This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Patients with Body Dysmorphic Disorder (BDD) are normal-appearing individuals who are painfully preoccupied with an imagined or slight defect in their appearance. Rather than exhibiting a simple exaggeration of common sensitivity about appearance, BDD patients have high rates of delusionality, psychiatric hospitalization, and suicidal ideation and attempts. BDD is severely disabling, resulting in significant impairment in social, academic, and occupational functioning. Many patients become housebound. Although there are no epidemiological studies of BDD's prevalence, there are estimates as high as 1.9% of the general population, and BDD has been found in 12% of psychiatric outpatients. BDD usually begins in childhood or adolescence, but its treatment in pediatric populations has not been investigated. Recent data suggests that adults with BDD may respond to serotonin reuptake inhibitors (SRIs) such as fluoxetine. Preliminary findings from case reports suggest that SRIs may also be effective in the treatment of BDD in children and adolescents. It appears that, as in adults, SRIs may also be effective in the treatment of children and adolescents with delusional BDD (delusional disorder, somatic type). This study is the first large-scale, double-blind, placebo-controlled medication trial of fluoxetine for children and adolescents with BDD. Hypothesis: The hypotheses are that fluoxetine will be well tolerated and more effective than placebo in treating BDD symptoms in children and adolescents, the degree of delusionality will not predict fluoxetine response--i.e., that subjects with poorer insight will be as likely to respond as subjects with better insight, delusionality will significantly improve in fluoxetine responders, including in delusional patients, comorbid major depression or OCD will not predict fluoxetine response and finally, that illness severity will not predict fluoxetine response.
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