Body Dysmorphic Disorder. A social issue or disruption of information processing?

Table of Contents

1 Introduction

2 Body Image
2.1 Social Perspective
2.2 Genetic and Neuroscientific Perspective
2.3 Media Influences on Body Image

3 Body Dysmorphic Disorder
3.1 Definition and Classification
3.2 Demographics and prevalence
3.3 Causes

4 Visual Information Processing
4.1 Abnormal Visual Processing
4.2 Stimulus inversion effects
4.3 Brain Activity

5 Discussion

Bibliography

Abstract

Body dysmorphic disorder (BDD) is a mental disorder characterized by distressing or impairing preoccupations with detrimental self-described defects in appearance. These self-prescribed defects lead to an onset of highly restrictive body image concerns in BDD patients which are not usually visible to others. Multiple examples in this literature review highlight the basics of body image perspectives and modern influences on BDD afflicted patients. This paper will present body dysmorphic disorder, its features and causes, and specifically investigate the visual processing abnormalities of BDD patients. Possible modes of onset for BDD are very broad and can be categorized into biological, psychological, and social risk factors. The following paper investigates how both social issues (such as the social comparison processes resulting from social media) and visual abnormalities are underlying modes of onset for BDD patients.

1 Introduction

It has never been easier to directly compare yourself to others. With the rise of social media networks in our society, seemingly every teen and young adult has created their own personal profile on multiple platforms where they can control the way they present themselves to the world. Social psychologist Leon Festinger introduced his social comparison theory over 50 years ago, but his hypothesis stating that “people evaluate their opinions and abilities by comparison respectively with the opinions and abilities of others” has never been more relevant than in today´s social media dominant world (Festinger, 1954). This has never been more convenient to study, especially when considering the overwhelming amount of information being shared continuously online. According to a 2018 worldwide survey conducted by the market research company eMarketer, an estimated 2.65 billion people were using social media networks. This number is projected to increase to 3.09 billion users by 2021. People´s social profiles portray the best snippets of their lives in the form of flattering photos, career achievements, vacation impressions and social activities. Being able to watch all of that through a phone screen can be toxic, especially when considering young and developing (i.e. impressionable) people. But can this form of constant social comparison lead to heavier consequences than just feeling insecure about oneself?

There are multiple risk factors to consider when acknowledging these insecurities. Ultimately, these behaviors could result in mental illnesses like Body Dysmorphic Disorder (BDD), which causes “normal-looking or even attractive people” to be “preoccupied with one or more defects or flaws in their appearance” (Phillips, 2009). People with BDD struggle with their own body image. When compared to the view that others have of them, they have a divergent and vastly different view of themselves and Phillips explains that “the defects aren’t visible - or are barely visible - to others”. Because BDD is a psychiatric disorder, it may be likely that the root of this is from a disruption of information processing, whether in developing youth or in adulthood. By this logic, abnormalities of visual processing could be a reasonable explanation for the onset of BDD.

Mental illness is a topic that is not talked about often enough because it comes with shame or feelings of guilt. This reasoning combined with my own personal interest sparked the topic of this paper which intends to clarify whether body dysmorphic disorder arises due to social comparison processes that are heavily displayed in the media or if the root is neurobiological in the form of a disruption of information processing, with a focus on visual information processing.

2 Body Image

The definition of body image is a “multi-dimensional phenomenon involving an individual’s subjective and malleable perceptions and feelings about their physical appearance” (Dhir, Ryan, McKay & Mundy, 2018). The described concept has become very important in contemporary Western societies. Marika Tiggemann describes how “the strong emphasis on appearance is abundantly displayed – on billboards, in any shop window, in any magazine, in the ordinary conversations of individuals, in the amount of money, time, and effort invested in the pursuit of beauty through clothes, hair, dieting, and other everyday grooming practices, and in the increasing popularity of cosmetic surgical procedures (Cash & Smolak, 2011).

Individuals have various levels of body dissatisfaction and can locate their own body image on a continuum ranging from healthy to unhealthy. The extreme end of this continuum, “where an individual potentially experiences intense appearance disturbances” (Dhir, Ryan, McKay & Mundy, 2018) is defined by a clinical diagnosis of body dysmorphic disorder (BDD). Because “body image is an important aspect of BDD” (Didie, Kuniega-Pietrzak & Phillips, 2009), this chapter functions as a foundation for what will be further discussed in the following chapter.

There are different perspectives to approach the concept body image from in order to find out what it stems from and what influences it. The most relevant for this paper are the social and the neuroscientific perspective, so the following subchapters will portray these perspectives. The chapter ends with an insight on influences on body image, specifically of media.

2.1 Social Perspective

Tiggemann (2011) states that the sociocultural perspective “has become in the literature one of the dominant theoretical frameworks for viewing body image.” One would likely assume initially that sociocultural ideals and pressures form body image disturbances. This perspective supports that explanation. As elucidated by Tiggemann, the process of the sociocultural model is divided into four steps that follow up on each other. It begins with the presumption that “there exist societal ideals of beauty (within a particular culture)” that are then “transmitted via a variety of sociocultural channels.” These can be the media, family and peers. The ideals are then “internalized by individuals.” The last step – the result of this process - is that “satisfaction (or dissatisfaction) with appearance will be a function of the extent to which individuals do (or do not) meet the ideal prescription,” in other words: the bigger the deviation is between the individual’s body image and the societal idea of beauty, the less content they will be. Matching the ideal is especially difficult because they are often virtually impossible to achieve by healthy means: For women, the ideal often entails being unnaturally thin while for men hyper-muscularity is commonly sought after. Consequences of this dissatisfaction due to not comparing to the ideal can be dieting and other (often unhealthy) attempts to pursue thinness or muscularity. In extreme cases disordered eating symptoms can be developed. Not every individual follows this model’s process and may not be affected to the same degree. For example, the extent to which someone internalizes the societal ideals might be influenced by the level of self-esteem or autonomy: The higher the self-esteem, the more someone can detach themselves from the ideal. Additional factors to consider are genetic and other biological as well as psychological influences that are further discussed in the chapter 2.2.

As already mentioned in the introduction of this paper, social comparison is easier now than it ever was before and can be harmful to people. Research related to Festinger’s theory of social comparison processes (1954) has led to the distinction of upward comparisons, downward comparisons, and their relations to self-esteem. Upward comparison describes the process of comparing oneself with more successful others. On the contrary, downward comparison describes comparing oneself with less successful people (Martinot & Redersdorff, 2005). While Festinger’s theory focuses on social comparison at the individual level, Tajfel and Turner have suggested a Social Identity Theory (1979) which explains how “social comparisons at the group level are likely to have a significant bearing on self-esteem.” Self-esteem plays a crucial role […] in social adaption and cognitive functioning (Greenberg et. al., 1992). Greenberg et. al. have explained that self-esteem is a “vital human need” which protects people from anxiety, thus being the motivation behind maintaining a positive self-image. Furthermore, they state that “threats to self-esteem should produce anxiety.”

Given this evidence, the connection between self-esteem and psychiatric disorders like Body Dysmorphic Disorder is plausible, as people with BDD possess a high concern with their own body image (Dhir, Ryan, McKay & Mundy, 2018).

2.2 Genetic and Neuroscientific Perspective

Since the sociocultural explanation of the development of body image problems is relatively simple and, in reality, doesn’t apply to everyone to the same degree, researchers hypothesize that “genetic and/or biological factors may increase susceptibility to poor body image, in some, but not all, individuals” (Suisman & Klump, 2011).

In order to determine possible genetic factors on body image problems, twin and adoption studies have been conducted as well as studies of particular genes by molecular geneticists. With advances in neuroimagining techniques, it was possible to determine specific brain areas that can be involved in the development of body image problems. Twin and adoption studies are often used with the aim of researching genetic influences on a trait or disorder. The studies either compare genetic similarities of monozygotic and dizygotic twins or those of adoptive siblings and biological siblings. Suisman & Klump (2011) have illustrated the estimated genetic effects from twin and adoption studies of various types of body image problems, sorted by “Female adolescents/adults”, “Female preadolescents” and “Males”. This overview shows that twin studies in female adolescents and adults sugesst “moderate-to-large genetic influences on a range of body image problems”. Since heritability results were over 50%, it verifies that at least half of the individual differences in body image problems within a population are a result of genetic factors. However, only two studies have examined this relation with preadolescent females and the results demonstrate that the genetic influence on body weight and shape concerns are 0% while the genetic influence on body dissatisfaction and weight preoccupation are moderate (49% and 47%). Yet, the difference of the genetic influences of weight/shape concerns between preadolescence and adolescence are noticeable: the younger group shows 0% while the older group shows 54% of genetic influence. This result shows that there might be “developmental effects, where heritability of body image problems in preadolescence may be lower than that in adolescence/adulthood” (p.32), but more research is needed to verify this. Past studies about disordered eating have indicated there are only few genetic effects that occur during prepuberty and preadolescence, but during puberty and adulthood there are substantial genetic effects. This could mean that puberty is “a critical period for the emergence of genetic influences on disordered eating and body image problems”. Because media is a big part of teens and young adult’s life nowadays, the next subchapter will be looking at media influences on body image. The results for male participants were not as clear. There were only three studies that have researched genetic influences on body image problems in males and their methodology differs so that the evidence was conflicting: two studies suggested significant genetic effects while the third study found no evidence. Hence, I will not be discussing the results for men due to this uncertainty.

Additionally to genetic factors, Suisman & Klump (2011) describe that there are also neurobiological processes that are thought to influence body image perception and problems. The method of magnetic resonance imaging (fMRI) is applied in studies that examine activated brain regions linked to various presented stimuli relevant to body image. These stimuli have in common that they shall “evoke the negative cognitions/feelings that would be associated with poor body image”. Examples are distorted images of participants’ own body or negative words in the context of body image. In this context, Body Dysmorphic Disorder (BDD) is mentioned as a relevant and helpful topic of study, as it is “characterized by excessive preoccupation with a perceived defect in physical feature(s)” which insinuates that patients have severe difficulties with body image concerns and perception. In response to body image stimuli, research has identified specific patterns of activation. When perceiving the stimuli, both female and male participants have shown an activation of their fusiform gyrus, which is a region in the inferior temporal cortex of the brain that plays important roles in face and body recognition. Therefore, it would make sense that this area is reactive to body-image related stimuli. The left hemisphere in the prefrontal cortex and temporal lobe were activated in studies with BDD patients that were examining faces. This suggests that “patients with BDD may be more detail oriented in face processing than controls”. Further research with BDD patients as well as nonclinical populations has shown that the amygdala and anterior cingulate cortex are activated in relation to emotion and fear responses. Particularly, these specific brain areas become activated in response to negative body image-related stimuli or face stimuli.

Suisman & Klump (2011) conclude that genetic and neurobiological influences on body images in females are prominent. In order to understand the development of body image and the risk and resilience for body image problems, one must factor in genetic/biological and psychosocial models in combination. Further research is needed to clarify whether differences in neural processing cause body image problems or an increase in body image problems leads to changes in neural processing. Another uncertainty that has not been studied involves the gene-environment interactions in the area of body image problem: individuals who develop body dissatisfaction “may have higher genetic or biological risk that becomes activated in the face of the psychosocial stressor”.

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