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Meta-Analysis
. 2009 Jan 21;2009(1):CD005332.
doi: 10.1002/14651858.CD005332.pub2.

Pharmacotherapy and psychotherapy for body dysmorphic disorder

Jonathan C Ipser  1 , Candice Sander, Dan J Stein
Affiliations
Meta-Analysis

Pharmacotherapy and psychotherapy for body dysmorphic disorder

Jonathan C Ipser et al. Cochrane Database Syst Rev. .

Abstract

Background: 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.

Objectives: To assess the efficacy of pharmacotherapy, psychotherapy or a combination of both treatment modalities for body dysmorphic disorder.

Search strategy: 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 Ongoing and unpublished trials were located through searching the metaRegister of Controlled Trials, the CRISP and WHO ICTRP search portals (databases searched in December 2007), and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.

Selection criteria: 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.

Main results: 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.

Authors' conclusions: 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.

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Conflict of interest statement

Potential conflicts of interest for individual reviewers

Jonathan Ipser has no known conflicts of interest outside of his employment by the MRC Unit on Anxiety Disorders.

Candice Sander has no known conflicts of interest. Dan Stein has received research grants and/or consultancy honoraria from Astrazeneca, Eli‐Lilly, GlaxoSmithKline, Lundbeck, Orion, Pfizer, Pharmacia, Roche, Servier, Solvay, Sumitomo, and Wyeth. He has participated in a number of ongoing trials, and has presented data from some of these trials on behalf of the sponsoring companies.

Figures

1.1
1.1. Analysis
Comparison 1 Pharmacotherapy versus placebo (primary outcomes), Outcome 1 Treatment response ‐ Clinical Global Impressions Scale ‐ Improvement item (CGI‐I).
1.2
1.2. Analysis
Comparison 1 Pharmacotherapy versus placebo (primary outcomes), Outcome 2 Symptom severity ‐ BDD Yale Brown Obsessive Compulsive scale.
2.1
2.1. Analysis
Comparison 2 Pharmacotherapy versus placebo (secondary outcomes), Outcome 1 Depression symptoms ‐ Hamilton Depression Scale (HAM‐D).
2.2
2.2. Analysis
Comparison 2 Pharmacotherapy versus placebo (secondary outcomes), Outcome 2 Quality of life ‐ 36‐Item Short‐Form Health Survey (SF‐36) .
2.3
2.3. Analysis
Comparison 2 Pharmacotherapy versus placebo (secondary outcomes), Outcome 3 Functional disability ‐ Range of Impaired Functioning Tool (RIFT).
3.1
3.1. Analysis
Comparison 3 Pharmacotherapy versus alternative medication (primary outcomes), Outcome 1 Symptom severity ‐ BDD Yale Brown Obsessive Compulsive scale.
4.1
4.1. Analysis
Comparison 4 Psychotherapy versus waiting list (primary outcomes), Outcome 1 Symptom severity ‐ Body Dysmorphic Disorder Examination (BDDE).
5.1
5.1. Analysis
Comparison 5 Psychotherapy versus waiting list (secondary outcomes), Outcome 1 Depression symptoms ‐ Montgomery‐Asberg Depression Rating Scale (MADRS).
See this image and copyright information in PMC

Update of

References

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References to ongoing studies

1K23MH076934‐01A1 {unpublished data only}
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NCT00029471 {published data only}
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NCT00106223 {published data only}
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NCT00149799 {published data only}
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