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Implicit and Explicit Self-Esteem and Attractiveness Beliefs among Individuals with Body Dysmorphic Disorder

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Abstract

Body Dysmorphic Disorder (BDD) is characterized by a preoccupation about imagined or slight defects in one’s appearance. In the present study, we evaluated explicit and implicit biases among individuals diagnosed with BDD (n = 15), individuals with subclinical BDD symptoms (n = 20), and healthy control participants (n = 20). Specifically, we used the Implicit Association Test [(IAT; Greenwald, McGhee, & Schwartz, (1998) Journal of personality and social psychology, 74, 1464] to measure automatic associations related to self-esteem (evaluations of the self vs. others as good vs. bad) and the importance of attractiveness (evaluations of attractiveness vs. kindness as important vs. meaninglessness). Results indicated that, as predicted, BDD participants had significantly lower implicit self-esteem, relative to healthy control participants, and the subclinical BDD participants were intermediate between these groups. Further, lower implicit self-esteem was positively related to each of the other implicit and explicit BDD-relevant indicators, including explicit beliefs about attractiveness. However, no group differences were observed on the implicit importance of attractiveness task. These findings mostly support cognitive-behavioral models of BDD that suggest vulnerable persons exaggerate the significance of appearance for self-evaluation.

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Notes

  1. It is important to mention that relatively more positive implicit associations were found toward the self (relative to others) among all groups, consistent with other recent studies using the IAT in high and low anxious populations (e.g., de Jong, 2002; Tanner et al., 2006). The critical finding, however, was the evidence of group differences, indicating relatively less positive implicit self-esteem among those with more severe BDD symptoms.

References

  • American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders (4th ed.) Washington, DC: American Psychiatric Association.

  • Allen, A., & Hollander, E. (2004). Similarities and differences between body dysmorphic disorder and other disorders. Psychiatric Annals, 34, 927–933.

    Google Scholar 

  • Asendorpf, J. B., Banse, R., & Mücke, D. (2002). Double dissociation between implicit and explicit personality self-concept: The case of shy behavior. Journal of Personality and Social Psychology, 83, 380–393.

    Article  PubMed  Google Scholar 

  • Beck, A. T., & Clark, D. A. (1997). An information processing model of anxiety: automatic and strategic processes. Behaviour Research and Therapy, 35, 49–58.

    Article  PubMed  CAS  Google Scholar 

  • Beck, A. T., & Steer, R. A. (1987). Manual for the revised Beck Depression Inventory. San Antonio, TX: Psychological Corporation.

    Google Scholar 

  • Biby, E. L. (1998). The relationship between body dysmorphic disorder and depression, self-esteem, somatization, and obsessive-compulsive disorder. Journal of Clinical Psychology, 54, 489–499.

    Article  PubMed  CAS  Google Scholar 

  • Bohne, A., Keuthen, N. J., Wilhelm, S., Deckersbach, T., & Jenike, M.A. (2002). Prevalence of symptoms of body dysmorphic disorder and its correlates: A cross-cultural comparison. Psychosomatics, 43, 486–490.

    Article  PubMed  Google Scholar 

  • Buhlmann, U., Etcoff, N. L., & Wilhelm, S. (2006). Emotion recognition bias for contempt and anger in body dysmorphic disorder. Journal of Psychiatric Research, 40, 105–111.

    Article  PubMed  Google Scholar 

  • Buhlmann, U., McNally, R. J., Etcoff, N. L., Tuschen-Caffier, B., & Wilhelm, S. (2004). Emotion recognition deficits in body dysmorphic disorder. Journal of Psychiatric Research, 38, 201–206.

    Article  PubMed  Google Scholar 

  • Buhlmann, U., Wilhelm, S., McNally, R. J., Tuschen-Caffier, B., Baer, L., & Jenike, M. A. (2002). Interpretive biases for ambiguous information in body dysmorphic disorder. CNS Spectrums, 7, 435–443.

    PubMed  Google Scholar 

  • Buhlmann U., & Wilhelm, S. (2004). Cognitive factors in body dysmorphic disorder. Psychiatric Annals, 34, 922–926.

    Google Scholar 

  • de Jong, P. (2002). Implicit self-esteem and social anxiety: Differential self-positivity effects in high and low anxious individuals. Behaviour Research and Therapy, 40, 501–508.

    Article  PubMed  Google Scholar 

  • Draine, S. (1999). Inquisit (Version 1.33) [Computer software]. Seattle, WA: Millisecond Software.

  • Fazio, R. H., & Olson, M. A. (2003). Implicit measures in social cognition: Their meaning and use. Annual Review of Psychology, 54, 297–327.

    Article  PubMed  Google Scholar 

  • Ferring, D., & Filipp, S.-H. (1996). Messung des Selbstwertgefühls: Befunde zur Reliabilität, Validität und Stabilität der Rosenberg-Skala. Diagnostica, 42, 284–292.

    Google Scholar 

  • Greenwald, A. G., & Banaji, M. R. (1995). Implicit social cognition: Attitudes, self-esteem, and stereotypes. Psychological Review, 102, 4–27.

    Article  PubMed  CAS  Google Scholar 

  • Greenwald, A. G., & Farnham, S. D. (2000). Using the Implicit Association Test to measure self-esteem and self-concept. Journal of Personality and Social Psychology, 79, 1022–1038.

    Article  PubMed  CAS  Google Scholar 

  • Greenwald, A. G., McGhee, D. E., & Schwartz, J. L. K. (1998). Measuring individual differences in implicit cognition: The implicit association test. Journal of Personality and Social Psychology, 74, 1464-1480.

    Article  PubMed  CAS  Google Scholar 

  • Greenwald, A. G., Nosek, B. A., & Banaji, M. R. (2003). Understanding and using the implicit association test: I. An improved scoring algorithm. Journal of Personality and Social Psychology, 85, 197–216.

    Article  PubMed  Google Scholar 

  • Hautzinger, M., Bailer, M., Worall, H., & Keller, F. (1995). Beck Depressionsinventar. Bern: Huber.

    Google Scholar 

  • McNally, R. J. (1995). Automaticity and the anxiety disorders. Behaviour Research and Therapy, 33, 747–754.

    Article  PubMed  CAS  Google Scholar 

  • Nosek, B. A. (2005). Moderators of the relationship between implicit and explicit evaluation. Journal of Experimental Psychology: General, 134, 565–584.

    Article  Google Scholar 

  • Petrie, T. A., Rogers, R. L., Johnson, C. E., & Diehl, N. (1996). Development and validation of the Beliefs About Attractiveness Scale-Revised. Paper presented at the 104th Annual Convention of the American Psychological Association. Toronto, Canada.

  • Phillips, K. A., Didie, E. R., Menard, W., Pagano, M. E., Fay, C., & Weisberg, R. B. (2006). Clinical features of body dysmorphic disorder in adolescents and adults. Psychiatry Research, 141, 305–314.

    Article  PubMed  Google Scholar 

  • Phillips, K. A., Hollander, E., Rasmussen, S. A., Aronowitz, B. R., DeCaria, C., & Goodman, W. K. (1997). A severity rating scale for body dysmorphic disorder: development, reliability, and validity of a modified version of the Yale-Brown Obsessive Compulsive Scale. Psychopharmacology Bulletin, 33, 17–22.

    PubMed  CAS  Google Scholar 

  • Phillips, K.A., Pinto, A., & Jain, S. (2004). Self-esteem in body dysmorphic disorder. Body Image, 1, 385–390.

    Article  PubMed  Google Scholar 

  • Phillips, K. A., McElroy, S. L., Keck, P. E. Jr., Pope, H. G. Jr. & Hudson, J. I. (1993). Body dysmorphic disorder: 30 cases of imagined ugliness. American Journal of Psychiatry, 150, 302–308.

    PubMed  CAS  Google Scholar 

  • Rosenberg, M. (1989). Society and the Adolescent Self-Image. Revised edition. Middletown, CT: Wesleyan University Press.

  • Tanner, R. J., Stopa, L., & De Houwer, J. (2006). Implicit views of the self in social anxiety. Behaviour Research and Therapy, 44, 1397–1409.

    Google Scholar 

  • Teachman, B. A. (2005). Information processing and anxiety sensitivity: Cognitive vulnerability to panic reflected in interpretation and memory biases. Cognitive Therapy and Research, 29, 483–503.

    Article  Google Scholar 

  • Teachman, B. A. & Allen, J. P. (in press). Development of social anxiety: Social interaction predictors of implicit and explicit fear of negative evaluation. Journal of Abnormal Child Psychology.

  • Teachman, B., Gapinski, K., Brownell, K., Rawlins, M., & Jeyaram, S. (2003). Demonstrations of implicit anti-fat bias: The impact of providing causal information and evoking empathy. Health Psychology, 22, 68–78.

    Article  PubMed  Google Scholar 

  • Teachman, B. A., Gregg, A., & Woody, S. (2001). Implicit processing of fear-relevant stimuli among individuals with snake and spider fears. Journal of Abnormal Psychology, 110, 226–235.

    Article  PubMed  CAS  Google Scholar 

  • Teachman, B. A., & Woody, S. (2003). Automatic processing among individuals with spider phobia: Change in implicit fear associations following treatment. Journal of Abnormal Psychology, 112, 100–109.

    Article  PubMed  Google Scholar 

  • Teachman, B. A., Woody, S. R., & Magee, J. C. (2006). Implicit and explicit appraisals of the importance of intrusive thoughts. Behaviour Research and Therapy, 44, 785–805.

    Article  PubMed  Google Scholar 

  • Veale, D., Boocock, A., Gournay, K., Dryden, W., Shah, F., Willson, R., & Walburn, J. (1996). Body dysmorphic disorder: A survey of fifty cases. British Journal of Psychiatry, 169, 196–201.

    Article  PubMed  CAS  Google Scholar 

  • Wilhelm, S., & Neziroglu, F. (2002). Cognitive Theory of Body Dysmorphic Disorder. In Frost RO, Steketee G (Eds.), Cognitive approaches to obsessions and compulsions: Theory, assessment and treatment. (pp. 203–214). Oxford: Elsevier Press.

    Google Scholar 

  • Wilhelm, S. (2006). Feeling good about the way you look: A program for overcoming body image problems. New York, NY: Guilford Press.

    Google Scholar 

  • Wittchen, H. U., Zaudig, M., & Fydrich, T. (1997). Strukturiertes Klinisches Interview für DSM-IV-(SKID-I und SKID-II). Göttingen: Hogrefe.

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Authors and Affiliations

  1. Body Dysmorphic Disorder Clinic, Massachusetts General Hospital and Harvard Medical School, Simches Research Building, 185 Cambridge Street, Suite 2280, Boston, MA, 02114, USA

    Ulrike Buhlmann

  2. University of Virginia, Charlottesville, VA, USA

    Bethany A. Teachman

  3. Marburg University, Marburg, Germany

    Anke Gerbershagen, Julia Kikul & Winfried Rief

Authors
  1. Ulrike Buhlmann
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  2. Bethany A. Teachman
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  3. Anke Gerbershagen
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  4. Julia Kikul
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  5. Winfried Rief
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Correspondence to Ulrike Buhlmann.

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Buhlmann, U., Teachman, B.A., Gerbershagen, A. et al. Implicit and Explicit Self-Esteem and Attractiveness Beliefs among Individuals with Body Dysmorphic Disorder. Cogn Ther Res 32, 213–225 (2008). https://doi.org/10.1007/s10608-006-9095-9

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