An examination of delusional thinking and cognitive styles in body dysmorphic disorder

Objective: Body dysmorphic disorder (BDD) is characterized by severe dissatisfaction with one's appearance. The aim of this study was to examine belief characteristics in BDD, particularly delusional beliefs and their relationship to other cognitive styles. Methods: Fourteen DSM-IV BDD patients and 14 matched control participants completed questionnaires that measured delusions, creative experiences, self-esteem, self-ambivalence, depression and anxiety symptoms. Results: BDD patients endorsed three times as many delusional beliefs as controls, but the number of delusional ideas in the BDD sample was on a continuum and did not divide patients into two discrete groups. Additionally, the BDD group had higher fantasy proneness, lower self-esteem, higher self-ambivalence and higher depression and anxiety. Conclusions: The data support the conceptualization of BDD as a single disorder with varying degrees of delusional thinking and suggests that BDD should not be dichotomized according to the presence or absence of delusional thinking, as is currently the case in the DSM-IV.