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Personality as a Predictor of Treatment Response to Escitalopram in Adults With Body Dysmorphic Disorder


Journal of Psychiatric Practice®: September 2019 - Volume 25 - Issue 5 - p 347–357
doi: 10.1097/PRA.0000000000000415

Objective: Serotonin reuptake inhibitors (SRIs) are the first-line pharmacotherapy for body dysmorphic disorder (BDD), a common and severe disorder. However, predictors and correlates of treatment response are not well understood. A closer examination of baseline personality dimensions and disorders and of changes in personality during SRI treatment is needed to advance knowledge of this clinically important issue.

Method: We conducted a secondary analysis of data from a pharmacotherapy relapse prevention trial of the SRI escitalopram in adults with BDD to examine personality dimensions and traits, as well as whether these variables predict and correlate with treatment response. A total of 65 participants with BDD completed the Revised NEO Personality Inventory (NEO PI-R) before starting open-label treatment with escitalopram and 42 participants completed the NEO PI-R after treatment.

Results: At baseline, participants with BDD displayed higher levels of neuroticism and lower levels of extraversion than a normed reference group. Higher baseline neuroticism was a significant predictor of nonresponse to escitalopram treatment, even when baseline depression severity was controlled for. Changes in neuroticism were not associated with treatment response.

Conclusion: Our findings underscore the relationship between BDD and neuroticism, and they suggest a link between neuroticism and SRI treatment response.

FANG, PORTH, WILHELM: Massachusetts General Hospital/Harvard Medical School, Boston, MA

PHILLIPS: New York-Presbyterian Hospital and Weill Cornell Medical College, New York, NY and Rhode Island Hospital and Alpert Medical School of Brown University, Providence, RI

Supported by the National Institute of Mental Health [Collaborative R01 grants to K.A.P. (R01 MH072917) and S.W. (R01 MH072854), and K23 grant to A.F. (K23 MH109593)]. Study medication and matching placebo pills were provided by Forest Laboratories. Trial Registry Number: NCT00149799. Escitalopram does not have approval from the US Food and Drug Administration for the treatment of body dysmorphic disorder.

The authors declare no conflicts of interest.

Please send correspondence to: Angela Fang, PhD, OCD and Related Disorders Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, 185 Cambridge Street, Suite 2000, Boston, MA 02114 (e-mail:

Online date: September 6, 2019

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