The stopping criteria for mirror-gazing in body dysmorphic disorder

To investigate whether prolonged compulsive mirror-gazing in body dysmorphic disorder (BDD) is characterized by the prioritization of internally referenced (internal) goals for the mirror session, such as feeling right about one's make-up or shaven face, over externally referenced (external) goals, such as seeing that one's make-up is applied, or seeing that there is no more stubble on one's face.

Cross-sectional case control.

Twenty-one participants with BDD and 18 community controls (CCs) recalled a recent mirror session in a semi-structured interview and then completed the Mirror-Gazing Goals and Terminating Factors Questionnaire (MGGTFQ), an instrument developed for the present study.

Internal goals were rated as more important in the BDD group than the CC group, but there was no difference between groups in the importance of external goals. The BDD group identified internal goals significantly more frequently than the CC group among their three most important goals. The BDD group reported significantly lower achievement ratings for the three most important goals and were more likely to terminate the session for reasons unrelated to their goals (e.g., frustration). For all participants, the importance of internal goals was positively correlated with the length of the mirror session.

The findings support current recommendations for targeting internal goals in interventions for problematic mirror use. Limitations and future directions are discussed, including the need to establish whether the use of internal goals is causally related to the length of the mirror session.

• BDD patients prioritize internal goals defined by feeling states when they look in the mirror (e.g., they aim above all to feel right about their make-up or shaven face), and then tend not to achieve their goals and end the mirror session for reasons unrelated to their goals (e.g., distress or time constraints). • Educating patients about these potentially problematic 'internal' goals, and encouraging them to aim for alternative goals (e.g., a fixed length of time, or an external goal defined by visual cues) might help patients to reduce the time they spend looking in the mirror. • The study is limited by the correlational design, the reliance on retrospective reporting, and the lack of a clinical control group.