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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*
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
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
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
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:



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.


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.


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.


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.

Original Research
© Cambridge University Press 2016 

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