The Phenomenology of Visual and Other Nonauditory Hallucinations in Affective and Nonaffective Psychosis: A Mixed Methods Analysis.

ABSTRACT: Nonauditory hallucinations in psychosis have not received as much attention relative to voice-hearing experiences. The current paper aimed to document the characteristics of these hallucinations in affective and nonaffective psychosis. Participants were selected from a primary voice-hearing sample, who had endorsed visual, tactile, or olfactory hallucinations ( N = 55-75). A comprehensive, semistructured phenomenological interview was conducted, followed by mixed methods analysis. Visual hallucinations typically occurred daily, for a few minutes per episode, within one's direct line of sight; persons and/or animals were most commonly seen, with low controllability and mostly engendered negative affective outcomes. Tactile and olfactory hallucinations were endorsed by 46.8% and 39.0% of participants, respectively. The affective psychosis group ( n = 33) reported significantly greater awareness and lower functional impairment relative to the nonaffective psychosis group ( n = 42). Qualitative thematic analysis revealed notable themes and subthemes across each of these hallucinations modes. Further phenomenological investigations should be carried out in lesser known hallucination modalities, assisted by the development of appropriate assessment tools.

Examining the relationships between cognition and auditory hallucinations: A systematic review.

OBJECTIVE: Auditory hallucinations (hearing voices) have been associated with a range of altered cognitive functions, pertaining to signal detection, source-monitoring, memory, inhibition and language processes. Yet, empirical results are inconsistent. Despite this, several theoretical models of auditory hallucinations persist, alongside increasing emphasis on the utility of a multidimensional framework. Thus, clarification of current evidence across the broad scope of proposed mechanisms is warranted. METHOD: A systematic search of the Web of Science, PubMed and Scopus databases was conducted. Records were screened to confirm the use of an objective behavioural cognitive task, and valid measurement of hallucinations specific to the auditory modality. RESULTS: Auditory hallucinations were primarily associated with difficulties in perceptual decision-making (i.e. reduced sensitivity/accuracy for signal-noise discrimination; liberal responding to ambiguity), source-monitoring (i.e. self-other and temporal context confusion), working memory and language function (i.e. reduced verbal fluency). Mixed or limited support was observed for perceptual feature discrimination, imagery vividness/illusion susceptibility, source-monitoring for stimulus form and spatial context, recognition and recall memory, executive functions (e.g. attention, inhibition), emotion processing and language comprehension/hemispheric organisation. CONCLUSIONS: Findings were considered within predictive coding and self-monitoring frameworks. Of concern was the portion of studies which - despite offering auditory-hallucination-specific aims and inferences - employed modality-general measures, and/or diagnostic-based contrasts with psychologically healthy individuals. This review highlights disparities within the literature between theoretical conceptualisations of auditory hallucinations and the body of rigorous empirical evidence supporting such inferences. Future cognitive investigations, beyond the schizophrenia-spectrum, which explicitly define and measure the timeframe and sensory modality of hallucinations, are recommended.

Exploring the cognitive profiles related to unimodal auditory versus multisensory hallucinations in schizophrenia-spectrum disorders.

INTRODUCTION: Hallucinations can be experienced across multiple sensory modalities, but psychiatric studies investigating the cognitive mechanisms of hallucinations have been somewhat restricted to the auditory domain. This study explored the cognitive profiles of individuals experiencing multisensory hallucinations (MH) in schizophrenia-spectrum disorders (SSD) and compared these to those experiencing unimodal auditory hallucinations (AH) or no hallucinations (NH). METHODS: Participants included SSD patients (n = 119) stratified by current hallucination status (NH, AH, MH) and nonclinical controls (NCs; n = 113). Group performance was compared across several cognitive domains: speed of processing, attention, working memory, verbal learning, visual learning, reasoning and problem-solving, social cognition, and inhibition. RESULTS: The clinical groups performed worse than NCs but differences between the clinical groups were not evident across most cognitive domains. Exploratory analyses revealed that the MH group was more impaired on the visual learning task compared to the NH (but not AH) group. CONCLUSIONS: Preliminary results suggest that impaired visual learning may be related to MH. This could be attributed to the presence of visual hallucinations (VH), or greater psychopathology, in this group. However, replication is needed, as well as the investigation of other potential cognitive mechanisms of MH.

Intersections of phenomenology, voice beliefs and distress in bipolar disorder: a comparison with schizophrenia.

BACKGROUND: Auditory verbal hallucinations (AVH), or voice-hearing, can be a prominent symptom during fluctuating mood states in bipolar disorder (BD). AIMS: The current study aimed to: (i) compare AVH-related distress in BD relative to schizophrenia (SCZ), (ii) examine correlations between phenomenology and voice beliefs across each group, and (iii) explore how voice beliefs may uniquely contribute to distress in BD and SCZ. METHOD: Participants were recruited from two international sites in Australia (BD=31; SCZ=50) and the UK (BD=17). Basic demographic-clinical information was collected, and mood symptoms were assessed. To document AVH characteristics, a 4-factor model of the Psychotic Symptoms Rating Scale and the Beliefs about Voices Questionnaire-Revised were used. Statistical analyses consisted of group-wise comparisons, Pearson's correlations and multiple hierarchical regressions. RESULTS: It was found that AVH-related distress was not significantly higher in BD than SCZ, but those with BD made significantly more internal attributions for their voices. In the BD group, AVH-related distress was significantly positively correlated with malevolence, omnipotence and resistance, However, only resistance, alongside mania and depressive symptoms, significantly contributed to AVH-related distress in BD. DISCUSSION: Our findings have several clinical implications, including identification of voice resistance as a potential therapeutic target to prioritise in BD. Factoring in the influence of mood symptoms on AVH-related distress as well as adopting more acceptance-oriented therapies may also be of benefit.

Eating behaviours and personality characteristics of clinicians and researchers working in eating disorders.

Disturbances in eating behaviours and differences in personality characteristics, such as perfectionism, cognitive flexibility, and obsessive-compulsive behaviours, are commonly reported in individuals with eating disorders (ED) and can influence the development and maintenance of EDs. The presence of these characteristics in ED professionals may also have an influence on their patients. The aim of this study was to gain a better understanding of the presence of these behaviours and characteristics in ED clinicians/researchers (EDCR). This study examined whether these constructs differed amongst 83 EDCR and 47 general mental health clinicians/researchers (MHCR), who completed an online survey, measuring eating disorder symptomology, orthorexia nervosa, perfectionism, cognitive flexibility, and obsessive-compulsive traits. Significantly less dietary restraint, eating concerns and orthorexia nervosa behaviours, but significantly poorer ability to seek out alternative solutions (i.e. a component of cognitive flexibility) were found in the EDCR group compared with the MHCR group. Moderation analysis found no effect of ED history on the relationship between eating behaviours and group. These results suggest that working in the ED field may be a protective factor against developing certain disordered eating behaviours. However, poorer cognitive flexibility may adversely impact EDCRs, and should be considered when carrying out their clinical and/or research duties.

Distinguishing multimodal versus multisensory hallucinations in psychosis: Key definitions and a way forward.

The study of hallucinations across multiple senses in psychosis has garnered renewed interest. Recent studies have adopted the term multimodal hallucinations to describe these experiences, yet some appear to be investigating a different, but related, phenomenon. In the current paper, we suggest use of the terms multimodal hallucinations and multisensory hallucinations to categorise distinct events that involve unusual sensory experiences across multiple domains. We propose that the constructs of temporality and relatedness are critical to delineating these experiences, where multimodal hallucinations refer to hallucinations in two or more sensory modes occurring concurrently in time and/or with significant thematic overlaps. Multisensory hallucinations conversely denote similar multisensory experiences, but with no temporal or relatedness constraints. This is accompanied by a decision-making framework for identifying whether a set of unusual perceptual experiences constitutes multimodal hallucinations or otherwise. We conclude by suggesting several priorities for future research, including empirical validation of our proposed model, further investigation of phenomenology, developing appropriate assessment tools and investigating underlying cognitive and other aetiological mechanisms.

The contribution of sleep to anorexia nervosa severity.

PURPOSE: Anorexia nervosa (AN) is associated with poor sleep and altered circadian rhythms. Evidence is unclear as to whether these features relate to ongoing psychiatric symptoms of AN, or are merely concomitant with low weight. In this study, we sought to evaluate subjective sleep quality and sleep-wake preferences in a sample of individuals with lifetime AN. Furthermore, we aimed to examine whether sleep quality would significantly predict AN symptom severity, after accounting for demographic features and negative emotions (depression, anxiety and stress). METHODS: Adults with a lifetime diagnosis of AN (n = 96) or no lifetime psychiatric diagnoses (NC; n = 246) completed an online survey assessing demographics, sleep quality, circadian sleep-wake preferences, eating disorder symptoms, and negative emotions. RESULTS: AN participants reported significantly poorer sleep quality overall, including increased sleep disturbances, use of sleep medications, and daytime dysfunction, as compared to NC participants. Groups did not differ significantly in circadian sleep-wake preferences. Regression analysis showed that among AN participants, sleep quality and negative emotions significantly predicted AN symptom severity, while sex and body mass index (BMI) did not. CONCLUSION: The findings demonstrate that poor sleep quality was associated with more severe symptoms of AN, even when accounting for negative emotions and BMI. Future research should investigate causal interactions between sleep quality and AN symptom severity longitudinally and across different recovery stages. LEVEL OF EVIDENCE: Level III-Cohort and case-control analytic studies.

Correlates of Hallucinatory Experiences in the General Population: An International Multisite Replication Study.

Hallucinatory experiences can occur in both clinical and nonclinical groups. However, in previous studies of the general population, investigations of the cognitive mechanisms underlying hallucinatory experiences have yielded inconsistent results. We ran a large-scale preregistered multisite study, in which general-population participants (N = 1,394 across 11 data-collection sites and online) completed assessments of hallucinatory experiences, a measure of adverse childhood experiences, and four tasks: source memory, dichotic listening, backward digit span, and auditory signal detection. We found that hallucinatory experiences were associated with a higher false-alarm rate on the signal detection task and a greater number of reported adverse childhood experiences but not with any of the other cognitive measures employed. These findings are an important step in improving reproducibility in hallucinations research and suggest that the replicability of some findings regarding cognition in clinical samples needs to be investigated.

The Relationship between Negative Symptoms and Both Emotion Management and Non-social Cognition in Schizophrenia Spectrum Disorders.

OBJECTIVE: There is ongoing debate regarding the relationship between clinical symptoms and cognition in schizophrenia spectrum disorders (SSD). The present study aimed to explore the potential relationships between symptoms, with an emphasis on negative symptoms, and social and non-social cognition. METHOD: Hierarchical cluster analysis with k-means optimisation was conducted to characterise clinical subgroups using the Scale for the Assessment of Negative Symptoms and Scale for the Assessment of Positive Symptoms in n = 130 SSD participants. Emergent clusters were compared on the MATRICS Consensus Cognitive Battery, which measures non-social cognition and emotion management as well as demographic and clinical variables. Spearman's correlations were then used to investigate potential relationships between specific negative symptoms and emotion management and non-social cognition. RESULTS: Four distinct clinical subgroups were identified: 1. high hallucinations, 2. mixed symptoms, 3. high negative symptoms, and 4. relatively asymptomatic. The high negative symptom subgroup was found to have significantly poorer emotion management than the high hallucination and relatively asymptomatic subgroups. No further differences between subgroups were observed. Correlation analyses revealed avolition-apathy and anhedonia-asociality were negatively correlated with emotion management, but not non-social cognition. Affective flattening and alogia were not associated with either emotion management or non-social cognition. CONCLUSIONS: The present study identified associations between negative symptoms and emotion management within social cognition, but no domains of non-social cognition. This relationship may be specific to motivation, anhedonia and apathy, but not expressive deficits. This suggests that targeted interventions for social cognition may also result in parallel improvement in some specific negative symptoms.

Empirical evidence for cognitive subgroups in body dysmorphic disorder.

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.

Comparing Primary Voice-Hearers with and without Hallucinations in Other Sensory Modalities.

There has been burgeoning interest in studying hallucinations in psychosis occurring across multiple sensory modalities. The current study aimed to characterize the auditory hallucination and delusion profiles in patients with auditory hallucinations only versus those with multisensory hallucinations. Participants with psychosis were partitioned into groups with voices only (AVH; n = 50) versus voices plus hallucinations in at least one other sensory modality (AVH+; n = 50), based on their responses on the Scale for the Assessment of Positive Symptoms (SAPS). Basic demographic and clinical information was collected, and the Questionnaire for Psychotic Experiences (QPE) was used to assess psychosis phenomenology. Relative to the AVH group, greater compliance to perceived commands, auditory illusions, and sensed presences was significantly elevated in the AVH+ group. The latter group also had greater levels of delusion-related distress and functional impairment and was more likely to endorse delusions of reference and misidentification. This preliminary study uncovered important phenomenological differences in those with multisensory hallucinations. Future hallucination research extending beyond the auditory modality is needed.

Eating and exercise behaviors in eating disorders and the general population during the COVID-19 pandemic in Australia: Initial results from the COLLATE project.

OBJECTIVE: Emerging evidence suggests that the coronavirus (COVID-19) pandemic may be negatively impacting mental health. The impact on eating and exercise behaviors is, however, currently unknown. This study aimed to identify changes in eating and exercise behaviors in an Australian sample among individuals with an eating disorder, and the general population, amidst the COVID-19 pandemic outbreak. METHOD: A total of 5,469 participants, 180 of whom self-reported an eating disorder history, completed questions relating to changes in eating and exercise behaviors since the emergence of the pandemic, as part of the COLLATE (COvid-19 and you: mentaL heaLth in AusTralia now survEy) project; a national survey launched in Australia on April 1, 2020. RESULTS: In the eating disorders group, increased restricting, binge eating, purging, and exercise behaviors were found. In the general population, both increased restricting and binge eating behaviors were reported; however, respondents reported less exercise relative to before the pandemic. DISCUSSION: The findings have important implications for providing greater monitoring and support for eating disorder patients during the COVID-19 pandemic. In addition, the mental and physical health impacts of changed eating and exercise behaviors in the general population need to be acknowledged and monitored for potential long-term consequences.

Considerations for assessing the impact of the COVID-19 pandemic on mental health in Australia.

During this unprecedented novel coronavirus (COVID-19) pandemic, there is an urgent need for empirical data to characterise its impact on the mental health and well-being of Australians. In this viewpoint, we outline a number of considerations for research on this topic, highlighting areas necessitating special attention, consideration of particular vulnerable groups and the need for longitudinal studies to track mental health fluctuations in the general population. We conclude by introducing the COLLATE (COvid-19 and you: mentaL heaLth in AusTralia now survEy) project, outlining its aims, addressing some considerations raised herein and detailing avenues for future research. Since the World Health Organization (WHO) declared the novel coronavirus (COVID-19) outbreak a Public Health Emergency of International Concern (PHEIC) on 30 January 2020 (WHO, 2020), the COVID-19 pandemic has caused major upheaval both in Australia and globally. While the search for a vaccine continues, current efforts towards tackling the virus and limiting contagion in several nations have focused on social distancing and the shutdown of non-essential services. In Australia, the first case was reported on 13 January 2020 (COVID-19 National Incident Room Surveillance Team, 2020), the first death occurred on 24 February and a spate of progressive restrictions were enforced throughout the 2 weeks leading up to 31 March 2020 (COVID-19 National Incident Room Surveillance Team, 2020a).

Alcohol use in Australia during the early days of the COVID-19 pandemic: Initial results from the COLLATE project.

AIM: The effects of social isolation measures used to control the spread of COVID-19 are negatively impacting the mental health of many. One of the consequences of exposure to disasters/pandemics is an increase in alcohol use. The current study aimed to examine what predisposing (distal) and pandemic-related (proximal) factors were associated with increased drinking in the wake of the COVID-19 pandemic. METHODS: On 1 April 2020, 5158 Australians completed a survey from the COvid-19 and you: mentaL heaLth in AusTralia now survEy (COLLATE) project, a nationwide study aimed at tracking key mental health concerns. Using logistic regression, distal (demographics and previous drinking behaviors) and proximal (employment, lifestyle factors, and mood) factors were assessed for their association with increased drinking since the onset of the COVID-19 pandemic. RESULTS: Distal factors, including heavier drinking pre-pandemic, middle age, and average or higher income, and proximal factors, including job loss, eating more, changes to sleep as well as stress and depression, were all associated with increased drinking in the COVID-19 pandemic environment. Female sex and self-reported history of mental illness became nonsignificant after proximal measures were added to the model. Living alone, exercise, anxiety, and status as an essential or health-care worker were not associated with increased drinking. CONCLUSION: These results provide guidance as to who might be targeted to receive support based on predisposing demographic factors and pre-pandemic drinking behavior. Second, they indicate what behaviors/factors accompany increased alcohol use and provide targets for psychosocial and psychoeducational supports to address these proximal factors.

Body parts of clinical concern in anorexia nervosa versus body dysmorphic disorder: a cross-diagnostic comparison.

OBJECTIVES: Anorexia nervosa and body dysmorphic disorder share a hallmark clinical feature of severe body image disturbance. This study aimed to document major demographic and clinical characteristics in anorexia nervosa versus body dysmorphic disorder, and it was the first to compare specific body parts related to body image dissatisfaction across these disorders directly. METHODS: Anorexia nervosa (n=26) and body dysmorphic disorder (n=24) patients were administered a range of clinical measures, including key questions about the specificities of their body image concerns. RESULTS: Results revealed increased psychiatric and personality co-morbidities in anorexia nervosa relative to body dysmorphic disorder. The anorexia nervosa group was mostly preoccupied with three body zones typically linked to weight concerns, whereas the body dysmorphic disorder group fixated on facial features, hair and skin. CONCLUSIONS: These findings may help inform differential diagnosis in complex cases and aid in the formulation of targeted interventions.

Impaired Recognition of Negative Facial Emotions in Body Dysmorphic Disorder.

OBJECTIVES: Patients with body dysmorphic disorder (BDD) have difficulty in recognising facial emotions, and there is evidence to suggest that there is a specific deficit in identifying negative facial emotions, such as sadness and anger. METHODS: This study investigated facial emotion recognition in 19 individuals with BDD compared with 21 healthy control participants who completed a facial emotion recognition task, in which they were asked to identify emotional expressions portrayed in neutral, happy, sad, fearful, or angry faces. RESULTS: Compared to the healthy control participants, the BDD patients were generally less accurate in identifying all facial emotions but showed specific deficits for negative emotions. The BDD group made significantly more errors when identifying neutral, angry, and sad faces than healthy controls; and were significantly slower at identifying neutral, angry, and happy faces. CONCLUSIONS: These findings add to previous face-processing literature in BDD, suggesting deficits in identifying negative facial emotions. There are treatment implications as future interventions would do well to target such deficits.

Face and Object Perception in Body Dysmorphic Disorder versus Obsessive-Compulsive Disorder: The Mooney Faces Task.

OBJECTIVES: Body dysmorphic disorder (BDD) is characterized by repetitive behaviors and/or mental acts occurring in response to preoccupations with perceived defects or flaws in physical appearance. There are some similarities, but also important differences, between BDD and obsessive-compulsive disorder (OCD), not just in terms of core clinical symptoms, but possibly in the domain of perception. This study compared the nature and extent of perceptual anomalies in BDD versus OCD and health controls (HC), using a modified Mooney task. METHODS: We included 21 BDD, 19 OCD, and 21 HC participants, who were age-, sex-, and IQ-matched. A set of 40 Mooney faces and 40 Mooney objects arranged in three configurations (i.e., upright, inverted, or scrambled) were presented under brief (i.e., 500 ms) free-viewing conditions. Participants were asked to decide whether each image represented a human face, an object, or neither in a forced-choice paradigm. RESULTS: The BDD group showed significantly reduced face and object inversion effects relative to the other two groups. This was accounted for by BDD participants being significantly more accurate in identifying inverted Mooney faces and objects than the other participants. CONCLUSIONS: These data were interpreted as reflecting an overreliance on independent components at the expense of holistic (configural) processing in BDD. (JINS, 2017, 23, 471-480).

Attentional biases in body dysmorphic disorder (BDD): Eye-tracking using the emotional Stroop task.

OBJECTIVE: Body dysmorphic disorder (BDD) is characterised by repetitive behaviours and/or mental acts occurring in response to preoccupations with perceived defects or flaws in physical appearance. This study aimed to examine attentional biases in BDD via the emotional Stroop task with two modifications: i) incorporating an eye-tracking paradigm, and ii) employing an obsessive-compulsive disorder (OCD) control group. METHOD: Twenty-one BDD, 19 OCD and 21 HC participants, who were age-, sex-, and IQ-matched, were included. A card version of the emotional Stroop task was employed based on seven 10-word lists: (i) BDD-positive, (ii) BDD-negative, (iii) OCD-checking, (iv) OCD-washing, (v) general positive, (vi) general threat, and (vii) neutral (as baseline). Participants were asked to read aloud words and word colours consecutively, thereby yielding accuracy and latency scores. Eye-tracking parameters were also measured. RESULTS: Participants with BDD exhibited significant Stroop interference for BDD-negative words relative to HC participants, as shown by extended colour-naming latencies. In contrast, the OCD group did not exhibit Stroop interference for OCD-related nor general threat words. Only mild eye-tracking anomalies were uncovered in clinical groups. Inspection of individual scanning styles and fixation heat maps however revealed that viewing strategies adopted by clinical groups were generally disorganised, with avoidance of certain disorder-relevant words and considerable visual attention devoted to non-salient card regions. CONCLUSION: The operation of attentional biases to negative disorder-specific words was corroborated in BDD. Future replication studies using other paradigms are vital, given potential ambiguities inherent in emotional Stroop task interpretation.

Insight in body dysmorphic disorder (BDD) relative to obsessive-compulsive disorder (OCD) and psychotic disorders: Revisiting this issue in light of DSM-5.

INTRODUCTION: In DSM-5, body dysmorphic disorder (BDD) was reclassified under the obsessive-compulsive and related disorders (OCRDs), but little is known about the nature of BDD beliefs. This study aimed to compare level of insight in BDD and consider related implications for DSM-5 classification. METHOD: Participants were 27 BDD, 19 obsessive-compulsive disorder (OCD), and 20 psychosis (SZ) participants as well as 42 non-clinical controls (NC), who completed the Brown Assessment of Beliefs Scale (BABS) and Peters Delusions Inventory (PDI). RESULTS: For total (and most individual) BABS items, BDD and SZ participants scored significantly higher than OCD and NC participants. On the PDI, there were significant group differences in number of questions endorsed, with clinical groups scoring significantly higher than the NC group on dimensions of distress and preoccupation, but not conviction. CONCLUSION: These findings suggest appearance-related concerns in BDD somewhat resemble delusions seen in psychosis (and not OCD), and convey important nosological and therapeutic implications.

How individuals with body dysmorphic disorder (BDD) process their own face: a quantitative and qualitative investigation based on an eye-tracking paradigm.

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.