Body dysmorphic disorder: a review of nosology, cognition and neurobiology

An understanding of the neurocognitive and neurobiological underpinnings of body dysmorphic disorder (BDD) is important in differentiating BDD from related disorders, namely obsessive-compulsive disorder and psychotic disorders. Similar cognitive anomalies in executive function, spatial visual processing and memory (bias to process detailed visual information) have been found in BDD and obsessive-compulsive disorder samples, while schizophrenia patients display more pervasive cognitive deficits. Emotional hyperactivity and misinterpretation of emotion in others have been found in BDD, with similar results to obsessive compulsive disorder samples. Neuroimaging has shown abnormalities in the prefrontal cortex, visual cortex, caudate nucleus and right amygdala in BDD patients. These findings are consistent with the neurocognitive profile. This field of research is in its infancy. However, the bias towards detailed visual analysis may be an important clue when investigating the neurobiological basis of BDD, and could explain why individuals exhibit focused attention on one aspect of their own appearance. Emotional hyperarousal caused by amygdala pathology may reinforce a perception of negative physical appearance.