Jan. 30, 2009 Worrying about a bad hair day or idly wishing for a more-perfect profile: we’ve all been there. However, people suffering from body dysmorphic disorder go far beyond that, obsessing over exaggerated or even imaginary physical defects, to the point where it affects their ability to work, attend school or have ordinary social contacts.
Now, a new review finds that both drug therapy and psychotherapy, alone or in combination, can effectively treat the condition. Moreover, treatment can bring be long-lasting relief, according to the South African research team.
“The key finding that treatment effects were maintained over a 4.5 month follow-up [period] after 12 weeks of cognitive behavioral psychotherapy indicates that such therapy may be effective in preventing remission over the longer term,” said lead reviewer Jonathan Ipser, whose work at the University of Stellenbosch in Tygerberg encompasses stress and anxiety disorders.
In body dysmorphic disorder, a person typically focuses the obsession on the face, hair or body odor. Sufferers often pursue plastic surgery to change the perceived defect. Since the condition is primarily psychological, such procedures rarely help and often lead to symptoms growing worse.
In the United States in 1997, body dysmorphic disorder received formal recognition as a mental disorder.
The review appears in the latest issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.
The investigators analyzed five studies: two drug studies (96 people) and three psychotherapy studies (83 people).
Results from single study of fluoxetine (Prozac) versus placebo showed that Prozac-treated subjects had three times the effective clinical response compared to placebo-treated subjects.
In the other included drug study, symptom severity declined significantly with clomipramine (Anafranil) treatment compared to desipramine (Norpramin); both are older tricyclic antidepressants.
The authors excluded studies that involved some newer, though commonly used, antidepressants due to a lack of a “control” or untreated group of patients in these studies.
In two of the three psychotherapy studies, researchers compared 12 weeks of cognitive behavioral therapy to a “waiting list” comparison group. Both studies reported significant improvements in symptoms among treated patients. In one of these studies, a follow-up examination at 4.5 months after treatment showed recovery from disorder symptoms in 20 of the 26 participants.
The third psychotherapy study looked at the effect of six months of maintenance psychotherapy following a six-week course of behavioral therapy. While overall ongoing symptoms did not differ between those who had or had not received maintenance therapy, significant reductions in anxiety and depression occurred among people in maintenance treatment.
“This review reinforces the value of psychotherapy, along with medications, in treating people with psychiatric disorders,” said Eric Plakun, M.D., an American Psychiatric Association spokesperson. “People are not just receptor sites for molecules and can make significant and enduring changes through therapy alone or in combination with medications.”
Plakun, the director of admissions and professional relations at the Austin Riggs Center in Stockbridge, Mass., said that the new review suggests that clinicians are properly identifying the condition as an obsessive compulsive disorder, “since BDD seems to respond best to medications and therapies that have been found to work with these disorders.”
The reviewers concluded that future studies need to include a focus on adolescence, where the disorder often first emerges, and include the use of other, newer antidepressants and various modes of psychotherapy.
Ipser JI, Sandler C, Stein DJ. Pharmacotherapy and psychotherapy for body dysmorphic disorder. Cochrane Database of Systematic Reviews 2009, Issue 1.
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