372 CHAPTER 8
disorder shares some features with anxiety disorders (see Chapter 7): (1) Like pho-
bia disorders (agoraphobia, social phobia, and specific phobias), body dysmor-
phic disorder can involve an avoidance of anxiety-causing stimuli. (2) Like social
phobia, it involves an excessive fear of being evaluated negatively. (3) Like OCD,
body dysmorphic disorder involves obsessions (thoughts about a “defect”), as well
as highly time-consuming compulsive behaviors. (As noted earlier, hypochondriasis
also shares some of these features, although the compulsive behaviors are not
usually as time-consuming.)
Because of these similarities and because patients with body dysmorphic disor-
der are highly anxious about the perceived defi cit, some researchers advocate clas-
sifying body dysmorphic disorder as an anxiety disorder (Castle & Rossell, 2006;
Mayou et al., 2005).Understanding Body Dysmorphic Disorder
Research on the factors that contribute to body dysmorphic disorder has been lim-
ited thus far and has tended to focus on psychological factors. We now examine
what is known about those factors as well as neurological and social ones.Neurological Factors
One hint about the brain systems that underlie body dysmorphic disorder was
provided by the tragic case of a young man whose brain became infl amed. This
infl ammation caused the frontal-temporal portions to atrophy, which in turn led to
body dysmorphic disorder (Gabbay et al., 2003). These brain areas are involved in
storing new information in memory—and thus abnormalities in them might explain
why patients with body dysmorphic disorder have difficulty “updating” their
impressions of themselves.
In addition, there is evidence that these patients have impaired functioning of
serotonin(Marazziti et al., 1999). People who have anxiety disorders—including
OCD—often have low levels of serotonin, and thus this fi nding is consistent with
the idea that body dysmorphic disorder is related to anxiety disorders.
Finally, body dysmorphic disorder may arise, at least in part,
from some of the same underlying genetic characteristics that give
rise to OCD: When fi rst-degree relatives of OCD patients were
studied, many more of them had body dysmorphic disorder than
in a comparable control group (Bienvenu et al., 2000). This fi nd-
ing is also consistent with the idea that body dysmorphic disorder
is related to anxiety disorders (particularly OCD).Psychological Factors: Focus on Imperfections
Patients with body dysmorphic disorder exhibit a variety of
cognitive biases. Such patients:- are easily distracted by emotional information, even when
the information is unrelated to appearance (Buhlmann
et al., 2002). - tend to focus their attention on isolated body parts and are
hypervigilant for any possible bodily imperfections. - engage in catastrophic thinking, believing that such imperfections will lead to dire
consequences, such as when a pimple acts as a neon light, calling attention to
itself for all to see, which leads observers to think ill of the individual with the
pimple (Buhlmann, Etcoff, & Wilhelm, 2008).
Like people with other somatoform disorders, people with body dysmorphic
disorder often engage in behaviors that temporarily reduce their anxiety. For
example, they might try to avoid mirrors (and possibly people) or develop new
ways to hide a “defect”—with painstakingly applied makeup or contrived use of
clothing or hats. However, just as avoidance of anxiety-inducing stimuli maintains
faulty beliefs in people with phobias, so too with avoidance in body dysmorphicCompared to people with major depressive
disorder, those with body dysmorphic disorder
are more likely to have an education or job in art
or design. However, don’t infer causality from this
correlation: Although it is possible that being
immersed in art or design causes body dys-
morphic disorder, it is also possible that people
preoccupied with their body tend to pursue
learning about or working in the arts (Veale,
Ennis, & Lambrou, 2002).Mauro Fermariello/Photo Researchers, Inc.
P SN