Internet-based interpretation bias modification for body dissatisfaction: A three-armed randomized controlled trial.

OBJECTIVE: Appearance-related interpretation bias is postulated to play a role in the maintenance of body dissatisfaction (BD), a risk factor for body dysmorphic disorder (BDD), and eating disorders (ED). Cognitive bias modification for interpretation (CBM-I) has been shown to reduce maladaptive interpretation bias and symptoms in various emotional disorders. This study investigated the acceptability and efficacy of an easily disseminable, web-based CBM-I program for BD. METHODS: Individuals with high BD (N = 318) were randomized to a multi-session CBM-I (Sentence Word Association Paradigm [SWAP] with feedback) vs. control (SWAP without feedback) versus waitlist condition. Interpretation bias, BD and associated symptoms were assessed at baseline and post-intervention. Symptoms were monitored up to 1-week and 4-week follow-up. We further investigated transference effects to stress reactivity, as predicted by cognitive-behavioral models, at post-intervention. RESULTS: Appearance-related CBM-I led to a differential pre-post increase in adaptive interpretation patterns, particularly for appearance-related and social situations (d = 0.65-1.18). Both CBM-I and control training reduced BD, BDD symptom severity, and depression. However, CBM-I (vs. control and waitlist) improved appearance-related quality of life (d = 0.51), self-esteem (d = 0.52), and maladaptive appearance-related beliefs (d = 0.47). State stress reactivity was overall reduced in the CBM-I condition (vs. waitlist). Intervention effects largely held stable up to follow-ups. Treatment satisfaction was comparable to other CBM-I studies, with low rates of adverse reactions. DISCUSSION: These findings support assumptions of cognitive-behavioral models for BD, BDD, and ED, and suggest that web-based CBM-I is an efficacious and acceptable intervention option.

Treatment utilization and treatment barriers in individuals with body dysmorphic disorder.

BACKGROUND: Although effective treatments are available, most individuals with body dysmorphic disorder (BDD) do not receive an appropriate diagnosis or treatment. We aimed to examine treatment utilization and barriers to treatment, and to identify associated socio-demographic and clinical characteristics. METHODS: German individuals completed an online self-report survey of appearance concerns. A sample of N = 429 individuals met criteria for BDD. We examined the frequency of treatment utilization and barriers, analyzed comparisons between treated and untreated individuals and assessed the relationships of socio-demographic and clinical features with mental health treatment utilization and treatment barriers, respectively. RESULTS: Only 15.2% of the individuals with BDD had been diagnosed with BDD, and lifetime rates of mental health treatment were low (39.9%). Individuals endorsed multiple barriers to mental health treatment, especially shame, low perceived need and a preference for cosmetic and medical treatments. Associated features were identified, including age, a BDD diagnosis, body dysmorphic symptom severity, a likely major depressive disorder, prior cosmetic surgery, and insight. CONCLUSIONS: The results of this largest study to date highlight that BDD is still underrecognized and undertreated even in a country with extensive mental health care and few financial barriers. We discuss modifiable factors and strategies to foster awareness of BDD in sufferers and professionals to improve treatment dissemination and to reduce treatment barriers.

Brain functional correlates of emotional face processing in body dysmorphic disorder.

Previous neuroimaging studies in body dysmorphic disorder (BDD) have focused on discordances in visual processing systems. However, little is known about brain functional aberrations in individuals with BDD during emotional face processing. An fMRI paradigm with negative emotional faces was employed in 20 individuals with BDD and 43 mentally healthy controls (HC). We compared functional activity and whole-brain connectivity patterns of the amygdala and the fusiform gyrus (FFG) between both groups. Regression analyses were performed for associations of body dysmorphic symptoms with brain activity and connectivity. Individuals with BDD exhibited higher activity in the left amygdala compared to HC (pFWE = .04) as well as increased functional connectivity of the left amygdala with a network including frontostriatal and temporal regions (pFWE < .05). The FFG revealed increased functional connectivity in individuals with BDD, mapping to brain areas such as the cingulate cortex and temporo-limbic regions (pFWE < .05). In HC, higher levels of body dysmorphic symptoms were associated with higher functional amygdala and FFG activity (pFWE < .05). Individuals with BDD show aberrant functional activity and connectivity patterns within the amygdala and the FFG for negative emotional face processing. Body dysmorphic symptoms in HC are associated with a mild pattern of brain functional alterations, which could emphasize the relevance of a dimensional approach in addition to diagnosis. Treatments for BDD could benefit from targeting visual misperception and evaluation processes upon confrontation with emotional information.

Disentangling the contributions of agentic, antagonistic, and neurotic narcissism to drive for thinness and drive for muscularity.

Body image concerns revolving around body ideals (thin ideal, muscular ideal) are widespread among women. Whereas a stronger preoccupation with ideal physical appearance is often assumed for narcissistic women, previous empirical findings have been mixed. Following a tripartite structure of agentic, antagonistic, and neurotic narcissism facets, we reexamined whether trait narcissism predicted drive for thinness and drive for muscularity. We further explored the role of importance of appearance as a mediator and moderator of the relation between narcissism and body image concerns. Latent structural equation modeling was applied to self-report data from two independent nonclinical female samples (NSample1 = 224, NSample2 = 342). Results underlined the importance of distinguishing between narcissism facets: Neurotic (but not agentic or antagonistic) narcissism uniquely predicted drive for thinness and drive for muscularity. Importance of appearance mediated but did not robustly moderate these relations. Hence, neurotic narcissistic women (characterized by hypersensitivity, shame, and a fragile self-esteem) are particularly prone to body image concerns. This vulnerability seems partly driven by how much importance they ascribe to their appearance. Future work might build on these insights to further unravel the processes linking neurotic narcissism to body image concerns and how these can be targeted in practical interventions.

Temporal dynamics of insight in body dysmorphic disorder: An ecological momentary assessment study.

Individuals with body dysmorphic disorder (BDD) often lack insight into the nature of their perceived appearance flaws that are slight, if they exist at all. Despite the generally held assumption that insight fluctuates over time within individuals with BDD, its temporal instability and associated features remain unstudied. We examined insight as a multidimensional, contextually embedded, and dynamic factor using ecological momentary assessment (EMA), further assessing affect and self-esteem as potentially associated states. Thirty individuals with BDD and 30 mentally healthy controls (HCs) completed 6 days of EMA (M = 8.54 assessments per day, N = 3075 assessments in total). Multilevel analyses revealed substantial intraindividual fluctuations of insight dimensions (across 30 min to hours) that were more pronounced for individuals with BDD than for HCs. Poorer insight correlated with higher negative affect, lower positive affect, and lower self-esteem at concurrent time points in the BDD group. Considering all predictors at the same time point, poorer insight was characterized by lower self-esteem and, partly, negative affect in the BDD group. Across time, self-esteem and insight influenced each other reciprocally, with comparatively stronger effects for the prediction of poorer insight by previously lower self-esteem. These findings demonstrate that insight is a highly variable phenomenon in BDD, further suggesting a clinically and etiologically relevant link between self-esteem and insight in symptom maintenance. (PsycInfo Database Record (c) 2021 APA, all rights reserved).