1
|
Möllmann A, Heinrichs N, Herwig A. A conceptual framework on body representations and their relevance for mental disorders. Front Psychol 2024; 14:1231640. [PMID: 38250111 PMCID: PMC10796836 DOI: 10.3389/fpsyg.2023.1231640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 12/11/2023] [Indexed: 01/23/2024] Open
Abstract
Many mental disorders are accompanied by distortions in the way the own body is perceived and represented (e.g., eating disorders, body dysmorphic disorder including muscle dysmorphia, or body integrity dysphoria). We are interested in the way these distortions develop and aim at better understanding their role in mental health across the lifespan. For this purpose, we first propose a conceptual framework of body representation that defines this construct and integrates different perspectives (e.g., cognitive neuroscience, clinical psychology) on body representations. The framework consists of a structural and a process model of body representation emphasizing different goals: the structural model aims to support researchers from different disciplines to structure results from studies and help collectively accumulate knowledge about body representations and their role in mental disorders. The process model is reflecting the dynamics during the information processing of body-related stimuli. It aims to serve as a motor for (experimental) study development on how distorted body representations emerge and might be changed. Second, we use this framework to review the normative development of body representations as well as the development of mental disorders that relate to body representations with the aim to further clarify the potential transdiagnostic role of body representations.
Collapse
Affiliation(s)
- Anne Möllmann
- Department of Psychology, Faculty of Psychology and Sports Science, Bielefeld University, Bielefeld, Germany
| | | | | |
Collapse
|
2
|
Hart LM, Mitchison D, Fuller-Tyszkiewicz M, Giles S, Fardouly J, Jarman HK, Damiano SR, McLean SA, Prichard I, Yager Z, Krug I. "Can you see me?" Videoconferencing and eating disorder risk during COVID-19: Anxiety, impairment, and mediators. Int J Eat Disord 2023; 56:235-246. [PMID: 36331070 PMCID: PMC10100378 DOI: 10.1002/eat.23844] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 10/17/2022] [Accepted: 10/18/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The use of videoconferencing has increased during the pandemic, creating prolonged exposure to self-image. This research aimed to investigate whether eating disorder (ED) risk was associated with videoconferencing performance for work or study and to explore whether the use of safety behaviors and self-focused attention mediated the relationship between ED risk and perceived control over performance anxiety, impaired engagement, or avoidance of videoconferencing for work or study. METHOD In 2020, an online survey was distributed within Australia to those aged over 18 years via academic and social networks, measuring: use of videoconferencing for work/study, demographics, ED risk, safety behaviors for appearance concerns, self-focused attention, perceived control over performance anxiety, perceived engagement impairment, and avoidance of videoconferencing. A total of 640 participants (77.3% female, Mage = 26.2 years) returned complete data and were included in analyses. RESULTS 245 participants (38.7%) were considered at-risk for EDs (SCOFF > 2). Those at-risk reported significantly more safety behaviors, self-focused attention, impaired engagement, and avoidance, plus lower perceived control over performance anxiety than those not at-risk. Multiple mediation models found the effects of ED risk on control over performance anxiety, impaired engagement, and avoidance were partially mediated by safety behaviors and self-focused attention. DISCUSSION Our cross-sectional findings suggest videoconferencing for work/study-related purposes is associated with performance anxiety, impaired engagement, and avoidance among individuals at-risk for EDs. Poorer videoconferencing outcomes appear more strongly related to social anxiety variables than ED status. Clinicians and educators may need to provide extra support for those using videoconferencing. PUBLIC SIGNIFICANCE Because videoconferencing often involves seeing your own image (via self-view) we wondered whether the appearance concerns experienced by those with eating disorders (EDs) might interfere with the ability to focus on or to contribute to work/study videoconferencing meetings. We found that although those with EDs experience more impairments in their videoconferencing engagement/contribution, these were linked just as strongly to social anxiety as they were to appearance concerns.
Collapse
Affiliation(s)
- Laura M Hart
- Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia.,EMBodiED Research, School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia.,The Body Confident Collective, Coffs Habour, New South Wales, Australia
| | - Deborah Mitchison
- Translational Health Research Institute, School of Medicine, Western Sydney University, Sydney, New South Wales, Australia
| | | | - Sarah Giles
- Melbourne School of Psychological Sciences, University of Melbourne, Parkville, Victoria, Australia
| | | | - Hannah K Jarman
- School of Psychology, Deakin University, Geelong, Victoria, Australia
| | - Stephanie R Damiano
- EMBodiED Research, School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - Siân A McLean
- EMBodiED Research, School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - Ivanka Prichard
- The Body Confident Collective, Coffs Habour, New South Wales, Australia.,College of Nursing & Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Zali Yager
- The Body Confident Collective, Coffs Habour, New South Wales, Australia.,Institute for Health and Sport, Victoria University, Footscray, Victoria, Australia
| | - Isabel Krug
- Melbourne School of Psychological Sciences, University of Melbourne, Parkville, Victoria, Australia
| |
Collapse
|
3
|
Schoenenberg K, Martin A. Cognitive-affective reactions to a non-judgmental and judgmental mirror gazing task in individuals with body dysmorphic concerns. J Behav Ther Exp Psychiatry 2022; 77:101779. [PMID: 36113914 DOI: 10.1016/j.jbtep.2022.101779] [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: 09/20/2021] [Revised: 07/08/2022] [Accepted: 08/26/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND AND OBJECTIVES The look into the mirror represents a typical trigger situation for people with body dysmorphic concerns. Mirror exposure on the other hand is commonly used in the treatment of Body Dysmorphic Disorder even though little is known about its precise effects. This study aimed to investigate cognitive-affective processes related to mirror gazing. METHODS A total of 125 individuals (screening for body dysmorphic concerns: NBDD+ = 56, negative NBDD- = 69) participated in a laboratory study using a guided 10-min mirror gazing task. Participants were randomized to one of two experimental conditions, a non-judgmental and judgmental description of the own body during mirror gazing. Distress, self-hostile cognitions and post-event processing were assessed after the task and at follow-up. RESULTS Participants with body dysmorphic concerns showed higher values regarding subjective appearance distortion, stress induced by the exposure, distress, self-hostile cognitions and post-event processing compared to the symptom negative group. The two conditions did not yield differential effects. LIMITATIONS The short duration of the mirror gazing and the only internal description of the body may have contributed to a missing effect for the approach. CONCLUSIONS The results indicate the importance of cognitive and affective processes in reaction to mirror exposure. They support the cognitive model of BDD and suggest post-event processing as a relevant factor requiring further investigation in future research.
Collapse
Affiliation(s)
- Katrin Schoenenberg
- Department for Clinical Psychology and Psychotherapy, University Wuppertal, Germany.
| | - Alexandra Martin
- Department for Clinical Psychology and Psychotherapy, University Wuppertal, Germany
| |
Collapse
|
4
|
Validity of the counter-app method in the assessment of intrusions. J Behav Ther Exp Psychiatry 2022; 77:101775. [PMID: 36113911 DOI: 10.1016/j.jbtep.2022.101775] [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: 05/23/2021] [Revised: 06/06/2022] [Accepted: 08/09/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND AND OBJECTIVES The counter-app method is often used to assess the frequency of intrusions. The method requires the participants to press a button on a smartphone whenever an intrusion occurs during a predefined time period. We evaluated the convergent, discriminant, and predictive validity of the counter-app method in two studies. METHODS In the first study, we assessed the frequency of intrusions with a counter-app method, thought-sampling method, and a retrospective measure in N = 77 students. Additionally, we assessed retrospectively-estimated duration, percentage of time, intensity, and intrusiveness of intrusions. The second study (N = 65) was identical to the first except the thinking-aloud method replaced the thought-sampling method, and additionally we assessed behavioral neutralizing. RESULTS The counter-app frequency was positively correlated with the convergent (thought-sampling and thinking-aloud frequencies, and retrospectively-estimated frequencies of intrusions) and predictive (behavioral neutralizing) validity criteria. The correlations between counter-app frequency and discriminant validity criteria (retrospectively-estimated duration, percentage of time, intensity, and intrusiveness of intrusions) were not smaller than the correlations between counter-app frequency and convergent validity criteria. LIMITATIONS We evaluated the predictive validity of the counter-app method using a criterion typical of obsessive-compulsive disorder research. Thus, the result for predictive validity might not transfer to other areas. CONCLUSIONS Our findings support convergent and predictive, but not discriminant, validity of the counter-app method. The counter-app method can validly assess the frequency of intrusions but is not appropriate if the study requires the differentiation of frequency from other constructs such as duration.
Collapse
|
5
|
Hartmann AS, Schmidt M, Staufenbiel T, Ebert DD, Martin A, Schoenenberg K. ImaginYouth-A Therapist-Guided Internet-Based Cognitive-Behavioral Program for Adolescents and Young Adults With Body Dysmorphic Disorder: Study Protocol for a Two-Arm Randomized Controlled Trial. Front Psychiatry 2021; 12:682965. [PMID: 34113273 PMCID: PMC8185230 DOI: 10.3389/fpsyt.2021.682965] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Accepted: 04/19/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Body dysmorphic disorder (BDD) is a relatively common mental disorder in adolescents and young adults, and is characterized by severe negative psychosocial consequences and high comorbidity as well as high mortality rates, mainly due to suicides. While patients in Germany have health insurance-financed access to evidence-based outpatient treatments, that is, cognitive-behavioral treatment (CBT), waiting lists are long. Furthermore, patients with BDD report diverse treatment barriers, primarily feelings of shame and the belief that they would be better off with treatments that would alter the perceived flaw(s). Given adolescents' and young adults' high affinity to electronic media, the accessibility of evidence-based care for this severe mental disorder could be improved by providing an internet-based therapist-guided CBT intervention. Methods: In a two-arm randomized controlled trial (N = 40), adolescents and young adults (15-21 years) with a primary diagnosis of BDD based on a semi-structured clinical expert interview will be randomly allocated to an internet-based therapist-guided CBT intervention or a supportive internet-based therapy intervention. Assessments will take place at baseline, after mid-intervention (after 6 weeks), post-intervention, and at 4-week follow-up. The primary outcome is expert-rated BDD symptom severity at the primary endpoint post-intervention. Secondary outcomes include responder and remission rates based on expert rating, self-reported BDD symptoms, and psychosocial variables associated with BDD. Interventions: The CBT-based intervention consists of six modules each comprising one to three sessions, which focus on psychoeducation, cognitive restructuring, work on self-esteem, exposure and ritual prevention, mirror retraining, and relapse prevention. A study therapist provides feedback after each session. The supportive therapy intervention consists of access to psychoeducational materials for the same 12-week period and at least one weekly supportive interaction with the study therapist. Conclusions: This is the first study to examine the feasibility and efficacy of an internet-based therapist-guided CBT intervention in adolescents and young adults with BDD. It could be an important first step to increase accessibility of care in this age group and for this severe and debilitating mental disorder. Clinical Trial Registration: German Register of Clinical Studies, DRKS00022055.
Collapse
Affiliation(s)
- Andrea S. Hartmann
- Institute of Psychology, Clinical Psychology and Psychotherapy, Osnabrück University, Osnabrück, Germany
| | - Michaela Schmidt
- Institute of Psychology, Clinical Psychology and Psychotherapy, Osnabrück University, Osnabrück, Germany
| | - Thomas Staufenbiel
- Institute of Psychology, Research Methods, Diagnostics and Evaluation, Osnabrück University, Osnabrück, Germany
| | - David D. Ebert
- Department of Sport and Health Sciences, Psychology and Digital Mental Health Care, Technical University Munich, Munich, Germany
| | - Alexandra Martin
- School of Human and Social Sciences, Clinical Psychology and Psychotherapy, University of Wuppertal, Wuppertal, Germany
| | - Katrin Schoenenberg
- School of Human and Social Sciences, Clinical Psychology and Psychotherapy, University of Wuppertal, Wuppertal, Germany
| |
Collapse
|
6
|
Schnackenberg N. Young people’s experiences of body dysmorphic disorder in education settings: a grounded theory. EDUCATIONAL PSYCHOLOGY IN PRACTICE 2021. [DOI: 10.1080/02667363.2021.1895079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Nicole Schnackenberg
- Southend Educational Psychology Service, Southend-on Sea Borough Council, Southend-on Sea, UK
| |
Collapse
|
7
|
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.
Collapse
|
8
|
Korn J, Dietel FA, Hartmann AS. An experimental Study on the Induction of an Eating Disorder-Specific Interpretation Bias in Healthy Individuals: Testing the Interpretation Modification Paradigm for Eating Disorders (IMP-ED). COGNITIVE THERAPY AND RESEARCH 2019. [DOI: 10.1007/s10608-019-10026-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
9
|
Tanck JA, Vocks S, Riesselmann B, Waldorf M. Gender Differences in Affective and Evaluative Responses to Experimentally Induced Body Checking of Positively and Negatively Valenced Body Parts. Front Psychol 2019; 10:1058. [PMID: 31156502 PMCID: PMC6530359 DOI: 10.3389/fpsyg.2019.01058] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 04/24/2019] [Indexed: 12/18/2022] Open
Abstract
Body checking (BC) is defined as behavior aimed at gaining information on body shape, size, or weight. Besides its occurrence as a transdiagnostic symptom in eating disorders (EDs), BC is widespread in non-clinical populations. It is associated with body dissatisfaction and the development of body image disturbances and ED. Males and females differ in terms of body dissatisfaction and associated BC strategies. However, the question of a gender-related intensity of negative affect and state body satisfaction as reactions to BC remains open. Therefore, the present experimental study aimed to examine gender differences in affective and evaluative responses to BC. We tested n = 60 women and n = 60 men in a crossover design, implementing two experimental conditions and one control condition. In the negative body checking condition (NBC), participants received standardized instructions to check negatively valenced body parts. In the positive body checking condition (PBC), by contrast, participants were asked to check positively valenced body parts. The control condition (CBC) consisted of playing a computer game. Before and after checking of one’s own body, participants rated negative body-related affect, i.e., guilt, shame, and disgust, and state body satisfaction. The results indicate that both NBC and PBC led to an increase in negative affect for men and women. Eating pathology predicted negative affect after checking in NBC for both genders. Men reported a significantly higher state body satisfaction in all conditions, whereas only women showed decreased body satisfaction in NBC. These findings suggest that BC of any body part (i.e., positively or negatively valenced) leads to increased negative affect for both genders. Eating pathology significantly influences the affective responses to BC for both genders. Changes in state body satisfaction, however, only occur in females. An explanation might be that men generally report higher body satisfaction, resulting in a more stable body image. Females and males with pathological eating behavior seem to be more vulnerable to changes in negative affect. As negative affect is equally increased after NBC and PBC for both genders, BC might play a central role in the maintenance of body image disturbances in males and females.
Collapse
Affiliation(s)
- Julia A Tanck
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Osnabrück University, Osnabrück, Germany
| | - Silja Vocks
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Osnabrück University, Osnabrück, Germany
| | - Bettina Riesselmann
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Osnabrück University, Osnabrück, Germany
| | - Manuel Waldorf
- Department of Clinical Psychology and Psychotherapy, Institute of Psychology, Osnabrück University, Osnabrück, Germany
| |
Collapse
|
10
|
Dietel FA, Möbius M, Steinbach L, Dusend C, Wilhelm S, Buhlmann U. Effects of induced appearance-related interpretation bias: A test of the cognitive-behavioral model of body dysmorphic disorder. J Behav Ther Exp Psychiatry 2018; 61:180-187. [PMID: 30118967 DOI: 10.1016/j.jbtep.2018.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 07/17/2018] [Accepted: 07/27/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND AND OBJECTIVES Interpretation biases are hypothesized to maintain body dysmorphic disorder (BDD). Although their existence and malleability have been investigated in clinical studies, their causal status in the maintenance of BDD remains unclear. This study examined the effects of a single-session appearance-related interpretation bias training (CBM-I) on bias indices and stress reactivity (i.e., distress, appearance dissatisfaction, self-esteem, perceived physical attractiveness), exploring the causality predicted in cognitive-behavioral models. METHODS We used a modified version of the Word Sentence Association Paradigm (WSAP), assessing explicit (i.e., decision rates) and more implicit interpretation bias components (i.e., reaction times). Mentally healthy students (N = 112) were randomized to training conditions enhancing positive interpretation patterns (PT) vs. negative interpretation patterns (NT) vs. a no-feedback control condition (CC). Stress reactivity was assessed during the Cyberball Paradigm. RESULTS The PT showed a pre-post increase in adaptive bias patterns regarding decision and a differential pre-post decrease in reaction times for the rejection of negative interpretations, compared to the other groups. There were no condition-congruent post-training differences in stress reactivity. However, residual interpretation bias change was significantly correlated with state distress, self-esteem and appearance dissatisfaction during stressor exposure. LIMITATIONS Limitations pertaining to sample characteristics, training and assessment overlap, and stressor task design are discussed. CONCLUSIONS Findings suggest that appearance-related interpretation bias is modifiable both explicitly and more implicitly via CBM-I in a mentally healthy sample. The causal status of interpretation bias in BDD maintenance warrants further investigation.
Collapse
Affiliation(s)
| | - Martin Möbius
- Behavioral Science Institute, Radboud University Nijmegen, Nijmegen, the Netherlands
| | | | | | - Sabine Wilhelm
- Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | | |
Collapse
|
11
|
Giraldo-O'Meara M, Belloch A. Escalation from normal appearance related intrusive cognitions to clinical preoccupations in Body Dysmorphic Disorder: A cross-sectional study. Psychiatry Res 2018; 265:137-143. [PMID: 29704773 DOI: 10.1016/j.psychres.2018.04.047] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 03/22/2018] [Accepted: 04/13/2018] [Indexed: 10/17/2022]
Abstract
Current cognitive approaches to Body Dysmorphic Disorder (BDD) assume that appearance-related intrusive cognitions and their functional consequences characterize the disorder, in a similar way that obsessive intrusive thoughts characterize the Obsessive-Compulsive Disorder (OCD). This study explores whether normal but unwanted appearance-related intrusive thoughts (AITs), escalate to clinical AITs when they are dysfunctionally appraised and instigate counterproductive neutralizing strategies. From a sample of 344 non-clinical individuals who reported a highly upsetting AIT during the past three months two subgroups were extracted according to their high (n = 68) and low (n = 276) vulnerability to BDD. The subjects in the high-risk group obtained significantly higher scores on the frequency of the most disturbing AIT and its emotional impact, interference, and appraisals evaluated with the Appearance Intrusions Questionnaire (AIQ). Additionally, two subgroups of 15 subjects each, with high and low risk to BDD, were formed and their scores were compared to 10 patients with BDD. The AIT had a greater emotional negative impact and more severe consequences on individuals with BDD compared to individuals at high-risk of BDD, which in turn, reported worse consequences of the AIT than those at low-risk. These results empirically support the similarities between BDD and OCD regarding their functional and phenomenological characteristics.
Collapse
Affiliation(s)
- Martha Giraldo-O'Meara
- Department of Personality Psychology, Research Unit for Obsessive-Compulsive and Related Disorders (I'TOC), Facultad de Psicología, Universidad de Valencia, Spain. http://www.itoc.org.es
| | - Amparo Belloch
- Department of Personality Psychology, Research Unit for Obsessive-Compulsive and Related Disorders (I'TOC), Facultad de Psicología, Universidad de Valencia, Spain.
| |
Collapse
|
12
|
Brohede S, Wyon Y, Wingren G, Wijma B, Wijma K. Body dysmorphic disorder in female Swedish dermatology patients. Int J Dermatol 2017; 56:1387-1394. [PMID: 28960272 DOI: 10.1111/ijd.13739] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 06/13/2017] [Accepted: 07/22/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Individuals with body dysmorphic disorder (BDD) are highly distressed and impaired owing to perceived defects in their physical appearance that are not noticeable to others. They are frequently concerned about their skin and often present to dermatologists rather than psychiatrists. However, BDD patients attending dermatology clinics may be at risk of not receiving an appropriate assessment and beneficial treatment. The aims of this study were to estimate the BDD prevalence rate among Swedish female dermatology patients and to assess the psychological condition of BDD patients compared to that of other dermatology patients. METHODS The occurrence of BDD was estimated using the Body Dysmorphic Disorder Questionnaire (BDDQ), a validated self-report measure for BDD. Symptoms of depression and anxiety were measured by the Hospital Anxiety and Depression Scale (HADS), and quality of life was assessed using the Dermatology Life Quality Index (DLQI). RESULTS The prevalence rate of BDD among female Swedish dermatology patients was 4.9% (95% CI 3.2-7.4). Anxiety (HADS A ≥ 11) was 4-fold more commonly reported by patients with positive BDD screening (48% vs. 11%), and depression (HADS D ≥ 11) was over 10-fold more common in patients with positive BDD screening (19% vs. 1.8%) (P < 0.001). The median DLQI score was 18 in the BDD group, compared to a score of 4 in the non-BDD group (P < 0.001). CONCLUSIONS Our results indicate that BDD is fairly common among female Swedish dermatology patients (4.9%) and that BDD patients have high levels of depression and anxiety and severely impaired quality of life.
Collapse
Affiliation(s)
- Sabina Brohede
- Unit of Medical Psychology, Department of Clinical and Experimental Medicine, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden.,Department of Paediatrics and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Yvonne Wyon
- Department of Dermatology and Venereology and Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden
| | - Gun Wingren
- Occupational and Environmental Medicine, Department of Clinical and Experimental Medicine, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Barbro Wijma
- Gender and Medicine, Department of Clinical and Experimental Medicine, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Klaas Wijma
- Unit of Medical Psychology, Department of Clinical and Experimental Medicine, Faculty of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| |
Collapse
|
13
|
Kollei I, Horndasch S, Erim Y, Martin A. Visual selective attention in body dysmorphic disorder, bulimia nervosa and healthy controls. J Psychosom Res 2017; 92:26-33. [PMID: 27998509 DOI: 10.1016/j.jpsychores.2016.11.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 11/18/2016] [Accepted: 11/19/2016] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Cognitive behavioral models postulate that selective attention plays an important role in the maintenance of body dysmorphic disorder (BDD). It is suggested that individuals with BDD overfocus on perceived defects in their appearance, which may contribute to the excessive preoccupation with their appearance. METHODS The present study used eye tracking to examine visual selective attention in individuals with BDD (n=19), as compared to individuals with bulimia nervosa (BN) (n=21) and healthy controls (HCs) (n=21). Participants completed interviews, questionnaires, rating scales and an eye tracking task: Eye movements were recorded while participants viewed photographs of their own face and attractive as well as unattractive other faces. RESULTS Eye tracking data showed that BDD and BN participants focused less on their self-rated most attractive facial part than HCs. Scanning patterns in own and other faces showed that BDD and BN participants paid as much attention to attractive as to unattractive features in their own face, whereas they focused more on attractive features in attractive other faces. HCs paid more attention to attractive features in their own face and did the same in attractive other faces. CONCLUSION Results indicate an attentional bias in BDD and BN participants manifesting itself in a neglect of positive features compared to HCs. Perceptual retraining may be an important aspect to focus on in therapy in order to overcome the neglect of positive facial aspects. Future research should aim to disentangle attentional processes in BDD by examining the time course of attentional processing.
Collapse
Affiliation(s)
- Ines Kollei
- Department of Clinical Psychology and Psychotherapy, University of Bamberg, Markusplatz 3, 96047 Bamberg, Germany.
| | - Stefanie Horndasch
- Department of Child and Adolescent Mental Health, University Hospital of Erlangen, Schwabachanlage 6/10, 91054 Erlangen, Germany.
| | - Yesim Erim
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, Schwabachanlage 6, 91054 Erlangen, Germany.
| | - Alexandra Martin
- Department of Clinical Psychology and Psychotherapy, University of Wuppertal, Max-Horkheimer-Str. 20, 42097 Wuppertal, Germany.
| |
Collapse
|
14
|
The effect of self-focused attention and mood on appearance dissatisfaction after mirror-gazing: An experimental study. J Behav Ther Exp Psychiatry 2016; 52:38-44. [PMID: 26989833 DOI: 10.1016/j.jbtep.2016.03.002] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 03/06/2016] [Accepted: 03/07/2016] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVES Self-focused attention is hypothesized to be a maintenance factor in body dysmorphic disorder (BDD). The aim of this study was to use an experimental paradigm to test this hypothesis by studying the effect of self-focused attention during mirror-gazing on appearance dissatisfaction. METHODS An experimental group design was used, in which 173 women were randomly allocated to one of three conditions before mirror-gazing for 2 min: (a) external focus of attention, (b) self-focus of attention, and (c) self-focus of attention with a negative mood induction. RESULTS After mirror-gazing, participants across all groups rated themselves as being more dissatisfied with their appearance. In both the self-focus conditions, there was an increase in sadness from pre to post mirror gazing, and there was a significant difference in focus of attention for participants in the self-focused, mood-induced group from pre to post manipulation, suggesting mood induction had more of an effect than focus of attention. LIMITATIONS (1) there was no condition involving an external focus with a negative mood induction, and (2) due to the level of information provided to patients on the nature of the task, we cannot rule out demand characteristics as an influencing factor on our results. CONCLUSIONS Self-focused attention during mirror-gazing may act indirectly to increase appearance dissatisfaction via the effect of negative mood. Further studies are required to establish the relative contribution of self-focused attention and negative mood to increases in appearance dissatisfaction as a function of mirror-gazing.
Collapse
|
15
|
Arditte KA, Shaw AM, Timpano KR. Repetitive Negative Thinking: A Transdiagnostic Correlate of Affective Disorders. JOURNAL OF SOCIAL AND CLINICAL PSYCHOLOGY 2016. [DOI: 10.1521/jscp.2016.35.3.181] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
16
|
Schieber K, Martin A. Die körperdysmorphe Störung: aktuelle Entwicklungen zu Diagnostik, Störungswissen und Therapie. ACTA ACUST UNITED AC 2016. [DOI: 10.1055/s-0041-105934] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
17
|
Cordes M, Bauer A, Waldorf M, Vocks S. Körperbezogene Aufmerksamkeitsverzerrungen bei Frauen und Männern. PSYCHOTHERAPEUT 2015. [DOI: 10.1007/s00278-015-0058-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
18
|
Schieber K, Kollei I, de Zwaan M, Martin A. Classification of body dysmorphic disorder - what is the advantage of the new DSM-5 criteria? J Psychosom Res 2015; 78:223-7. [PMID: 25595027 DOI: 10.1016/j.jpsychores.2015.01.002] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 01/02/2015] [Accepted: 01/05/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVE In DSM-5 the diagnosis of body dysmorphic disorder (BDD) has been subjected to two important changes: Firstly, BDD has been assigned to the category of obsessive-compulsive and related disorders. Secondly, a new criterion has been defined requiring the presence of repetitive behaviors or mental acts in response to appearance concerns. The aims of this study were to report the prevalence rates of BDD based on a DSM-5 diagnosis, and to evaluate the impact of the recently introduced DSM-5 criteria for BDD by comparing the prevalence rates (DSM-5 vs. DSM-IV) METHODS BDD-criteria (DSM-IV/DSM-5), dysmorphic concerns, and depressive symptoms, were assessed in a representative sample of the German general population (N=2129, aged 18-65years). RESULTS The association between BDD case identification based on DSM-IV and DSM-5 was strong (Phi=.95, p<.001), although point prevalence of BDD according to DSM-5 was slightly lower (2.9%, n=62 vs. 3.2%, n=68). Approximately one third of the identified BDD (DSM-5) cases reported time-consuming behavioral acts in response to appearance concerns. In detail, 0.8% of the German general population fulfilled the BDD criteria and reported repetitive acts of at least one hour/day. CONCLUSIONS The revised criteria of BDD in DSM-5 do not seem to have an impact on prevalence rates. However, the recently added B-criterion reflects more precisely the clinical symptoms of BDD, and may be useful for distinguishing between various severity levels related to repetitive behaviors/mental acts.
Collapse
Affiliation(s)
- Katharina Schieber
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital of Erlangen, University of Erlangen-Nuernberg, Schwabachanlage 6, 91054 Erlangen, Germany.
| | - Ines Kollei
- (b)Department of Clinical Psychology and Psychotherapy, University of Erlangen-Nuernberg, Nägelsbachstr. 25a, 91052 Erlangen, Germany
| | - Martina de Zwaan
- (c)Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Carl-Neuberg-Str. 1, 30625 Hannover, Germany
| | - Alexandra Martin
- (d)Department of Clinical Psychology and Psychotherapy, University of Wuppertal, Max-Horkheimer-Str. 20, 42097 Wuppertal, Germany
| |
Collapse
|
19
|
Accept, distract, or reframe? An exploratory experimental comparison of strategies for coping with intrusive body image thoughts in anorexia nervosa and body dysmorphic disorder. Psychiatry Res 2015; 225:643-50. [PMID: 25530419 DOI: 10.1016/j.psychres.2014.11.031] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 09/08/2014] [Accepted: 11/09/2014] [Indexed: 11/20/2022]
Abstract
Negative body image is the hallmark of anorexia nervosa (AN) and body dysmorphic disorder (BDD). One aspect of body image, appearance-related thoughts, have shown to be a major contributor to relapse, thus further investigation of successful treatment strategies targeting these maladaptive thoughts are warranted. The present study tested an acceptance/mindfulness (AC), a cognitive restructuring (CR), and a distraction strategy with regard to their short-term effectiveness of reducing the frequency of thought occurrence and associated outcomes in participants with AN (n=20), BDD (n=21), and healthy controls (HC; n=22). Although all strategies led to a significant reduction of thought frequency, there was no group × strategy interaction effect in their reduction. Positive affect increased in the BDD group through the AC strategy, but decreased in healthy controls. Acceptance of the thought increased in the CR strategy in AN, whereas that strategy seemed to work least for BDD. Healthy controls showed most acceptance when using distraction. Taken together, the study suggests that all strategies might have their benefits and that it might be worthwhile further investigating differential indication of the strategies with regard to diagnosis and individual factors.
Collapse
|