Body dysmorphic disorder (BDD) is an OCD-related disorder. A patient is preoccupied with an imagined defect in his nose and spends 4 hours daily checking mirrors and seeking surgical consultations. The medication class with BEST evidence for BDD is:
- A SSRIs at high doses (e.g., fluoxetine 60-80 mg/day) ✓
- B Antipsychotics (risperidone monotherapy)
- C Benzodiazepines
- D Mood stabilizers (valproate)
Correct answer: A. SSRIs at high doses (e.g., fluoxetine 60-80 mg/day)
Explanation
SSRIs at higher doses than used for depression are the evidence-based pharmacotherapy for BDD. Fluoxetine (up to 80 mg/day), escitalopram, and clomipramine are used. Response rate is ~50-60% and treatment requires at least 12-16 weeks. Antipsychotic augmentation is used in partial responders but not monotherapy. BDD with delusional severity does not respond better to antipsychotics alone than SSRIs — this is a key clinical teaching point.
Reference: Kaplan & Sadock's Synopsis of Psychiatry, 11th ed.
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