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Patients with Body Dysmorphic Disorder (BDD) are characterized by excessive concerns about imagined defects in their appearance, most commonly, facial features. In this study, we investigated (1) the ability to identify facial expressions of emotion, and (2) to discriminate single facial features in BDD patients, Obsessive-Compulsive Disorder (OCD) patients, and in healthy control participants. Specifically, their ability for general facial feature discrimination was assessed using the Short Form of the Benton Facial Recognition Test (Benton AL, Hamsher KdeS, Varney NR, Spreen O. Contributions to neuropsychological assessment: a clinical manual. New York: Oxford University Press; 1983). However, findings of the BFRT indicate no differences among the groups. Moreover, participants were presented with facial photographs from the Ekman and Friesen (Ekman P, Friesen W. Unmasking the face: a guide to recognizing emotions from facial cues. Englewood Cliffs, NJ: Prentice-Hall; 1975 and Ekman P, Friesen W. Pictures of facial affect. Palo Alto: Consulting Psychologists Press, 1976) series and were asked to identify the corresponding emotion. The BDD group was less accurate than the control group, but not the OCD group, in identifying facial expressions of emotion. Relative to the control and OCD groups, the BDD group more often misidentified emotional expressions as angry. In contrast to the findings of Sprengelmeyer et al. [Proc. Royal Soc. London Series B: Biol. Sci. 264 (1997),1767], OCD patients did not show a disgust recognition deficit. Poor insight and ideas of reference, common in BDD, might partly result from an emotion recognition bias for angry expressions. Perceiving others as angry and rejecting might reinforce concerns about one's personal ugliness and social desirability.

Patients with Body Dysmorphic Disorder (BDD) are distressed about imagined defects in their appearance, most commonly, facial flaws (American Psychiatric Association, 1994). They are very self-critical, fear negative evaluation by others, and often suffer significant morbidity, including social/occupational impairment, hospitalization, and suicide attempts (e.g., Phillips et al., 1993). Research has shown that neuropsychological deficits and selective information processing might play an important role in the etiology or maintenance of emotional disorders (for review, see Williams et al., 1997 and Lezak, 1995). For example, when drawing a complex figure from memory (Osterrieth, 1944), BDD patients tend to recall details rather than larger organizational design features, resulting in memory deficits (Deckersbach et al., 2000). These maladaptive strategies may also be related to the etiology and maintenance of BDD. Indeed, BDD patients tend to ritualistically compare themselves to others (e.g., Phillips et al., 1993). Based on our clinical experience, we would assume that BDD patients focus on the body part of concern when unfavorably comparing themselves to others (i.e., a patient with nose concerns would focus on other people's noses and disregard the rest of the face). This focus on specific body parts rather than considering global aspects of appearance might impair overall face recognition and could interfere with interpreting facial expressions accurately.