Successful Treatment of Nondelusional Body Dysmorphic Disorder With Olanzapine: A Case Report

Letter to the Editor

Sir: Evidence suggests that body dysmorphic disorder (BDD), a preoccupation with an imagined or slight defect in appearance, responds preferentially to serotonin reuptake inhibitors (SRIs). Given that BDD symptoms are often psychotic, and given BDD’s similarities to OCD, antipsychotic augmentation of BDD is a promising although unstudied treatment strategy. The use of neuroleptics as monotherapy to treat BDD, however, has been limited. Although pimozide has been said to be effective for the delusional form of BDD (monosymptomatic hypochondriacal psychosis), SRI augmentation with pimozide was unsuccessful in a small series of patients. In case reports, typical neuroleptics (loxapine, trifluoperazine, thioridazine) have generally been reported to be ineffective. The following case represents the first reported successful treatment of nondelusional BDD with an atypical neuroleptic, olanzapine.