BDD and Addiction
Last Updated:
January 16th, 2024
There is a common misconception that individuals with Body Dysmorphic Disorder (BDD) are merely preoccupied with vanity or are excessively concerned with their looks. This oversimplification can lead to a misunderstanding of the complexity of BDD and may contribute to the stigma surrounding mental health issues. Unsurprisingly, addiction is also commonly linked to those with BDD, underscoring the need for a closer examination of this relationship.
What is BDD?
BDD is a mental health condition characterised by a preoccupation with perceived flaws or defects in physical appearance that are not observable or appear minor to others. Individuals with BDD are excessively concerned about their appearance, so much so that it can impact negatively on the individual’s quality of life.
Individuals with BDD often exhibit signs of depression, such as persistent sadness, social withdrawal and low self-esteem. The obsessive focus on perceived flaws in appearance can contribute to a cycle of negative thoughts.
BDD is categorised within the obsessive-compulsive and related disorders section of the DSM-5, highlighting its connection with obsessive-compulsive behaviours.
What are the main BDD symptoms?
What are the causes of BDD?
The exact causes of BDD are not fully understood, but a combination of biological, psychological and environmental factors may contribute. Here are some potential causes or risk factors associated with BDD:
- Genetic factors: There may be a genetic predisposition to BDD, as individuals with a family history of obsessive-compulsive disorder (OCD) or BDD may be more susceptible.
- Neurotransmitters: Imbalances in neurotransmitters, such as serotonin, have been implicated in BDD. These imbalances can affect mood, anxiety and perception. It is worth noting that some researchers have stated that the link between serotonin and BDD is complex and needs to be fully understood.
- Childhood abuse: Childhood abuse, whether it be physical, emotional, or sexual, can be considered a significant environmental factor that may contribute to the development of BDD. Traumatic experiences during childhood can have a lasting impact on an individual’s mental health and self-perception. In the context of BDD, childhood abuse may contribute to distorted beliefs about one’s appearance, low self-esteem and heightened sensitivity to criticism or negative social evaluations.
- Personality traits: Certain personality traits may increase the vulnerability to BDD. Research suggests that individuals with BDD usually show signs of perfectionism, high levels of neuroticism and low extraversion.
- Neurocognitive functioning: Distorted thinking patterns, including cognitive biases and irrational beliefs about appearance, contribute to the maintenance of BDD symptoms. Individuals with BDD often have difficulties in accurately perceiving their appearance.
- Being bullied/teased: Experiencing negative events related to appearance, such as bullying or teasing, can contribute to the development of BDD. When a person links negative feelings about their appearance to how others react, these thoughts and emotions can persist and potentially lead to symptoms of BDD during everyday interactions and experiences.
Does BDD and addiction co-occur?
SUD and BDD
In an attempt to self-medicate or cope with these distressing emotions, individuals with BDD may turn to substances, leading to the development of a Substance Use Disorder (SUD). The use of drugs or alcohol may provide temporary relief from the psychological distress associated with BDD, creating a cycle of dependence.
An old study involving 86 individuals with BDD revealed significant associations with substance use disorders (SUD). Nearly half (48.9%) of the subjects had a lifetime SUD, with 29.5% reporting substance abuse and 35.8% reporting substance dependence, predominantly alcohol dependence (29.0%).
Worryingly, 17% exhibited current substance abuse or dependence, with 9.1% reporting ongoing substance abuse and 9.7% reporting current dependence.
One of the most interesting parts of the study showed that 68% of those with a lifetime SUD attributed BDD as a contributing factor to their substance use issues, suggesting a complex interplay between the two conditions.
Behavioural addiction and BDD
While there are links between substance abuse and BDD, emerging research suggests that those with BDD may be more likely to show signs of behavioural addictions, such as exercise addiction.
Exercise addiction refers to a compulsive engagement in physical activity that goes beyond the point of health and becomes harmful. It involves a persistent desire to exercise, even with negative consequences.
Someone with exercise addiction may show the following symptoms:
Given a preoccupation with appearance, repetitive behaviours and excessive self-examination as some of the key signs of BDD, it’s not surprising that many reports suggest a link between exercise addiction and BDD.
One study found a high risk of exercise addiction, appearance anxiety and BDD amongst international gym users. Researchers also found that 11.7% were above the ‘cut off’ for exercise addiction, with the people from the Netherlands and the UK showing alarming peaks. 38.5% of those with exercise addiction were found at risk of BDD.
Some individuals with BDD may also turn to behaviours such as cosmetic procedures, excessive grooming, or other rituals in an attempt to alleviate their distress or fix perceived flaws. This can create a cycle of compulsive behaviours and reinforce the negative impact of BDD on an individual’s well-being.
BDD and addiction treatment options
Due to BDD being classed as a form of OCD, treatment approaches for BDD often parallel those used for OCD, involving behavioural therapies and, in some cases, medication to address compulsive behaviours and improve overall mental well-being.
Addressing both BDD and addiction as dual challenges can significantly enhance overall success.
While UKAT doesn’t offer a specific rehab programme tailored for BDD, many of our addiction treatment methods are applicable and beneficial for individuals dealing with both BDD and addiction.
What are the next steps?
If you’re currently facing the difficult task of managing BDD and addiction, remember that there’s never a bad time to start your journey to recovery. At UKAT, we understand the challenges that come with dealing with addiction and BDD, and want to let you know that we’re here to help. Contact us today for assistance and access to effective treatment for a dual diagnosis of BDD and addiction.
(Click here to see works cited)
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- Corazza O, Simonato P, Demetrovics Z, et al. The emergence of Exercise Addiction, Body Dysmorphic Disorder and other image-related psychopathological correlates in fitness settings: A cross sectional study. PLoS One. 2019;14(4):e0213060. Published 2019 Apr 3. doi:10.1371/journal.pone.0213060
