Metacognition in Body Dysmorphic Disorder-A Preliminary Exploration

A preliminary exploration of metacognition in Body Dysmorphic Disorder (BDD) was undertaken. The study investigated how 18 patients with BDD controlled, corrected, regulated, and appraised their thinking, in relation to a mental image of their concerns with appearance. Verbal thoughts related to these concerns were also investigated. A semistructured interview was administered. Patients reported attempts to distract themselves from their (invariably distressing) images, which had few advantages and many disadvantages. Images increased self-consciousness and decreased self confidence. Some patients sought to counter their distress by recalling past positive memories. All patients made negative self-judgments as a result of having these images. They thought that they were unattractive, ugly, inferior, and worthless. Looking in the mirror was a common source of evidence for these judgments, together with reactions from others. Examination of the verbal thoughts produced similar findings. Some tentative implications are discussed.