The Role of Perfectionism and Cognitive Processing Abnormalities in Dysmorphic Concern

Author: Shevaugn Johnson

Johnson, Shevaugn, 2019 The Role of Perfectionism and Cognitive Processing Abnormalities in Dysmorphic Concern, Flinders University, College of Education, Psychology and Social Work

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Dysmorphic concern (DC), described in the literature as an excessive preoccupation with appearance-related concerns and camouflaging behaviours used to conceal the perceived flaws, is generally described as a broad, dimensional construct, found across several disorders and thought to be the core diagnostic feature of body dysmorphic disorder (BDD). BDD is a debilitating psychiatric disorder that generally emerges during early adolescence, consisting of obsessions (preoccupations with perceived facial feature and/or bodily imperfections) and compulsions (behaviours used to neutralise appearance-based anxiety). The current available DC and BDD research and models have highlighted the role of specific personality styles, environmental stressors, and cognitive processing abnormalities in contributing to the development and maintenance of symptoms. Treatment barriers in these populations are common, which significantly delay help-seeking behaviours.

There were two main aims of the current research. First, to explore the role of perfectionism and the four cognitive processes (i.e., global-local processing, selective, attention, interpretive biases, and memory deficits) as risk factors for DC and BDD, as suggested by the most recent cognitive-behavioural model of BDD. Guided by these results, the predictive power of selective attention and subtypes of perfectionism on symptoms of DC were investigated. Second, we used the results of this study to inform the selection and evaluation of a novel therapeutic approach to target symptoms of DC.

To address the first aim, we present a systematic review and meta-analysis involving the role of local processing, interpretive biases, memory deficits, and selective attention biases in contributing to BDD development and maintenance. Using multilevel modelling analyses, it was determined that, with the exception of local processing, the BDD and control groups significantly differed across all cognitive processes. Further, selective attention had the largest effect size difference. A second study was conducted, based on these findings and previous BDD research and models, recruiting fifty-seven male and female participants. A dot probe task was devised to measure selective attention consistent with DC, and after covarying for the effects of mood and stress, perfectionism and selective attention were examined as predictors of DC. Using Pearson r correlations and multiple regression analyses, the Doubts about Actions subscale from the Frost Multidimensional Perfectionism Scale and DC-positive word stimuli from the dot-probe task were found to be significant predictors of DC. Although methodology may have played a role, perfectionism explained more of the variance in DC symptomology. Informed by the results of this study and pre-existing meta-analytic findings highlighting the role of perfectionism as an important transdiagnostic factor, thirty-one participants with clinically significant DCs were recruited to take part in an internet-delivered cognitive-behavioural therapy program for perfectionism. Using a case series design and linear mixed modelling analyses, it was found that compared to assessment at baseline, scores on primary measures of perfectionism and secondary measures of depression, stress, body image disturbance, selective attention biases, and DC were reduced with small to large effect sizes at the end-of-treatment, which was maintained at one-month follow-up.

In summary, these findings indicate that future research investigating the role of selective attention and perfectionism in DC and BDD populations warrants further investigation. A variety of suggestions involving future assessment and treatment targets are presented in the Discussion.

Keywords: body dysmorphic disorder, cognitive-behavioural therapy, cognitive processing, dot-probe task, dysmorphic concern, Internet, perfectionism

Subject: Psychology thesis

Thesis type: Doctor of Philosophy
Completed: 2019
School: College of Education, Psychology and Social Work
Supervisor: Tracey Wade