When people have body dysmorphic disorder, they are obsessed with supposed
flaws in their appearance—say, "a crooked lip," "a
bumpy nose," "tiny breasts," or "drooping
buttocks." They may spend hours a day brooding about their"
defect" and lead painfully isolated lives. Although the disorder
appears to affect about 1 percent of the population, which makes it about as
common as bipolar disorder, patients rarely share their obsessions with a
doctor and thus go undiagnosed.
Both SSRI antidepressants and cognitive-behavioral therapy can reduce the
symptoms of body dysmorphic disorder, growing evidence suggests. But can SSRIs
also improve functioning and quality of life for such patients? The answer
appears to be "to some degree," a study conducted by Katharine
Phillips, M.D., a professor of psychiatry at Brown University, and Steven
Rasmussen, M.D., an associate professor of psychiatry at Brown, has found.
Results appeared in the October Psychosomatics.
In this study, 60 subjects with DSM-IV-defined body dysmorphic
disorder received either the SSRI fluoxetine or a placebo for a 12-week
period. Subjects getting fluoxetine started at 20 mg a day and reached a
maximum dose of 80 mg a day if tolerated. The average fluoxetine dose at the
end of the study was 77.7 mg a day. Subjects did not receive psychotherapy
during the study.
Patients' psychosocial functioning and quality of life were assessed at the
start and end of the study with SOFAS, a global clinician-rated measure of
functioning; LIFE-RIFT, a reliable and valid semistructured clinician-rated
measure of functional impairment; and SF-36, a reliable, valid, and widely
used self-report measure of mental and physical health-related quality of
Patients' average scores on the SOFAS, LIFE-RIFT, and SF-36 at the start of
the study reflected impaired functioning in many domains and a very poor
mental health—related quality of life. Their SF-36 scores, in fact, were
even poorer than for patients with major depression.
By the end of the study, subjects getting fluoxetine had improved
significantly more on the measures of functioning than had subjects getting a
placebo. But even though they improved significantly more in function than
subjects on placebo did, they were still not functioning at all that high a
level and did better in some domains, such as work functioning, than in
others, such as relationships with friends. Regarding the quality-of-life
measure, subjects on fluoxetine did not score significantly higher than
subjects on a placebo. In fact, the post-treatment SF-36 mental health
subscale scores of the fluoxetine group were poorer than posttreatment scores
on that instrument in other 12-week pharmacotherapy trials, including studies
of major depression and posttraumatic stress disorder.
Psychiatric News asked Phillips whether she was disappointed with
these results. "Yes and no," she replied. "Our finding that
even after treatment patients are not functioning at a high level and quality
of life is still fairly poor underscores the need to develop even more
effective treatments for body dysmorphic disorder. [Still,] these patients are
often so severely ill, functionally impaired, and suicidal that even partial
improvement in functioning and quality of life is a welcome relief and can
make a big difference in their lives."
The take-home message for clinical psychiatrists, she added, is that"
SSRIs can be very helpful in improving not only the core symptoms of
body dysmorphic disorder, a serious mental illness, but also daily
The study was funded by the National Institute of Mental Health. Study
medication and matching placebo were supplied by Eli Lilly and Company.
The study, "Change in Psychosocial Functioning and Quality of
Life of Patients With Body Dysmorphic Disorder Treated With Fluoxetine: A
Placebo-Controlled Study," is posted online at<http://psy.psychiatryonline.org/cgi/content/full/45/5/438>.▪