Mental Imagery of the Self in Body Dysmorphic Disorder: A Mixed-Methods Systematic Review

Mental imagery has been identified as a key feature of the onset, maintenance and treatment of psychological disorders. Research on the role of mental imagery in body dysmorphic disorder (BDD), a condition hallmarked by negative sensory appraisals of the self, has been increasingly recognised in theoretical perspectives and psychological interventions. However, the scope and implications of this work have not yet been reviewed. This systematic review sought to identify the characteristics and proposed mechanisms of imagery in BDD, synthesising qualitative and quantitative data using Meta-Integration. Quality was assessed using the Mixed Methods Appraisal Tool. Thirty-seven studies were identified among 33 publications. Study quality was mixed with significant methodological heterogeneity. Mental imagery in BDD is consistently reported to be vivid, emotionally intense, recurrent and important in the maintenance and potentially the onset of BDD. These findings concur with theoretical frameworks of BDD (and other related conditions) which highlight the causal role of imagery and encourage the use of imagery-based interventions. Crucial areas for future work include stronger causal tests, unpacking mechanisms, attention to individual differences and intersectionality and exploring the potential for imagery-based approaches for innovations in treatment and prevention across the lifespan, particularly in adolescence when BDD first develops.