Pharmacotherapy and psychotherapy for body dysmorphic disorder
Editorial Group: Cochrane Depression, Anxiety and Neurosis Group
Published Online: 21 JAN 2009
Assessed as up-to-date: 2 MAY 2004
Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
How to Cite
Ipser JC, Sander C, Stein DJ. Pharmacotherapy and psychotherapy for body dysmorphic disorder. Cochrane Database of Systematic Reviews 2009, Issue 1. Art. No.: CD005332. DOI: 10.1002/14651858.CD005332.pub2.
- Publication Status: New
- Published Online: 21 JAN 2009
Body dysmorphic disorder (BDD) is a prevalent and disabling preoccupation with a slight or imagined defect in appearance. Trials have investigated the use of serotonin reuptake inhibitors (SRIs) and cognitive behaviour therapy (CBT) for BDD.
To assess the efficacy of pharmacotherapy, psychotherapy or a combination of both treatment modalities for body dysmorphic disorder.
We searched the Cochrane Depression, Anxiety and Neurosis Trial Register (December 2007), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 4, 2007), MEDLINE (January 1966 to December 2007), and PsycINFO (1967 to December 2007). Ongoing and unpublished trials were located through searching the metaRegister of Controlled Trials, the CRISP and WHO ICTRP search portals (databases searched in December 2007), and through contacting key researchers and pharmaceutical companies. 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.
Data collection and analysis
Two review authors independently assessed RCTs for inclusion in the review, collated trial data, and 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 review, with data from four short-term RCTs (169 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) 3.07, 95% CI 1.4 to 6.72, n = 67). Symptom severity was also significantly reduced in the RCTs of fluoxetine and clomipramine (relative to desipramine), as well as in the two CBT trials (WMD -44.96, 95% CI -54.43 to -35.49, n = 73). A low relapse rate (4/22) was demonstrated in one trial of CBT.
Results from the small number of available RCTs suggest that SRIs and CBT may be useful in treating patients with BDD. 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 combination), are essential in supplementing the sparse data currently available.
Plain language summary
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. 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). In the only placebo-controlled medication trial included in our review, people with BDD treated with fluoxetine were more likely to respond (56%, 19 out of 34) than those allocated placebo (18%, 6 out of 33). 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. There is preliminary evidence from one trial of CBT that the effects of CBT may persist once treatment has ended. 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 ongoing), the results suggest that treatment with both medication or psychotherapy can be effective in treating the symptoms of body dysmorphic disorder.
身體畸形性疾患(Body Dysmorphic Disorder, BDD)的藥物及心理治療
身體畸形性疾患(BDD)者會沉浸在外表些微或想像的缺陷想法中，而使其失能。試驗在探究以血清素再吸收抑制劑(serotonin reuptake inhibitors, SRIs)及認知行為療法來治療BDD的效果。
我們搜尋Cochrane Depression, Anxiety and Neurosis Trial Register(2007年12月), the Cochrane Central Register of Controlled Trials(The Cochrane Library 第四期, 2007), MEDLINE(1966年12月至2007年12月)及PsycINFO(1967至2007年12月)搜尋the metaRegister of Controlled Trials 裡面進行中及 未發表的試驗, the CRISP and WHO ICTRP 搜尋站(search portals)(搜尋2007年12月的資料庫)及聯絡主要的研究者與藥廠。額外的研究案從研究參考名單中找尋。
兩個藥物試驗及三個心理治療試驗符合納入規則，且共有四個隨機控制試驗的資料(169位受試者)可被分析。從單一安慰劑控制試驗比較flouxetine的治療反應資料顯示整體藥物效果優於安慰劑(relative risk (RR) 3.07, 95% CI 1.4 to 6.72, n = 67)。症狀嚴重度也顯著降低在隨機控制試驗中的flouxetine及clomipramine，如同在兩個認知行為治療試驗(WMD −44.96, 95% CI −54.43 to −35.49, n = 73)。在其中一個認知行為治療試驗中顯示較低的惡化率。
此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。
身體畸形性疾患的特色是折磨且失能的沉浸在外表些微或想像的缺陷想法中。這些造成患者顯著失能或影響其日常生活(或兩者均是)。目前我們逐漸了解身體畸形性疾患是常見的疾病且伴隨顯著的失能。有一些證據顯示藥物及心理治療是有幫助的。我們系統性的回顧隨機控制試驗，評估藥物或心理治療在單獨或合併下的治療效果。我們發現五個合適的試驗，包含三各心理治療(認知行為治療、曝露與避免反應治療)及兩個藥物治療(血清素回收抑制劑，flouxetine及clomipramine)。只有一個安慰劑控制的藥物試驗被納入在我們的回顧裡。fluoxetine的治療組(56%, 19 out of 34)比安慰劑更有反應(18%, 6 out of 33)。經過合併藥物及心理治療後，症狀有減輕。副作用的嚴重度約在輕微至中度，治療組中沒有人因為治療造成的副作用而離開研究。一個CBT的試驗顯示治療結束後治療仍可持續的證據。藥物試驗的治療反應沒有因為個案對自身情況的病識感程度不同而受影響。雖然只有很少的控制試驗，且現有的試驗樣本數小，所以我們的發現結論需要謹慎的使用，除非有更大研究的支持(目前有些在進行中)。這些結果支持合併藥物與心理治療在身體畸形性疾患的症狀治療上有效果。