BDD and Addiction | Links, Symptoms and Treatment

Body Dysmorphic Disorder (BDD) is a mental health condition where individuals obsess over perceived flaws in their appearance, which are often minor or unnoticeable to others. This intense preoccupation usually starts in adolescence, a pivotal time for self-image development and can cause significant emotional distress.

BDD is recognised as a genuine and serious disorder, officially listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), highlighting its legitimacy and the importance of professional treatment.

The NHS recognises that around 1-2 people in every 100 have BDD in the UK, with gender not being a factor.

What are the signs of BDD?

Understanding the exact causes of BDD is still a work in progress, but a combination of biological, psychological and environmental factors plays a role. Here are some potential causes or risk factors associated with BDD:

Excessive grooming: Spending a lot of time fixing or hiding perceived flaws.
Frequent mirror checking: Constantly look in mirrors or avoid them altogether.
Seeking reassurance: Frequently asking others for their opinion on their appearance.
Avoiding social situations: Staying away from events due to self-consciousness.
Comparing appearance: Continuously comparing themselves to others.
Camouflaging: Using makeup, clothing or accessories to cover perceived flaws.
Skin picking: Engaging in behaviours like picking at skin to fix flaws.
Obsessive behaviours: Performing repetitive actions or routines related to appearance.
Distress or impairment: Experiencing significant anxiety or problems in daily functioning due to appearance concerns.

What are the causes of BDD?

Neurocognitive functioning: People with BDD often have distorted thinking patterns, including cognitive biases and irrational beliefs about their appearance. This makes it hard for them to accurately perceive their own looks.
Genetic factors: There might be a genetic predisposition to BDD, especially if there’s a family history of obsessive-compulsive disorder (OCD) or BDD itself. This suggests a hereditary component that could increase susceptibility.

Bullying and teasing: Negative experiences related to appearance, such as bullying or teasing, could significantly contribute to BDD. These experiences can cause lasting negative feelings about one’s appearance, which may persist and manifest as BDD symptoms in daily life.
Childhood abuse: Physical, emotional or sexual abuse during childhood can be a significant environmental factor contributing to BDD. Such traumatic experiences can deeply affect mental health and self-perception, leading to distorted beliefs about one’s appearance, low self-esteem and increased sensitivity to criticism or negative social evaluations.

Is there a link between BDD and addiction?

Research indicates that addiction is significantly more common among individuals with BDD than those without.

30%–50% of people with BDD have experienced a substance use disorder, with nearly 70% attributing their substance use to the distress caused by BDD. This suggests that many turn to substances as a way to cope with the intense emotional pain and negative body image associated with BDD.

Studies have also suggested that behavioural addictions are also present in those with BDD. For example, A study revealed a significant risk of exercise addiction, appearance anxiety and body dysmorphic disorder (BDD) among international gym-goers. The research indicated that 11.7% of participants exceeded the threshold for exercise addiction, with particularly high levels observed in the Netherlands and the UK. Additionally, 38.5% of those identified with exercise addiction were also at risk of BDD.

These findings underscore the critical need for integrated treatment approaches that address both BDD and substance use disorders to support individuals in overcoming these challenges and improving their quality of life.

Surgery

What is a dual diagnosis?

A dual diagnosis means a person is dealing with both a mental health disorder and a substance use disorder at the same time. This can be quite complex because each condition can worsen the other. To effectively recover, it’s often necessary to use integrated treatment approaches that address both the mental health and substance use issues together.

When addiction is combined with BDD, the situation becomes even more challenging. The distress and anxiety from BDD might lead someone to use substances to cope, which in turn can make BDD symptoms worse. This creates a vicious cycle where the person becomes more preoccupied with their appearance and more anxious. To effectively treat this dual diagnosis, a comprehensive approach is needed to address both the addiction and the underlying BDD.

How is BDD and addiction treated at Linwood House?

At Linwood House, we don’t specifically treat BDD. However, when there’s a dual diagnosis of BDD and addiction, many of the therapies and recovery techniques used for addiction can positively impact BDD. Our comprehensive approach addresses both conditions, promoting holistic healing and long-term recovery.

Detox

The first step in treating addiction is detoxification. At Linwood House, we provide a medically monitored detox to ensure safety and comfort. This process helps the body rid itself of harmful substances, laying the groundwork for further treatment. While detox focuses on addiction, the supportive environment can also alleviate some of the distressing symptoms of BDD.

Therapies

Dialectical Behaviour Therapy (DBT): DBT combines cognitive-behavioural techniques with mindfulness practices. It’s particularly effective for those struggling with intense emotions and self-destructive behaviours, which are common in both addiction and BDD. DBT teaches skills like emotional regulation and distress tolerance, aiding recovery.
One-on-one Counselling: Personalised counselling sessions provide a safe space to explore the underlying issues contributing to addiction and BDD. Our experienced therapists work closely with patients to develop tailored treatment plans, ensuring that both conditions are addressed comprehensively.
Holistic Therapies: We believe in a holistic approach to treatment, incorporating therapies such as yoga, meditation and art therapy. These practices promote overall well-being, reduce stress and help patients connect with themselves on a deeper level. Such therapies can significantly enhance the recovery process for both addiction and BDD.

Aftercare

Recovery doesn’t end after the initial treatment. At Linwood House, we offer a robust aftercare programme to support long-term sobriety and mental health. This includes ongoing therapy sessions and relapse prevention planning. By maintaining these connections, you can continue to manage both your addiction and BDD effectively.

What are the next steps?

If you or a loved one is struggling with a dual diagnosis of addiction and BDD, Linwood House is here to help. Our comprehensive programme is designed to address both issues, providing the support and treatment necessary for effective recovery. Take the first step towards healing by contacting Linwood House today to learn more about our integrated treatment options and start your journey to a healthier, happier life.

Frequently asked questions

Is BDD considered an eating disorder?

Body Dysmorphic Disorder (BDD) is not classified as an eating disorder, but it often co-occurs with eating disorders. BDD involves an obsession with perceived flaws in physical appearance, which can lead to unhealthy behaviours related to weight and body image. However, its primary focus is on body image dissatisfaction rather than eating behaviours alone.

How can I get diagnosed for BDD?

To get diagnosed with BDD, you should consult a mental health professional, such as a psychologist or psychiatrist. They will conduct a thorough assessment, which may include interviews about your symptoms, feelings about your appearance, and any related behaviours. Self-reported questionnaires may also be used to aid in the diagnosis.

What are common subtypes of BDD?

Common subtypes of BDD include:

Muscle Dysmorphia: Preoccupation with perceived lack of muscle size or definition.
Skin Dysmorphia: Excessive concern about skin flaws, such as acne, scarring, or ageing.
Facial Dysmorphia: Focus on perceived defects in facial features, leading to distress or avoidance of social situations.

Each subtype can influence how individuals experience and cope with BDD.

(Click here to see works cited)

“NHS BDD.” NHS Choices, NHS, slam.nhs.uk/body-dysmorphic-disorder. Accessed 25 June 2024.
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Feusner, Jamie D, et al. “What Causes BDD: Research Findings and a Proposed Model.” Psychiatric Annals, U.S. National Library of Medicine, 1 July 2010, www.ncbi.nlm.nih.gov/pmc/articles/PMC3859614/.
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Corazza O, Simonato P, Demetrovics Z, Mooney R, van de Ven K, Roman-Urrestarazu A, Rácmolnár L, De Luca I, Cinosi E, Santacroce R, Marini M, Wellsted D, Sullivan K, Bersani G, Martinotti G. The emergence of Exercise Addiction, Body Dysmorphic Disorder, and other image-related psychopathological correlates in fitness settings: A cross sectional study. PLoS One. 2019 Apr 3;14(4):e0213060. doi: 10.1371/journal.pone.0213060. PMID: 30943200; PMCID: PMC6447162.