OCD patients with body-image worries report more substance use

A Rutgers-led study in Genomic Psychiatry found that people with obsessive-compulsive disorder who also reported body dysmorphic concerns had higher rates of marijuana, illicit drug, tobacco and alcohol use. The findings suggest clinicians should screen for appearance-related symptoms and substance use together, not in isolation.

Why it matters: - People with obsessive-compulsive disorder who also have body dysmorphic concerns may face a higher risk of substance use across multiple categories. - The study suggests appearance-related distress can affect how clinicians assess OCD patients and what they screen for in treatment.

What happened: - A peer-reviewed study in Genomic Psychiatry examined substance use in a large OCD cohort led by corresponding author Michele T. Pato of Rutgers University. - The research used data from the Genomic Psychiatry Cohort's OCD study, a National Institute of Mental Health-funded effort collected from 2014 to 2019. - Researchers recruited participants through online postings, clinic flyers and annual conferences of the International OCD Foundation. - A trained clinician verified each OCD diagnosis. - Of 1,475 people with OCD, 705 reported probable body dysmorphic disorder concerns and 770 did not.

The details: - Probable BDD was identified with one screening question about being excessively concerned with a body part or appearance feature despite reassurance. - Participants with probable BDD reported higher lifetime marijuana use than the OCD-only group, 26.2% versus 15.5%. - Participants with probable BDD reported higher lifetime illicit drug use, 21.4% versus 10.3%. - Tobacco use was also higher in the probable BDD group, at 32.6% versus 24.3%, using a lifetime definition of more than 100 cigarettes or other tobacco. - Possible alcohol dependence on screening questions adapted from the CAGE instrument was higher in the probable BDD group, 20.4% versus 13.9%. - Alcohol severity scores and tobacco severity scores were higher in the probable BDD group, with p-values of 0.0002 and less than 0.0001. - The comorbid group also had more severe OCD symptoms. - On alcohol items, the most common endorsement in the probable BDD group was drinking more than intended or drinking to calm nerves, at 26% versus 17.7% in the OCD-only group. - The authors say that pattern matches earlier work showing some people with BDD use alcohol to cope with appearance-related distress. - The study was funded by the National Institute of Mental Health, and the authors reported no conflicts of interest.

Between the lines: - The findings point to a broad pattern, not a single substance-specific effect, because higher use appeared across marijuana, illicit drugs, tobacco and alcohol. - The association looks meaningful, but the study cannot show whether body-image concerns came before substance use, followed it or developed alongside it. - The sample was volunteer-based and did not include people with BDD alone, which limits how far the results can be generalized. - Probable BDD was based on one screening question, not a full clinical assessment, so the measure is less precise than a diagnostic interview. - The statistical models explained only a modest share of the differences between people, suggesting other factors also shape substance use in OCD.

What's next: - The authors recommend screening OCD patients for BDD and for use of alcohol, tobacco, marijuana and illicit drugs. - They also call for studies that track people over time to better understand how OCD, appearance concerns and substance use interact. - Future research may test whether treating appearance-focused beliefs and behaviors alongside substance use improves outcomes more than treating OCD symptoms alone. - The article, "BDD's impact on substance use in a large OCD cohort," is available open access via the study DOI.

The bottom line: - In this OCD cohort, body-image worries lined up with heavier substance use across every category the researchers measured, making combined screening a practical next step for clinicians.