What the cognitive deficits in body dysmorphic disorder tell us about the underlying neurobiology: An investigation of three cases

Body Dysmorphic Disorder (BDD) has only recently received attention in current research. As such, little is understood with regards to the underlying cognitive impairments and neurobiological substrates implicated in this disorder. The current report provides first, a review of the background of BDD; second, a description of the clinical features of three BDD cases; and last, the outcomes from a cognitive assessment administered to three BDD cases. The cognitive assessment included (a) executive function, (b) facial affect perception, and (c) general social cognition. All three BDD cases illustrated many of the disorder’s clinical features such as excessive disproportionate concerns about their appearance, repetitive (checking) behaviours, and camouflaging. Further, they experience significant distress and impairment in social, occupational, and other important areas of functioning. They also demonstrated poor self-esteem, greater self-ambivalence, and more pronounced delusional thinking than a comparison group of ten healthy controls. The cognitive assessment demonstrated deficits in executive functioning and facial affect perception, but not in general social cognition. The findings implicate frontalamygdala and temporal-parietal pathology in BDD although neuroimaging studies are needed to confirm this speculation. The implications of our findings for the treatment of BDD are discussed.