CPSY 265, Body Dysmorphic Disorder, Winter 07 Gregg Williams
3 of 13Cognitions
People with BDD tend to have certain thoughts about the appearance of certain body parts, aswell as additional thoughts about how others see them. These include:
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a preoccupation with "the idea that some aspect of their appearance is unattractive,deformed, ugly, or 'not right'" (Phillips and Castle, 2002)
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a belief that "others share their view of the perceived defect...take notice and are dis-gusted by it (Wilhelm and Neziroglu, 2002)
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a belief that "the perceived defect reveals some personal flaw and is indicative of their self-worth" (Wilhelm and Neziroglu, 2002)
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a conviction that, because of these thoughts, "the only way to improve their self-esteem is to improve the way they look" (Rosen, 1998)This last belief contributes to the tenacity of BDD. Unfortunately, for people with BDD, thedistortion is in their internal body image (Veale, 2002). As a result, no amount of change or camou-flage to the person's physical body will be satisfying, and the person will be continually dissatisfiedand continually driven to take additional actions in pursuit of decreasing the resulting anxiety.
Level of Insight
Multiple sources have reported that many people with BDD so firmly believe "with absoluteconviction that the flaw they perceive is actually noticeable and ugly" (Wilhelm and Neziroglu, 2002)that they are delusional. Phillips and Castle (2002) put the population of delusional BDD patients asbeing 50% of the total BDD population. Wilhelm and Neziroglu, among others, believe that such peo-ple should be given an additional diagnosis of delusional disorder, somatic type. More recently,
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