Facial symmetry perception and attractiveness ratings in body dysmorphic disorder

Cognitive-behavioral models of body dysmorphic disorder (BDD) conceptualize biases in visual information processing as maintaining factors of the disorder. Empirical findings point to selective attentional mechanisms and a detail-oriented information processing style in facial perception, which are related to perceived facial aesthetics. However, so far, it remains unclear whether higher discrimination abilities of facial symmetry and related attractiveness ratings contribute to the mind as a filter in BDD. BDD (n = 25) and mentally healthy subjects (n = 25) rated symmetry and attractiveness of fifty animated, three-dimensional facial photographs characterized by diverging geometrical symmetry. Main findings emerging from mixed effects models indicated that perceived symmetry, but not objective symmetry, predicted perceived attractiveness. Group status did not predict symmetry or attractiveness ratings. Exploratory analyses indicated potentially clinically relevant mechanisms of symmetry ratings in BDD and revealed faster attractiveness ratings in unattractive vs. attractive faces across groups. Our findings refute the hypothesis of higher discrimination abilities of facial symmetry as a maintaining factor in BDD. Implications for attention and perception retraining in the context of cognitive-behavioral therapy for BDD are discussed.