BDD and Addiction

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?

Preoccupation with appearance
Individuals with BDD are excessively concerned about one or more perceived defects or flaws in their physical appearance. These concerns are often minor or not visible to others.
Repetitive behaviours
People with BDD may engage in repetitive behaviours or rituals in response to their perceived flaws. These can include excessive grooming, checking mirrors, seeking reassurance from others, or comparing themselves to others.
Individuals with BDD may go to great lengths to avoid situations or activities that they believe highlight their perceived defects. This avoidance can interfere with daily functioning and lead to social isolation.
Excessive self-examination
BDD often involves spending significant time examining oneself in mirrors or other reflective surfaces. The scrutiny is focused on the perceived flaw, and individuals may believe that others are as critical as they are about their appearance.
Seeking reassurance
People with BDD frequently seek reassurance from others about their appearance, but the relief is often short-lived, and the preoccupation persists.
Impairment in social or occupational functioning
BDD can significantly impact a person’s ability to engage in social or occupational activities. The preoccupation with appearance can be time-consuming and may lead to difficulties in relationships or at work.
Emotional distress
Individuals with BDD often experience high levels of emotional distress, including anxiety and signs of depression, related to their perceived flaws.

The belief that others notice and negatively judge the perceived defects
Individuals with BDD may be convinced that others are staring at, mocking, or negatively evaluating their appearance, even if the perceived flaws are not noticeable to others.

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?


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:

  • Exercising for extended periods despite physical injury or illness.
  • Prioritising exercise over social, occupational, or family activities.
  • Experiencing distress or anxiety when unable to exercise.
  • A lack of control over the amount or intensity of exercise.
  • Using exercise as a way to cope with stress or negative emotions.
  • 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.

    Individual and group counselling
    Our counselling sessions are designed to address the root causes of addiction and BDD on both individual and group levels. Through personalised sessions, individuals have the space to explore and navigate their emotions. We employ Dialectical Behavioural Therapy (DBT) techniques, equipping individuals with essential emotional regulation skills that are instrumental in effectively managing both BDD and addiction. This approach ensures that the therapeutic process is tailored to the unique needs of each individual.
    Holistic therapies for well-being
    Incorporating holistic therapies like yoga and meditation into our treatment plans contributes to overall well-being. These practices serve to enhance self-awareness, alleviate stress and build emotional resilience. By creating a supportive environment, these holistic approaches become integral components of the comprehensive treatment for BDD and addiction. The emphasis on holistic well-being complements the traditional therapeutic methods, promoting a more balanced and sustainable recovery journey.
    Aftercare for ongoing support
    Aftercare plays a crucial role in providing ongoing support for individuals on their recovery path. Group therapy sessions are a key aftercare component, fostering a sense of community and shared experiences. These sessions serve to reinforce coping strategies, helping individuals manage BDD while staying committed to their recovery. The continuity of care in aftercare is vital for individuals to navigate challenges and sustain the progress made during the treatment phase.

    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.

    Call us now for help

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