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Katrina HÀC, Malcolm A, Toh WL, Rossell SL. A systematic review of neurocognition and social cognition in body dysmorphic disorder. Aust N Z J Psychiatry 2025; 59:224-247. [PMID: 39764591 PMCID: PMC11837421 DOI: 10.1177/00048674241309747] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2025]
Abstract
OBJECTIVE Neurocognitive underpinnings are implicated in the aetiology and maintenance of body dysmorphic disorder (BDD); however, inconsistent findings across a range of neurocognitive domains suggest that a comprehensive synthesis of the literature using a hierarchical framework of neurocognition is needed. METHODS A final search across OVID Medline, PsycNET, Scopus and Web of Science databases was conducted on 20 June 2024 to identify research that examined performance on behavioural tasks of objective neurocognition in BDD. Risk of bias was assessed using the Newcastle-Ottawa Scale. Fifty-four studies aligned with the following inclusion criteria: (1) full-text; (2) peer-reviewed; (3) published in English; (4) employed a neurocognitive task with an objective outcome and (5) involved a case-controlled paradigm consisting of BDD and healthy control samples. Findings were synthesised according to neurocognitive sub-domains viewed as a hierarchy from basic to higher-level domains. RESULTS Neurocognitive differences in BDD relative to controls were identified at almost all levels of the hierarchy, most consistently in the upper domains of executive function and social cognition. Vulnerabilities were also demonstrated in the sub-domains of visual perception of faces, Gestalt processing, selective attention to faces and verbal memory. Methodological limitations or the influence of neurocognitive sub-groups may contribute to inconsistencies across the literature. CONCLUSIONS Although neurocognitive differences appear central to BDD, a picture of neurocognitive heterogeneity emerged with the salience of stimuli important and a likely bias to local-over-global processing demonstrated across the domains.
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Affiliation(s)
| | - Amy Malcolm
- Centre for Mental Health, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Wei Lin Toh
- Centre for Mental Health, Swinburne University of Technology, Melbourne, VIC, Australia
| | - Susan L Rossell
- Centre for Mental Health, Swinburne University of Technology, Melbourne, VIC, Australia
- Psychiatry, St Vincent’s Hospital, Melbourne, VIC, Australia
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2
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Rück C, Mataix-Cols D, Feusner JD, Shavitt RG, Veale D, Krebs G, Fernández de la Cruz L. Body dysmorphic disorder. Nat Rev Dis Primers 2024; 10:92. [PMID: 39639018 DOI: 10.1038/s41572-024-00577-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/29/2024] [Indexed: 12/07/2024]
Abstract
Body dysmorphic disorder (BDD) is an obsessive-compulsive disorder-related psychiatric condition characterized by an intense preoccupation with perceived physical flaws that are not observable by others. BDD affects ~2% of the adult population but is underdiagnosed, partly owing to limited clinician awareness, and undertreated, partly due to limited access to treatment. Research on the aetiology of BDD is scarce but likely involves an interplay between genetic and environmental factors. A few studies suggest functional and structural brain differences (compared with controls) in the regions involved in visual and emotional processing, although firm conclusions about the pathophysiology of the disorder cannot be made at this stage. Diagnosis requires the presence of repetitive behaviours or mental acts typically aimed at checking, correcting or concealing perceived flaws. The disorder typically has its onset before 18 years of age, with a female preponderance in youth but no major gender disparity in adults. Quality of life is markedly impaired across multiple domains and suicide risk is considerable. Evidence-based treatments include cognitive behavioural therapy and selective serotonin reuptake inhibitors. Future research should focus on understanding the biological and environmental factors that increase the risk of BDD, and on improving access to effective treatments, thereby addressing a critical gap in care for this often misunderstood and overlooked disorder.
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Affiliation(s)
- Christian Rück
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Healthcare Services, Region Stockholm, Stockholm, Sweden.
| | - David Mataix-Cols
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Healthcare Services, Region Stockholm, Stockholm, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Jamie D Feusner
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Department of Women's and Children's Health, Karolinska Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Roseli Gedanke Shavitt
- Obsessive-Compulsive Spectrum Disorders Program, LIM23, Hospital das Clinicas HCFMUSP, Instituto & Departamento de Psiquiatria da Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - David Veale
- South London and Maudsley NHS Foundation Trust, London, UK
- Institute of Psychiatry, Psychology, and Neursocience, King's College London, London, UK
| | - Georgina Krebs
- Research Department of Clinical, Educational, and Health Psychology, University College London, London, UK
| | - Lorena Fernández de la Cruz
- Center for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Healthcare Services, Region Stockholm, Stockholm, Sweden
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3
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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] [MESH Headings] [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
- Orygen, Centre for Youth Mental Health, University of Melbourne, 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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4
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Diaz-Fong JP, Feusner JD. Visual Perceptual Processing Abnormalities in Body Dysmorphic Disorder. Curr Top Behav Neurosci 2024. [PMID: 38691313 DOI: 10.1007/7854_2024_472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
Phenomenological observations of individuals with body dysmorphic disorder (BDD), coupled with evidence from neuropsychological, psychophysical, and neuroimaging studies, support a model of aberrant visual perception characterized by deficient global/holistic, enhanced detail/local processing, and selective visual-attentional biases. These features may contribute to the core symptomatology of distorted perception of their appearance, in addition to misinterpretation of others' facial expressions and poor insight regarding their misperceived appearance defects. Insights from visual processing studies can contribute to the development of novel interventions, such as perceptual retraining and non-invasive neuromodulation. However, much remains to be understood about visual perception in BDD. Future research should leverage brain imaging modalities with high temporal resolutions and employ study designs that induce conflicts in multisensory integration, thereby advancing our mechanistic understanding of distorted visual perception observed in BDD.
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Affiliation(s)
- Joel P Diaz-Fong
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Jamie D Feusner
- Institute of Medical Science, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
- Centre for Addiction and Mental Health, Toronto, ON, Canada.
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
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5
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Bernstein EE, Klare D, Weingarden H, Greenberg JL, Snorrason I, Hoeppner SS, Vanderkruik R, Harrison O, Wilhelm S. Impact of sleep disruption on BDD symptoms and treatment response. J Affect Disord 2024; 346:206-213. [PMID: 37952909 PMCID: PMC10842714 DOI: 10.1016/j.jad.2023.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 08/08/2023] [Accepted: 11/09/2023] [Indexed: 11/14/2023]
Abstract
BACKGROUND Body dysmorphic disorder (BDD) is severe, undertreated, and relatively common. Although gold-standard cognitive behavioral therapy (CBT) for BDD has strong empirical support, a significant number of patients do not respond. More work is needed to understand BDD's etiology and modifiable barriers to treatment response. Given its high prevalence and impact on the development, maintenance, and treatment of related, frequently comorbid disorders, sleep disruption is a compelling, but not-yet studied factor. METHODS Data were drawn from a randomized controlled trial of guided smartphone app-based CBT for BDD. Included participants were offered 12-weeks of treatment, immediately (n = 40) or after a 12-week waitlist (n = 37). Sleep disruption and BDD symptom severity were assessed at baseline, week-6, and week-12. RESULTS Hypotheses and analysis plan were pre-registered. Two-thirds of patients reported significant insomnia symptoms at baseline. Baseline severity of sleep disruption and BDD symptoms were not related (r = 0.02). Pre-treatment sleep disruption did not predict BDD symptom reduction across treatment, nor did early sleep improvements predict greater BDD symptom improvement. Early BDD symptom improvement also did not predict later improvements in sleep. LIMITATIONS Limitations include the small sample, restricted ranges of BDD symptom severity and treatment response, and few metrics of sleep disruption. CONCLUSIONS Although insomnia was disproportionately high in this sample and both BDD symptoms and sleep improved in treatment, results suggest sleep and BDD symptoms may function largely independent of one another. More work is encouraged to replicate and better understand findings as well as potential challenges and benefits of addressing sleep in BDD.
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Affiliation(s)
- Emily E Bernstein
- Massachusetts General Hospital, United States of America; Harvard Medical School, United States of America.
| | - Dalton Klare
- Massachusetts General Hospital, United States of America
| | - Hilary Weingarden
- Massachusetts General Hospital, United States of America; Harvard Medical School, United States of America
| | - Jennifer L Greenberg
- Massachusetts General Hospital, United States of America; Harvard Medical School, United States of America
| | - Ivar Snorrason
- Massachusetts General Hospital, United States of America; Harvard Medical School, United States of America
| | - Susanne S Hoeppner
- Massachusetts General Hospital, United States of America; Harvard Medical School, United States of America
| | - Rachel Vanderkruik
- Massachusetts General Hospital, United States of America; Harvard Medical School, United States of America
| | | | - Sabine Wilhelm
- Massachusetts General Hospital, United States of America; Harvard Medical School, United States of America
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6
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Gu YQ, Zhu Y. A randomized controlled trial of mindfulness-based cognitive therapy for body dysmorphic disorder: Impact on core symptoms, emotion dysregulation, and executive functioning. J Behav Ther Exp Psychiatry 2023; 81:101869. [PMID: 37311379 DOI: 10.1016/j.jbtep.2023.101869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 04/27/2023] [Accepted: 05/06/2023] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVES Mindfulness-based cognitive therapy (MBCT) is garnering increasing empirical interest as an intervention for Body Dysmorphic Disorder (BDD), although no studies of mindfulness as a standalone treatment have included a sample composed entirely of patients with BDD or a comparison group. The aim of this study was to investigate the improvement of MBCT intervention on the core symptoms, emotional dysfunction, and executive function of BDD patients, as well as the feasibility and acceptability of MBCT training. METHOD Patients with BDD were randomized into an 8-week MBCT group (n = 58) or treatment-as-usual (TAU) control group (n = 58) and were assessed at pre-treatment, post-treatment, and 3-month follow-up. RESULTS Participants who received MBCT showed greater improvement on self-reported and clinician ratings of BDD symptoms, self-reported emotion dysregulation symptoms and executive function compared with TAU participants. Improvement for executive function tasks was partially supported. In addition, feasibility and acceptability of MBCT training were positive. LIMITATIONS There is no systematic assessment of the severity of key potential outcome variables associated with BDD. CONCLUSION MBCT may be a useful intervention for patients with BDD, improving patients' BDD symptoms, emotion dysregulation, and executive functioning.
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Affiliation(s)
- Ying-Qi Gu
- Department of Psychology, Zhejiang Sci-Tech University, Hangzhou, 310018, Zhejiang Province, China.
| | - Yi Zhu
- Department of Psychology, The First Affiliated Hospital of Hainan Medical University, Haikou, 570102, Hainan Province, China; School of Psychology, Hainan Medical University, Haikou, 571199, Hainan Province, China
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7
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Jalal B, Chamberlain SR, Sahakian BJ. Obsessive-compulsive disorder: Etiology, neuropathology, and cognitive dysfunction. Brain Behav 2023; 13:e3000. [PMID: 37137502 PMCID: PMC10275553 DOI: 10.1002/brb3.3000] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 03/14/2023] [Accepted: 03/24/2023] [Indexed: 05/05/2023] Open
Abstract
BACKGROUND This review provides an overview of obsessive-compulsive disorder (OCD) symptoms, including the four partially distinct subtypes of the disorder, current diagnostic criteria, and common comorbidities. Critically, it focuses on the etiology of OCD, including its underlying neuropathology, and examines cognitive dysfunction in OCD. METHODS This review study was conducted by library method. RESULTS We show how dysfunction in cortico-striato-thalamo-cortical (CSTC) circuits may underpin symptoms; and shed light on the putative neurochemistry within these loops such as the role of serotonin, dopamine, and glutamate systems. We also show how OCD is characterized by cognitive dysfunction including problems in cognitive flexibility, visuospatial memory, response inhibition, and goal-directed behavior, linked to aberrant activity within CSTC circuits. CONCLUSIONS In brief, research questions we shed light on include (1) what are the symptoms in OCD; (2) what is the etiology of the disorder and do existing models explain OCD; and (3) what are key cognitive deficits in OCD and do these improve with treatment?
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Affiliation(s)
- Baland Jalal
- Department of PsychiatryUniversity of Cambridge School of Clinical MedicineCambridgeUK
- Behavioural and Clinical Neuroscience Institute, Department of PsychologyUniversity of CambridgeCambridgeUK
| | - Samuel R. Chamberlain
- Faculty of Medicine, Department of PsychiatryUniversity of SouthamptonSouthamptonUK
- Specialist Clinic for Impulsive and Compulsive Disorders, and the Southern Gambling ServiceSouthern Health NHS Foundation TrustSouthamptonUK
| | - Barbara J. Sahakian
- Department of PsychiatryUniversity of Cambridge School of Clinical MedicineCambridgeUK
- Behavioural and Clinical Neuroscience Institute, Department of PsychologyUniversity of CambridgeCambridgeUK
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8
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Executive functioning in body dysmorphic disorder and obsessive-compulsive disorder. CNS Spectr 2023; 28:33-40. [PMID: 34313212 DOI: 10.1017/s1092852921000705] [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] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To assess executive functions (EFs) in patients with body dysmorphic disorder (BDD) and obsessive-compulsive disorder (OCD) compared with healthy controls. METHODS Adults diagnosed with BDD (n = 26) or OCD (n = 29) according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, and healthy controls (n = 28) underwent validated and computerized neuropsychological tests, spatial working memory (SWM), intra-extra-dimensional set shifting (IED), and stop signal task (SST), from the Cambridge Neuropsychological Test Automated Battery (CANTAB). Test performance was compared between groups, and correlated with standardized symptom severity of BDD and OCD. Significance level was set to P < .05. RESULTS There were no statistically significant between-group differences on key outcome measures in SWM, IED, or SST. There was a weak positive correlation between symptom severity and test errors on SWM and IED in both OCD and BDD groups; increased clinical severity was associated with more errors in these tests. Furthermore, there was a negative correlation between symptom severity and SST in the BDD group. CONCLUSIONS Patients with BDD or OCD did not differ from healthy control subjects in terms of test performance; however, there were several statistically significant correlations between symptom severity and performance in those with BDD or OCD. More studies on EFs in BDD and OCD are required to elucidate if there are differences in EFs between these two disorders.
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9
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Rossell S. Understanding and treating body dysmorphic disorder. Psychiatry Res 2023; 319:114980. [PMID: 36470162 DOI: 10.1016/j.psychres.2022.114980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/18/2022] [Accepted: 11/20/2022] [Indexed: 11/23/2022]
Abstract
Body dysmorphic disorder (BDD) is a mental disorder that involves a distressing preoccupation with a perceived defect in physical appearance, associated with excessive or repetitive behaviours or mental acts aimed at camouflaging, checking or 'improving' the perceived area of concern. BDD is relatively common, affecting at least 2% of the population world-wide, yet is poorly understood. Professor Susan Rossell has produced a substantial body of influential research, which has improved our understanding of BDD. This includes a more comprehensive understanding of the phenomenology, neurocognition and neurobiology, as well as significant treatment advances. This work will be reviewed in this commentary.
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Affiliation(s)
- Susan Rossell
- Centre for Mental Health, School of Health Sciences, Swinburne University of Technology, Melbourne, VIC, Australia; Department of Mental Health, St Vincent's Hospital, Melbourne, VIC, Australia.
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Rajabi S, Kamran L, Joukar KamalAbadi M. Epidemiology of body dysmorphic disorder among adolescents: A study of their cognitive functions. Brain Behav 2022; 12:e01710. [PMID: 35307985 PMCID: PMC9015000 DOI: 10.1002/brb3.1710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 05/02/2020] [Accepted: 05/16/2020] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Body dysmorphic disorder (BDD) is characterized by a preoccupation with an imagined defect in one's appearance. In case of a slight physical anomaly, the person would experience an excessive concern. This disorder causes cognitive dysfunction. PURPOSE The aim of this study was to examine epidemiology of body dysmorphic disorder among students at secondary schools of the first and second stage in Shiraz, Iran. It also compares executive functions in students with BDD to healthy students. METHODS The Body Dysmorphic Disorder Questionnaire (BDDQ), Stroop Color and Word Test (SCWT),Wisconsin Card Sorting Test (WCST), Tower of London test (ToL), and Trail Making Test (TMT) were measured in participants with BDD (N = 52; Mage = 16.20; SD = 1.03) and healthy control group (N = 52; Mage = 15.91; SD = 0.96). RESULTS The frequency of BDD was significantly higher in women than men (14.8% vs. 6.8%), and its prevalence was 10.4% in total. There was a significant difference between the two groups of students concerning attentional set-shifting, inhibition of cognitive interference, visual-spatial searching, and sequencing, but not problem-solving tasks. CONCLUSIONS Students with BDD have cognitive deficits, which need to be addressed in cognitive rehabilitation.
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Affiliation(s)
- Soran Rajabi
- General Psychology, Persian Gulf University, Bushehr, Iran
| | - Leila Kamran
- General Psychology, Persian Gulf University, Bushehr, Iran
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11
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Dingemans AE, Volkmer SA, Mulkens S, Vuijk R, van Rood YR. The obsessive-compulsive spectrum: A network analysis. Psychiatry Res 2022; 308:114351. [PMID: 34979379 DOI: 10.1016/j.psychres.2021.114351] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 12/17/2021] [Accepted: 12/18/2021] [Indexed: 11/24/2022]
Abstract
Several studies have shown that obsessive-compulsive disorder (OCD), eating disorders (ED), autism spectrum disorders (ASD) and body dysmorphic disorder (BDD) share obsessive-compulsive (OC) symptoms and often co-occur, which could be seen as indicative of a common etiological basis. In addition, they also appear to have similarities in executive functioning. The present study investigated disorder-specific symptoms and executive functioning as a possible joint factor in individuals with OCD (n=53), BDD (n=95), ED (n=171) and ASD (n=73), and in healthy controls (n=110). The participants completed online questionnaires measuring OCD, ED, ASD and BDD related symptoms as well as executive functioning. The clinical groups were first compared to the healthy controls. Subsequently, a network analysis was performed only with the OC-groups. This network approach assumes that psychopathological disorders are the result of causal symptom interactions. As expected, the healthy controls reported less severe symptoms compared to the OC patient groups. The network analysis suggested that the executive functioning skill set shifting/attention switching and the ASD symptoms, social and communication skills were the most central nodes in the model. Difficulty with cognitive flexibility and social factors are central in OC-spectrum disorders and may be perpetuating factors and thus a relevant focus of treatment.
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Affiliation(s)
| | | | - Sandra Mulkens
- Department of Psychiatry and Neuropsychology, and Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands
| | | | - Yanda R van Rood
- Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
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12
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Malcolm A, Pikoos T, Castle DJ, Rossell SL. Cross-diagnostic cognitive heterogeneity in body dysmorphic disorder and obsessive-compulsive disorder. J Behav Ther Exp Psychiatry 2021; 73:101674. [PMID: 34242980 DOI: 10.1016/j.jbtep.2021.101674] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 05/03/2021] [Accepted: 06/30/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND OBJECTIVES Previous research has indicated that body dysmorphic disorder (BDD) and obsessive-compulsive disorder (OCD) often demonstrate similar cognitive impairments across multiple domains. However, findings for both disorders have not consistently shown impaired cognition. As such, BDD and OCD might share an overlapping pattern of cognitive heterogeneity, characterised by subgroups with different cognitive profiles. METHODS To evaluate this possibility, we compared 26 BDD, 24 OCD, and 26 healthy control participants on a comprehensive eight-domain cognitive battery. Then, cluster analysis was performed on the BDD and OCD participants' combined data to explore for cognitive subgroups. RESULTS No significant differences were found between the three groups' cognitive functioning, except for poorer visual learning in OCD relative to healthy controls. Cluster analysis produced two cognitive subgroups within the combined BDD and OCD data, characterised by intact cognition (52%) and broadly impaired cognition (48%). Each subgroup comprised both BDD and OCD participants, in similar proportions. The subgroups did not differ in clinical or demographic features. LIMITATIONS Sample sizes were moderate. Future research should investigate clustering patterns both in larger groups and separately in BDD and OCD samples to determine replicability. CONCLUSIONS These findings suggest that BDD and OCD may involve similar patterns of cognitive heterogeneity, and further imply that individuals with either disorder can show a wide range of cognitive profiles, thus necessitating a nuanced approach to future cognitive research in BDD and OCD.
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Affiliation(s)
- Amy Malcolm
- Centre for Mental Health, Faculty of Health, Arts & Design, Swinburne University of Technology, Hawthorn, VIC, Australia.
| | - Toni Pikoos
- Centre for Mental Health, Faculty of Health, Arts & Design, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - David J Castle
- Department of Mental Health, St Vincent's Hospital, Melbourne, VIC, Australia; The University of Melbourne, Melbourne, VIC, Australia; Centre for Addiction and Mental Health and the Department of Psychiatry, University of Toronto, Canada
| | - Susan L Rossell
- Centre for Mental Health, Faculty of Health, Arts & Design, Swinburne University of Technology, Hawthorn, VIC, Australia; Department of Mental Health, St Vincent's Hospital, Melbourne, VIC, Australia
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13
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Malcolm A, Brennan SN, Grace SA, Pikoos TD, Toh WL, Labuschagne I, Buchanan B, Kaplan RA, Castle DJ, Rossell SL. Empirical evidence for cognitive subgroups in body dysmorphic disorder. Aust N Z J Psychiatry 2021; 55:381-390. [PMID: 33637003 DOI: 10.1177/0004867421998762] [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] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Current understanding of cognitive functioning in body dysmorphic disorder is limited, owing to few studies, small sample sizes and assessment across only limited cognitive domains. Existing research has also shown inconsistent findings, with both intact and impaired cognition reported in body dysmorphic disorder, which might point towards cognitive heterogeneity in the disorder. This study aimed to examine the cognitive profile of body dysmorphic disorder in a large sample across eight cognitive domains, and to explore whether cognitive subgroups might be identified within body dysmorphic disorder. METHOD Cognitive domains of inhibition/flexibility, working memory, speed of processing, reasoning and problem-solving, visual and verbal learning, attention/vigilance and social cognition were assessed and compared between 65 body dysmorphic disorder patients and 70 healthy controls. Then, hierarchical clustering analysis was conducted on the body dysmorphic disorder group's cognitive data. RESULTS Group-average comparisons demonstrated significantly poorer cognitive functioning in body dysmorphic disorder than healthy controls in all domains except for attention/vigilance and social cognition. Cluster analysis identified two divergent cognitive subgroups within our body dysmorphic disorder cohort characterised by (1) broadly intact cognitive function with mild selective impairments (72.3%), and (2) broadly impaired cognitive function (27.7%). However, the clusters did not significantly differ on clinical parameters or most sociodemographic characteristics. CONCLUSION Our findings demonstrate considerable cognitive heterogeneity among persons with body dysmorphic disorder, rather than uniform deficits. Poor performances in the broadly impaired subgroup may have driven group-level differences. However, our findings also suggest a dissociation between cognitive functioning and clinical characteristics in body dysmorphic disorder that has implications for current aetiological models. Additional research is needed to clarify why some people with body dysmorphic disorder demonstrate cognitive deficits while others do not.
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Affiliation(s)
- Amy Malcolm
- Centre for Mental Health, Faculty of Health, Arts & Design, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Sarah N Brennan
- Centre for Mental Health, Faculty of Health, Arts & Design, Swinburne University of Technology, Hawthorn, VIC, Australia.,The Royal Children's Hospital, Melbourne, VIC, Australia
| | - Sally A Grace
- Centre for Mental Health, Faculty of Health, Arts & Design, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Toni D Pikoos
- Centre for Mental Health, Faculty of Health, Arts & Design, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Wei Lin Toh
- Centre for Mental Health, Faculty of Health, Arts & Design, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Izelle Labuschagne
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, VIC, Australia
| | - Ben Buchanan
- Centre for Mental Health, Faculty of Health, Arts & Design, Swinburne University of Technology, Hawthorn, VIC, Australia
| | - Ryan A Kaplan
- Centre for Mental Health, Faculty of Health, Arts & Design, Swinburne University of Technology, Hawthorn, VIC, Australia.,Sydney Body Dysmorphic Disorder & Body Image Clinic, Bondi Junction, NSW, Australia
| | - David J Castle
- Department of Mental Health, St Vincent's Hospital, Melbourne, VIC, Australia.,Department of Psychiatry, Faculty of Medicine, The University of Melbourne, Melbourne, VIC, Australia
| | - Susan L Rossell
- Centre for Mental Health, Faculty of Health, Arts & Design, Swinburne University of Technology, Hawthorn, VIC, Australia.,Department of Mental Health, St Vincent's Hospital, Melbourne, VIC, Australia
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14
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Examining memory performance in body dysmorphic disorder (BDD): A comparison study with obsessive compulsive disorder (OCD). Asian J Psychiatr 2020; 53:102110. [PMID: 32505114 DOI: 10.1016/j.ajp.2020.102110] [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: 01/10/2020] [Revised: 03/31/2020] [Accepted: 04/14/2020] [Indexed: 11/24/2022]
Abstract
The aim of this study is comparing directly the BDD and OCD disorders in terms of similarities and differences in memory function for the first time. 19 BDD patients, 15 OCD patients and 26 individuals in a healthy control group were recruited from three hospitals in Tehran. They were administered the following subtests of the Wechsler Memory Scale: logical memory (immediate and delayed), verbal paired association (immediate and delayed), digit span and spatial span as well as the Rey-Osterrieth complex figure test (RCFT). The results showed that BDD and OCD groups had lower performance in comparison to the control group across all measures, except for the immediate memory of the verbal paired associate task, which was similar across the three groups. Both the BDD and OCD groups showed poor performance on the auditory-verbal memory tasks. However, only the BDD group showed poor performance in the visual domain (i.e. spatial span and RCFT). This suggest that memory deficits are similar between BDD and OCD patients in the verbal domain. Furthermore, BDD patients demonstrated poorer visual working memory. The findings of this study reveal that BDD and OCD patients have more similarities than differences regarding neuropsychological features, in other words, the idea of the incorporation of BDD within the obsessive-compulsive and related disorders (OCRDs) spectrum in DSM-5 is supported, at least through the viewpoint of neuropsychology.
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15
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Rossell SL, Labuschagne I, Castle DJ, Toh WL. Delusional themes in Body Dysmorphic Disorder (BDD): Comparisons with psychotic disorders and non-clinical Controls. Psychiatry Res 2020; 284:112694. [PMID: 31785950 DOI: 10.1016/j.psychres.2019.112694] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 11/15/2019] [Accepted: 11/16/2019] [Indexed: 01/08/2023]
Abstract
The prevailing nosological classification of body dysmorphic disorder (BDD) encompasses an optional specifier "with absent insight/delusional beliefs" for patients who hold high conviction of the veracity of their disorder-specific beliefs. Yet limited research has examined the explicit nature of delusional beliefs in BDD. The current study therefore aimed to compare themes of delusional ideation in BDD relative to schizophrenia (SCZ) and healthy controls (HCs). Participants had a primary diagnosis of BDD (n = 44) or SCZ (n = 55), or were HCs (n = 55) with no personal or immediate family history of a diagnosable mental health disorder. Assessment of multidimensional delusional ideation was based on the Peters Delusional Inventory (PDI). Results showed that BDD and SCZ groups endorsed significantly more items, and had significantly elevated preoccupation and conviction than the HC group. Only the SCZ group exhibited significantly elevated distress relative to HC participants. In addition, BDD (akin to SCZ) participants were more likely to endorse somatic (appearance-related), control and thought alienation themes than the HC group. These findings suggest that delusional beliefs in BDD may not be strictly appearance-related, but rather span broader themes. This conveys therapeutic implications in terms of designing and administering targeted treatments aimed at delusional thinking in BDD.
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Affiliation(s)
- Susan L Rossell
- Centre for Mental Health, Swinburne University, Australia; Department of Psychiatry, St. Vincent's Mental Health, Australia.
| | - Izelle Labuschagne
- Cognition and Emotion Research Centre, School of Psychology, Australian Catholic University, Fitzroy, VIC, Australia
| | - David J Castle
- Department of Psychiatry, St. Vincent's Mental Health, Australia; Departments of Psychological Sciences and Psychiatry, University of Melbourne, Australia
| | - Wei Lin Toh
- Centre for Mental Health, Swinburne University, Australia; Departments of Psychological Sciences and Psychiatry, University of Melbourne, Australia
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16
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Enander J, Ivanov VZ, Mataix-Cols D, Kuja-Halkola R, Ljótsson B, Lundström S, Pérez-Vigil A, Monzani B, Lichtenstein P, Rück C. Prevalence and heritability of body dysmorphic symptoms in adolescents and young adults: a population-based nationwide twin study. Psychol Med 2018; 48:2740-2747. [PMID: 29486813 PMCID: PMC6236441 DOI: 10.1017/s0033291718000375] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Revised: 01/21/2018] [Accepted: 01/30/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND Body dysmorphic disorder (BDD) usually begins during adolescence but little is known about the prevalence, etiology, and patterns of comorbidity in this age group. We investigated the prevalence of BDD symptoms in adolescents and young adults. We also report on the relative importance of genetic and environmental influences on BDD symptoms, and the risk for co-existing psychopathology. METHODS Prevalence of BDD symptoms was determined by a validated cut-off on the Dysmorphic Concerns Questionnaire (DCQ) in three population-based twin cohorts at ages 15 (n = 6968), 18 (n = 3738), and 20-28 (n = 4671). Heritability analysis was performed using univariate model-fitting for the DCQ. The risk for co-existing psychopathology was expressed as odds ratios (OR). RESULTS The prevalence of clinically significant BDD symptoms was estimated to be between 1 and 2% in the different cohorts, with a significantly higher prevalence in females (1.3-3.3%) than in males (0.2-0.6%). The heritability of body dysmorphic concerns was estimated to be 49% (95% CI 38-54%) at age 15, 39% (95% CI 30-46) at age 18, and 37% (95% CI 29-42) at ages 20-28, with the remaining variance being due to non-shared environment. ORs for co-existing neuropsychiatric and alcohol-related problems ranged from 2.3 to 13.2. CONCLUSIONS Clinically significant BDD symptoms are relatively common in adolescence and young adulthood, particularly in females. The low occurrence of BDD symptoms in adolescent boys may indicate sex differences in age of onset and/or etiological mechanisms. BDD symptoms are moderately heritable in young people and associated with an increased risk for co-existing neuropsychiatric and alcohol-related problems.
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Affiliation(s)
- Jesper Enander
- Department of Clinical Neuroscience, Karolinska Institutet, Centre for Psychiatry Research, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm County Council
| | - Volen Z. Ivanov
- Department of Clinical Neuroscience, Karolinska Institutet, Centre for Psychiatry Research, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm County Council
| | - David Mataix-Cols
- Department of Clinical Neuroscience, Karolinska Institutet, Centre for Psychiatry Research, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm County Council
| | - Ralf Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Brjánn Ljótsson
- Department of Clinical Neuroscience, Karolinska Institutet, Centre for Psychiatry Research, Stockholm, Sweden
| | - Sebastian Lundström
- Centre for Ethics Law and Mental Health, University of Gothenburg, Gothenburg, Sweden
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden
| | - Ana Pérez-Vigil
- Department of Clinical Neuroscience, Karolinska Institutet, Centre for Psychiatry Research, Stockholm, Sweden
| | - Benedetta Monzani
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, UK
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Christian Rück
- Department of Clinical Neuroscience, Karolinska Institutet, Centre for Psychiatry Research, Stockholm, Sweden
- Stockholm Health Care Services, Stockholm County Council
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17
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Hartanto A, Yong JC. Measurement matters: higher waist-to-hip ratio but not body mass index is associated with deficits in executive functions and episodic memory. PeerJ 2018; 6:e5624. [PMID: 30210946 PMCID: PMC6130234 DOI: 10.7717/peerj.5624] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 08/22/2018] [Indexed: 01/13/2023] Open
Abstract
Background The current study aimed to reconcile the inconsistent findings between obesity, executive functions, and episodic memory by addressing major limitations of previous studies, including overreliance on body mass index (BMI), small sample sizes, and failure to control for confounds. Methods Participants consisted of 3,712 midlife adults from the Cognitive Project of the National Survey of Midlife Development. Executive functions and episodic memory were measured by a battery of cognitive function tests. Results We found that higher waist-to-hip ratio was associated with deficits in both executive functions and episodic memory, above and beyond the influence of demographics, comorbid health issues, health behaviors, personality traits, and self-perceived obesity. However, higher BMI was not associated with deficits in executive functions and episodic memory. More importantly, these differential associations were robust and stable across adulthood. Discussion Our findings confirm the association between obesity and episodic memory while highlighting the need for better measures of obesity when examining its associations with individual differences in cognitive functions.
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Affiliation(s)
- Andree Hartanto
- School of Social Sciences, Singapore Management University, Singapore, Singapore
| | - Jose C Yong
- School of Social Sciences, Singapore Management University, Singapore, Singapore.,National University of Singapore, Singapore, Singapore
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18
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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: 25] [Impact Index Per Article: 3.6] [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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19
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Blum AW, Redden SA, Grant JE. Neurocognitive Functioning in Young Adults with Subclinical Body Dysmorphic Disorder. Psychiatr Q 2018; 89:45-52. [PMID: 28367586 DOI: 10.1007/s11126-017-9510-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Despite reasonable knowledge of body dysmorphic disorder (BDD), little is known of its cognitive antecedents. In this study, we evaluated executive functioning and decision-making in people at risk of developing BDD using neuropsychological tests. Participants were non-treatment seeking volunteers (18-29 years) recruited from the general community, and split into two groups: those "at risk" of developing BDD (N = 5) and controls (N = 82). Participants undertook the One-Touch Stockings of Cambridge, Cambridge Gamble and Spatial Working Memory tasks and were assessed with the Body Dysmorphic Disorder Questionnaire. Results showed that the at-risk subjects performed significantly worse on a measure of executive function, whereas measures of risk-seeking behavior, quality of decision-making, and spatial working memory were largely intact. The findings suggest that selective cognitive dysfunction may already be present in terms of executive functioning in those at risk of developing BDD, even before psychopathology arises.
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Affiliation(s)
- Austin W Blum
- Department of Psychiatry & Behavioral Neuroscience, Pritzker School of Medicine, University of Chicago, 5841 S. Maryland Avenue, MC-3077, Chicago, IL, 60637, USA.
| | - Sarah A Redden
- Department of Psychiatry & Behavioral Neuroscience, Pritzker School of Medicine, University of Chicago, 5841 S. Maryland Avenue, MC-3077, Chicago, IL, 60637, USA
| | - Jon E Grant
- Department of Psychiatry & Behavioral Neuroscience, Pritzker School of Medicine, University of Chicago, 5841 S. Maryland Avenue, MC-3077, Chicago, IL, 60637, USA
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20
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Greenberg JL, Weingarden H, Reuman L, Abrams D, Mothi SS, Wilhelm S. Set shifting and visuospatial organization deficits in body dysmorphic disorder. Psychiatry Res 2018; 260:182-186. [PMID: 29202381 DOI: 10.1016/j.psychres.2017.11.062] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Revised: 11/20/2017] [Accepted: 11/22/2017] [Indexed: 10/18/2022]
Abstract
Individuals with body dysmorphic disorder (BDD) over-attend to perceived defect(s) in their physical appearance, often becoming "stuck" obsessing about perceived flaws and engaging in rituals to hide flaws. These symptoms suggest that individuals with BDD may experience deficits in underlying neurocognitive functions, such as set-shifting and visuospatial organization. These deficits have been implicated as risk and maintenance factors in disorders with similarities to BDD but have been minimally investigated in BDD. The present study examined differences in neurocognitive functions among BDD participants (n = 20) compared to healthy controls (HCs; n = 20). Participants completed neuropsychological assessments measuring set-shifting (Cambridge Neuropsychological Test Automated Battery Intra-Extra Dimensional Set Shift [IED] task) and visuospatial organization and memory (Rey-Osterrieth Complex Figure Test [ROCF]). Results revealed a set-shifting deficit among BDD participants compared to HCs on the IED. On the ROCF, BDD participants exhibited deficits in visuospatial organization compared to HCs, but they did not differ in visuospatial memory compared to HCs. Results did not change when accounting for depression severity. Findings highlight neurocognitive deficits as potential endophenotype markers of clinical features (i.e., delusionality). Understanding neuropsychological deficits may clarify similarities and differences between BDD and related disorders and may guide targets for BDD treatment.
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Affiliation(s)
- Jennifer L Greenberg
- Department of Psychiatry, Massachusetts General Hospital & Harvard Medical School, Simches Research Building 185 Cambridge Street, Suite 2000, Boston, MA 02114, USA.
| | - Hilary Weingarden
- Department of Psychiatry, Massachusetts General Hospital & Harvard Medical School, Simches Research Building 185 Cambridge Street, Suite 2000, Boston, MA 02114, USA.
| | - Lillian Reuman
- Department of Psychology and Neuroscience, The University of North Carolina at Chapel Hill, Davie Hall, Campus Box 3270, Chapel Hill, 27599 NC, USA.
| | - Dylan Abrams
- Department of Psychiatry, Massachusetts General Hospital & Harvard Medical School, Simches Research Building 185 Cambridge Street, Suite 2000, Boston, MA 02114, USA.
| | - Suraj S Mothi
- Department of Psychiatry, Massachusetts General Hospital & Harvard Medical School, Simches Research Building 185 Cambridge Street, Suite 2000, Boston, MA 02114, USA.
| | - Sabine Wilhelm
- Department of Psychiatry, Massachusetts General Hospital & Harvard Medical School, Simches Research Building 185 Cambridge Street, Suite 2000, Boston, MA 02114, USA.
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21
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The neurobiology of body dysmorphic disorder: A systematic review and theoretical model. Neurosci Biobehav Rev 2017; 83:83-96. [DOI: 10.1016/j.neubiorev.2017.10.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Revised: 07/27/2017] [Accepted: 10/02/2017] [Indexed: 12/12/2022]
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22
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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: 41] [Impact Index Per Article: 5.1] [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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23
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Toh WL, Castle DJ, Rossell SL. How individuals with body dysmorphic disorder (BDD) process their own face: a quantitative and qualitative investigation based on an eye-tracking paradigm. Cogn Neuropsychiatry 2017; 22:213-232. [PMID: 28322616 DOI: 10.1080/13546805.2017.1300090] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Body dysmorphic disorder (BDD) is characterised by repetitive behaviours and/or mental acts occurring in response to preoccupations with perceived flaws in physical appearance. Based on an eye-tracking paradigm, this study aimed to examine how individuals with BDD processed their own face. METHODS Participants were 21 BDD patients, 19 obsessive-compulsive disorder patients and 21 healthy controls (HC), who were age-, sex-, and IQ-matched. Stimuli were photographs of participants' own faces as well as those from the Pictures of Facial Affect battery. Outcome measures were affect recognition accuracy as well as spatial and temporal scanpath parameters. RESULTS The BDD group exhibited significantly decreased recognition accuracy for their own face relative to the HC group, and this was most pronounced for those who had a key concern centred on their face. Individual qualitative scanpath analysis revealed restricted and extensive scanning behaviours in BDD participants with a facial preoccupation. Persons with severe BDD also exhibited more marked scanpath deficits. CONCLUSIONS Future research should be directed at extending the current work by incorporating neuroimaging techniques, and investigations of eye-tracking focused on affected body parts in BDD. These could yield fruitful therapeutic applications via incorporation with existing treatment approaches.
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Affiliation(s)
- Wei Lin Toh
- a Departments of Psychological Sciences and Psychiatry , University of Melbourne , Parkville , Australia.,b Brain and Psychological Sciences Research Centre, Swinburne University , Hawthorn , VIC , Australia.,c Cognitive Neuropsychiatry , Monash Alfred Psychiatry Research Centre , Melbourne , Australia
| | - David J Castle
- a Departments of Psychological Sciences and Psychiatry , University of Melbourne , Parkville , Australia.,d Department of Psychiatry , St. Vincent's Mental Health , Fitzroy , Australia
| | - Susan L Rossell
- a Departments of Psychological Sciences and Psychiatry , University of Melbourne , Parkville , Australia.,b Brain and Psychological Sciences Research Centre, Swinburne University , Hawthorn , VIC , Australia.,c Cognitive Neuropsychiatry , Monash Alfred Psychiatry Research Centre , Melbourne , Australia.,d Department of Psychiatry , St. Vincent's Mental Health , Fitzroy , Australia
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24
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Munro BA, Weyandt LL, Hall LE, Oster DR, Gudmundsdottir BG, Kuhar BG. Physiological substrates of executive functioning: a systematic review of the literature. ACTA ACUST UNITED AC 2017; 10:1-20. [PMID: 28332146 DOI: 10.1007/s12402-017-0226-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 03/07/2017] [Indexed: 10/19/2022]
Abstract
Executive function (EF) is a multifaceted construct that has been defined as a set of higher-order cognitive processes that allow for flexibility, self-regulation, strategic planning, and goal-directed behaviors. EFs have been studied in numerous clinical disorders using a variety of neuropsychological tasks and, more recently, neuroimaging techniques. The underlying physiological substrates of EF were historically attributed to the frontal lobes; however, recent studies suggest more widespread involvement of additional brain regions. The purpose of the present study was to conduct a systematic review (using PRISMA 2009 guidelines) of neuroimaging studies employing functional magnetic resonance imaging and diffusion tensor imaging methods investigating the physiological substrates of EFs in attention-deficit/hyperactivity disorder compared to other clinical groups and non-clinical participants. Research articles were retrieved using PsycINFO, PsycARTICLES, MEDLINE, and ScienceDirect, beginning February 2015 through May 2016. A total of 42 studies met eligibility. Of those 42 studies, 22 studies included clinical participants and 20 studies included non-clinical participants. Results revealed increased activation of the frontal brain region in the majority of non-clinical studies and approximately 50% of the clinical studies, albeit with some inconsistencies across subregions, tasks, and age groups. Implications, methodological limitations, and suggestions for future research are discussed.
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Affiliation(s)
- Bailey A Munro
- Interdisciplinary Neuroscience Program, University of Rhode Island, Chafee Hall, 10 Chafee Road, Kingston, RI, 02881, USA.
| | - Lisa L Weyandt
- Interdisciplinary Neuroscience Program, University of Rhode Island, Chafee Hall, 10 Chafee Road, Kingston, RI, 02881, USA
| | - Lily E Hall
- Department of Psychology, University of Rhode Island, Kingston, RI, USA
| | - Danielle R Oster
- Department of Psychology, University of Rhode Island, Kingston, RI, USA
| | | | - Benjamin G Kuhar
- Department of Psychology, University of Rhode Island, Kingston, RI, USA
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25
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Cognitive dysfunction in body dysmorphic disorder: new implications for nosological systems and neurobiological models. CNS Spectr 2017; 22:51-60. [PMID: 27899165 PMCID: PMC5322826 DOI: 10.1017/s1092852916000468] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
UNLABELLED Introduction Body dysmorphic disorder (BDD) is a debilitating disorder, characterized by obsessions and compulsions relating specifically to perceived appearance, and which has been newly classified within the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) Obsessive-Compulsive and Related Disorders grouping. Until now, little research has been conducted into the cognitive profile of this disorder. METHODS Participants with BDD (n=12) and participants without BDD (n=16) were tested using a computerized neurocognitive battery investigating attentional set-shifting (Intra/Extra Dimensional Set Shift Task), decision-making (Cambridge Gamble Task), motor response-inhibition (Stop-Signal Reaction Time Task), and affective processing (Affective Go-No Go Task). The groups were matched for age, IQ, and education. RESULTS In comparison to controls, patients with BDD showed significantly impaired attentional set-shifting, abnormal decision-making, impaired response inhibition, and greater omission and commission errors on the emotional processing task. CONCLUSION Despite the modest sample size, our results showed that individuals with BDD performed poorly compared to healthy controls on tests of cognitive flexibility, reward and motor impulsivity, and affective processing. Results from separate studies in OCD patients suggest similar cognitive dysfunction. Therefore, these findings are consistent with the reclassification of BDD alongside OCD. These data also hint at additional areas of decision-making abnormalities that might contribute specifically to the psychopathology of BDD.
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26
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Thanveer F, Khunger N. Screening for Body Dysmorphic Disorder in a Dermatology Outpatient Setting at a Tertiary Care Centre. J Cutan Aesthet Surg 2016; 9:188-191. [PMID: 27761090 PMCID: PMC5064684 DOI: 10.4103/0974-2077.191649] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Context: A distressing pre-occupation with an imagined or slight defect in appearance with a marked negative effect on the patient's life is the core symptom of body dysmorphic disorder (BDD). Aim: To screen the patients attending a dermatology clinic at a tertiary care centre for BDD using the BDD-dermatology version (DV) questionnaire. Settings and Design: This cross-sectional study enrolled 245 consecutive patients from the dermatology outpatients clinic. Methods: The demographic details were collected and the DV of BDD screening questionnaire was administered. A 5-point Likert scale was used for objective scoring of the stated concern and patients who scored ≥3 were excluded from the study. Statistical Analysis Used: The results were statistically analysed. Differences between the groups were investigated by Chi-square analysis for categorical variables, and Fisher exact test wherever required. Results: A total of 177 patients completed the study, and of these, eight patients screened positive for BDD. The rate of BDD in patients presenting with cosmetic complaints was 7.5% and in those with general dermatology, complaints were 2.1%, with no significant difference between the two groups (P = 0.156). Facial flaws (62.5%) were the most common concern followed by body asymmetry (25%). Conclusion: The rates of BDD found in this study are comparable but at a lower rate than that reported in literature data.
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Affiliation(s)
- Fibin Thanveer
- Department of Dermatology, Starcare Hospital Kozhikode, Kozhikode, Kerala, India
| | - Niti Khunger
- Department of Dermatology and STD, VM Medical College and Safdarjang Hospital, New Delhi, India
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27
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Phillipou A, Gurvich C, Castle DJ, Abel LA, Rossell SL. Comprehensive neurocognitive assessment of patients with anorexia nervosa. World J Psychiatry 2015; 5:404-411. [PMID: 26740932 PMCID: PMC4694554 DOI: 10.5498/wjp.v5.i4.404] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 08/31/2015] [Accepted: 10/08/2015] [Indexed: 02/05/2023] Open
Abstract
AIM: To utilise a comprehensive cognitive battery to gain a better understanding of cognitive performance in anorexia nervosa (AN).
METHODS: Twenty-six individuals with AN and 27 healthy control participants matched for age, gender and premorbid intelligence, participated in the study. A standard cognitive battery, the Measurement and Treatment Research to Improve Cognition in Schizophrenia Consensus Cognitive Battery, was used to investigate performance on seven cognitive domains with the use of 10 different tasks: speed of processing [Brief Assessment Of Cognition In Schizophrenia: Symbol Coding, Category Fluency: Animal Naming (Fluency) and Trail Making Test: Part A], attention/vigilance [Continuous Performance Test - Identical Pairs (CPT-IP)], working memory [Wechsler Memory Scale (WMS®-III): Spatial Span, and Letter-Number Span (LNS)], verbal learning [Hopkins Verbal Learning Test - Revised], visual learning [Brief Visuospatial Memory Test - Revised], reasoning and problem solving [Neuropsychological Assessment Battery: Mazes], and social cognition [Mayer-Salovey-Caruso Emotional Intelligence Test: Managing Emotions]. Statistical analyses involved the use of multivariate and univariate analyses of variance.
RESULTS: Analyses conducted on the cognitive domain scores revealed no overall significant difference between groups nor any interaction between group and domain score [F(1,45) = 0.73, P = 0.649]. Analyses conducted on each of the specific tasks within the cognitive domains revealed significantly slower reaction times for false alarm responses on the CPT-IP task in AN [F(1,51) = 12.80, P < 0.01, Cohen’s d = 0.982] and a trend towards poorer performance in AN on the backward component of the WMS®-III Spatial Span task [F(1,51) = 5.88, P = 0.02, Cohen’s d = -0.665]. The finding of slower reaction times of false alarm responses is, however, limited due to the small number of false alarm responses for either group.
CONCLUSION: The findings are discussed in terms of poorer capacity to manipulate and process visuospatial material in AN.
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Toh WL, Castle DJ, Rossell SL. Examining neurocognition in body dysmorphic disorder using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS): A comparison with obsessive-compulsive disorder. Psychiatry Res 2015; 228:318-24. [PMID: 26144584 DOI: 10.1016/j.psychres.2015.05.094] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Revised: 04/20/2015] [Accepted: 05/25/2015] [Indexed: 10/23/2022]
Abstract
Body dysmorphic disorder (BDD) is characterised by (i) an excessive preoccupation with an imagined defect in appearance, as well as (ii) repetitive behaviours and/or mental acts that occur in response to the preoccupation. To date, neuropsychological investigations have been limited. This study examined performance on the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), tapping into five indices of neurocognition: (i) Immediate Memory, (ii) Visuospatial Construction, (iii) Language, (iv) Attention, and (iv) Delayed Memory. Twenty-one BDD participants were compared with 19 obsessive-compulsive disorder (OCD) participants and 21 healthy controls (HC), who were age-, sex-, and IQ-matched. Results indicated the BDD and OCD groups demonstrated poor overall neuropsychological performance (i.e. total RBANS) as well as deficits on the indices of Immediate Memory and Attention. Further group differences involving the subtests of Story Memory, Digit Span, and Story Recall were detected. Neuropsychological impairment in BDD with indicated similarities in OCD were corroborated. Future research should extend investigations focusing on gist and delayed memory, and aspects of attentional processing.
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Affiliation(s)
- Wei Lin Toh
- Departments of Psychological Sciences and Psychiatry, University of Melbourne, Parkville, VIC 3010, Australia; Cognitive Neuropsychiatry Stream, Monash Alfred Psychiatry Research Centre, Alfred Hospital and Monash University School of Psychology and Psychiatry, Level 4, 607 St. Kilda Road, Melbourne, VIC 3004, Australia; Brain and Psychological Sciences Research Centre, Swinburne University, PO Box 218, Hawthorn, VIC 3122, Australia.
| | - David J Castle
- Departments of Psychological Sciences and Psychiatry, University of Melbourne, Parkville, VIC 3010, Australia; Department of Psychiatry, St. Vincent's Mental Health, PO Box 2900, Fitzroy, VIC 3065, Australia
| | - Susan L Rossell
- Departments of Psychological Sciences and Psychiatry, University of Melbourne, Parkville, VIC 3010, Australia; Cognitive Neuropsychiatry Stream, Monash Alfred Psychiatry Research Centre, Alfred Hospital and Monash University School of Psychology and Psychiatry, Level 4, 607 St. Kilda Road, Melbourne, VIC 3004, Australia; Brain and Psychological Sciences Research Centre, Swinburne University, PO Box 218, Hawthorn, VIC 3122, Australia; Department of Psychiatry, St. Vincent's Mental Health, PO Box 2900, Fitzroy, VIC 3065, Australia
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Phillips KA. Body dysmorphic disorder: common, severe and in need of treatment research. PSYCHOTHERAPY AND PSYCHOSOMATICS 2015; 83:325-9. [PMID: 25322928 DOI: 10.1159/000366035] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 07/19/2014] [Indexed: 11/19/2022]
Affiliation(s)
- Katharine A Phillips
- Rhode Island Hospital, and Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, R.I., USA
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Brennan E, Flessner C. An interrogation of cognitive findings in pediatric obsessive-compulsive and related disorders. Psychiatry Res 2015; 227:135-43. [PMID: 25912428 DOI: 10.1016/j.psychres.2015.03.032] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 02/23/2015] [Accepted: 03/08/2015] [Indexed: 10/23/2022]
Abstract
Current findings in the field of psychology have led to increased interest and a new conceptualization of disorders characterized by repetitive behaviors, namely the obsessive compulsive and related disorders (OCRDs). Scant research, however, has sought to collect and categorize the extant research on pediatric OCRDs. Particularly, no adequate review of the pediatric cognitive literature existed until now, despite the clear implication of abnormalities in neuroanatomical structures and cognitive functioning in adult samples. While evidence for cognitive dysfunction in pediatric samples is presented, this paper also suggests that differences in cognitive dysfunction may indeed exist between adults and youth with OCRDs. Specifically, those irregularities present in said youth at varying developmental stages may impact the origination and maintenance of OCRDs across time. Finally, this paper seeks to formulate potential future goals for the research field, particularly through transdiagnostic approaches to processes linked with symptom presentations. This is of particular importance as an improved understanding of the interaction of cognitive function and growth is key to further comprehension of the OCRDs.
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Affiliation(s)
- Elle Brennan
- Department of Psychological Sciences, Kent State University, Kent Hall, 600 Hilltop Drive, Kent, OH 442440, USA.
| | - Christopher Flessner
- Department of Psychological Sciences, Kent State University, Kent Hall, 600 Hilltop Drive, Kent, OH 442440, USA
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Kerwin L, Hovav S, Helleman G, Feusner JD. Impairment in local and global processing and set-shifting in body dysmorphic disorder. J Psychiatr Res 2014; 57:41-50. [PMID: 24972487 PMCID: PMC4260461 DOI: 10.1016/j.jpsychires.2014.06.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 06/05/2014] [Indexed: 01/01/2023]
Abstract
Body dysmorphic disorder (BDD) is characterized by distressing and often debilitating preoccupations with misperceived defects in appearance. Research suggests that aberrant visual processing may contribute to these misperceptions. This study used two tasks to probe global and local visual processing as well as set-shifting in individuals with BDD. Eighteen unmedicated individuals with BDD and 17 non-clinical controls completed two global-local tasks. The embedded figures task requires participants to determine which of three complex figures contains a simpler figure embedded within it. The Navon task utilizes incongruent stimuli comprised of a large letter (global level) made up of smaller letters (local level). The outcome measures were response time and accuracy rate. On the embedded figures task, BDD individuals were slower and less accurate than controls. On the Navon task, BDD individuals processed both global and local stimuli slower and less accurately than controls, and there was a further decrement in performance when shifting attention between the different levels of stimuli. Worse insight correlated with poorer performance on both tasks. Taken together, these results suggest abnormal global and local processing for non-appearance related stimuli among BDD individuals, in addition to evidence of poor set-shifting abilities. Moreover, these abnormalities appear to relate to the important clinical variable of poor insight. Further research is needed to explore these abnormalities and elucidate their possible role in the development and/or persistence of BDD symptoms.
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Affiliation(s)
- Lauren Kerwin
- UCLA Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine at UCLA, USA
| | - Sarit Hovav
- Creighton University/University of Nebraska Medical Center, Department of Psychiatry, USA
| | - Gerhard Helleman
- UCLA Semel Institute for Neuroscience and Human Behavior, Biostatistics Core, USA
| | - Jamie D. Feusner
- UCLA Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine at UCLA, USA, Corresponding author. UCLA Semel Institute for Neuroscience and Human Behavior, David Geffen School of Medicine at UCLA, 300 UCLA Medical Plaza, Suite 2200, Los Angeles, CA 90095-8346, USA. (J.D. Feusner)
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Buchanan B, Rossell S, Maller JJ, Toh WL, Brennan S, Castle D. Regional brain volumes in body dysmorphic disorder compared to controls. Aust N Z J Psychiatry 2014; 48:654-62. [PMID: 24497623 DOI: 10.1177/0004867413520253] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Body dysmorphic disorder (BDD) is characterized by a preoccupation with a misperceived flaw in appearance, causing significant distress and disability. Neuropsychological research has revealed deficits in executive function and inhibitory control of emotional responses. The few previous structural neuroimaging studies have had inconclusive findings and we aimed to take this field of research forward by contributing high quality structural data. METHODS To investigate regional brain volumes we compared 20 BDD participants and 20 matched controls using high-resolution structural T1-weighted magnetic resonance imaging (MRI). The MRI data was subjected to cortical reconstruction and volumetric segmentation using Freesurfer software. RESULTS Results showed the right orbitofrontal cortex, bilateral thalamus, left anterior cingulate cortex, hippocampus and amygdala were significantly smaller in the BDD sample compared to controls. The most pronounced differences were in the right orbitofrontal cortex and left anterior cingulate cortex, as these areas were smaller in BDD participants independent of reduced global brain volumes. Duration of illness significantly negatively correlated with right orbitofrontal cortex volumes. CONCLUSIONS This is the largest volumetric neuroimaging study in BDD to date and provides important data on volumetric differences that implicate fronto-limbic circuits.
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Affiliation(s)
- Ben Buchanan
- Monash Alfred Psychiatry Research Centre, Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University and The Alfred Hospital, Melbourne, Australia School of Psychology and Psychiatry, Monash University, Melbourne, Australia
| | - Susan Rossell
- Monash Alfred Psychiatry Research Centre, Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University and The Alfred Hospital, Melbourne, Australia Brain and Psychological Sciences Research Centre (BPsyC), Faculty of Life and Social Sciences, Swinburne University of Technology, Melbourne, Australia Departments of Psychiatry and Behavioural Science, The University of Melbourne, Melbourne, Australia
| | - Jerome J Maller
- Monash Alfred Psychiatry Research Centre, Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University and The Alfred Hospital, Melbourne, Australia
| | - Wei Lin Toh
- Monash Alfred Psychiatry Research Centre, Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University and The Alfred Hospital, Melbourne, Australia Departments of Psychiatry and Behavioural Science, The University of Melbourne, Melbourne, Australia
| | - Sarah Brennan
- Monash Alfred Psychiatry Research Centre, Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University and The Alfred Hospital, Melbourne, Australia Brain and Psychological Sciences Research Centre (BPsyC), Faculty of Life and Social Sciences, Swinburne University of Technology, Melbourne, Australia
| | - David Castle
- Departments of Psychiatry and Behavioural Science, The University of Melbourne, Melbourne, Australia Psychiatry, St Vincent's Hospital, Melbourne, Australia
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Abstract
INTRODUCTION This paper reviews the literature as it relates to perceptual processes in body dysmorphic disorder (BDD). METHODS A narrative-style review of the literature was undertaken to explore the relationship between BDD and obsessive-compulsive disorder, the empirical evidence for aberrant own-body perception in BDD, and the possible role of the parietal cortex in the disorder. RESULTS The extant literature appears to support the postulation that BDD is underpinned by a dysfunction in somatoperception-the process by which individuals formulate a sense of what they look like. CONCLUSIONS Investigation of somatoperceptive processes in BDD and related brain structures would provide important insight about the development and maintenance of this complex and often neglected psychiatric condition, and, in turn, help improve its treatment.
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Affiliation(s)
- Ryan A Kaplan
- a School of Psychology and Psychiatry , Monash University , Melbourne , Australia
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Using theories of delusion formation to explain abnormal beliefs in Body Dysmorphic Disorder (BDD). Psychiatry Res 2014; 215:599-605. [PMID: 24412353 DOI: 10.1016/j.psychres.2013.12.030] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 12/09/2013] [Accepted: 12/16/2013] [Indexed: 11/23/2022]
Abstract
Body Dysmorphic Disorder (BDD) is characterised by overvalued or delusional beliefs of 'imagined ugliness'. Delusional beliefs have been explained by a number of cognitive theories, including faulty perceptions, biases in attention, and corruption of semantic memory. Atypical aesthetics may also influence beliefs in BDD. In fourteen BDD patients, compared to controls (n=14), we examined these theories of beliefs in a cognitive test battery consisting of perceptual organisation and visual affect perception tasks, a Stroop task using body words, a sentence verification task, a fluency task, and an attractiveness task. BDD patients performed similar to controls on tasks measuring information (bias) processing and aesthetics. However, BDD showed abnormal abilities on semantic processing involving sentence verification and category fluency. There was only a trend finding of impaired performance on perceptual processing tasks in BDD. The findings suggest that the delusional beliefs in BDD may be explained by impaired semantic processing.
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Buchanan BG, Rossell SL, Maller JJ, Toh WL, Brennan S, Castle DJ. Brain connectivity in body dysmorphic disorder compared with controls: a diffusion tensor imaging study. Psychol Med 2013; 43:2513-2521. [PMID: 23473554 DOI: 10.1017/s0033291713000421] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Several neuroimaging studies have investigated brain grey matter in people with body dysmorphic disorder (BDD), showing possible abnormalities in the limbic system, orbitofrontal cortex, caudate nuclei and temporal lobes. This study takes these findings forward by investigating white matter properties in BDD compared with controls using diffusion tensor imaging. It was hypothesized that the BDD sample would have widespread significantly reduced white matter connectivity as characterized by fractional anisotropy (FA). METHOD A total of 20 participants with BDD and 20 healthy controls matched on age, gender and handedness underwent diffusion tensor imaging. FA, a measure of water diffusion within a voxel, was compared between groups on a voxel-by-voxel basis across the brain using tract-based spatial statistics within the FSL package. RESULTS Results showed that, compared with healthy controls, BDD patients demonstrated significantly lower FA (p < 0.05) in most major white matter tracts throughout the brain, including in the superior longitudinal fasciculus, inferior fronto-occipital fasciculus and corpus callosum. Lower FA levels could be accounted for by increased radial diffusivity as characterized by eigenvalues 2 and 3. No area of higher FA was found in BDD. CONCLUSIONS This study provided the first evidence of compromised white matter integrity within BDD patients. This suggests that there are inefficient connections between different brain areas, which may explain the cognitive and emotion regulation deficits within BDD patients.
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Affiliation(s)
- B G Buchanan
- Monash Alfred Psychiatry Research Centre, School of Psychology and Psychiatry, Faculty of Medicine, Nursing and Health Sciences, Monash University and The Alfred Hospital, Melbourne, Australia
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Visual processing in anorexia nervosa and body dysmorphic disorder: similarities, differences, and future research directions. J Psychiatr Res 2013; 47:1483-91. [PMID: 23810196 PMCID: PMC3786585 DOI: 10.1016/j.jpsychires.2013.06.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2013] [Revised: 06/04/2013] [Accepted: 06/06/2013] [Indexed: 12/11/2022]
Abstract
Anorexia nervosa (AN) and body dysmorphic disorder (BDD) are psychiatric disorders that involve distortion of the experience of one's physical appearance. In AN, individuals believe that they are overweight, perceive their body as "fat," and are preoccupied with maintaining a low body weight. In BDD, individuals are preoccupied with misperceived defects in physical appearance, most often of the face. Distorted visual perception may contribute to these cardinal symptoms, and may be a common underlying phenotype. This review surveys the current literature on visual processing in AN and BDD, addressing lower- to higher-order stages of visual information processing and perception. We focus on peer-reviewed studies of AN and BDD that address ophthalmologic abnormalities, basic neural processing of visual input, integration of visual input with other systems, neuropsychological tests of visual processing, and representations of whole percepts (such as images of faces, bodies, and other objects). The literature suggests a pattern in both groups of over-attention to detail, reduced processing of global features, and a tendency to focus on symptom-specific details in their own images (body parts in AN, facial features in BDD), with cognitive strategy at least partially mediating the abnormalities. Visuospatial abnormalities were also evident when viewing images of others and for non-appearance related stimuli. Unfortunately no study has directly compared AN and BDD, and most studies were not designed to disentangle disease-related emotional responses from lower-order visual processing. We make recommendations for future studies to improve the understanding of visual processing abnormalities in AN and BDD.
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Abstract
Body dysmorphic disorder (BDD) is characterized by preoccupation with misperceived defects of appearance, causing significant distress and disability. Previous studies suggest abnormalities in information processing characterized by greater local relative to global processing. The purpose of this study was to probe whole-brain and regional white matter network organization in BDD, and to relate this to specific metrics of symptomatology. We acquired diffusion-weighted 34-direction MR images from 14 unmedicated participants with DSM-IV BDD and 16 healthy controls, from which we conducted whole-brain deterministic diffusion tensor imaging tractography. We then constructed white matter structural connectivity matrices to derive whole-brain and regional graph theory metrics, which we compared between groups. Within the BDD group, we additionally correlated these metrics with scores on psychometric measures of BDD symptom severity as well as poor insight/delusionality. The BDD group showed higher whole-brain mean clustering coefficient than controls. Global efficiency negatively correlated with BDD symptom severity. The BDD group demonstrated greater edge betweenness centrality for connections between the anterior temporal lobe and the occipital cortex, and between bilateral occipital poles. This represents the first brain network analysis in BDD. Results suggest disturbances in whole brain structural topological organization in BDD, in addition to correlations between clinical symptoms and network organization. There is also evidence of abnormal connectivity between regions involved in lower-order visual processing and higher-order visual and emotional processing, as well as interhemispheric visual information transfer. These findings may relate to disturbances in information processing found in previous studies.
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Hartmann AS, Greenberg JL, Wilhelm S. The relationship between anorexia nervosa and body dysmorphic disorder. Clin Psychol Rev 2013; 33:675-85. [PMID: 23685673 DOI: 10.1016/j.cpr.2013.04.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2012] [Revised: 04/10/2013] [Accepted: 04/10/2013] [Indexed: 12/27/2022]
Abstract
Anorexia nervosa (AN) and body dysmorphic disorder (BDD) are severe body image disorders that highly impair individuals in their daily functioning. They are discrete but overlapping nosological entities. In this review, we examine similarities between AN and BDD with regard to clinical, personality and demographic aspects, such as comorbidity, phenomenology, and treatment outcome. The review suggests that the two disorders are highly comorbid, and show similar ages of onset, illness trajectories, and comparable clinical and personality characteristics. However, important differences emerge in their responsiveness to psychosocial and psychopharmacological treatment, which are discussed. Clinical implications of these findings are summarized and directions for future research are delineated, with a focus on how current treatment components from each disorder may inform new interventions for both disorders.
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Li W, Arienzo D, Feusner JD. Body Dysmorphic Disorder: Neurobiological Features and an Updated Model. ZEITSCHRIFT FUR KLINISCHE PSYCHOLOGIE UND PSYCHOTHERAPIE 2013; 42:184-191. [PMID: 25419211 PMCID: PMC4237698 DOI: 10.1026/1616-3443/a000213] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Body Dysmorphic Disorder (BDD) affects approximately 2% of the population and involves misperceived defects of appearance along with obsessive preoccupation and compulsive behaviors. There is evidence of neurobiological abnormalities associated with symptoms in BDD, although research to date is still limited. This review covers the latest neuropsychological, genetic, neurochemical, psychophysical, and neuroimaging studies and synthesizes these findings into an updated (yet still preliminary) neurobiological model of the pathophysiology of BDD. We propose a model in which visual perceptual abnormalities, along with frontostriatal and limbic system dysfunction, may combine to contribute to the symptoms of impaired insight and obsessive thoughts and compulsive behaviors expressed in BDD. Further research is necessary to gain a greater understanding of the etiological formation of BDD symptoms and their evolution over time.
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Affiliation(s)
- Wei Li
- Neuroscience Interdepartmental Program, University of California Los Angeles, Los Angeles, CA, USA
| | - Donatello Arienzo
- Department of Psychiatry, University of Illinois, Chicago, Chicago, IL, USA
| | - Jamie D. Feusner
- Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Kyrios M. Introduction to the Special Section: Cognitive-Behavioral and Neursscientific Approaches to Obsessive-Compulsive and Related Phenomena: Why the Need for an Interface? Int J Cogn Ther 2011. [DOI: 10.1521/ijct.2011.4.1.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Buchanan BG, Rossell SL, Castle DJ. Body dysmorphic disorder: a review of nosology, cognition and neurobiology. ACTA ACUST UNITED AC 2011. [DOI: 10.2217/npy.10.3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Szabó P. [An old "new" disease: body dysmorphic disorder (dysmorphophobia)]. Orv Hetil 2010; 151:1805-15. [PMID: 20961842 DOI: 10.1556/oh.2010.28971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Body dysmorphic disorder causes significant suffering and serious impairment in psychosocial functions. However, this disease with dangerous risks is scarcely mentioned in the Hungarian medical literature. The objective of the author is to give a detailed review about this almost unknown, but relatively common disorder. The serious disorder of body perception is in the centre of symptoms, leading to social isolation, anxiety, depression and obsessive-compulsive phenomena. The disorder often remains unrecognized because of the lack of insight of disease. Comorbidity with affective disorders, anxiety disorders, personality disorders, eating disorders, alcoholism and substance use disorders is common. The life quality of affected patients is bad, the risk of suicide or violence is high. Biological, psychological and sociocultural factors play an important role in the etiopathogenesis of the disorder. Imaging techniques and neuropsychological measures revealed changes characteristic for the disease. Childhood abuse and neglect, appearance-related critical remarks, stressors and the impact of media are also supposed to have role in the development of the disorder. The point prevalence is 0.7-2.5% in the general population, however, in special groups such as in tertiary students, psychiatric, dermatological and cosmetic surgery patients the prevalence rates may be much higher. Typically, the disease begins in early adolescence, and it persists and deteriorates without treatment, showing a chronic course. By means of pharmacotherapy and/or psychotherapy long-during improvement or full recovery can be achieved within a relatively short period of time.
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Affiliation(s)
- Pál Szabó
- Debreceni Egyetem, Tudományegyetemi Karok Bölcsészettudományi Kar, Pszichológiai Intézet Debrecen 10. Pf. 28 4010.
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