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Virgili G, Neill E, Enticott P, Castle D, Rossell SL. A systematic review of visual processing in body dysmorphic disorder (BDD). Psychiatry Res 2024; 339:116013. [PMID: 38924902 DOI: 10.1016/j.psychres.2024.116013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 05/06/2024] [Accepted: 06/03/2024] [Indexed: 06/28/2024]
Abstract
To understand the visual preponderance of perceived flaws in appearance in body dysmorphic disorder (BDD), the study of visual processing has been growing. Studies have focused on facial and other basic visual stimuli. The current literature does not provide evidence of consistent behavioural patterns, lacking an overarching body of work describing visual processing in BDD. This systematic review aims to characterise behavioural outcomes of visual processing anomalies and/or deficits in BDD. Articles were collected through online databases MEDLINE and PubMed, and were included if they comprised a clinical BDD group, and were published after 1990. Results indicate that individuals with BDD demonstrate deficits in emotional face processing, a possible overreliance on detail processing, aberrant eye-scanning behaviours, and a tendency to overvalue attractiveness. While findings consistently signal towards visual deficits in BDD, there is lack of clarity as to the type. This inconsistency may be attributed to heterogeneity within BDD samples and differences in experimental design (i.e., stimuli, tasks, conditions). There are difficulties distinguishing between BDD-associated deficits and those associated with OCD or eating disorders. A coherent framework, including sample characterisation and task design will seek to generate clear and consistent behavioural patterns to guide future treatments.
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Affiliation(s)
- Gemma Virgili
- Centre for Mental Health, Faculty of Health, Arts & Design, Swinburne University of Technology, Hawthorn, VIC, Australia.
| | - Erica Neill
- Centre for Mental Health, Faculty of Health, Arts & Design, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Peter Enticott
- Cognitive Neuroscience Unit, Faculty of Health, Deakin University, Burwood, VIC, Australia
| | | | - Susan Lee Rossell
- Centre for Mental Health, Faculty of Health, Arts & Design, Swinburne University of Technology, Hawthorn, VIC, Australia
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2
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Loizou P, Panagiotou G, Zanos P, Paraskevopoulos E. Exploring the neurofunctional impairments and cognitive biases concerning food and body related stimuli in anorexia nervosa: An integrated EEG and eye-tracking study protocol. PLoS One 2024; 19:e0299529. [PMID: 38547188 PMCID: PMC10977685 DOI: 10.1371/journal.pone.0299529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 02/13/2024] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Patients with Anorexia Nervosa (AN) exhibit significant cognitive and neural disturbances compared to healthy individuals when processing food and body-related stimuli. These disturbances not only contribute to the manifestation and chronification of their pathological eating behaviour but also underscore the complex interplay of cognitive, emotional, and neurobiological factors in AN. However, the precise underlying cognitive and neural mechanisms of these disturbances remain a compelling area of investigation. METHODS This study presents a protocol developed for conducting a cross-sectional quasi-experimental study using a mixed model ANOVA approach with a crossover design. Our participants will consist of 20 patients with an active diagnosis of AN, 20 Overweight/obese individuals, and 20 Healthy Controls (HCs) with a normal BMI. An integrated eye-tracking and EEG methodology will be used in conjunction, with the primary aim of assessing participants' cognitive and neural processing towards high and low-calorie food stimuli. On an exploratory level, by utilizing the same methods, the present study will also investigate AN patients' responses towards high weight, normal weight, low weight, and self-body pictures, as well as towards images from the International Affective Picture System (IAPS) characterized by elevated valence and arousal levels. Additionally, behavioural methods such as yes or no questions, and self-reported questionnaires will be administered. The EEG and eye-tracking data will be analysed at early (50-300 ms) and late (350-500 ms) time intervals. DISCUSSION The investigation of the underlying cognitive and neural processes employed by patients with AN during the processing of food and body-related stimuli can help us develop a better understanding of the cognitive and neural mechanisms that contribute to the manifestation and maintenance of the disorder and assist in the development of more effective screening methods. ETHICAL APPROVAL AND CONSENT TO PARTICIPATE Ethical approval for the study has been obtained by the Cyprus National Bioethics Committee on 27.04.2023 (ΕΕΒΚ/ΕΠ/2023/19), and by the University of Cyprus (20.02.2023). Written informed consent will be obtained from all participants.
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Affiliation(s)
| | | | - Panos Zanos
- Department of Psychology, University of Cyprus, Nicosia, Cyprus
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3
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Coleman C, Gillmeister H. Body image and self-perception in women with navel piercings. PLoS One 2022; 17:e0274099. [PMID: 36083973 PMCID: PMC9462717 DOI: 10.1371/journal.pone.0274099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 08/23/2022] [Indexed: 11/19/2022] Open
Abstract
The present study investigated how women’s body image and body-perceptual processes are affected by navel piercings, an embellishment of the abdominal region women often feel negatively about. We probed perceptual (response times), cognitive (surveys), affective (aesthetic ratings) and neural (event-related potentials, ERPs) facets of (own) body perception. We found that navel piercings are primarily motivated by the desire to enhance one’s body image, and can significantly improve bodily self-perception relative to before and to imagined removal of the piercing. Hence, body image concerns in women with navel piercings were found to be comparable to those of a control group; and their aesthetic ratings of other women’s abdomens only differed, positively, for images depicting navel piercings. ERPs indicated that the sight of navel piercings enhances early structural encoding of bodies as well as late emotional-motivational processes, especially in women with navel piercings. We further found a strong self-advantage in both cortical and behavioural responses during recognition of own and others’ abdomens, especially for images displaying the piercing. Altogether, findings suggest that navel piercings become strongly, and beneficially, integrated into women’s bodily self image. Such piercings may thus be seen as expressions of body care that can protect against self-harming thoughts and behaviours.
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Affiliation(s)
- Christine Coleman
- Department of Psychology and Centre for Brain Science, University of Essex, Colchester, United Kingdom
| | - Helge Gillmeister
- Department of Psychology and Centre for Brain Science, University of Essex, Colchester, United Kingdom
- * E-mail:
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4
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Borgers T, Kürten M, Kappelhoff A, Enneking V, Möllmann A, Schulte J, Klug M, Leehr EJ, Dohm K, Grotegerd D, Krause P, Zwiky E, Dannlowski U, Buhlmann U, Redlich R. Brain functional correlates of emotional face processing in body dysmorphic disorder. J Psychiatr Res 2022; 147:103-110. [PMID: 35030511 DOI: 10.1016/j.jpsychires.2022.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 12/14/2021] [Accepted: 01/03/2022] [Indexed: 11/29/2022]
Abstract
Previous neuroimaging studies in body dysmorphic disorder (BDD) have focused on discordances in visual processing systems. However, little is known about brain functional aberrations in individuals with BDD during emotional face processing. An fMRI paradigm with negative emotional faces was employed in 20 individuals with BDD and 43 mentally healthy controls (HC). We compared functional activity and whole-brain connectivity patterns of the amygdala and the fusiform gyrus (FFG) between both groups. Regression analyses were performed for associations of body dysmorphic symptoms with brain activity and connectivity. Individuals with BDD exhibited higher activity in the left amygdala compared to HC (pFWE = .04) as well as increased functional connectivity of the left amygdala with a network including frontostriatal and temporal regions (pFWE < .05). The FFG revealed increased functional connectivity in individuals with BDD, mapping to brain areas such as the cingulate cortex and temporo-limbic regions (pFWE < .05). In HC, higher levels of body dysmorphic symptoms were associated with higher functional amygdala and FFG activity (pFWE < .05). Individuals with BDD show aberrant functional activity and connectivity patterns within the amygdala and the FFG for negative emotional face processing. Body dysmorphic symptoms in HC are associated with a mild pattern of brain functional alterations, which could emphasize the relevance of a dimensional approach in addition to diagnosis. Treatments for BDD could benefit from targeting visual misperception and evaluation processes upon confrontation with emotional information.
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Affiliation(s)
- Tiana Borgers
- Institute for Translational Psychiatry, University of Münster, Albert-Schweitzer-Campus 1, Building A9, 48149, Münster, Germany.
| | - Marla Kürten
- Institute for Translational Psychiatry, University of Münster, Albert-Schweitzer-Campus 1, Building A9, 48149, Münster, Germany; Institute of Psychology, University of Münster, Fliednerstrasse 21, 48149, Münster, Germany.
| | - Anna Kappelhoff
- Institute for Translational Psychiatry, University of Münster, Albert-Schweitzer-Campus 1, Building A9, 48149, Münster, Germany.
| | - Verena Enneking
- Institute for Translational Psychiatry, University of Münster, Albert-Schweitzer-Campus 1, Building A9, 48149, Münster, Germany.
| | - Anne Möllmann
- Institute of Psychology, University of Bremen, Grazer Strasse 2, 28359, Bremen, Germany.
| | - Johanna Schulte
- Institute of Psychology, University of Münster, Fliednerstrasse 21, 48149, Münster, Germany.
| | - Melissa Klug
- Institute for Translational Psychiatry, University of Münster, Albert-Schweitzer-Campus 1, Building A9, 48149, Münster, Germany.
| | - Elisabeth J Leehr
- Institute for Translational Psychiatry, University of Münster, Albert-Schweitzer-Campus 1, Building A9, 48149, Münster, Germany.
| | - Katharina Dohm
- Institute for Translational Psychiatry, University of Münster, Albert-Schweitzer-Campus 1, Building A9, 48149, Münster, Germany.
| | - Dominik Grotegerd
- Institute for Translational Psychiatry, University of Münster, Albert-Schweitzer-Campus 1, Building A9, 48149, Münster, Germany.
| | - Philine Krause
- Institute of Psychology, University of Halle, Emil Abderhaldenstraße 26, 06108, Halle, Germany.
| | - Esther Zwiky
- Institute of Psychology, University of Halle, Emil Abderhaldenstraße 26, 06108, Halle, Germany.
| | - Udo Dannlowski
- Institute for Translational Psychiatry, University of Münster, Albert-Schweitzer-Campus 1, Building A9, 48149, Münster, Germany.
| | - Ulrike Buhlmann
- Institute of Psychology, University of Münster, Fliednerstrasse 21, 48149, Münster, Germany.
| | - Ronny Redlich
- Institute for Translational Psychiatry, University of Münster, Albert-Schweitzer-Campus 1, Building A9, 48149, Münster, Germany; Institute of Psychology, University of Halle, Emil Abderhaldenstraße 26, 06108, Halle, Germany.
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5
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Brain activation and connectivity in anorexia nervosa and body dysmorphic disorder when viewing bodies: relationships to clinical symptoms and perception of appearance. Brain Imaging Behav 2021; 15:1235-1252. [PMID: 32875486 DOI: 10.1007/s11682-020-00323-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Anorexia nervosa (AN) and body dysmorphic disorder (BDD) are characterized by distorted perception of appearance, yet no studies have directly compared the neurobiology associated with body perception. We compared AN and BDD in brain activation and connectivity in relevant networks when viewing images of others' bodies and tested their relationships with clinical symptoms and subjective appearance evaluations. We acquired fMRI data from 64 unmedicated females (20 weight-restored AN, 23 BDD, 21 controls) during a matching task using unaltered or spatial-frequency filtered photos of others' bodies. Using general linear model and independent components analyses we compared brain activation and connectivity in visual, striatal, and parietal networks and performed univariate and partial least squares multivariate analyses to investigate relationships with clinical symptoms and appearance evaluations. AN and BDD showed partially overlapping patterns of hyperconnectivity in the dorsal visual network and hypoconnectivity in parietal network compared with controls. BDD, but not AN, demonstrated hypoactivity in dorsal visual and parietal networks compared to controls. Further, there were significant activity and connectivity differences between AN and BDD in both networks. In both groups, activity and/or connectivity were associated with symptom severity and appearance ratings of others' bodies. Thus, AN and BDD demonstrate both distinct and partially-overlapping aberrant neural phenotypes involved in body processing and visually encoding global features. Nevertheless, in each disorder, aberrant activity and connectivity show relationships to clinically relevant symptoms and subjective perception. These results have implications for understanding distinct and shared pathophysiology underlying perceptual distortions of appearance and may inform future novel treatment strategies.
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6
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Silva WRD, Barra JV, Neves AN, Marôco J, Campos JADB. Sociocultural pressure: a model of body dissatisfaction for young women. CAD SAUDE PUBLICA 2020; 36:e00059220. [PMID: 33331590 DOI: 10.1590/0102-311x00059220] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 08/10/2020] [Indexed: 12/31/2022] Open
Abstract
The aim of the study was to verify the influence of pressure from sociocultural agents on dissatisfaction with face and body in young women mediated by the internalization of the lean and muscular body and to identify the contribution of individual characteristics to this model. A total of 612 university female students participated of study. The students completed the Portuguese versions of the Sociocultural Attitudes Towards Appearance Questionnaire-4 and of the Body Area Scale-Revised and a sociodemographic questionnaire. A hypothetical model was constructed using structural equation modeling to test the relationship between the variables. The model fit and the significance of the hypothetical paths were verified. The results provide evidence that the greater the pressure of sociocultural agents and the internalization of the lean body, the more women were dissatisfied with body and face appearance. The media contributed to a greater internalization of the muscular body, which reduced the body dissatisfaction. The practice of physical activity and a higher economic level contributed to a greater internalization of the muscular body, which reduced body dissatisfaction. A higher economic level also influenced the internalization of the lean body and increased the dissatisfaction with face and body. A higher body mass index contributed to a greater pressure from sociocultural agents, greater internalization of the lean body, and greater dissatisfaction with body and face. The relationships identified in the model can contribute to the development of strategies aimed at reducing body dissatisfaction and eating disorders in the population, such as body acceptance.
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Affiliation(s)
| | | | | | - João Marôco
- Instituto Universitário de Ciências Psicológicas, Sociais e da Vida, Lisboa, Portugal
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7
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Matthews KN, Psihogios M, Dettmer E, Steinegger C, Toulany A. "I am the embodiment of an anorexic patient's worst fear": Severe obesity and binge eating disorder on a restrictive eating disorder ward. Clin Obes 2020; 10:e12398. [PMID: 32911574 PMCID: PMC7685105 DOI: 10.1111/cob.12398] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/15/2020] [Accepted: 07/22/2020] [Indexed: 12/05/2022]
Abstract
Adolescents who have been diagnosed with an eating disorder commonly have comorbid mental health conditions which have a significant impact on illness trajectory and may even limit access to effective treatment. Current models of eating disorder care focus mainly on treatment for patients diagnosed with restrictive eating disorders with fewer options available for those with binge eating disorder. We describe a case of an adolescent living with severe, complex obesity and binge eating disorder, presenting in a mental health crisis, admitted to an in-patient unit primarily for patients being treated for restrictive eating disorders such as anorexia nervosa. This case report describes multiple challenges that arose in admitting such a patient on a ward specializing in the treatment of restrictive eating disorders and highlights the need for equitable and more accessible care for patients living with all types of eating disorders.
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Affiliation(s)
| | - Maria Psihogios
- Department of PaediatricsMichael Garron HospitalTorontoOntarioCanada
| | | | - Cathleen Steinegger
- Department of PaediatricsUniversity of TorontoTorontoOntarioCanada
- Division of Adolescent MedicineHospital for Sick ChildrenTorontoOntarioCanada
| | - Alene Toulany
- Department of PaediatricsUniversity of TorontoTorontoOntarioCanada
- Division of Adolescent MedicineHospital for Sick ChildrenTorontoOntarioCanada
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8
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Gazing rituals in body dysmorphic disorder. J Behav Ther Exp Psychiatry 2020; 68:101522. [PMID: 31877406 DOI: 10.1016/j.jbtep.2019.101522] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 08/11/2019] [Accepted: 10/17/2019] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND OBJECTIVES Gazing rituals and selective attention to perceived flaws during gazing are considered as maintaining factors in cognitive-behavioral models for body dysmorphic disorder (BDD). This study investigated different durations of BDD-like gazing at different facial stimuli (an unfamiliar face, the participant's own face, and the participant's own reflection in the mirror) with regard to effects on dissociation, attractiveness evaluations and perceptual uncertainty. The aim of this study was to examine the hypothesized causal effects of gazing rituals on appearance preoccupation. METHODS We asked 115 females to complete a face gazing paradigm with three different facial stimuli and, depending on the condition, different gazing durations. We also examined the influence of BDD symptom severity on the reactions to different facial stimuli. RESULTS Five minutes of gazing significantly increased dissociation. Participants rated the attractiveness of self-relevant stimuli, especially the own photographed face, below average and lower than the unfamiliar face. LIMITATIONS Limitations with regard to sample characteristics and experimental design are discussed. CONCLUSIONS Our findings support cognitive-behavioral models for BDD and indicate that therapists may extend therapeutic interventions like mirror retraining by specific perceptual retraining with photographs of the patients.
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9
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Voges MM, Giabbiconi CM, Schöne B, Gruber T, Hartmann AS, Vocks S. Time course of body recognition in women with weight and shape concerns assessed by steady-state visual evoked potentials (SSVEP). Biol Psychol 2020; 154:107906. [PMID: 32464169 DOI: 10.1016/j.biopsycho.2020.107906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 04/03/2020] [Accepted: 05/18/2020] [Indexed: 01/19/2023]
Abstract
This study aimed to examine self-body recognition in women with high (HWSC) and low weight and shape concerns (LWSC). Thus, the detection rate, the reaction time and the perceptual threshold for recognizing one's own body in a morphed body were measured in n = 25 women with HWSC and n = 26 women with LWSC. Furthermore, by using steady-state visual evoked potentials (SSVEPs), neuronal correlates of body recognition were recorded. The perceptual threshold for recognizing one's own body was higher for women with HWSC in the case of a morph with a thinner body. No group differences emerged for morphs with obese or average-weight bodies. The SSVEP amplitudes did not differentiate between one's own and another body in either group. The results suggest that for women with HWSC, their negative body schemata might hamper recognition of their own body in a thinner morph. Otherwise, self-body recognition is similar in women with LWSC and HWSC.
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Affiliation(s)
- Mona M Voges
- Department of Clinical Psychology and Psychotherapy, Osnabrück University, Knollstraße 15, 49069 Osnabrück, Germany.
| | - Claire-Marie Giabbiconi
- Department of Clinical Psychology and Psychotherapy, Osnabrück University, Knollstraße 15, 49069 Osnabrück, Germany.
| | - Benjamin Schöne
- Department of Experimental Psychology I, Osnabrück University, Seminarstraße 20, 49074 Osnabrück, Germany.
| | - Thomas Gruber
- Department of Experimental Psychology I, Osnabrück University, Seminarstraße 20, 49074 Osnabrück, Germany.
| | - Andrea S Hartmann
- Department of Clinical Psychology and Psychotherapy, Osnabrück University, Knollstraße 15, 49069 Osnabrück, Germany.
| | - Silja Vocks
- Department of Clinical Psychology and Psychotherapy, Osnabrück University, Knollstraße 15, 49069 Osnabrück, Germany.
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10
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Welsch R, Hecht H, Kolar DR, Witthöft M, Legenbauer T. Body image avoidance affects interpersonal distance perception: A virtual environment experiment. EUROPEAN EATING DISORDERS REVIEW 2019; 28:282-295. [PMID: 31845447 DOI: 10.1002/erv.2715] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Revised: 11/20/2019] [Accepted: 11/25/2019] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Eating disorders have a considerable influence on social contacts. The avoidance towards the own body may result in the avoidance of others. Previous research has found a preference for larger interaction distances in individuals with eating disorders (ED) as compared to control participants (CG). We aimed to replicate these findings and to investigate whether the body weight of the interactant moderates the effect. METHOD We recruited a female sample with mixed ED subtypes (n = 21) and a female CG (n = 28). Participants were immersed in a virtual environment and engaged in a number of fictitious social interactions. They approached a virtual person until a comfortable distance for interaction was reached. The approached virtual persons differed with respect to body weight in five levels (underweight to obese). RESULTS Our results indicate that interpersonal distance varies as a U-shaped function of the avatar's body weight, and that higher levels of body avoidance, present in ED individuals, magnify this effect. CONCLUSIONS We discuss our results with regard to the role of perspective and disgust to provide a useful framework and to motivate future studies in the domain of body avoidance in social interactions.
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Affiliation(s)
- Robin Welsch
- General Experimental Psychology, Johannes Gutenberg-Universität Mainz, Department of Psychology, Mainz, Germany
| | - Heiko Hecht
- General Experimental Psychology, Johannes Gutenberg-Universität Mainz, Department of Psychology, Mainz, Germany
| | - David R Kolar
- Department of Child and Adolescent Psychiatry and Psychotherapy, University Medical Center of the Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Michael Witthöft
- Clinical Psychology, Psychotherapy, and Experimental Psychopathology, Johannes Gutenberg-Universität Mainz, Department of Psychology, Mainz, Germany
| | - Tanja Legenbauer
- LWL University Hospital Hamm for Child and Adolescent Psychiatry, Psychotherapy and Psychosomatic, Ruhr-University Bochum, Hamm, Germany
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11
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Brooks KR, Mond J, Mitchison D, Stevenson RJ, Challinor KL, Stephen ID. Looking at the Figures: Visual Adaptation as a Mechanism for Body-Size and -Shape Misperception. PERSPECTIVES ON PSYCHOLOGICAL SCIENCE 2019; 15:133-149. [PMID: 31725353 DOI: 10.1177/1745691619869331] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Many individuals experience body-size and -shape misperception (BSSM). Body-size overestimation is associated with body dissatisfaction, anxiety, depression, and the development of eating disorders in individuals who desire to be thinner. Similar symptoms have been noted for those who underestimate their muscularity. Conversely, individuals with high body mass indices (BMI) who underestimate their adiposity may not recognize the risks of or seek help for obesity-related medical issues. Although social scientists have examined whether media representations of idealized bodies contribute to the overestimation of fat or underestimation of muscle, other scientists suggest that increases in the prevalence of obesity could explain body-fat underestimation as a form of renormalization. However, these disparate approaches have not advanced our understanding of the perceptual underpinnings of BSSM. Recently, a new unifying account of BSSM has emerged that is based on the long-established phenomenon of visual adaptation, employing psychophysical measurements of perceived size and shape following exposure to "extreme" body stimuli. By inducing BSSM in the laboratory as an aftereffect, this technique is rapidly advancing our understanding of the underlying mental representation of human bodies. This nascent approach provides insight into real-world BSSM and may inform the development of therapeutic and public-health interventions designed to address such perceptual errors.
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Affiliation(s)
- Kevin R Brooks
- Department of Psychology, Macquarie University.,Perception in Action Research Centre, Macquarie University
| | - Jonathan Mond
- Centre for Rural Health, University of Tasmania.,Translational Health Research Institute, School of Medicine, Western Sydney University
| | - Deborah Mitchison
- Department of Psychology, Macquarie University.,Translational Health Research Institute, School of Medicine, Western Sydney University.,Centre for Emotional Health, Department of Psychology, Macquarie University
| | - Richard J Stevenson
- Department of Psychology, Macquarie University.,Perception in Action Research Centre, Macquarie University
| | | | - Ian D Stephen
- Department of Psychology, Macquarie University.,Perception in Action Research Centre, Macquarie University
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12
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Gazing at facial features increases dissociation and decreases attractiveness ratings in non-clinical females - A potential explanation for a common ritual in body dysmorphic disorder. PLoS One 2019; 14:e0219791. [PMID: 31344065 PMCID: PMC6657848 DOI: 10.1371/journal.pone.0219791] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 07/01/2019] [Indexed: 12/01/2022] Open
Abstract
Rituals, such as gazing at faces, are common in body dysmorphic disorder (BDD) and appear in cognitive-behavioral models as a maintaining factor. Rituals are also common in obsessive-compulsive disorder (OCD). In contrast to OCD, the proposed associations between rituals and intrusive thoughts/appearance preoccupation have not been empirically investigated for BDD. We examined if the assumed effect of gazing rituals on attractiveness ratings exists and if it is associated with dissociation. In an experiment, we asked N = 65 non-clinical females to focus on the nose of a photographed face at pre- and post-test. In between, participants gazed at the nose of either the same (relevant gazing) or another face (irrelevant gazing). We found increasing dissociation after gazing in both conditions and a differentially stronger decrease of attractiveness ratings in the relevant gazing condition. Our findings support the hypothesized effect of gazing rituals on attractiveness evaluation in cognitive-behavioral models for BDD.
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13
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Gledhill LJ, George HR, Tovée MJ. Perceptual Not Attitudinal Factors Predict the Accuracy of Estimating Other Women's Bodies in Both Women With Anorexia Nervosa and Controls. Front Psychol 2019; 10:997. [PMID: 31143143 PMCID: PMC6520613 DOI: 10.3389/fpsyg.2019.00997] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Accepted: 04/15/2019] [Indexed: 12/17/2022] Open
Abstract
Disturbance in how one's body shape and size is experienced, usually including over-estimation of one's own body size, is a core feature of the diagnostic criteria of anorexia nervosa (AN). Is this over-estimation specific to women with AN's judgments of their own body? Or is it just a general feature of their judgments about all bodies? If the latter, it would be consistent with a general error in the perception of body size potentially linked to the use of a different set of visual cues for judging body size. If the former, then this suggests that the over-estimation of own body size has a strong attitudinal component and may be part of the psycho-pathology of their condition. To test this hypothesis, 20 women with AN and 80 control observers estimated the body size of 46 women. The results show a strong effect of perceptual factors in estimating body size for both controls and women with AN. This result is consistent with size over-estimation of own body in AN having a strong attitudinal basis and being a core feature of the psycho-pathology of the condition.
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Affiliation(s)
- Lucinda J. Gledhill
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Hannah R. George
- Deaf Children, Young People and Family Service (National Deaf CAMHS), York, United Kingdom
| | - Martin J. Tovée
- School of Psychology, University of Lincoln, Lincoln, United Kingdom
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14
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Phillipou A, Castle DJ, Rossell SL. Direct comparisons of anorexia nervosa and body dysmorphic disorder: A systematic review. Psychiatry Res 2019; 274:129-137. [PMID: 30784781 DOI: 10.1016/j.psychres.2019.01.106] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 01/31/2019] [Accepted: 01/31/2019] [Indexed: 11/29/2022]
Abstract
Anorexia nervosa (AN) and body dysmorphic disorder (BDD) are serious psychiatric conditions, both of which are associated with a disturbance of body image. The aim of this paper was to review those studies that have directly compared groups of individuals with AN and BDD, to determine similarities and differences in presentation between the two conditions. The literature was searched to September 2018, and studies were included if they were English language, empirical research papers published in peer-reviewed journals, specifically comparing AN and BDD patients. Fifteen relevant studies were identified. The results suggested that individuals with AN and BDD share a number of similarities, including their degree of body dissatisfaction. Differences between the conditions included primary concerns with body shape and weight in AN, and much more diffuse concerns (but predominantly the face) in BDD. The small number of studies, along with the limited replication of results emphasises the need for greater research in this area. However, the studies undertaken to date highlight the high degree of overlap between AN and BDD and suggests that the conditions may represent similar body image disorders. This has implications for the nosological status of AN and BDD.
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Affiliation(s)
- Andrea Phillipou
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia; Department of Mental Health, St Vincent's Hospital, Melbourne, Australia; Department of Psychiatry, The University of Melbourne, Melbourne, Australia; Department of Mental Health, Austin Health, Melbourne, Australia.
| | - David Jonathan Castle
- Department of Mental Health, St Vincent's Hospital, Melbourne, Australia; Department of Psychiatry, The University of Melbourne, Melbourne, Australia
| | - Susan Lee Rossell
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia; Department of Mental Health, St Vincent's Hospital, Melbourne, Australia
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15
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Johnson S, Williamson P, Wade TD. A systematic review and meta-analysis of cognitive processing deficits associated with body dysmorphic disorder. Behav Res Ther 2018; 107:83-94. [PMID: 29935380 DOI: 10.1016/j.brat.2018.05.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 05/16/2018] [Accepted: 05/29/2018] [Indexed: 10/16/2022]
Abstract
This systematic review and meta-analysis examined the evidence supporting the association between body dysmorphic disorder (BDD) symptomology and four types of cognitive processing abnormalities: local processing, selective attention, interpretive biases, and memory deficits. Twenty-three studies met inclusion requirements that examined differences in performance on cognitive tasks between BDD and control groups across the four categories. Multilevel modelling was used to calculate an overall effect size for each cognitive category. BDD and control groups differed significantly on measures of selective attention (g = 0.60, 95% CI = 0.26: 0.93), interpretive biases (g = 0.30, 95% CI = . 07: 0.54), and memory deficits (g=.56, 95% CI = 0.26: 0.87). Differences between the BDD and control groups on measures of local processing did not reach significance. These findings support the hypothesis that people with BDD may selectively attend to perceived threats or to disorder-related stimuli, misinterpret ambiguous stimuli as threatening, overvalue the importance of attractiveness, and have inaccurate coding and recall for facial or bodily stimuli. Recommendations for future research of these specific cognitive deficits in BDD include introducing the use of Modified Dot Probe Paradigms and new treatment targets that can be used as adjuncts to current treatment modalities.
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Affiliation(s)
- Shevaugn Johnson
- School of Psychology, Flinders University, PO Box 2100, Adelaide, SA, 5001, Australia.
| | - Paul Williamson
- School of Psychology, Flinders University, PO Box 2100, Adelaide, SA, 5001, Australia
| | - Tracey D Wade
- School of Psychology, Flinders University, PO Box 2100, Adelaide, SA, 5001, Australia
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16
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Effects of an Appearance-Focused Interpretation Training Intervention on Eating Disorder Symptoms. Behav Cogn Psychother 2018. [DOI: 10.1017/s1352465818000164] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background: Previous research suggests that computerized interpretation bias modification (IBM) techniques may be useful for modifying thoughts and behaviours relevant to eating pathology; however, little is known about the utility of IBM for decreasing specific eating disorder (ED) symptoms (e.g. bulimia, drive for thinness). Aims: The current study sought to further examine the utility of IBM for ED symptoms via secondary analyses of an examination of IBM for individuals with elevated body dysmorphic disorder (BDD) symptoms (see Summers and Cougle, 2016), as these disorders are both characterized by threat interpretation biases of ambiguous appearance-related information. Method: We recruited 41 participants for a randomized trial comparing four sessions of IBM aimed at modifying problematic social and appearance-related threat interpretation biases with a placebo control training (PC). Results: At 1-week post-treatment, and relative to the PC, the IBM group reported greater reductions in negative/threat interpretations of ambiguous information in favour of positive/benign biases. Furthermore, among individuals with high pre-treatment bulimia symptoms, IBM yielded greater reductions in bulimia symptoms compared with PC at post-treatment. No treatment effects were observed on drive for thinness symptoms. Conclusions: The current study suggests that cognitive interventions for individuals with primary BDD symptoms may improve co-occurring ED symptoms such as bulimia.
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17
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Mölbert SC, Thaler A, Mohler BJ, Streuber S, Romero J, Black MJ, Zipfel S, Karnath HO, Giel KE. Assessing body image in anorexia nervosa using biometric self-avatars in virtual reality: Attitudinal components rather than visual body size estimation are distorted. Psychol Med 2018; 48:642-653. [PMID: 28745268 PMCID: PMC5964466 DOI: 10.1017/s0033291717002008] [Citation(s) in RCA: 87] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 06/20/2017] [Accepted: 06/21/2017] [Indexed: 12/01/2022]
Abstract
BACKGROUND Body image disturbance (BID) is a core symptom of anorexia nervosa (AN), but as yet distinctive features of BID are unknown. The present study aimed at disentangling perceptual and attitudinal components of BID in AN. METHODS We investigated n = 24 women with AN and n = 24 controls. Based on a three-dimensional (3D) body scan, we created realistic virtual 3D bodies (avatars) for each participant that were varied through a range of ±20% of the participants' weights. Avatars were presented in a virtual reality mirror scenario. Using different psychophysical tasks, participants identified and adjusted their actual and their desired body weight. To test for general perceptual biases in estimating body weight, a second experiment investigated perception of weight and shape matched avatars with another identity. RESULTS Women with AN and controls underestimated their weight, with a trend that women with AN underestimated more. The average desired body of controls had normal weight while the average desired weight of women with AN corresponded to extreme AN (DSM-5). Correlation analyses revealed that desired body weight, but not accuracy of weight estimation, was associated with eating disorder symptoms. In the second experiment, both groups estimated accurately while the most attractive body was similar to Experiment 1. CONCLUSIONS Our results contradict the widespread assumption that patients with AN overestimate their body weight due to visual distortions. Rather, they illustrate that BID might be driven by distorted attitudes with regard to the desired body. Clinical interventions should aim at helping patients with AN to change their desired weight.
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Affiliation(s)
- S. C. Mölbert
- Department of Psychosomatic Medicine and
Psychotherapy, Medical University Hospital
Tübingen, Tübingen, Germany
- Max Planck Institute for Biological
Cybernetics, Tübingen, Germany
- Graduate Training Centre of Neuroscience,
International Max Planck Research School, Universität Tübingen,
Tübingen, Germany
| | - A. Thaler
- Max Planck Institute for Biological
Cybernetics, Tübingen, Germany
- Graduate Training Centre of Neuroscience,
International Max Planck Research School, Universität Tübingen,
Tübingen, Germany
| | - B. J. Mohler
- Max Planck Institute for Biological
Cybernetics, Tübingen, Germany
| | - S. Streuber
- École Polytechnique Fédérale de Lausanne, Brain
Mind Institute, Lausanne,
Switzerland
| | - J. Romero
- Max Planck Institute for Intelligent
Systems, Tübingen, Germany
| | - M. J. Black
- Max Planck Institute for Intelligent
Systems, Tübingen, Germany
| | - S. Zipfel
- Department of Psychosomatic Medicine and
Psychotherapy, Medical University Hospital
Tübingen, Tübingen, Germany
| | - H.-O. Karnath
- Division of Neuropsychology,
Center of Neurology, Hertie-Institute for Clinical Brain Research, University
of Tübingen, Tübingen, Germany
| | - K. E. Giel
- Department of Psychosomatic Medicine and
Psychotherapy, Medical University Hospital
Tübingen, Tübingen, Germany
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18
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Rangaprakash D, Bohon C, Lawrence KE, Moody T, Morfini F, Khalsa SS, Strober M, Feusner JD. Aberrant Dynamic Connectivity for Fear Processing in Anorexia Nervosa and Body Dysmorphic Disorder. Front Psychiatry 2018; 9:273. [PMID: 29997532 PMCID: PMC6028703 DOI: 10.3389/fpsyt.2018.00273] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 06/05/2018] [Indexed: 01/20/2023] Open
Abstract
Anorexia nervosa (AN) and body dysmorphic disorder (BDD) share distorted perceptions of appearance with extreme negative emotion, yet the neural phenotypes of emotion processing remain underexplored in them, and they have never been directly compared. We sought to determine if shared and disorder-specific fronto-limbic connectivity patterns characterize these disorders. FMRI data was obtained from three unmedicated groups: BDD (n = 32), weight-restored AN (n = 25), and healthy controls (HC; n = 37), while they viewed fearful faces and rated their own degree of fearfulness in response. We performed dynamic effective connectivity modeling with medial prefrontal cortex (mPFC), rostral anterior cingulate cortex (rACC), and amygdala as regions-of-interest (ROI), and assessed associations between connectivity and clinical variables. HCs exhibited significant within-group bidirectional mPFC-amygdala connectivity, which increased across the blocks, whereas BDD participants exhibited only significant mPFC-to-amygdala connectivity (P < 0.05, family-wise error corrected). In contrast, participants with AN lacked significant prefrontal-amygdala connectivity in either direction. AN showed significantly weaker mPFC-to-amygdala connectivity compared to HCs (P = 0.0015) and BDD (P = 0.0050). The mPFC-to-amygdala connectivity was associated with greater subjective fear ratings (R2 = 0.11, P = 0.0016), eating disorder symptoms (R2 = 0.33, P = 0.0029), and anxiety (R2 = 0.29, P = 0.0055) intensity scores. Our findings, which suggest a complex nosological relationship, have implications for understanding emotion regulation circuitry in these related psychiatric disorders, and may have relevance for current and novel therapeutic approaches.
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Affiliation(s)
- D Rangaprakash
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - Cara Bohon
- Department of Psychiatry and Behavioral Sciences, Stanford University, Stanford, CA, United States
| | - Katherine E Lawrence
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - Teena Moody
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - Francesca Morfini
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - Sahib S Khalsa
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States.,Oxley College of Health Sciences, University of Tulsa, Tulsa, OK, United States.,Laureate Institute for Brain Research, University of Tulsa, Tulsa, OK, United States
| | - Michael Strober
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
| | - Jamie D Feusner
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, Los Angeles, CA, United States
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19
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Beilharz F, Castle DJ, Grace S, Rossell SL. A systematic review of visual processing and associated treatments in body dysmorphic disorder. Acta Psychiatr Scand 2017; 136:16-36. [PMID: 28190269 DOI: 10.1111/acps.12705] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/12/2017] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Recent advances in body dysmorphic disorder (BDD) have explored abnormal visual processing, yet it is unclear how this relates to treatment. The aim of this study was to summarize our current understanding of visual processing in BDD and review associated treatments. METHOD The literature was collected through PsycInfo and PubMed. Visual processing articles were included if written in English after 1970, had a specific BDD group compared to healthy controls and were not case studies. Due to the lack of research regarding treatments associated with visual processing, case studies were included. RESULTS A number of visual processing abnormalities are present in BDD, including face recognition, emotion identification, aesthetics, object recognition and gestalt processing. Differences to healthy controls include a dominance of detailed local processing over global processing and associated changes in brain activation in visual regions. Perceptual mirror retraining and some forms of self-exposure have demonstrated improved treatment outcomes, but have not been examined in isolation from broader treatments. CONCLUSION Despite these abnormalities in perception, particularly concerning face and emotion recognition, few BDD treatments attempt to specifically remediate this. The development of a novel visual training programme which addresses these widespread abnormalities may provide an effective treatment modality.
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Affiliation(s)
- F Beilharz
- Brain and Psychological Sciences Research Centre, Swinburne University of Technology, Melbourne, Vic., Australia
| | - D J Castle
- Department of Psychiatry, St Vincent's Hospital, Melbourne, Vic., Australia.,Psychiatry, Faculty of Medicine, University of Melbourne, Melbourne, Vic., Australia
| | - S Grace
- Brain and Psychological Sciences Research Centre, Swinburne University of Technology, Melbourne, Vic., Australia
| | - S L Rossell
- Brain and Psychological Sciences Research Centre, Swinburne University of Technology, Melbourne, Vic., Australia.,Department of Psychiatry, St Vincent's Hospital, Melbourne, Vic., Australia.,Monash Alfred Psychiatry Research Centre (MAPrc), The Alfred Hospital and Monash University Central Clinical School, Melbourne, Vic., Australia
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20
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Beilharz F, Rossell SL. Treatment Modifications and Suggestions to Address Visual Abnormalities in Body Dysmorphic Disorder. J Cogn Psychother 2017; 31:272-284. [PMID: 32755901 DOI: 10.1891/0889-8391.31.4.272] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Recent psychophysical and neurocognitive findings implicate abnormal visual processing for a range of stimuli in body dysmorphic disorder (BDD); such abnormalities differentiate BDD from other mental health disorders. Current treatments most commonly involve cognitive behavior therapy with or without accompanying antidepressant medications. These are moderately successful yet appear to overlook the core phenomenological aspect of abnormal perception in BDD. The following text summarizes the current literature of perceptual abnormalities within BDD and how these findings may be applied and incorporated into treatment options. Possible modifications of cognitive behavioral therapy (CBT) based on the widespread visual abnormalities within BDD include making perceptual mirror retraining a compulsory component of therapy and implementing self-exposure tasks within exposure and response prevention. Alternative options such as a visual training program to remediate visual abnormalities across a range of visual stimuli are also explored, which may be included as an adjunctive treatment alongside CBT.
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Affiliation(s)
- Francesca Beilharz
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia
| | - Susan L Rossell
- Centre for Mental Health, Swinburne University of Technology, Melbourne, Australia.,The Alfred Hospital and Monash University Central Clinical School, Melbourne, Australia.,Department of Psychiatry, St. Vincent's Hospital, Melbourne, Australia
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