

Serotonin reuptake inhibitors (SRIs) are the first-line medication treatment for body dysmorphic disorder (BDD). They usually substantially improve BDD symptoms and many co-occurring disorders and symptoms. SRIs must be optimized in terms of dose and trial duration. High doses are often needed to effectively treat BDD (as for obsessive-compulsive disorder). Excellent adherence to the medication is also required for a good outcome. Treatment with an SRI alone is as effective for patients with delusional BDD beliefs as for those with nondelusional beliefs. These medications also usually improve co-occurring depressive symptoms, anxiety, anger/hostility, suicidality, psychosocial functioning, and quality of life. An SRI may be used regardless of BDD severity but is always recommended for severe BDD and for more highly suicidal patients. Unfortunate myths about these medications abound; with competent prescribing, most SRIs are usually well tolerated. If an optimized SRI trial insufficiently improves symptoms, certain medications, such as atypical neuroleptics (perhaps in particular aripiprazole) and buspirone can improve treatment outcomes when added to an SRI. This chapter reviews the evidence for the efficacy of SRIs, SRI augmentation and switching strategies, and alternatives to an SRI. It also discusses how to effectively implement medication treatment for BDD.