Body dysmorphic disorder linked to deficits in cognitive flexibility and visual-spatial skills

Body dysmorphism is something that many people suffer from, and it can lead to low self-esteem and eating disorders. A study published in Brain and Behavior tries to understand the differences in cognitive function between people who struggle with body dysmorphism and people who do not struggle with body dysmorphism.

Beauty standards are sold to us from all sides, from the internet to social media to movies to magazines. When you live in this society, it is easy to worry or be insecure about your physical appearance. An obsessive preoccupation with this can be described as a body dysmorphic disorder.

Body dysmorphism has been associated with eating disorders and obsessive-compulsive disorder. It is usually seen from adolescence and can lead to negative outcomes for people who struggle with it. There is a gap in research documenting the relationship between body dysmorphism and cognitive functioning that this study seeks to bridge.

Researcher Soran Rajabi and colleagues used 500 male and female students in high schools in Iran. After screening for body dysmorphism, 52 students were assigned to the body dysmorphic group and 52 gender-equal students were assigned to the healthy control group. Body dysmorphism was assessed based on a questionnaire and the DSM-5 materials. Participants completed measurements of body dysmorphism and several cognitive and executive function tests, including the Stroop Color and Word Test, Wisconsin Map Sorting Test, Tower of London Test, and the Trace Making Test.

The results showed that mood disorders showed the highest co-morbidities with body dysmorphism, followed by anxiety, OCD and then eating disorders. Women showed higher rates of body dysmorphism than men. Men were likely concerned about their skin, hair, and nose, while women were concerned about their skin, nose, and belly.

The Wisconsin map sorting test, which measures cognitive flexibility, showed worse results for people with body dysmorphism. This is thought to be possibly due to people being obsessive, preoccupied and 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 with BDD cannot let go of their thoughts related to the appearance of the body and refocus on a different stimulus. Disrupted set-shifting in repetitive actions is reflected in the compulsive nature of checking the mirror,” wrote Rajabi and colleagues in their study.

In addition, participants with body dysmorphism in the trace-making test scored significantly lower, implying that they have weaker visuospatial skills. People with body dysmorphism experience distorted perception, which is a large factor in these findings.

“It is believed that people with BDD focus much more on visual details, while lacking 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 is often immediately focused on the perceived flaws, even if they are standing near the mirror but unable to to see the bigger picture of their body shape.”

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