Cognitive-behavioural models of body dysmorphic disorder (BDD) suggest that mirrors can act as a trigger for individuals with BDD, resulting in a specific mode of cognitive processing, characterised by an increase in self-focussed attention and associated distress. The aim of the current study was to investigate these factors experimentally by exposing participants with BDD (n = 25) and without BDD (n = 25) to a mirror in a controlled setting. An additional aim was to ascertain the role of duration of mirror gazing in the maintenance of distress and self-consciousness by manipulating the length of gazing (short check vs. long gazing). Findings demonstrated that contrary to what was predicted, not only participants with BDD, but also those without BDD experienced an increase in distress and self-focused attention upon exposure to the mirror. In addition, people without BDD, unlike those with BDD, experienced more distress when looking in the mirror for a long period of time as opposed to a short period of time. This lends some support to the idea that, for people with BDD, gazing in a mirror, regardless of duration, might act as an immediate trigger for an abnormal mode of processing and associated distress, and that this association has developed from past excessive mirror gazing. Further theoretical implications of these findings, as well as subsidiary research questions relating to additional cognitive factors are discussed.
People with body dysmorphic disorder (BDD) are preoccupied with either an imagined defect or a slight anomaly in their appearance, which causes them clinically significant distress and/or impairments in functioning (American Psychiatric Association, 1994). Appearance-related concerns in BDD can centre on specific features of the body (e.g. skin or hair) or on generalised feelings of being ugly, deformed, or odd-looking (Phillips et al., 1993, Rosen, 1996 and Veale et al., 1996). In most cases multiple aspects of appearance are disliked (Hollander et al., 1993, Perugi et al., 1997, Phillips et al., 1993, Phillips et al., 1994, Rosen, 1996, Rosen, 1998 and Veale et al., 1996). Concerns about appearance in BDD are frequently accompanied by a host of repetitive and time-consuming behaviours, aimed at verifying, camouflaging, or enhancing the person’s appearance (Allen, 2006, Cororve and Gleaves, 2001, Perugi et al., 1997, Phillips et al., 1993 and Rosen et al., 1995). These include mirror gazing, excessive grooming, compulsive skin-picking, attempting to conceal perceived flaws, reassurance seeking, and seeking cosmetic procedures. Taken together, the features of BDD frequently lead to a high degree of morbidity and impairments in functioning. People with BDD often experience high levels of distress (Phillips, Siniscalchi, & McElroy, 2004), a high life-time rate of psychiatric hospitalisation (Phillips et al., 1993 and Veale et al., 1996) and a high rate of suicidal ideation and suicide attempts (Grant et al., 2001, Hollander et al., 1993, Perugi et al., 1997, Phillips, 1991, Phillips and Diaz, 1997, Phillips et al., 1993, Phillips et al., 1994, Phillips and Menard, 2006, Rief et al., 2006 and Veale et al., 1996). In addition, many individuals with BDD are single and unemployed (Neziroglu and Yaryura-Tobias, 1993 and Veale et al., 1996).
