Seeing the Flaws? Visual Perception of Faces in Individuals Screening Positive for Body Dysmorphic Disorder: An...

Background: Body dysmorphic disorder (BDD) is a psychiatric condition characterized by a preoccupation with perceived appearance flaws. It is highly prevalent among aesthetic surgery candidates and can negatively impact surgical outcomes. The Body Dysmorphic Disorder Questionnaire (BDDQ) is used for BDD screening, but objective validation is limited. This study aimed to determine whether individuals screening positive for BDD exhibit different visual perception patterns of their own and model faces compared to controls, using eye-tracking technology. Methods: We conducted a cross-sectional study among 79 participants, including psychiatric patients and medical students. Participants completed the BDDQ and underwent eye-tracking while evaluating standardized photographs of models and their own faces. Gaze fixation patterns were recorded across pre-defined facial areas of interest. Perception and aesthetic assessment differences between the BDDQ-positive and BDDQ-negative groups were studied. Results: Participants focused most frequently on the nose, eyes and eyebrows. Compared to model faces, more attention was directed toward their own chin and cheeks. However, BDDQ screening results did not significantly influence fixation patterns or eye-tracking metrics. Psychiatric patients, regardless of BDDQ status, exhibited more numerous and shorter fixations than students. All participants rated model faces as significantly more attractive (i.e., higher aesthetic rating) than their own, with the largest difference observed in the BDDQ-positive group. Conclusions: While individuals screening positive for BDD reported lower self-attractiveness, eye-tracking patterns did not differ significantly from those of healthy participants. These findings suggest that BDDQ remains a useful screening tool for subjective dissatisfaction but may not correspond to objective differences in facial visual processing.