Hostname: page-component-cd9895bd7-gbm5v Total loading time: 0 Render date: 2024-12-23T03:16:45.709Z Has data issue: false hasContentIssue false
  • English
  • Français

Cognitive dysfunction in body dysmorphic disorder: new implications for nosological systems and neurobiological models

Published online by Cambridge University Press:  30 November 2016

Kiri Jefferies-Sewell ,
Samuel R. Chamberlain ,
Naomi A. Fineberg  and
Keith R. Laws
Kiri Jefferies-Sewell*
Affiliation:
Highly Specialized OCD Service, Hertfordshire, Partnership University National Health Service Foundation Trust, Welwyn Garden City, UK Department of Psychology, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
Samuel R. Chamberlain
Affiliation:
Department of Psychiatry, School of Clinical Medicine, University of Cambridge, Cambridge, UK Cambridge & Peterborough NHS Foundation Trust (CPFT, UK), Addenbrookes Hospital, Cambridge, UK
Naomi A. Fineberg
Affiliation:
Highly Specialized OCD Service, Hertfordshire, Partnership University National Health Service Foundation Trust, Welwyn Garden City, UK Postgraduate Medicine, University of Hertfordshire, Hatfield, UK
Keith R. Laws
Affiliation:
Department of Psychology, School of Life and Medical Sciences, University of Hertfordshire, Hatfield, UK
*
*Address for correspondence: Kiri Jefferies-Sewell, Research & Development Department, The Colonnades, Beaconsfield Close, Hatfield, Hertfordshire AL10 8YD, UK.(Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction

Body dysmorphic disorder (BDD) is a debilitating disorder, characterized by obsessions and compulsions relating specifically to perceived appearance, and which has been newly classified within the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) Obsessive-Compulsive and Related Disorders grouping. Until now, little research has been conducted into the cognitive profile of this disorder.

Methods

Participants with BDD (n=12) and participants without BDD (n=16) were tested using a computerized neurocognitive battery investigating attentional set-shifting (Intra/Extra Dimensional Set Shift Task), decision-making (Cambridge Gamble Task), motor response-inhibition (Stop-Signal Reaction Time Task), and affective processing (Affective Go-No Go Task). The groups were matched for age, IQ, and education.

Results

In comparison to controls, patients with BDD showed significantly impaired attentional set-shifting, abnormal decision-making, impaired response inhibition, and greater omission and commission errors on the emotional processing task.

Conclusion

Despite the modest sample size, our results showed that individuals with BDD performed poorly compared to healthy controls on tests of cognitive flexibility, reward and motor impulsivity, and affective processing. Results from separate studies in OCD patients suggest similar cognitive dysfunction. Therefore, these findings are consistent with the reclassification of BDD alongside OCD. These data also hint at additional areas of decision-making abnormalities that might contribute specifically to the psychopathology of BDD.

Keywords

Affective processingbody dysmorphic disordercognitive deficitscognitive inflexibilityneurobiologicalobsessive compulsive disorderresponse inhibition
Type
Original Research
Information
CNS Spectrums , Volume 22 , Issue 1 , February 2017 , pp. 51 - 60
Copyright
© Cambridge University Press 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Grant, JE, Phillips, KA. Recognizing and treating body dysmorphic disorder. Ann Clin Psychiatry. 2005; 17(4): 205–210.CrossRefGoogle ScholarPubMed
2. Rosen, JC. The nature of body dysmorphic disorder and treatment with cognitive behavior therapy. Cognitive and Behavioral Practice. 1995; 2(1): 143–166.Google Scholar
3. Veale, D, Riley, S. Mirror, mirror on the wall, who is the ugliest of them all? The psychopathology of mirror gazing in body dysmorphic disorder. Behav Res Ther. 2001; 39(12): 1381–1393.CrossRefGoogle ScholarPubMed
4. Rief, W, Buhlmann, U, Wilhelm, S, Borkenhagen, A, Brähler, E. The prevalence of body dysmorphic disorder: a population-based survey. Psychol Med. 2006; 36(6): 877–885.Google Scholar
5. Koran, LM, Abujaoude, E, Large, MD, Serpe, RT. The prevalence of body dysmorphic disorder in the United States adult population. CNS Spectr. 2008; 13(4): 316–322.Google Scholar
6. Biby, EL. The relationship between body dysmorphic disorder and depression, self‐esteem, somatization, and obsessive–compulsive disorder. J Clin Psychol. 1998; 54(4): 489–499.Google Scholar
7. Bohne, A, Wilhelm, S, Keuthen, NJ, Florin, I, Baer, L, Jenike, MA. Prevalence of body dysmorphic disorder in a German college student sample. Psychiatry Res. 2002; 109(1): 101–104.CrossRefGoogle Scholar
8. Bohne, A, Keuthen, NJ, Wilhelm, S, Deckersbach, T, Jenike, MA. Prevalence of symptoms of body dysmorphic disorder and its correlates: a cross-cultural comparison. Psychosomatics. 2002; 43(6): 486–490.Google Scholar
9. Sarwer, DB, Cash, TF, Magee, L, et al. Female college students and cosmetic surgery: an investigation of experiences, attitudes, and body image. Plast Reconstr Surg. 2005; 115(3): 931–938.Google Scholar
10. Rashid, H, Khan, AA, Fineberg, NA. Adjunctive antipsychotic in the treatment of body dysmorphic disorder—a retrospective naturalistic case note study. Int J Psychiatry Clin Pract. 2015; 19(2): 84–89.CrossRefGoogle ScholarPubMed
11. Phillips, KA, Menard, W. Suicidality in body dysmorphic disorder: a prospective study. Am J Psychiatry. 2006; 163(7): 1280–1282.Google Scholar
12. Rosen, JC, Ramirez, E. A comparison of eating disorders and body dysmorphic disorder on body image and psychological adjustment. J Psychosom Res. 1998; 44(3): 441–449.Google Scholar
13. Thornton, C, Russell, J. Obsessive compulsive comorbidity in the dieting disorders. Int J Eat Disord. 1997; 21(1): 83–87.3.0.CO;2-P>CrossRefGoogle ScholarPubMed
14. Bienvenu, OJ, Samuels, JF, Riddle, MA, et al. The relationship of obsessive–compulsive disorder to possible spectrum disorders: results from a family study. Biol Psychiatry. 2000; 48(4): 287–293.Google Scholar
15. Costa, C, Lucas, D, Chagas Assunção, M, et al. Body dysmorphic disorder in patients with obsessive–compulsive disorder: prevalence and clinical correlates. Depress Anxiety. 2012; 29(11): 966–975.Google Scholar
16. Grant, JE, Kim, SW, Eckert, ED. Body dysmorphic disorder in patients with anorexia nervosa: prevalence, clinical features, and delusionality of body image. Int J Eat Disord. 2002; 32(3): 291–300.Google Scholar
17. Dingemans, AE, van Rood, YR, de Groot, I, van Furth, EF. Body dysmorphic disorder in patients with an eating disorder: prevalence and characteristics. Int J Eat Disord. 2012; 45(4): 562–569.Google Scholar
18. Hartmann, AS, Greenberg, JL, Wilhelm, S. The relationship between anorexia nervosa and body dysmorphic disorder. Clin Psychol Rev. 2013; 33(5): 675–685.Google Scholar
19. Roberts, ME, Tchanturia, K, Treasure, JL. Exploring the neurocognitive signature of poor set-shifting in anorexia and bulimia nervosa. J Psychiatr Res. 2010; 44(14): 964–970.CrossRefGoogle ScholarPubMed
20. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th ed. Washington, DC: American Psychiatric Association; 2013.Google Scholar
21. Bienvenu, O, Samuels, J, Wuyek, L, et al. Is obsessive–compulsive disorder an anxiety disorder, and what, if any, are spectrum conditions? A family study perspective. Psychol Med. 2012; 42(1): 1–13.Google Scholar
22. Chamberlain, SR, Blackwell, AD, Fineberg, NA, Robbins, TW, Sahakian, BJ. The neuropsychology of obsessive compulsive disorder: the importance of failures in cognitive and behavioural inhibition as candidate endophenotypic markers. Neurosci Biobehav Rev. 2005; 29(3): 399–419.CrossRefGoogle ScholarPubMed
23. Fineberg, NA, Potenza, MN, Chamberlain, SR, et al. Probing compulsive and impulsive behaviors, from animal models to endophenotypes: a narrative review. Neuropsychopharmacology. 2010; 35(3): 591–604.Google Scholar
24. Fineberg, NA, Chamberlain, SR, Goudriaan, AE, et al. New developments in human neurocognition: clinical, genetic, and brain imaging correlates of impulsivity and compulsivity. CNS Spectr. 2014; 19(1): 69–89.Google Scholar
25. Robbins, TW, James, M, Owen, AM, et al. A study of performance on tests from the CANTAB battery sensitive to frontal lobe dysfunction in a large sample of normal volunteers: implications for theories of executive functioning and cognitive aging. J Int Neuropsychol Soc. 1998; 4(5): 474–490.Google Scholar
26. Fineberg, N, Chamberlain, S, Hollander, E, Boulougouris, V, Robbins, T. Translational approaches to obsessive‐compulsive disorder: from animal models to clinical treatment. Br J Pharmacol. 2011; 164(4): 1044–1061.Google Scholar
27. Keeler, J, Robbins, T. Translating cognition from animals to humans. Biochem Pharmacol. 2011; 81(12): 1356–1366.Google Scholar
28. Chamberlain, SR, Fineberg, NA, Menzies, LA, et al. Impaired cognitive flexibility and motor inhibition in unaffected first-degree relatives of patients with obsessive-compulsive disorder. Am J Psychiatry. 2007; 164(2): 335–338.Google Scholar
29. Cavedini, P, Zorzi, C, Piccinni, M, Cavallini, MC, Bellodi, L. Executive dysfunctions in obsessive-compulsive patients and unaffected relatives: searching for a new intermediate phenotype. Biol Psychiatry. 2010; 67(12): 1178–1184.Google Scholar
30. Rajender, G, Bhatia, M, Kanwal, K, Malhotra, S, Singh, T, Chaudhary, D. Study of neurocognitive endophenotypes in drug‐naïve obsessive–compulsive disorder patients, their first‐degree relatives and healthy controls. Acta Psychiatr Scand. 2011; 124(2): 152–161.Google Scholar
31. Menzies, L, Chamberlain, SR, Laird, AR, Thelen, SM, Sahakian, BJ, Bullmore, ET. Integrating evidence from neuroimaging and neuropsychological studies of obsessive-compulsive disorder: the orbitofronto-striatal model revisited. Neurosci Biobehav Rev. 2008; 32(3): 525–549.Google Scholar
32. Hanes, KR. Neuropsychological performance in body dysmorphic disorder. J Int Neuropsychol Soc. 1998; 4(2): 167–171.Google Scholar
33. Deckersbach, T, Savage, CR, Phillips, KA, et al. Characteristics of memory dysfunction in body dysmorphic disorder. J Int Neuropsychol Soc. 2000; 6(6): 673–681.Google Scholar
34. Dunai, J, Labuschagne, I, Castle, D, Kyrios, M, Rossell, S. Executive function in body dysmorphic disorder. Psychol Med. 2010; 40(9): 1541–1548.Google Scholar
35. Chamberlain, SR, Fineberg, NA, Blackwell, AD, Robbins, TW, Sahakian, BJ. Motor inhibition and cognitive flexibility in obsessive-compulsive disorder and trichotillomania. Am J Psychiatry. 2006; 163(7): 1282–1284.Google Scholar
36. Labuschagne, I, Rossell, S, Dunai, J, Castle, D, Kyrios, M. A comparison of executive function in body dysmorphic disorder (BDD) and obsessive-compulsive disorder (OCD). J Obsessive Compuls Relat Disord. 2013; 2(3): 257–262.Google Scholar
37. Toh, WL, Castle, DJ, Rossell, SL. Examining neurocognition in body dysmorphic disorder using the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS): a comparison with obsessive-compulsive disorder. Psychiatry Res. 2015; 228(3): 318–324.CrossRefGoogle ScholarPubMed
38. Kerwin, L, Hovav, S, Hellemann, G, Feusner, JD. Impairment in local and global processing and set-shifting in body dysmorphic disorder. J Psychiatr Res. 2014; 57: 41–50.Google Scholar
39. Zois, E, Kortlang, N, Vollstädt‐Klein, S, et al. Decision‐making deficits in patients diagnosed with disordered gambling using the Cambridge Gambling task: the effects of substance use disorder comorbidity. Brain Behav. 2014; 4(4): 484–494.Google Scholar
40. Phillips, KA, Hollander, E, Rasmussen, SA, Aronowitz, BR. A severity rating scale for body dysmorphic disorder: development, reliability, and validity of a modified version of the Yale-Brown Obsessive Compulsive Scale. Psychopharmacol Bull. 1997; 33(1): 17–22.Google Scholar
41. Nelson, HE. National Adult Reading Test (NART): For the Assessment of Premorbid Intelligence in Patients with Dementia: Test Manual. Windsor, UK: NFER-Nelson; 1982.Google Scholar
42. Montgomery, SA, Asberg, M. A new depression scale designed to be sensitive to change. Br J Psychiatry. 1979; 134(4): 382–389.Google Scholar
43. Hamilton, M. The assessment of anxiety states by rating. Br J Med Psychol. 1959; 32(1): 50–55.CrossRefGoogle ScholarPubMed
44. Lawrence, AD, Sahakian, BJ, Robbins, TW. Cognitive functions and corticostriatal circuits: insights from Huntington’s disease. Trends Cogn Sci. 1998; 2(10): 379–388.CrossRefGoogle ScholarPubMed
45. Hampshire, A, Owen, AM. Fractionating attentional control using event-related fMRI. Cereb Cortex. 2006; 16(12): 1679–1689.CrossRefGoogle ScholarPubMed
46. Müller-Thomsen, T, Arlt, S, Mann, U, Maß, R, Ganzer, S. Detecting depression in Alzheimer’s disease: evaluation of four different scales. Arch Clin Neuropsychol. 2005; 20(2): 271–276.Google Scholar
47. Chamberlain, SR, Fineberg, NA, Blackwell, AD, Clark, L, Robbins, TW, Sahakian, BJ. A neuropsychological comparison of obsessive–compulsive disorder and trichotillomania. Neuropsychologia. 2007; 45(4): 654–662.Google Scholar
48. Clark, L, Cools, R, Robbins, T. The neuropsychology of ventral prefrontal cortex: decision-making and reversal learning. Brain Cogn. 2004; 55(1): 41–53.Google Scholar
49. Rogers, RL, Andrews, TK, Grasby, P, Brooks, D, Robbins, T. Contrasting cortical and subcortical activations produced by attentional-set shifting and reversal learning in humans. J Cogn Neurosci. 2000; 12(1): 142–162.Google Scholar
50. Chamberlain, SR, Derbyshire, K, Leppink, E, Grant, JE. Impact of ADHD symptoms on clinical and cognitive aspects of problem gambling. Compr Psychiatry. 2015; 57: 51–57.Google Scholar
51. Murphy, F, Sahakian, B, Rubinsztein, J, et al. Emotional bias and inhibitory control processes in mania and depression. Psychol Med. 1999; 29(6): 1307–1321.Google Scholar
52. Elliott, R, Rubinsztein, JS, Sahakian, BJ, Dolan, RJ. Selective attention to emotional stimuli in a verbal go/no‐go task: an fMRI study. Neuroreport. 2000; 11(8): 1739–1744.Google Scholar
53. Veale, D, Sahakian, B, Owen, A, Marks, I. Specific cognitive deficits in tests sensitive to frontal lobe dysfunction in obsessive–compulsive disorder. Psychol Med. 1996; 26(6): 1261–1269.Google Scholar
54. Watkins, LH, Sahakian, BJ, Robertson, MM, et al. Executive function in Tourette’s syndrome and obsessive–compulsive disorder. Psychol Med. 2005; 35(4): 571–582.CrossRefGoogle ScholarPubMed
55. Dias, R, Robbins, T, Roberts, A. Dissociation in prefrontal cortex of affective and attentional shifts. Nature. 1996; 380(6569): 69–72.CrossRefGoogle ScholarPubMed
56. Brown, VJ, Bowman, EM. Rodent models of prefrontal cortical function. Trends Neurosci. 2002; 25(7): 340–343.Google Scholar
57. McAlonan, K, Brown, VJ. Orbital prefrontal cortex mediates reversal learning and not attentional set shifting in the rat. Behav Brain Res. 2003; 146(1): 97–103.Google Scholar
58. Hornak, J, O’Doherty, JE, Bramham, J, et al. Reward-related reversal learning after surgical excisions in orbito-frontal or dorsolateral prefrontal cortex in humans. J Cogn Neurosci. 2004; 16(3): 463–478.Google Scholar
59. Nagahama, Y, Okada, T, Katsumi, Y, et al. Dissociable mechanisms of attentional control within the human prefrontal cortex. Cereb Cortex. 2001; 11(1): 85–92.Google Scholar
60. Rogers, RD, Owen, AM, Middleton, HC, et al. Choosing between small, likely rewards and large, unlikely rewards activates inferior and orbital prefrontal cortex. J Neurosci. 1999; 19(20): 9029–9038.Google Scholar
61. Rogers, RD, Everitt, B, Baldacchino, A, et al. Dissociable deficits in the decision-making cognition of chronic amphetamine abusers, opiate abusers, patients with focal damage to prefrontal cortex, and tryptophan-depleted normal volunteers: evidence for monoaminergic mechanisms. Neuropsychopharmacology. 1999; 20(4): 322–339.Google Scholar
62. Deakin, J, Aitken, M, Robbins, T, Sahakian, BJ. Risk taking during decision-making in normal volunteers changes with age. J Int Neuropsychol Soc. 2004; 10(4): 590–598.Google Scholar
63. Lochner, C, Chamberlain, SR, Kidd, M, Fineberg, NA, Stein, DJ. Altered cognitive response to serotonin challenge as a candidate endophenotype for obsessive-compulsive disorder. Psychopharmacology (Berl.) 2016; 233(5): 883–891.Google Scholar
64. Hollander, E, Wong, CM. Body dysmorphic disorder, pathological gambling, and sexual compulsions. J Clin Psychiatry. 1995; 56(Suppl 4): 7–12; discussion 13.Google Scholar
65. Aron, AR, Fletcher, PC, Bullmore, ET, Sahakian, BJ, Robbins, TW. Stop-signal inhibition disrupted by damage to right inferior frontal gyrus in humans. Nat Neurosci. 2003; 6(2): 115–116.Google Scholar
66. Aron, AR, Robbins, TW, Poldrack, RA. Inhibition and the right inferior frontal cortex. Trends Cogn Sci. 2004; 8(4): 170–177.Google Scholar
67. Menzies, L, Achard, S, Chamberlain, SR, et al. Neurocognitive endophenotypes of obsessive-compulsive disorder. Brain. 2007; 130(12): 3223–3236.Google Scholar
68. Veale, D. Outcome of cosmetic surgery and ‘DIY’surgery in patients with body dysmorphic disorder. The Bulletin. 2000; 24(6): 218–220.Google Scholar
69. Stein, DJ, Bouwer, C, Van Heerden, B, Stein, D, Bouwer, C. Pica and the obsessive-compulsive spectrum disorders. S Afr Med J. 1996; 86(12 Suppl): 1586–1588, 1591–1592.Google Scholar
70. Bannon, S, Gonsalvez, CJ, Croft, RJ, Boyce, PM. Response inhibition deficits in obsessive–compulsive disorder. Psychiatry Res. 2002; 110(2): 165–174.Google Scholar
71. Aycicegi, A, Dinn, WM, Harris, CL, Erkmen, H. Neuropsychological function in obsessive-compulsive disorder: effects of comorbid conditions on task performance. Eur Psychiatry. 2003; 18(5): 241–248.Google Scholar
72. Wilhelm, S, Mcnally, RJ, Baer, L, Florin, I. Directed forgetting in obsessive-compulsive disorder. Behav Res Ther. 1996; 34(8): 633–641.Google Scholar
73. Tolin, DF, Abramowitz, JS, Przeworski, A, Foa, EB. Thought suppression in obsessive-compulsive disorder. Behav Res Ther. 2002; 40(11): 1255–1274.Google Scholar
74. Johansen, T, Dittrich, WH. Cognitive performance in a subclinical obsessive-compulsive sample 1: cognitive functions. Psychiatry Journal. 2013; 2013: 565191.Google Scholar
75. Bentall, RP. Madness Explained: Psychosis and Human Nature. London: Penguin; 2004.Google Scholar
76. McAdams, DP. The Stories We Live By: Personal Myths and the Making of the Self. New York: Guilford Press; 1993.Google Scholar
77. Osman, S, Cooper, M, Hackmann, A, Veale, D. Spontaneously occurring images and early memories in people with body dysmorphic disorder. Memory. 2004; 12(4): 428–436.Google Scholar
78. Silver, J, Reavey, P, Anne Fineberg, N. How do people with body dysmorphic disorder view themselves? A thematic analysis. Int J Psychiatry Clin Pract. 2010; 14(3): 190–197.Google Scholar
79. Vinkers, D, Van Rood, Y, Van der Wee, N. Prevalence and comorbidity of body dysmorphic disorder in psychiatric outpatients. Tijdschr Psychiatr. 2007; 50(9): 559–565.Google Scholar