Body Dysmorphic Disorder and Risperidone Abuse: Exploiting Hyperprolactinemia

This case report describes a 16-year-old female with body dysmorphic disorder (BDD), tics, and social withdrawal who intentionally abused risperidone to exploit its hyperprolactinemia-induced breast enlargement, perceiving it as beneficial to her body image. Initial treatment with sertraline improved social withdrawal; however, adjunctive risperidone (0.5 mg/day) reduced tics and BDD symptoms. Elevated prolactin levels (44.85 ng/mL) triggered breast enlargement, galactorrhea, and secondary amenorrhea. The patient continued risperidone despite medical advice to discontinue it. Switching to aripiprazole normalized prolactin levels (9.13 ng/mL) and resolved the side effects, with sustained symptom control at 3-month follow-up. This case highlights the risk of antipsychotic side effects reinforcing BDD pathology and adolescents' vulnerability to medication abuse when somatic changes align with dysmorphic goals. To the best of our knowledge, this is the first report of deliberate risperidone abuse for cosmetic hyperprolactinemia in BDD. Clinicians must monitor prolactin levels, prioritize prolactin-sparing agents (e.g., aripiprazole), and consider how adverse effects may perpetuate body image disturbances in adolescents.