Body dysmorphic disorder linked to deficits in cognitive flexibility and visuospatial skills

Body dysmorphia is something a lot of people suffer from, and it can lead to low self-esteem and disordered eating. A study published in Brain and Behavior seeks to understand the differences in cognitive function between people struggling with body dysmorphia and people not struggling with body dysmorphia.

Beauty standards are sold to us from every direction, from the internet to social media to movies to magazines. Living in this society, it is easy to be fussed or insecure about one’s physical appearance. Obsessive preoccupation with this can be described as a body dysmorphic disorder.

Body dysmorphia has be linked to eating disorders and obsessive compulsive disorder. It typically is seen beginning in adolescence and can lead to negative outcomes for people struggling with it. There is a gap in research documenting the relationship between body dysmorphia and cognitive functioning, which this study seeks to bridge.

Researcher Soran Rajabi and colleagues utilized 500 male and female students in secondary schools in Iran. After screening for body dysmorphia, 52 students were assigned to the body dysmorphic group and 52 students with an even gender split were assigned to the healthy control group. Body dysmorphia was assessed based on a questionnaire and the DSM-5 materials. Participants completed measures on body dysmorphia and several cognitive and executive functioning tests including the Stroop color and word test, Wisconsin card sorting test, tower of London test, and the trail making test.

Results showed that mood disorders showed the highest comorbidities with body dysmorphia, followed by anxiety, OCD, and then eating disorders. Women showed higher rates of body dysmorphia than men. Men were likely to worry about their skin, hair, and nose, while women worried about their skin, nose, and abdomen.

The Wisconsin card sorting test, which measures cognitive flexibility, showed worse results for people with body dysmorphia. This is thought to be potentially due to people who are obsessive and preoccupied having trouble focusing on other stimuli. The Stroop test, which tests selective attention, alternating attention, and response control, also showed lower scores for people with OCD.

“A person affected with BDD may fail to abandon one’s thoughts associated with bodily appearance and re-focus on another stimulus. Disrupted set-shifting in repetitive actions is reflected with the compulsive nature of checking the mirror,” Rajabi and colleagues wrote in their study.

Additionally, in the trail making test, participants with body dysmorphia scored significantly lower, implying that they have weaker visuospatial skills. People with body dysmorphia are experiencing distorted perception, which is a big factor in these findings.

“It is believed that people with BDD focus much more on visual details, while they lack overall visual processing,” the researchers said. “Such a tendency is usually observed in the phenomenology of individuals with BDD. For example, when they look in the mirror, their attention often focuses immediately on the perceived defects even if they are standing near the mirror but unable to see the larger image of their body shape.”

The study, “Epidemiology of body dysmorphic disorder among adolescents: A study of their cognitive functions“, Soran Rajabi, Leila Kamran, and Mahnaz Joukar KamalAbadi.


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