The effect of body dysmorphic gazing on body representations: an eye-tracking paradigm

Biases in the processing of appearance-relevant stimuli have been proposed to play a role in the etiology and maintenance of body dysmorphic disorder (BDD). Gaze behavior of individuals with BDD shows abnormalities for own and other people's face stimuli, which is expressed in an increased frequency of fixation on perceived flaws. The proposed causal effect on BDD development has yet to be investigated. The aim of the present study is to clarify whether gaze behavior has the potential to causally affect disorder development or body representation at all. To this end, the effect of gaze behavior on the assessment of the attractiveness of one's own face and other people's faces is investigated in a non-BDD sample within an experimental psychopathological approach. In 2 experiments, own and other people's facial photos were to be viewed by N = 44 (Exp. 1) and N = 36 (Exp. 2) participants for several minutes with BDD-typical gaze behavior or freely. Importantly, eye-tracking was used to monitor and maintain the respective gaze behavior by interrupting stimulus presentation as soon as the gaze behavior no longer corresponded to the current strategy (e.g., focus on unattractive area). Forced viewing of unattractive areas led to a decrease in attractiveness judgements in both experiments (Exp. 1: Cohen's d = -0.23, [-0.42, -0.03]; Exp. 2: Cohen's d = -0.35 [-0.67, -0.03]). Free gaze was characterized by a positive processing bias on attractive facial areas (Exp. 1: Cohen's d = 2.06, [1.13, 2.83]; Exp. 2: Cohen's d = 1.40, [0.72, 2.08]). The results support the assumption that gaze behavior directly affects the formation and alteration of body representations and therefore may serve as potential causal risk factor for the development of distorted body representation and eventually clinical conditions like BDD.