Cognitive complaints in body dysmorphic disorder: An exploratory characterization across clinical and community samples
Katrina Holmes à Court, Tamsyn E. Van Rheenen, Susan Lee RossellAbstract
Background
Cognitive complaints in body dysmorphic disorder (BDD) remain poorly characterized. This study examined subjective cognitive complaints across clinical and community BDD samples.
Methods
A two-stage exploratory design was used. Study 1 included a clinically diagnosed BDD sample ( n = 15) and healthy controls ( n = 29). Study 2 comprised a large international community sample reporting clinically significant BDD symptoms ( N = 433). Participants completed BodyThink , an exploratory BDD-focused measure of subjective cognitive complaints. In Study 1, additional clinical and performance-based cognitive measures contextualized subjective reports.
Results
Across both studies, endorsed items spanned multiple cognitive domains, with processing speed, attention, memory, executive functioning, and social cognition items consistently reported. Processing speed complaints were particularly salient. In Study 1, individuals with BDD reported markedly elevated cognitive complaints relative to controls, with large group differences ( d = 1.64–1.95) on both BodyThink and an established measure of subjective cognition. Cognitive complaints showed a preliminary association with perceived social self-efficacy ( ρ = −.71) but not with BDD symptom severity, objective cognitive performance, or emotional distress. Across both samples, social cognition items were disproportionately endorsed during symptom exacerbation.
Conclusions
Individuals with BDD reported markedly elevated cognitive complaints relative to controls, with substantial individual variation. Patterns were broadly consistent across symptom severity, with social cognition difficulties showing greater salience during symptom exacerbation. The variability in complaints highlights the importance of individualized assessment, while associations with perceived social self-efficacy suggest that cognitive complaints may reflect negatively biased self-appraisals that may be relevant to treatment engagement.