By Simay Inci Ipek, BA & Hilary Weingarden, PhD
A large proportion – approximately 30% of people with BDD – develop a substance use disorder in their lifetime, most commonly alcohol or cannabis use disorders. Symptoms of an alcohol or substance use disorder often begin slightly later than BDD symptoms, around age 17-20. Among those with muscle dysmorphia, a subtype of BDD in which a person’s primary worry is that his or her body is not muscular enough, 20 – 46% misuse anabolic-androgenic steroids to increase muscle mass. Overall, alcohol use disorder, substance use disorders, and steroid misuse are more common in BDD patients compared to the general population and more often occur in men than women with BDD.
There are likely various reasons why people with BDD misuse substances at such high rates. One of the most widely described reasons is self-medication – that is, using substances not as prescribed, to temporarily mask or alleviate BDD symptoms. Evidence for self-medication in BDD comes from studies showing that for most people with BDD, symptoms begin approximately 1 year before substance and/or alcohol use begins. The most common reasons for using substances among people with BDD include feeling upset about one’s appearance, wanting to forget about appearance concerns, and wanting to feel more comfortable with one’s appearance. Therefore, oftentimes substance and alcohol use act as coping mechanisms, to relieve BDD symptoms.
Typically, those with comorbid BDD and substance use disorders experience greater impairment in social, work, and school functioning, are more likely to experience suicidal thoughts, and have higher rates of attempted suicide compared to people with BDD without substance use disorders. On the other hand, research has not found differences in BDD, anxiety, or depression severity between people with BDD who do or do not have substance use disorders. Altogether, substance use disorders experienced alongside BDD are related to greater impairment and risks than BDD alone.
For people who are experiencing BDD and an alcohol or substance use disorder, it may be most effective to seek treatment for both sets of symptoms at the same time. This may especially be the case when substance or alcohol use is worsening a person’s BDD symptoms, or vice versa. It is possible that some people with BDD and a substance use disorder might benefit from more intensive types of care, and – as always with BDD – it will be especially important for care providers to monitor and help manage suicide risk in those experiencing both disorders at the same time.