New research shows that tanning may be linked to psychiatric conditions like obsessive-compulsive disorder (OCD) and body dysmorphic disorder (BDD), offering a more complex explanation of the habit that can cause skin cancer and other dermatological complications.

With new regulation restricting the use of tanning beds among minors, a beauty ideal moving away from artificial tans, and New Jersey’s infamous “Tanning Mom” out of rehab, America appears to be losing interest in UV-light booths. Why, then, are patients still reporting complications associated with excessive tanning? Dr. Erin Bonar and doctoral candidate Lisham Ashrafioun have an idea.

"While more research is needed regarding the idea of tanning as an addiction, this study suggests that some people who tan also experience mental health symptoms that warrant further assessment," Bonar said in a press release. "Although tanning behavior could be separate and distinct from these concerns, it's possible that the symptoms of OCD or BDD are contributing to the tanning in some way. For these people, prevention messages and public health campaigns may not be as helpful, but further assessment and treatment could be."

While most are familiar with the recurrent obsessive thoughts of OCD, fewer may be acquainted with BDD. Put simply, BDD is the inability to acquiesce in the fact that your own view of yourself is very different from what other people see. For this reason, people with BDD can’t stop thinking about slight or imagined imperfections they perceive in mirrors and photos of themselves. It affects about one percent of the population and is, by many accounts, hell.

The new study, which is published in the Journal of the American Academy of Dermatology, surveyed 533 students at Bowling Green State University who met the criteria for regular tanning. Thirty-one percent of participants were considered to display tanning dependence, and 12 percent showed signs of problematic tanning. The researchers then compared tanning habits with psychiatric problems in the sample.

They found that both BDD and OCD corresponded to excessive tanning. While BDD appeared to be linked to tanning dependence, OCD was more closely related to problematic tanning. According to Ashrafioun, this would help explain why some many young adults keep tanning in the face of regulation and public health advisories.

"It may be that some individuals in our sample engage in excessive tanning because of obsessive thoughts about, or the compulsion to tan, or because tanning is a strategy for relaxation to decrease OCD symptoms," Ashrafioun told reporters. "If problem tanning is conceptualized as an addictive disorder, obsessions and compulsions about tanning may instead represent craving to tan."

Tanning Causes Skin Cancer — But What Causes Tanning?

According to the National Institutes of Health, skin cancer is the most common form of cancer in the U.S. While everyone is susceptible to the disease, risk factors include too much time in the sun, light skin, and a history of cancer. It is estimated that indoor tanners are nearly twice as likely to develop the disease compared to people who have never used a tanning bed.

"Previously, clinicians educated patients on the harms of tanning,” Ashrafioun told reporters. “It's probably more than that — most people know there are harms, but they continue to do it. We need to be more focused on intervention than just telling people it's bad for them.”

Source: Ashrafioun L, Bonar E. Tanning addiction and psychopathology: Further evidence of anxiety disorders and substance abuse. Journal of the American Academy of Dermatology. 2014.