In a short story written by Nathaniel Hawthorne called “The Birthmark,” a scientist is married to a lovely woman who has the tiniest of red marks on her cheek. The man notices this flaw right away, and he spends the rest of the story attempting to remove that stain from the face of the woman he loves. In the end, he succeeds, but he kills his fair bride in the process. Most literature students are encouraged to think of this tale as an allegory about science and nature, and the futility of man’s attempts to control the world around them. Mental health professionals, on the other hand, might recognize aspects of their clients as they read this tale.
People with body dysmorphic disorder develop their own fixations about some part of their appearance, and they become desperate to change the way they look.
In a sense, they become both the bride and the scientist of Hawthorne’s story, taking any step they can think of to make their bodies perfect. They may even use and abuse very dangerous substances as part of their harmful quest.
Deceit in the Mirror
Anyone can pick on a flaw they see in the mirror, and it’s common for people to develop a persistent belief that they’re not quite up to par in some way. People who are overweight might be self-conscious about their appearance, for example, while people with persistent acne might know that their skin has flaws others can see. While people with body dysmorphic disorder (BDD) might also choose to fixate on some portion of their appearance that sets them apart from universally recognized standards of beauty, they might also look in the mirror and see things that others just don’t see.
They might exaggerate by using words like “monstrous,” “hideous” or “deformed” to describe some part of their body, including:
- Facial features, like the nose or the eyes
To people with BDD, these attributes are just so disgusting that they simply must be hidden. They may apply makeup repeatedly, trying to hide the blemish. They may comb and style their hair, trying to hide the issue from view. Clothes, including hats and gloves, might also be put to the test as people try to hide their bodies from sight. According to an article in the journal World Psychiatry, people with BDD spend an average of three to eight hours each and every day on these behaviors, and they may not get any relief from any tactic they try.
A Dangerous Solution
In the hopes of improving their bodies, people with body dysmorphic disorder may begin to lean on very dangerous drugs, and they may develop addictions in the process. The path to addiction might look similar in most people who have BDD, but the drugs people use during the course of the disease might be very different.
According to the Harvard Medical School, men who develop BDD often focus on weight and muscle size. They may become convinced that they’re too small for their age or for their height, and they may begin to spend hours and hours in the gym, hoping to bulk up to a size they think is appropriate. Unfortunately, the disorder prevents these men from ever feeling as though they’ve developed an adequate amount of muscle, so no matter how much they might work and train, they might feel as though they’re still much too small. These men may turn to steroids, hoping to jumpstart their workouts and put down intense amounts of muscle in a short period of time. Anabolic steroids have been associated with intense addictions that form in an incredibly short period of time, and people with BDD may find this out in no time at all.
While women can also develop body dysmorphic disorder symptoms relating to their muscles, they may also develop preoccupations with their weight and with the size of specific parts of their bodies. These women may choose to dabble in the use and abuse of stimulant drugs, as these substances can reduce the appetite and allow people to skip meals without feeling either hungry or deprived. Women who want to slim down due to BDD may find out, however, that stimulants can also leave chemical damage behind, even when the person feels sober and normal once more. That chemical damage can lead to compulsive use and abuse of drugs. Women like this may not be able to control how much of the drug they take, and they may not be able to stop taking drugs once they have started.
Drugs might be attractive for them as well, as many addictive drugs play directly on the reward center of the brain. As soon as these drugs attach to their receptors, they begin to trigger a series of chemical reactions that can prompt the release of chemicals associated with pleasure or even outright joy. People with body dysmorphic disorder may find that the joy they experience with a hit of drugs allows them to forget their bodily concerns, if only for a moment, and they may return to drugs each time their thoughts become too distressing.
In all of these situations, the mental illness works as a trigger for drug abuse. As soon as the mental illness begins to impact the person, that person has some prompt that could lead him or her to pick up a needle, swallow a pill or pour out a drink. Dealing with only the addiction, while leaving the mental illness in place, could lead directly to a relapse, as that prompt to use might still be in place. Similarly, leaving the addiction in place while treating only the mental illness could also lead to disaster, as the person might continue to wreck the body and ravage the mind due to a chemical dependence on those drugs. The best way to help involves providing care for both the addiction and the mental illness, and that help must be provided at the same time by the same treatment team.
Dual Diagnosis Assistance
It’s remarkably common for people with body dysmorphic disorder to have a substance use and abuse disorder. In fact, in a study of the issue published in the Journal of Clinical Psychiatry, researchers found that almost half of all people who had BDD had some sort of substance use disorder at one time in their lives. Even so, it’s not a given that a treatment program for BDD will provide care for substance abuse and vice versa. In the past, it was assumed that substance abuse disorders would disappear when the mental illness was amended, and as a result, the illness was sometimes ignored. Now, experts know that BDD really benefits from a Dual Diagnosis approach when a substance abuse disorder is also in play.
In a program like this, experts attempt to determine the severity of both the BDD and the addiction. Interviews, blood tests, physical exams, urine tests and psychological screenings might all play a role in this process. With this information, experts can pull together the proper program that can help the person to improve. Often, however, the treatment program can’t be put into place until the person goes through the detoxification process. Here, the person’s body adjusts to the lack of drugs in a controlled environment, ensuring that the transition takes place with no serious medical problems taking hold in the interim. Once this process is complete, the person’s mind will be clear and free of drugs, and the real healing can begin.
Therapy sessions for BDD and addiction can take many forms, but therapists often consider using these techniques to help their clients:
- Challenging assumptionsHere, clients are asked to really think about their beliefs concerning their appearance. Often, this means combatting all-or-nothing thinking patterns or the persistent opinion that physical beauty relates to psychological worth.
- Thought acceptance. People with BDD sometimes become so distressed by their thoughts that they simply can’t move forward. In this technique, people are encouraged to think of their distressing thoughts as clouds passing in front of the sun, in that they are something to comment on, but they can’t be changed, and shouldn’t be acted upon.
- Trigger identification. BDD thoughts and drug-taking behaviors often stem from specific people, places and things. When people understand the conditions that encourage them to behave badly, they can learn to avoid these situations.
- Increased exposure. Here, clients are encouraged to describe other parts of their appearance or walk in front of a mirror without looking inside at all. They might find that their thoughts about their least favorite body part might fade with each additional exposure.
Medications might also play a role in the treatment of body dysmorphic disorder, as some antidepressant medications can help to correct chemical imbalances in the brain and allow people to move past their destructive thoughts and dangerous behaviors without acting upon them in any way. People with addictive pasts might need to be monitored closely, however, as they might be tempted to take their drugs on an unusual schedule or augment their drug use with other substances that could cause them harm. This is an issue specialists keep well in mind as therapy progresses.
Who Is Affected?
Reading about BDD and substance abuse can be frightening, and some people might develop concerns about the people they love after reading an article like this. Does that statement from a girlfriend about her hips merit a BDD diagnosis? Does a boy who spends time at the gym have a real problem that should be addressed? These are questions that only qualified therapists can answer, but there is some reason to relax.
The Anxiety and Depression Association of America reports that BDD is relatively rare, impacting about one percent of the population. However, the behaviors that are attributed to body dysmorphic disorder can also be part of the spectrum of illnesses such as obsessive-compulsive disorder, eating disorders or anxiety disorders, and these are much more common. When someone’s behavior seems to be causing them distress and when that person seems tempted to medicate with drugs, it’s always best to be proactive and get the person help.
If you’d like to talk through your options or find out more about how Dual Diagnosis treatment might help someone you love, please call us. We have trained experts on hand who are willing to answer your questions, and all of our calls are kept completely confidential. Please call.
David W. Newton is a board certified pharmacist and also has been a board member for boards of examiners for the National Association of Boards of Pharmacy since 1983. His areas of expertise are primarily pharmaceuticals as well as cannabinoids. You can read an article about his expertise in CBD on the National Library of Medicine.