Substance Use Disorders in Individuals With Body Dysmorphic Disorder Jon E. Grant, J.D., M.D., William Menard, B.A., Maria E. Pagano, Ph.D., Christina Fay, B.A., and Katharine A. Phillips, M.D. Butler Hospital and the Department of Psychiatry and Human Behavior, Brown Medical School, Providence, R.I. Abstract Background—Little is known about substance use disorders (SUDs) in individuals with body dysmorphic disorder (BDD). Although studies have examined SUD comorbidity in BDD, no previous studies have examined clinical correlates of SUD comorbidity. Method—We examined rates and clinical correlates of comorbid SUDs in 176 consecutive subjects with DSM-IV BDD (71% female; mean ± SD age = 32.5 ± 12.3 years). Comorbidity data were obtained with the Structured Clinical Interview for DSM-IV. BDD severity was assessed with the Yale-Brown Obsessive Compulsive Scale Modified for BDD, and delusionality (insight) was assessed with the Brown Assessment of Beliefs Scale. Quality of life and social/occupational functioning were examined using the Social Adjustment Scale, Quality of Life Enjoyment and Satisfaction Questionnaire, Medical Outcomes Study 36-Item Short-Form Health Survey, and Range of Impaired Functioning Tool. All variables were compared in BDD subjects with and without lifetime and current SUDs. Data were collected from January 2001 to June 2003. Results—48.9% of BDD subjects (N = 86) had a lifetime SUD, 29.5% had lifetime substance abuse, and 35.8% had lifetime substance dependence (most commonly, alcohol dependence [29.0%]). 17% (N = 30) had current substance abuse or dependence (9.1 % reported current substance abuse, and 9.7% reported current dependence). 68% of subjects with a lifetime SUD reported that BDD contributed to their SUD. There were far more similarities than differences between subjects with a comorbid SUD and those without an SUD, although those with a lifetime SUD had a significantly higher rate of suicide attempts (p = .004). Conclusion—These preliminary results suggest that SUDs are very common in individuals with BDD. Subjects with and without a comorbid SUD were similar in most domains that were examined. Body dysmorphic disorder (BDD), a distressing and/or impairing preoccupation with an imagined or slight defect in appearance, 1 is characterized by intrusive thoughts about perceived defects in appearance and repetitive, ritualistic behaviors such as mirror checking and reassurance seeking. 2,3 BDD may be both socially and occupationally incapacitating. 2 Although the disorder was once considered rare, recent evidence suggests that the lifetime prevalence of BDD in the general population may be 1% to 2%. 4 Research on BDD has increased in the past decade, but relatively little attention has been paid to substance use disorders (SUDs) in this population. To our knowledge, only a few studies Corresponding author and reprints: Jon E. Grant, J.D., M.D., Butler Hospital, 345 Blackstone Blvd., Providence, RI 02906 (e-mail: Jon_Grant@brown.edu).. Disclosure of off-label usage: The authors have determined that, to the best of their knowledge, no investigational information about pharmaceutical agents that is outside U.S. Food and Drug Administration-approved labeling has been presented in this article. NIH Public Access Author Manuscript J Clin Psychiatry. Author manuscript; available in PMC 2008 August 10. Published in final edited form as: J Clin Psychiatry. 2005 March ; 66(3): 309–405. NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript