Tripping Towards Self-Love: Psychedelics & Body Dysmorphic Disorder
Body dysmorphic disorder is a growing concern with few treatment options. Could psychedelics open a new door for treatment?
Living in a house of mirrors, those with body dysmorphic disorder (BDD) are held captive by obsessive worry and distorted perceptions of their physical appearance. They spot flaws that remain invisible to the outside world, spiraling into an abyss that's hard to climb back out of.
Despite its crippling trickle-down effects on nearly all facets of life, BDD has been somewhat of a wallflower — often overlooked by mainstream clinical research.
But as the number of individuals suffering from BDD and related body image issues continues to rise every year, isn't it high time we shifted the spotlight?
Let’s take a look into body dysmorphia and the promising new findings coming out of the psychedelic sphere.
Psychedelics & BDD: What We Know So Far
BDD, as well as eating disorders and obsessive-compulsive disorders, are characterized by perfectionist behaviors fueled by inflexible and unhelpful beliefs about one’s image.
Classic psychedelics, such as psilocybin, LSD, and ayahuasca, have the ability to disrupt thought patterns and encourage flexible thinking (for more on this, see our article on the default mode network) — thereby providing possible relief to obsessive thoughts and behavior patterns associated with BDD.
Research in BDD is limited — so it’s no surprise that research on psychedelics for BDD is almost non-existent.
Advocates for BDD research have pointed to the general lack of knowledge in this area and have pushed for psychedelic trials, suggesting work specifically with psilocybin given its wide research in the contemporary psychedelic therapy field.
To date, there have only been a handful of early-stage studies observing the effects of psychedelics in the treatment of BDD.
A recently published pilot study by Schneier and colleagues observed the effects of a single dose of psilocybin in 12 adults who have had no improvements from SSRI treatment. The trials included psychotherapy for the participants before, during, and after the administration.
When the trial concluded, researchers observed significantly lower markers on BDD assessments compared to pre-trial data and observed improvements that persisted 12 weeks after treatment.
There’s anecdotal evidence and some non-experimental qualitative research that points toward the potential of psychedelics to aid the recovery of BDD, but these are more tailored toward eating disorders.
Given the common crossover between the two diagnoses, these findings could help guide further clinical research for BDD.
For example, Lafrance and colleagues observed that people who were battling eating disorders and also had experience with ayahuasca believed their experience helped catalyze their healing and recovery.
Similarly, participants in other studies have reported that ayahuasca supported the spiritual components of their recovery and helped process painful memories that may be at the root of the disorder.
There are a few anecdotes in research articles where people diagnosed with eating disorders have reported significant improvement after experiences with LSD. Additionally, several research proposals hypothesize that 5-Meo-DMT may hold promise for the treatment of BDD.
However, there is no specific clinical research to date that explores the potential of these substances for BDD or subclinical body image issues.
“I believe this theme — love, the need to reconnect with our true selves — addresses the underlying outcome of our psilocybin studies. Yet very often we’re afraid to open ourselves to this connection so we put up barriers and wear masks. If we are able to remove the barriers, to let down our defenses, we can begin to know and accept ourselves, thus allowing ourselves to receive and to give love.”
What is Body Dysmorphic Disorder? The Phantom of Perfection
Body dysmorphic disorder (BDD) is characterized by a strong preoccupation about a perceived flaw in one’s physical appearance. It’s generally focused on a specific aspect like skin, hair, or a feature like one’s nose or smile.
The DSM-V classifies BDD within the category of obsessive-compulsive and related disorders, and it states certain criteria for diagnosing, including:
Preoccupation is about an aspect of physical appearance that outside observers can't see or perceive as mild. (Distorted view of one's appearance).
The preoccupation causes distress that is significant enough to affect social or occupational aspects of life.
Repetitive behaviors (mirror checking, skin picking, or excessive grooming) or obsessive thoughts such as comparison to the appearance of others.
How Common is BBD?
BBD affects nearly 2.4% of the general population. However, this prevalence rises within specific demographics.
For example, BDD can affect over 30% of individuals with obsessive-compulsive disorder (OCD), 13% of people with social anxiety disorder, and up to 42% of those with major depressive disorders.
It's also more common to observe cases of BDD in certain occupational settings, including dermatology and plastic surgery.
Teenagers and young adults of all genders are at the highest risk of developing BDD, with a slightly higher prevalence in women.
Sexual orientation and gender identity may also be a risk factor, especially in younger populations, with gay and bisexual men being more vulnerable to body image issues than straight men and transgender men scoring higher in appearance anxiety assessments.
BDD & Eating Disorders
Although BDD is commonly associated with eating disorders, the two have different diagnostic criteria.
The main difference is that eating disorders have a component of disturbed eating behaviors and compensatory practices (binge eating, restriction, purging, over-exercising, etc.), while BDD does not.
In fact, the DSM-V diagnostic criteria for BDD specify that the preoccupation is "not better explained by concerns with body fat or weight in an individual whose symptoms meet diagnostic criteria for an eating disorder.”
Despite this explicit difference in diagnosis, nearly 40% of those whose primary diagnosis of an eating disorder have BDD as a comorbidity, and for those with BDD as their primary diagnosis, eating disorders have comorbid eating disorders at a prevalence of 31.5%.
In the case of both BDD and eating disorders, especially anorexia nervosa, patients present abnormal visual processing, which supports the maintenance of the distorted view of their appearance and, therefore, further perpetuates the disorder.
Muscle Dysmorphia
Although not an actual diagnosis itself but rather a subgroup of BDD, muscle dysmorphia is a growing concern, especially among men.
The main preoccupation of people with muscle dysmorphia is their belief that they don’t have sufficient or adequate muscularity.
Muscle dysmorphia may overlap with disordered eating behaviors and compulsive exercise. It's most common in athletic circles and fitness environments.
One study reports that 22% of men between 18-24 years old have reported disordered eating patterns due to concerns about muscularity.
The onset of these symptoms tends to occur around the age of 19, which leaves young adult men at higher risk.
How is BDD Currently Treated?
BDD is usually treated with serotonin selective reuptake inhibitors (SSRIs) and psychotherapy — with cognitive behavioral therapy (CBT) being the most common evidence-based modality.
SSRIs
SSRIs are antidepressant medications typically used to treat mood disorders like major depressive disorder and some anxiety disorders. They’ve demonstrated an effectiveness of 40-60% in treating depression but have proven to give even stronger results for BDD, with improvement in symptoms for 63-83% of patients.
Although this is a significant advancement, it still leaves up to 27–37% of cases that need to seek relief elsewhere.
Additionally, it seems like relapse rates for medicated participants, although lower than control groups, were still quite high at 18%, and the risk of relapse increases up to 83% if medication is stopped.
Cognitive Behavioral Therapy (CBT)
CBT is a short-term therapeutic modality that focuses on changing behavior and observing, understanding, and reframing cognitions (thoughts, mental images, and beliefs) that contribute to emotional distress.
CBT uses behavioral experiments to bind behaviors and habits helpful to the patient and techniques such as Socratic questioning to question the helpfulness and accuracy of one’s thoughts and beliefs.
Although there isn't much research observing the efficiency of CBT for BDD compared to other treatments, a few studies have shown it to be significantly more helpful in improving symptoms than other treatment modalities like anxiety management and general supportive therapy.
CBT has also proven to be fairly effective in treating obsessive-compulsive disorder (which shares traits with BDD) — with a symptom improvement rate of 50-70%.
A Call For More Research on Psychedelics & BDD
Despite the large prevalence of BDD, research on the condition and possibilities of treatment is scarce and leaves more questions than answers.
The field requires more research with growing urgency as body image concerns and BDD have been on a steady rise in the past couple of decades — with social media exposure playing a key role.
This is especially true for teenagers and younger adults who are more susceptible to the influence of media exposure and have started to show increased rates of BDD compared to previous generations.
Despite the lack of attention this disorder has gotten, the preliminary studies in psychedelic-assisted options show some promise that could guide further research.
Hopefully, the growing concern for BDD and these initial findings will propel the field of psychedelics into further exploration of recovery and healing possibilities.
Further Reading
How to Know if You Have Body Dysmorphic Disorder (YouTube Short by Dr. Tracey Marks)
How Psilocybin Can Rewire the Brain (Andrew Huberman)
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