Body dysmorphic disorder

DAVID VEALE AND SUSAN RILEY’S STUDY ON BODY DYSMORPHIC DISORDER (2001)

Introduction
Body dysmorphic disorder (BDD) is a psychological disorder that is also known as “dysmorphophobia”, meaning “the fear of having a deformity”. In BDD, a person has symptoms of the mental disorder but the symptoms cannot be explained by anything physical. People with BDD are preoccupied with an imagined physical defect or a minor “defect” that others can’t usually see. They often spend long hours gazing at themselves in a mirror. The symptoms of BDD often overlap with some symptoms of obsessive-compulsive disorder and anorexia nervosa.

bdd

The exact cause of BDD is not yet known but Veale and Riley decided to carry out this study when one of their patients, who was suffering from BDD, reported that he had just spent six hours staring at himself in front of different mirrors. They decided to use a self-report methodology to explore the different aspects of this mental illness.

Sample
The sample consisted of 107 participants in total: 52 were BDD patients who had problems with mirror gazing, and 55 were part of the control group. This experiment used a matched-pairs design, meaning here that all the participants were matched by age and sex.

Procedure
The participants were given a questionnaire about mirror gazing that used a five-point scale (with answer choices from “Strongly disagree” to “Strongly agree”). The instructions told them that the researchers were interested in the patients’ feelings felt in front of mirrors during the past month.

The patient was first asked if they had a long session in front of a mirror on most days of only the past month. A “long session” is defined as the longest time during the day that a person spends in front of a mirror. For example: when getting ready for the day. If the respondent said they had at least one long session, then they were asked a series of questions about a typical long session in front of the mirror.

The questions were then repeated in the same way for a typical “short session” in front of the mirror. For example: checking their appearance during the day.

Length of time spent mirror gazing –
Subjects were asked:

  • The average duration of a long session in minutes.
  • The estimated maximum amount of time on any one occasion spent in front of a mirror in hours/minutes.
  • The average duration in minutes and the frequency of a short session in front of a mirror.

Motivation before looking in a mirror –
Subjects were requested to rate their strength of agreement with 12 statements regarding a long mirror session. At the end, they had an option of writing any other motivations they felt. None of the statements were reversed and they were all repeated for the short session questioning.

The 12 questions asked about motivation

The 12 statements to be rated by patients

Focus of attention –
Participants were asked about the focal point of their concentration when in front of a mirror for both short and long sessions. They were given a nine-point analogue scale from +4 to 4 (where 4 represented “I am entirely focused on my reflection in the mirror” and +4 represented “I am entirely focused on an impression or feeling that I get about myself”).

Distress before and after looking in the mirror –
The sample was asked to rate their degree of distress on a visual analogue scale between 1 and 10 (where a zero represented “not at all distressed” and 10 was “extremely distressed”). They had to rate their degree of stress at different times, more specifically: before looking in a mirror for a long session, immediately after looking in a mirror, and after resisting the urge to look in a mirror. The questions were repeated for short sessions. However, the questionnaire made a mistake because it missed out the question about distress “after resisting the urge for a short session”.

Behaviour in front of a mirror –
The questionnaire asked about which activities they did in front of a mirror during short and long sessions. They were given a list of options and asked to rate the percentage of time spent on each activity, ensuring that the total added up to 100. The activities were:

  • Trying to hide my defects or enhance my appearance by the use of make-up
  • Combing or styling my hair
  • Trying to make my skin smooth by picking or squeezing spots
  • Plucking or removing hairs or shaving
  • Comparing what I see in the mirror with an image that I have in my mind
  • Trying to see something different in the mirror
  • Feeling the skin with my fingers
  • Practising the best position to pull or show in public
  • Measuring parts of my face

At the end, an option was given for adding any other relevant behaviour.

Type of light preferred –
The sample was asked if the type of lighting was important for mirror gazing. They used a visual analogue scale with one extreme being “natural daylight” and the other extreme being “artificial light”.

Type of reflective surfaces –
Questions were asked about whether the sample used a series of mirrors for different profiles or if they used any other reflective surfaces when mirror gazing, such as the back of CD cases or spoons.

Mirror avoidance –
The participants were asked if they avoided certain types of mirrors and in which situations such avoidance occurred.

BDD

Results
The results of this study are summarised as follows:

  • More BDD patients reported to having a long session in front of the mirror every day.
  • BDD patients used a mirror for longer than the control group.
  • 87% of BDD patients and 80% of controls said they had one or more short sessions.
  • No difference between BDD patients and controls in the duration of short sessions.
  • BDD patients checked mirrors most frequently.
  • BDD patients were more likely to use a mirror when feeling depressed.
  • BDD patients did have some insight on their behaviour; they were more likely to agree with statements like “Looking in a mirror so often and for so long distorts my judgement about how attractive I am.”
  • BDD patients are more likely to compare what they see in the mirror with images in their mind or their ideal appearance, and try to see something different in the mirror.
  • BDD patients were significantly more distressed than controls before mirror gazing.
  • In long sessions, BDD patients were more distressed after mirror gazing.
  • BDD patients were more distressed if they resisted the urge to mirror gaze.
  • BDD patients were more likely to focus their attention on internal feelings in long sessions.
  • BDD patients were more likely to focus their attention on specific parts of appearance.
  • No significant differences were found in lighting preference.
  • For short sessions, BDD patients and controls both used shop windows.
  • For long sessions, BDD patients were more likely to use various mirrors for profiles.
  • BDD patients reported that they spontaneously used different reflective surfaces too.
  • BDD patients found mirror gazing time-consuming and distressing so avoided mirrors sometimes.
  • BDD patients reported that they avoided only certain types of mirrors.
  • Four mirror avoidances were found (selective avoidance of a specific defect, selective avoidance of specific mirrors, using mirrors privately and avoiding them in public, and flipping between avoidance and gazing).

Type of research method
This method can be described as a case study on one topic: body dysmorphic disorder.

Independent variable
The IV was the diagnosis of BDD in a person.

Dependent variable
The DV was the results of the questionnaire about mirror gazing.

Strengths

  1. Good level of control: Both sample groups (patients and controls) were matched by age and sex, meaning that individual differences were much less likely to affect the results.
  2. Standardised structure: The questionnaire was strictly standardised when talking about long and short sessions, and was standardised for all participants. This made the results more likely to be reliable.
  3. Data: This study yielded both quantitative and qualitative data, meaning that a lot of thorough information was collected as well as straightforward statistics.
  4. Replicable: This is a replicable procedure because it used a standardised questionnaire and a matched-pairs sample. By replicating the case study, it is possible to check the reliability of the results.
  5. Applicability to real life: The results of this study can be successfully used to treat patients of BDD.

Weaknesses

  1. Demand characteristics: Since this was a laboratory-based case study with researchers and questionnaires, it is possible that the patients of BDD altered the information they were giving because they wanted to seem socially desirable or “normal”. Maybe they were embarrassed or maybe there were participants who gained pleasure from screwing up study results – who knows? Demand characteristics could definitely have occurred.
  2. Not generalisable: The results of this study are restricted in terms of sex and age, and probably culture, too. Would the results have been the same if a group of teenage girls was tested, or a set of elderly men? What would the results show if the study was conducted in India or Singapore or Africa? We cannot generalise the results of Veale and Riley’s study because the sample was not very representative.

Ethical issues

  1. Informed consent: This was properly gained from all participants.
  2. Deception: There was no deception involved.
  3. Confidentiality: Yes, the identities of the participants were kept private.
  4. Emotional or physical harm: There was no physical harm but emotional harm is a relevant issue here. Maybe the researchers unwillingly and accidentally encouraged some of the BDD-related behaviour or made some patients feel distressed about their problem? It is highly unlikely that any long-term harm took place, though.
  5. The right to withdraw: As far as we can see, no one was forced to continue with the study although their right to withdraw was not mentioned very clearly.
  6. Debriefing: There was no deception or particular confusion so debriefing was not very necessary.

Reference: Veale, D. and Riley, S. (2001). Mirror, mirror on the wall, who is the ugliest of them all? The psychopathology of mirror gazing in body dysmorphic disorder. Behaviour Research and Therapy. 39: 1381-1393.

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13 thoughts on “Body dysmorphic disorder

  1. May I ask who were in the control group? Were they normal people or were they BDD patients too? Thank youuu

  2. hey.. awesome thing you are doing here.. God bless you.
    by any chance do you have any alternatives to case studies that either you or some one else has created for exams for exams.. i would like to get a few ideas on how to go about the process…

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