Body dysmorphic disorder (BDD) concerns may be on a continuum with normal appearance concerns, differing only quantitatively. As emerging evidence suggests that an increased aesthetic sensitivity plays a role in BDD, individuals with BDD (n = 50) were compared with a control group of individuals with an education or employment in art and design related fields (n = 50) and a control group of individuals without aesthetic training (n = 50). Participants completed a demographic questionnaire and a series of measures for depression, BDD symptomatology, and body image. Most controls (with and without aesthetic training) reported appearance concerns and expressed comparable ideals to those with BDD. However, BDD participants differed by using negative, emotive, and morally based descriptions for their defect(s), spending a greater time preoccupied with their defect(s) causing increased interference with functioning, performing appearance-related behaviors more frequently, and experiencing greater distress when performing those behaviors.
For those with body dysmorphic disorder (BDD), the concern with an imagined or slight defect in their appearance is excessive, causing them significant distress and/or impairment in their social and/or occupational functioning. BDD concerns may be on a continuum with normal appearance concerns, differing quantitatively as a more severe version.
The preoccupation in BDD typically focuses on one aspect of the body, which can shift during the course of the disorder, especially following surgical treatment (Tignol et al., 2007 and Veale, 2000). Some sufferers are preoccupied with several body parts simultaneously (Phillips, Menard, Fay, & Weisberg, 2005). Any body part may be the focus in BDD. Complaints about skin, hair, and the size, shape, or symmetry of facial features however, are the most common (Phillips et al., 1993, Phillips et al., 2006, Phillips et al., 2005 and Veale et al., 1996).
Individuals with BDD resemble those with an eating disorder in their overall body dissatisfaction; but they report greater self-evaluative and appearance-managing investment, as well as greater overall body image disturbance and a more detrimental impact of body image on quality of life than those with an eating disorder (Hrabosky et al., 2009). Unlike other body image disorders, BDD affects approximately an equal proportion of men and women (Phillips & Diaz, 1997). Gender may differentially influence localisation of the preoccupations in BDD (Phillips and Diaz, 1997 and Phillips et al., 2006). Some of these gender differences may reflect the trends in the general population (Harris & Carr, 2001), suggesting that BDD concerns represent an extreme version of normal appearance concerns.
Many in the general population express dissatisfaction, to some degree, with at least one facet of their appearance (Harris & Carr, 2001). Paralleling trends observed in those with BDD (Phillips et al., 2006), concerns about the nose, skin, and weight are reported most frequently by both men and women in the general population (Harris & Carr, 2001). Women are twice more likely than men to have an appearance concern; interestingly, among women the prevalence of concern peaks during the late teens and late twenties and remains high through to age 60 years, whereas among males it peaks during the late teens and early twenties and decreases progressively with age (Harris & Carr, 2001).
Individuals with BDD appear to appreciate art and beauty to a greater degree than comparative psychiatric groups, as evidenced by their choice of occupation and/or education (Veale, Ennis, & Lambrou, 2002). This raises an interesting question about the definition of BDD as a preoccupation with an imagined defect or a minor physical anomaly. Perhaps those with BDD are more aesthetically sensitive than the mental health professionals who diagnose them and who are therefore unable to appreciate art and beauty to the same degree (Veale & Lambrou, 2002). A high aesthetic sensitivity would augment a person's self-consciousness and distress over any appearance defect (Harris, 1982). Preliminary evidence suggests that a higher aesthetic sensitivity may partly explain why a small defect in their appearance severely disturbs those with BDD (Lambrou et al., 2011 and Stangier et al., 2008). Akin to the perceptual and affective/attitudinal components of body image, aesthetic sensitivity has a perceptual, emotional, and evaluative component (see Lambrou et al., 2011, for the aesthetic sensitivity model). Rather than suffering from a perceptual deficit, individuals with BDD have a superior accuracy in their self-actual estimation; instead, they resemble nonclinical individuals with an education or employment in art and design related fields in their increased understanding of aesthetic proportions (Lambrou et al., 2011). The source of their disturbance is in their emotional/evaluative processing of their self-image, where they display a negative emotional bias and a discrepancy between their self-actual and self-ideal, because of an absent self-serving bias in their self-actual; they also overvalue the importance of appearance and self-objectify.
Since appearance concerns are the norm in our culture, it is important to distinguish the traits that typically define those with BDD, and how they are distinguished from the general population; particularly from those with an art and design education and/or occupation as emerging evidence suggests that an increased aesthetic sensitivity plays a role in BDD. Previous surveys have assessed the demographic and clinical characteristics of those with BDD (e.g., Phillips et al., 2005 and Veale et al., 1996), but comparative control surveys are sparse.
The aims of the present study were two-fold: (a) to report the demographic characteristics of a sample comprising individuals with BDD and healthy controls (with and without aesthetic training) and (b) to explore how those with BDD compare with healthy controls (with and without aesthetic training) in their clinical characteristics including their depressive symptomatology, as well as the nature and extent of their appearance concerns.
