Body Dysmorphic Disorder, or BDD, is a “body-image disorder characterized by persistentImage result for body dysmorphia cartoon and intrusive preoccupations with an imagined or slight defect in one’s appearance”. See here for an expanded definition as well as signs, symptoms, and co-morbidity: https://adaa.org/understanding-anxiety/related-illnesses/other-related-conditions/body-dysmorphic-disorder-bdd. For those of you who have experienced this, it can be very strange. Most of the time you feel completely fine. Then, something happens to change your entire view of yourself, leaving you questioning your ability to perceive.

I have memories of holding up pairs of pants and thinking there’s no way these are going to fit me and then having them slide right on. One time, I was trying to convince my friend that in the first few months of her new job she had gotten so much narrower than I was. She put one hand on my stomach and one on my back and slid them out so I could see. I was so convinced that she had measured wrong or made a mistake because I was positive I was not that size. Some days my hands look huge and some days they look tiny. My dad and I have a joke about

Image result for body dysmorphia meme whether it’s a “big hand day” or a “little hand day”. It can be very disconcerting to realize you have no idea what you actually look like.

In trying to find a good topic for this blog post, I somehow came across an article about cognitive deficiencies in people with BDD compared to those with OCD and healthy individuals. The study used RBANS (a comprehensive neuropsychological test) to measure things like memory, visuospatial construction, attention, and language among other things. It was kind of alarming to hear that those with BDD struggled significantly in areas of memory, attention, and story recall. https://www-sciencedirect-com.umw.idm.oclc.org/science/article/pii/S0165178115004096.

Several other studies have showed similar findings. This study found deficiencies in neuroperformance skills such as reaction time, extra-dimensional shift tasks, and decision-making. They suggest cognitive inflexibility as one of the possible causes for these results as well as overall impulse control and affective processing. They describe these causes in correlation with OCD patients and those who have both BDD and OCD. It is an interesting study, worth a read https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5322826/.

But why does this happen? I had always correlated BDD with anxiety and OCD in my head but never really thought about what caused people to actually see things that were not there. Is there a neurological reason that people with BDD can’t trust their perception?

Regions positively correlated with body dysmorphic disorder symptom severity as measured by the body dysmorphic disorder version of the Yale-Brown Obsessive Compulsive Scale. Representative slices depict activations in the right visual cortex (A), right caudate (B), right precentral and postcentral gyri (C), right anterior cingulate gyrus (D), and right orbitofrontal cortex (E). R indicates right; L, left; P, posterior; and A, anterior. Source: https://www.researchgate.net/publication/41399223_Abnormalities_of_Visual_Processing_and_Frontostriatal_Systems_in_Body_Dysmorphic_Disorder/figures

Well, as you may have guessed from the title of this post, there is! There has been success in using serotonin reuptake inhibitors in BDD patients, suggesting that they may have a deficiency in serotonin. However, no results have been causal. The exciting findings come from brain image studies. A test of facial processing showed that individuals with BDD showed a more detailed processing system in their left hemisphere, as opposed to healthy individuals who processed at a more general right hemisphere level. These results were correlated with symptom severity as well. BDD participants were also faster at recognizing upside down faces, suggesting they have superior detail processing capabilities.

Further small-scale studies have suggested physical differences in brains of those with BDD, not just how they use them. There is some evidence that both females and males with BDD have more white matter and smaller right orbitofrontal cortices and left anterior cingulated cortices. There is also some evidence of reduced integrity of white matter “wiring” that would help explain visual, emotional, and information processing impairments in BDD patients. https://bdd.iocdf.org/professionals/neurobiology-of-bdd/

Unfortunately BDD is a relatively unrecognized and unstudied disorder on it’s own. It is generally studied in relation to other mental disorders, most prevalently OCD. These neuro-imaging studies, while intriguing, are few and inconsistent. I hope in the future there will be more research into the cognitive and neuropsychological reasons behind BDD itself. For now, if you are interested in the current literature, there are several studies on co-morbidity with OCD https://www.ncbi.nlm.nih.gov/pubmed/26345330, sexuality, impulsivity, and addiction https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6420059/.

5 thoughts on “Cognitive Effects and Neuropsychology of Body Dysmorphic Disorder

  1. afjones

    I really enjoyed and valued reading the information that you gave regarding BDD. I think it is interesting because I have seen celebrities be diagnosed or come forward saying that they suffer from body dysmorphia and while I understood the basis of the disease, I did not know actual perspectives from it. I wondered if it made you interpret your body and appearance differently, or just warped your thinking about yourself and self-confidence. I also found it interesting how people with BDD had “superior detail processing capabilities” and I wonder if that plays into their disease of overanalyzing and misinterpreting their own bodies. The addition of more white matter and the differences it makes is something that I did not know, and I wonder how the visual, emotional, and information processing impairments change due to this. I found it interesting finding out that BDD affects a lot of a person’s brain because it is one of the diseases that you do not hear as much about. I hope so as well that there will be more research for BDD and its patients, it seems like a harmful disease, but also an interesting one because of how it manipulates its patients.

  2. mocooper

    This was a super interesting post to read. My sister has BDD so I knew what it was but I had never taken the time to read up about it so this was really enlightening. It gave me a deeper understanding of what could possibly going on in my sisters mind. The articles you linked were also good to read, although I will admit that I didn’t read all of them yet. Hopefully more of a spotlight will be put on BDD in the near future!

  3. krb8

    I find BDD so interesting, I have struggled with confidence issues myself and thinking I am more overweight than others think I am. But, the fact that people with this disorder have a completely different perception of themselves is very interesting to me. I have always wondered how it worked and why it happened or even how it started. Is it something learned or is it more biological? I definitely agree that there needs to be more research done on this topic to really figure out its root.

  4. kmarston

    As someone who has Obsessional Compulsive Disorder, I have a tendency to hyperfixtate on things and perceive situations as drastically different than they actually are. I convince myself that I have food in my teeth and that I feel something, but when I look at the mirror there’s nothing there. Rather than believing that I see changes such as consistent variations in my stomach like Body Dysmorphic Disorder would suggest, I mentally perceive changes, such as germs cascading across my toothbrush every time my roommate’s toothbrush touches mine. It doesn’t surprise me that the two disorders are similar and share discrepancies in cognitive processing. I’m curious if BDD would have escalated effects or be comorbid in those who identify as transgender or gender-variant and experience Gender Dysphoria Disorder. Those who experience gender dysphoria often are unsatisfied with their body both pre- and post-surgical treatment and deal with inconsistencies with their assigned-at-birth anatomy compared to their internal gender identification. It wouldn’t surprise me if a large number of these individuals experience BDD as well by having persistent preoccupations of imagined or of slight defects in their bodies. I doubt there is much if any research concerning the comorbidity between gender dysphoria and BDD, but it may make for an interesting study for researchers in the future.

  5. afinegan

    This is a very intriguing article and I quite enjoyed reading it because it has to do with something that so many people deal with, but no one really understands. It was very interesting to see the connection that most eating disorders or bodily view disorders come from this BDD because I had never heard this term but it makes sense that they would all branch from the same mental disorder. I really liked this article because it showed in physical scans and evidence what processes and errors in certain processes make people with BDD so different in the way they perceive their bodies. Reading the article, at one point where it explained the superior functions of the left hemisphere in relation to seeing details. Thinking about it, it could be beneficial to a person to have this superiority but also has the potential to have such detrimental effects, as it has shown it does. I hope the studies behind this disease are increased and make many strides to help understand and treat it because there are too many people who suffer the consequences of what body dysmorphia does to their brains and thus the effects of what they do to their bodies to try to fix it.

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