It’s not uncommon for people to use drugs and alcohol as a way to cope with how they feel. Less known, and even less understood, is that sometimes people use drugs because of how they look. Research has discovered a strong correlation between body dysmorphia and addiction. While only 3.8% of Americans have a substance abuse disorder, one study found that 49% of people with body dysmorphic disorder also had a SUD — a frequency that’s nearly 13 times higher than the general U.S. population. 

What is body dysmorphia? 

Body dysmorphic disorder (BDD), also known as dysmorphophobia, is a severe psychiatric mental health disorder. It’s characterized by persistent negative thoughts about one’s appearance and is estimated to affect 1-2% of Americans.

The behavior of an individual with BDD is difficult to control and may be compulsive, similar to that of a person with OCD (obsessive-compulsive disorder), and often includes:

  • Constantly checking mirrors
  • Comparing themselves to others
  • Excessive grooming
  • Frequent outfit changes
  • Skin picking
  • Reassurance seeking
  • Eating disorders

These thoughts about their flaws, either real or imagined, makes individuals excessively self-conscious, resulting in severe emotional distress that interferes with normal daily functioning such as going to work or school, or participating in social activities. 

Body dysmorphia causes

Science has yet to discover the precise cause of body dysmorphia. Currently, the cause does not appear to be a single factor that’s the culprit, but several which can be both environmental and biological. Possible risk factors for BDD include:

  • Having blood relatives with BDD or OCD
  • Bullying, neglect, or abuse
  • Personality traits like perfectionism
  • Societal pressure
  • Mental illness (i.e. anxiety or depression)
  • Low self-esteem

Body dysmorphia and drug use

At the core of the correlation between body dysmorphia and addiction is the well-established understanding that mental illness of any kind, including BDD, can increase a person’s risk of experimenting with drugs. People suffering from a mental illness, especially those who are undiagnosed, often turn to alcohol and narcotics to self-medicate and find temporary relief from their distress. Not only does this not resolve the greater issue, but can often make their BDD symptoms worse, creating a vicious cycle.

The emotional state of people with body dysmorphia bears a striking overlap with that of people who abuse drugs. Often there is frustration, shame, or embarrassment for either condition. In addition to fueling the perceived need for more drugs, these feelings often prevent individuals from seeking help for either condition.

However, self-medication alone isn’t the only reason for the intersectionality of these two disorders. Sometimes individuals with BDD use drugs to change their bodies. Cocaine is a popular drug of choice for those with body dysmorphia because of its appetite-suppressing properties which can lead to extreme weight loss. 

Steroids are another example. These along with growth hormones are commonly abused by those with muscle dysmorphic disorder (a subset of BDD), to increase muscle growth.

Further proof of how closely the causes of body dysmorphia and addiction are is that both conditions can be helped with similar treatments. 

Treating body dysmorphic disorder and addiction

Body dysmorphic disorder and addiction are an example of comorbid or co-occurring disorders; where each disorder can cause and worsen the other. Regardless of which one was first, successful treatment will need to recognize how BDD and drugs can play into one another and will target both conditions simultaneously. 


Cognitive behavioral therapy (CBT) is one of the most widely used therapy modalities used in modern mental health and addiction treatment. A specialized form of psychotherapy, CBT helps to undo negative thoughts and behavioral patterns, provide self-awareness of a person’s negative patterns and replace them with healthy coping mechanisms. This can be applied to both addiction and body dysmorphia. 


Currently, there are no medications to treat body dysmorphic disorder specifically. However, medications used to treat other mental illnesses can be highly effective. SSRIs (selective serotonin reuptake inhibitors) can help if the BDD is primarily caused by serotonin imbalances. These are more effective in treating body dysmorphia than other types of antidepressants. 

Lifestyle changes

Both BDD and addiction are challenging conditions to control, but ones that can successfully be managed with strategic lifestyle adjustments. 

General healthy activities like abstaining from drugs and alcohol, exercising regularly, or journaling or meditating can lower stress, making it easier to avoid falling back into a harmful cycle. If a person is working with a therapist, they’ll learn how to recognize the warning signs that might trigger a relapse and develop strategies to overcome those feelings. 

If you or a loved one is struggling with body image, talk to a mental health professional today.