Body Dysmorphia and Substance Abuse

People with body dysmorphic disorder (BDD) are at increased risk of developing substance use disorders. This is a cause for concern because substance use worsens symptoms of BDD and contributes to poorer treatment outcomes.

People with body dysmorphic disorder (BDD) are at increased risk of developing substance use disorders. This is a cause for concern because substance use worsens symptoms of BDD and contributes to poorer treatment outcomes. Substance use not only interferes with the therapy and medications that are used to treat BDD but also elevates the risk that people with BDD will have suicidal thoughts or attempt suicide.

Effects of Substance Abuse on Body Dysmorphic Disorder Symptoms

People with a mental health condition often use substances to attempt to alleviate, distract from or otherwise disrupt their symptoms. This is particularly true for people with co-occurring body dysmorphia and substance use disorders.

Body dysmorphic disorder is similar to obsessive-compulsive disorder (OCD) in that the two main causes of distress for people who suffer from it experience obsessive thoughts and compulsive behavior. Both can be impacted by substance use. Stimulants can aggravate both, but in ways, people sometimes find distracting or less painful. Alcohol, marijuana, benzodiazepines and opiates can all seem to provide temporary relief from these thoughts and related distress.

However, these effects are only temporary and people with substance use disorders often experience uncomfortable effects during periods between use. Symptoms of depression and anxiety typically become more intense than they were before during these periods. Obsessive thoughts can also worsen.

This “see-saw” effect often leads to addiction and the symptoms of BDD can intensify. As co-occurring conditions worsen, people are at greater risk of several negative outcomes. They are much more likely to act on distorted or delusional thoughts while under the influence of a substance, including suicidal thoughts. In addition, people are much less likely to respond to treatment for BDD while actively misusing substances.

Drug Abuse as a Hindrance to Body Dysmorphic Disorder Treatment

The two most effective interventions for BDD are cognitive behavioral treatment (CBT) and taking selective serotonin reuptake inhibitors (SSRIs), a class of antidepressant medications. Using substances are counterproductive as they interfere with the therapeutic effects of medications and CBT, leading to worse treatment outcomes for people with body dysmorphic disorder.

Drug Abuse as a Cause of Body Dysmorphic Disorder

Substance use has not been established as a cause of body dysmorphic disorder but is known to trigger symptoms associated with the disorder. It is possible that people who use substances, especially in adolescence, may ultimately develop the full disorder after experiencing prolonged symptoms of body dysmorphia Some known causes of BDD can include:

• Genetic predisposition to mental illness
• Biological factors that increase physical and emotional sensitivity
• Episodes of abuse or trauma
• Histories of medical conditions or injuries that affect appearance,
• An obsessive or perfectionistic temperament.

Substance abuse cannot change genetics or temperament, but it can shape the body and mind to experience things differently. People who regularly use and abuse substances often become more or less physically and emotionally sensitive than they were before and develop new or distorted bodily perceptions.

The painful emotional effects of BDD symptoms are deeply linked with the feeling of shame, which is something that people with substance use disorders also commonly experience. The social stigma associated with drug use and the behavioral changes addiction often causes can make people with substance use disorders feel deeply flawed. This can exacerbate any underlying tendency toward body-related shame and cause symptoms of body dysmorphia to develop.

Statistics on Body Dysmorphic Disorder and Drug Abuse

People diagnosed with BDD are at a higher risk of developing a substance use disorder, some statistics to show this relationship include:

• Nearly 50 percent of people with body dysmorphic disorder have a substance use disorder at some point in their lives
• About 17 percent of people with body dysmorphic disorder have an active substance use disorder at the same time they are experiencing BDD symptoms
• Almost 70 percent of people with a lifetime history of both substance use and body dysmorphic disorder report that BDD contributed to the development of their substance use disorder

People with co-occurring substance use disorders and BDD are 16 percent more likely to attempted suicide than people who only are diagnosed with BDD. This is a significant concern because people with BDD already experience suicidal ideation and suicide attempts at a significantly higher rate than people in the general population.

Body Dysmorphic Disorder and Alcohol

People with BDD are more likely to abuse alcohol than any other substance. About 75 percent of people with BDD have a lifetime history of an alcohol use disorder. The reasons are similar to those that cause people with anxiety disorders to use alcohol at higher rates. It is especially effective in temporarily disrupting self-conscious thought patterns and lowering inhibition, allowing people to enjoy social situations they would normally avoid.

All co-occurring alcohol use and mental health disorders come with specific additional risks:

• Anxiety, depression, and other psychiatric symptoms intensify during periods between alcohol use, causing mental health conditions to worsen over time.
• Alcohol use carries significant health risks and increases the likelihood a person will develop physical or medical disorders.
• Alcohol use increases the risk of engaging in dangerous or self-destructive behavior.

The most significant concern for people with co-occurring BDD and alcohol use disorders is the increased risk of self-harm. Both BDD and alcohol use disorders are linked with higher rates of suicide. A meta-analysis by Harris found people with alcohol use disorders have a risk of suicide that is five times higher than that of “social drinkers.”

Marijuana Abuse and Body Dysmorphic Disorder

Marijuana is the second most commonly used substance for people with BDD. A little more than 50 percent of people with BDD have a lifetime history of a marijuana use disorder. Like alcohol, marijuana can temporarily alleviate the anxiety and distress associated with BDD. However, due to the way it works in the brain, it has a unique capacity to make both worse.

Many people who use marijuana have episodes of anxiety while under the influence, especially when they use it in high doses or in large amounts. These episodes sometimes escalate to the point of panic attacks and paranoid delusions. This sudden surge of anxiety can be particularly distressing to people with underlying mental health conditions. People with BDD may become afraid that everyone in the room is judging them for their physical defects and remain affected by such experiences long after the effects of marijuana have worn off.

Marijuana also disrupts the effects of SSRIs and other psychiatric medications and its cognitive effects can make it difficult, if not impossible, to progress in CBT during periods of active use. While marijuana use is becoming more socially accepted, it presents specific risks for people with mental health conditions. Like alcohol, its use should be considered in light of its particular effects on the people using it and not simply relative to wider social norms.

Body Dysmorphic Disorder and Stimulants

Stimulant use disorders are less common in people with BDD than alcohol and marijuana use disorders, though they are common enough to warrant attention. About 16 percent of people with BDD have a cocaine use disorder in their lifetime and 11 percent have a lifetime history of misusing other stimulants. These comorbid disorders are cause for special concern, as stimulant drugs are known to exacerbate obsessive thinking, anxiety and paranoia. It is even more likely that a person using stimulants will experience sudden episodes of panic, suspecting others of judging them or having malicious intent toward them.

When people develop a stimulant use disorder, it frequently involves one or more of the following six types of stimulants:

• Cocaine
• MDMA (Ecstasy)
• Amphetamines
• Methamphetamines
• Prescription stimulant drugs like Adderall
• Synthetic stimulant drugs like “bath salts“

All of these drugs have immediate negative effects for people who experience common symptoms of depression, OCD, and BDD, including negative and obsessive thought patterns, compulsive behavior, and feelings of shame or unworthiness.

Treatment for Body Dysmorphic Disorder with Co-Occurring Substance Use Disorders

Both SSRIs and CBT, the two most effective treatments for BDD, can be used in the integrated treatment of co-occurring substance use and mental health disorders. Simultaneous treatment of dual disorders has been linked with positive outcomes for both, including reduced substance use and improved psychiatric functioning.

An analysis by McHugh, Hearon and Otto shows that CBT effectively treats substance use disorders. A combination of individual and group CBT may be especially effective for people with dual disorders. Group formats are common in addiction treatment for several reasons, including the positive effects of peer support and social learning. By helping people learn from one another and understand they are not alone, treatment groups create healing communities and promote sustained recovery.

If you or someone you know is struggling with a substance use disorder and a co-occurring disorder like BDD, help is available. At The Recovery Village, a team of professionals offers a number of treatment programs for addiction and co-occurring disorders. Call and speak with a representative to learn more about which treatment program could work for you or your loved one.

Editor – Jennifer Kopf

Jennifer Kopf is a Florida-based writer who likes to balance creative writing with helpful and informative pieces. Her passion for helping people has translated into writing about the importance of treatment for substance use and mental health disorders. Read more

Medically Reviewed By – Stephanie Hairston, MSW

Stephanie Hairston received her Bachelor of Arts degree in Psychology and English from Pomona College and her Master of Social Work degree from New York University. Read more