Self-reported cognition in body dysmorphic disorder: A mixed-methods investigation of lived experiences and functional impact.

Abstract

Objective: A recent systematic review has demonstrated objective neurocognitive difficulties in people with body dysmorphic disorder (BDD). Limited research has also shown that individuals with BDD frequently self-report cognitive difficulties, but little is known about how they understand these difficulties in relation to their disorder or daily and life functioning. This study aimed to comprehensively examine adults' perceptions of cognitive difficulties in BDD.

Method: A mixed-methods design was employed using an international online survey, which analysed quantitative and qualitative data (Interpretative Phenomenological Analysis) of lived experiences of cognitive difficulties from participants who self-reported a BDD diagnosis or severe BDD symptomatology via the Dysmorphic Concern Questionnaire (N = 433).

Results: Most participants (82%) endorsed significant cognitive difficulties they believed were linked to their disorder, with 75% reporting substantial effects on daily life and overall quality of life. Few had discussed these concerns with clinicians due to shame, misattribution, or uncertainty about their relevance. Participants expressed strong support for research into cognitive aspects of BDD.

Conclusions: Perceived cognitive difficulties are widespread, distressing, and functionally impactful for individuals with BDD. These findings highlight the need for clinicians to actively assess cognitive difficulties, consider the possibility of co-occurring conditions such as ADHD, and incorporate this understanding into treatment planning to enhance engagement and therapeutic outcomes.

Statement of research significance: Research Question(s) or Topic(s): How do adults with body dysmorphic disorder perceive their cognitive difficulties and what impacts do they report?

Main findings: Adults who reported a diagnosis of body dysmorphic disorder or severe dysmorphic concerns described frequent cognitive difficulties they believed were connected to their condition. Most reported effects on daily functioning and quality of life, yet many had not discussed these concerns with clinicians due to shame, uncertainty about their cause, or not recognising their significance. Study Contributions: This study offers the most detailed account to date of how people with body dysmorphic disorder understand and experience their cognitive difficulties. It identifies barriers to disclosure, emphasises the need for clinicians to enquire proactively about cognitive concerns, and calls for further research to clarify their role in the disorder.