How effective are pharmacotherapy and psychotherapy for treatment of body dysmorphic disorder (BDD)?

Clinical question: 
How effective are pharmacotherapy and psychotherapy for treatment of body dysmorphic disorder (BDD)?
Bottom line: 
The trials reviewed showed symptoms became less severe after treatment with medication (fluoxetine or clomipramine) or psychotherapy (cognitive behavioural therapy [CBT]). A single placebo-controlled trial of fluoxetine showed a positive response rate of 56%, compared to 18% with placebo (NNT* 2.7). Adverse events were mild to moderate in severity, and none of the people in the active treatment groups were reported to have withdrawn from the studies because of treatment-emergent adverse events. There is preliminary evidence from one trial of CBT that the effects may persist once treatment has ended. *NNT = number needed to treat to benefit one individual.
Caveat: 
The review contained only 2 pharmacotherapy and 3 psychotherapy trials, and the number of participants in each trial was small (10-67). Inadequacies of reporting (and possibly trial methodology) limit the strength of the conclusions that can be drawn.
Context: 
Body dysmorphic disorder is a condition characterised by a distressing and disabling preoccupation with an imagined or slight defect in appearance, causing significant illness and disruption to daily functioning. Preliminary evidence from surveys indicates that approximately a quarter of patients with BDD may have attempted suicide in their lifetimes.
Review CD#: 
CD005332
PEARLS No: 
167
Date: 
June, 2009
Authored by: 
Brian R McAvoy