Table 3.

Evidence regarding the relationship between delusional BDD and nondelusional BDD: predictive validators

Study design	Sample size	Results
Course of illness
Prospective examination of course of illness and predictors of course in a broadly ascertained sample of individuals with BDD (clinical and nonclinical) using the Longitudinal Interval Follow-Up Evaluation.45–47	n=68 delusional BDD n=123 nondelusional BDD	No significant differences in age at BDD onset or duration of BDD (years).32 Over one year of prospective follow-up, no significant differences in terms of the probability of remission from BDD, and intake score on the Brown Assessment of Beliefs Scale (BABS) did not predict full or partial remission from BDD.46 After 4 years of follow-up, a lower probability of full or partial remission was not predicted by delusional BDD beliefs or by greater delusionality of BDD beliefs on the BABS at intake.47 Delusional BDD beliefs and greater delusionality on the BABS did not redict a higher probability of full or partial relapse.48
Cross-sectional/retrospective data from a treatment-seeking clinical sample of individuals with BDD using a semistructured interview.16	n=52 delusional BDD n=48 nondelusional BDD	No significant differences in age at BDD onset, duration of BDD (years), or course of illness.
Assessment of BDD outpatients at intake and most recent visit with the Clinical Global Impressions (CGI) Rating Scale48 in a treatment-seeking clinical practice setting.15	n=39 delusional BDD n=26 nondelusional BDD	No significant differences in age at BDD onset or duration of BDD (years). Delusional subjects had more severe BDD at follow-up on the CGI-Severity scale and significantly less improvement on the CGI-Improvement scale.
Chart review of BDD outpatients’ status at baseline and the most recent clinic visit in a clinical practice setting.49	n=22 delusional BDD n=30 nondelusional BDD	No significant association between baseline delusionality and endpoint BDD severity.
Response to treatment
Double-blind crossover trial of clomipramine versus desipramine (8 weeks of each medication).26	n=12 delusional BDD n=10 nondelusional BDD	Clomipramine was more efficacious than desipramine regardless of whether patients had insight or held their BDD beliefs with delusional intensity, and was more efficacious for delusional patients than for nondelusional patients.
Double-blind parallel-group trial of 12 weeks of fluoxetine versus placebo.27	n=27 delusional BDD n=37 nondelusional BDD	Fluoxetine was as efficacious for those with delusional BDD as for those with nondelusional BDD.
Double-blind parallel-group trial of 8 weeks of augmentation of fluoxetine with pimozide versus placebo.50	n=12 delusional n=16 nondelusional	Pimozide was not more efficacious than placebo. There was no significant effect of baseline delusionality on endpoint BDD severity.
Chart review study of BDD patients treated for up to 8 years in a clinical practice.51	n=27 delusional n=44 nondelusional	Only 15% (2/13) of antipsychotic augmentation of SRI treatments led to response of BDD.
Retrospective assessment of course of illness in a treatment-seeking sample with a semi-structured interview.16	n=52 delusional subjects n=48 nondelusional subjects	Only 1 of 45 antipsychotic treatments was efficacious for delusional BDD.