Self-discrepancy in body dysmorphic disorder

According to self-discrepancy theory (SDT), depression, social anxiety, eating disorders and paranoia result from different types of conflicting self-beliefs. Body dysmorphic disorder (BDD) consists of a preoccupation with imagined or slight defects in one's appearance, which is often associated with a depressed mood and social anxiety. SDT was therefore applied to BDD patients to further understand their beliefs about their appearance.

Using a comparative group design, BDD patients were compared against a non-patient control group.

A sample of 149 participants, consisting of three groups - BDD (72), BDD preoccupied with their weight and shape (35), and controls (42) - completed a modified version of the Selves Questionnaire (Higgins, Bond, Klein, & Strauman, 1986) requiring them to list and rate physical characteristics according to the following standpoints: (a) self-actual; (b) self-ideal; (c) self-should; (d) other-actual; and (e) other-ideal.

BDD patients displayed significant discrepancies between their self-actual and both their self-ideal and self-should. However, there were no significant discrepancies in BDD patients between their self-actual and other-actual or other-ideal domains. Analysis of variance using depression and social anxiety scores as covariates revealed a significant difference for both the self-ideal and self-should discrepancy.

The results suggest that BDD patients have an unrealistic ideal or demand as to how they should look. BDD patients are more like depressed patients (rather than social phobics or bulimics), being more concerned with a failure to achieve their own aesthetic standard than with the perceived ideals of others.