Figure 1.

Proposed Medication Treatment Algorithm for BDD^a

^a This is an abbreviated version of a proposed medication treatment approach to BDD; see the text for more detail. This algorithm incorporates and is consistent with scientific evidence, but because such evidence is currently limited, the algorithm is also based on clinical experience. The algorithm is for medication treatment only and does not include CBT, which appears effective for BDD (see article by Veale et al in this issue).

^b In some cases (for example, for severe anxiety and suicidal thinking), consider combining a benzodiazepine or antipsychotic with an SRI as initial treatment.

^c Has the highest SRI dose recommended by the pharmaceutical company or tolerated by the patient been reached and used for a minimum of 3 weeks, and has the total SRI trial duration been at least 12–16 weeks?

^d Try to reach the highest SRI dose recommended by the pharmaceutical company or the highest dose tolerated for at least 3 weeks; continue the SRI for a total duration of 12–16 weeks to see if it will work.

^e Options are discussed in the text