Treating body dysmorphic disorder with medication:
Evidence, misconceptions, and a suggested approach
Katharine A. Phillips
, Eric Hollander
Butler Hospital and The Warren Alpert Medical School of Brown University, 345 Blackstone Boulevard,
Providence, RI 02906, United States
Mount Sinai School of Medicine, New York, NY, United States
Received 2 July 2007; received in revised form 28 December 2007; accepted 28 December 2007
Body dysmorphic disorder (BDD) is a relatively common and often disabling disorder with high morbidity and mortality. Both
psychotropic medication and cognitive behavioral therapy (CBT) are considered ﬁrst-line treatments for BDD, and medication
treatment is often essential for more severely ill and suicidal patients. In this practical overview of the pharmacotherapy of BDD, we
brieﬂy describe BDD’s clinical features, associated morbidity, and how to recognize and diagnose BDD. We describe the
importance of forming a therapeutic alliance with the patient, the need for psychoeducation, and other essential groundwork for
successful treatment of BDD. We review available pharmacotherapy research, with a focus on serotonin-reuptake inhibitors (SSRIs,
or SRIs), which are currently considered the medication of choice for BDD. Many patients have substantial improvement in core
BDD symptoms, psychosocial functioning, quality of life, suicidality, and other aspects of BDD when treated with appropriate
pharmacotherapy that targets BDD symptoms. We also discuss practical issues such as dosing, length of treatment, and potential
side effects associated with the use of SRIs. In addition, we discuss pharmacotherapy approaches that can be tried if SRI treatment
alone is not adequately helpful. Finally, some misconceptions about pharmacotherapy, gaps in knowledge about BDD’s treatment,
and the need for additional research are discussed.
# 2008 Elsevier Ltd. All rights reserved.
Keywords: Body dysmorphic disorder (BDD); Pharmacotherapy; Psychotropic medication; Delusional disorder; Treatment
Why treat BDD with medication?
Body dysmorphic disorder (BDD), a distressing or
impairing preoccupation with an imagined or slight
defect in one’s physical appearance, is a relatively
common disorder. An estimated 0.7–1.7% of the
general population has BDD (Bienvenu et al., 2000;
Faravelli et al., 1997; Otto, Wilhelm, Cohen, & Harlow,
2001; Rief, Buhlmann, Wilhelm, Borkenhagen, &
Brahler, 2006). BDD appears far more common than
this in inpatient and outpatient settings (Phillips,
2005a). Currently, psychotropic medication and cog-
nitive behavioral therapy (CBT) are considered the ﬁrst-
line treatments for BDD. Medication treatment is
appropriate for individuals who meet full DSM-IV
criteria for BDD, and, in our view, medication is
essential for more severely ill and suicidal patients
(Phillips, 2005a). Available data indicate that appro-
priate pharmacotherapy substantially improves core
BDD symptoms, psychosocial functioning, suicidality,
and other aspects of BDD in a majority of patients
Available online at www.sciencedirect.com
Body Image 5 (2008) 13–27
* Corresponding author. Tel.: +1 401 455 6490;
fax: +1 401 455 6539.
E-mail address: Katharine_Phillips@Brown.edu (K.A. Phillips).
1740-1445/$ – see front matter # 2008 Elsevier Ltd. All rights reserved.