Interoceptive Awareness and Self-Objectification in Body Dysmorphic Disorder

Abstract

The cognitive model of BDD (Veale, 2004) proposes high levels of self-objectification (viewing and treating oneself as an object) as an important maintaining factor; however, to date this construct has not been empirically measured in this population. In addition, recent models of the self (Damasio, 2010) point towards the central role of interoceptive awareness (IA; the ability to identify bodily signals) in developing a sense of self. Low levels of IA have been associated to body dissatisfaction, eating disorders and depression. The aim of this study was to investigate the role of self-objectification and interoceptive awareness in patients with BDD. Three groups of participants with BDD (n=14), anxiety (n=23), and non-clinical participants (n=23) completed a heartbeat detection task to measure levels of IA under two conditions: blank screen and while facing a mirror in order to also explore the impact of self-focus attention on IA. Levels of self-objectification and self-focussed attention were measured through self-report questionnaires. Statistical comparisons between groups indicated significantly lower levels of IA in the BDD group at blank screen only when compared to the non-clinical group. In the mirror condition the BDD group had significantly lower IA scores than both control groups. Furthermore, the BDD group reported significantly higher self-objectification than the non-clinical group, and there was a trend towards the group scoring at a higher level than the anxiety group. Across groups there was no significant relationship between levels of IA in either condition, and self-reported levels of self-objectification or self-focussed attention. The results support the role of self-objectification in BDD and points towards the potential contribution of somatoperception. The theoretical and clinical implications of these findings, the limitations of the methodology employed, and suggestions for future research are discussed.