Facial processing in body dysmorphic disorder

Individuals with body dysmorphic disorder (BDD) are characterized by imagined or slight defects in appearance, which lead to significant distress and interference in their everyday life. Several cognitive-behavioral models of BDD have recently been developed to explain BDD's unique symptoms (e.g., Wilhelm, 2006). According to Wilhelm's (2006) cognitive-behavioral model of BDD, everybody has some concerns about one's appearance. Individuals with BDD, however, over-focus on single aspects of their appearance while ignoring the entire face (the big picture) and are characterized by negative, self-defeating interpretations (e.g., or I have to look perfect), which leads to negative emotions and maladaptive behaviors such as avoidance behaviors or rituals. Wilhelm's (2006) model is supported from findings such as that individuals with BDD misinterpret ambiguous situations and others facial expressions in a negative way (Buhlmann et al., 2002, 2004, 2006). However, it is unclear whether they are characterized by a stronger acquisition and resistance to extinction of de novo skin conductance conditioned responses to critical emotional expressions as conditioned stimuli, i.e., stronger conditionability. This could explain why individuals with BDD are characterized by a strong fear of negative evaluation by others and why they are more sensitive to emotional expressions in social situations. Moreover, it is unclear whether emotion recognition deficits observed in BDD (Buhlmann et al., 2004, 2006) diminish through specific training interventions, which could have invaluable implications for cognitive-behavioral interventions such as mirror retraining. Thus, based on recent cognitive-behavioral models of BDD, the proposed project aims at investigating (1) whether individuals with BDD exhibit deficits in holistic face processing, (2) whether observed emotion recognition deficits in BDD can be normalized through specific training procedures, and (3) whether individuals with BDD exhibit a stronger acquisition and resistance to extinction of conditional stimuli such as critical faces.