Body dysmorphic disorder (BDD) is a disorder associated with depression and eating disorders. It often arises from minor defects in appearance or an individual imagining that he or she is defective. However, the mechanisms causing BDD remain unclear, and its pathogenesis and adjuvant treatment methods still need to be explored. Here, we employed a liquid chromatography-mass spectrometry (LC-MS)-based metabolomics approach to identify key metabolic differences in BDD versus healthy patients. We obtained plasma samples from two independent cohorts (including eight BDD patients and eight healthy control patients). Raw data were analyzed using Compound Discoverer to determine peak alignment, retention time correction, and extraction of peak areas. Metabolite structure identification was also obtained using Compound Discoverer by of accurate mass matching (< 10 ppm) and secondary spectral matching queries of compound databases. Next, multidimensional statistical analyses were performed using the ropls R package. These analyses included: unsupervised principal component analysis, supervised partial Least-Squares Discriminant Analysis, and orthogonal partial Least-Squares Discriminant Analysis. We then identified the most promising metabolic signatures associated with BDD across all metabolomic datasets. Principal component analysis showed changes in small-molecule metabolites in patients, and we also found significant differences in metabolite abundance between the BDD and normal groups. Our findings suggest that the occurrence of BDD may be related to metabolites participating in the following KEGG pathways: ABC transporters, purine metabolism, glycine, serine and threonine metabolism, pyrimidine, pyrimidine metabolism, biosynthesis of 12-, 14-, and 16-membered macrolides, microbial metabolism in diverse environments, biosynthesis of secondary metabolites, and caffeine and insect hormone biosynthesis. 

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Untargeted metabolomic analysis of metabolites related to body dysmorphic disorder (BDD)

• We examined the concurrent and longitudinal relationships between multidimensional perfectionism, perceived stress, and self-critical thinking in a sample of UK university students. • Longitudinal analysis revealed baseline perfectionism to predict increased stress and self-critical thinking at follow-up. • Self-hatred and inadequacy at baseline mediated the. longitudinal relationship between baseline perfectionism and perceived stress at follow-up • Whilst perfectionism may amplify perceived stress, self-critical thinking may accentuate this relationship due to self-defeating styles of cognitive appraisal. The present study examined the concurrent and longitudinal relationships between multidimensional perfectionism, perceived stress, and self-critical thinking in a sample of UK university students. Specifically, to determine whether self-critical thinking at baseline mediated the longitudinal relationship between baseline perfectionism and future stress at follow-up. At baseline, N=220 students completed measures of multidimensional perfectionism, perceived stress, and self-critical thinking, whereas N=84 completed the same measures at follow-up. Socially prescribed, and self-oriented perfectionism were related to increased stress, self-hatred, and self-inadequacy at baseline. Longitudinal analysis revealed that baseline self-oriented and socially prescribed perfectionism were significantly related to increased reports of stress and self-critical thinking fifteen weeks later at follow-up. More crucially, multiple mediation analysis found self-hatred and inadequacy at baseline mediated the longitudinal relationship between baseline perfectionism and perceived stress at follow-up. Perfectionistic and self-critical thinking appears to accentuate the experience of perceived stress in the university student population. Student-based interventions to reduce self-critical thinking may prove beneficial in preventing the onset of perceived stress. 

Self-critical thinking mediates the relationship between perfectionism and perceived stress in undergraduate students: a longitudinal study

Objective: Although health and wellness behaviors are associated with positive body image, research is limited regarding the relationship between sleep and positive body image. We propose that negative affective states may link sleep and body image. Specifically, we examined whether better sleep may relate to positive body image through reductions in negative affective experiences. Participants: Participants were 269 undergraduate women. Methods: Cross-sectional surveys were administered. Results: We found correlations in the expected directions between sleep, positive body image variables (i.e., body appreciation, appearance evaluation, and appearance orientation), and negative affective states (i.e., depression, anxiety, and stress). There were group differences in negative affective states and body image based on adequate sleep. Data supported indirect effects of sleep through depression on appearance evaluation, and through depression and stress on body appreciation, respectively. Conclusions: Our findings indicate sleep warrants further research attention as a wellness behavior related to more positive body image.

The effects of sleep on body image: examining the roles of depression, perceived stress, and anxiety.

Introduction: Certain forms of disgust, specifically contamination disgust, may represent risk factors for eating psychopathology such as eating concerns (e.g., cognitive distress/worries surrounding eating). Furthermore, anti-fat attitudes, specifically fear of fat, may increase risk for eating concerns. However, research has yet to investigate these risk factors together despite notable associations between these constructs and eating concerns. Therefore, this study examined associations between contamination disgust and eating concerns, with fear of fat moderating these associations. Furthermore, these associations were examined with other eating psychopathology outcomes to investigate if theoretical relationships between focal predictors would generalize to other forms of eating psychopathology. Methods: Participants were 173 females (Mage = 18.9; SD = 1.00; Range = 18-23) from a Midwestern university in the United States. Analyses examined associations of contamination disgust, fear of fat, and their interaction with eating disorder symptoms. Results: Simple slopes revealed that contamination disgust was not significantly associated with eating concerns at low fear of fat. However, at high fear of fat, contamination disgust was significantly positively associated with eating concerns. These interactions were not significant when predicting shape concerns, weight concerns, or restraint. Discussion: Results suggest that contamination disgust and fear of fat may be risk factors for eating concerns and that these variables should potentially be modeled in tandem. Screening for fear of fat among clients likely to report high levels of contamination disgust may provide indirect information on these clients’ comorbid eating concerns. Future research should examine if current associations generalize to other populations outside of college-aged women.

Fear of Fat Moderates the Association between Contamination Disgust and Eating Concerns

Although the fear of fat is considered central to the transdiagnostic conceptualization and treatment of eating disorders, the origin of this fear is unclear. Self-disgust, the profound revulsion at one's own character or actions, has been linked with various eating disorder symptoms, including drive for thinness, and may be a mechanism that partially explains the fear of fat observed among those with eating disorders. The present study examines the extent to which self-disgust explains the association between an eating disorder diagnosis and fear of fat. The sample consisted of community adult females diagnosed with an eating disorder (n = 30) and healthy comparisons (n = 30). Participants completed validated measures of fear of fat, self-disgust, and depression. Compared to healthy participants, individuals with an eating disorder reported significantly more fear of fat (t(58) = 9.51, p < .001, d = -2.45), self-disgust (t(46.58) = 8.87, p < .001, d = -2.29, and depression (t(41.17) = 8.30, p < .001, d = -2.14). Mediation analyses revealed self-disgust significantly mediated the relationship between an eating disorder diagnosis and fear of fat after controlling for depression (Effect = 6.10, SE = 1.41). Findings suggest that individuals with an eating disorder may employ various maladaptive strategies to prevent gaining weight (i.e., purging) that partially originate from a profound revulsion of the self. The implications for a transdiagnostic conceptualization and treatment of self-disgust in eating disorders as well as limitations and suggestions for future research directions are discussed. 

Fear of fat in eating disorders: The mediating role of individual differences in self-disgust

Self-disgust as a potential mechanism underlying the association between body image disturbance and suicidal thoughts and behaviours

Specific cognitive behavioural mechanisms related to selective attention, situational avoidance and physical appearance are implicated in the development and maintenance of insomnia and negative reinforcement of body image disturbances. Therefore, we examined whether these processes potentially mediate the relationship between insomnia and body image perception. N = 728 participants completed self-reported measures of sleep-associated monitoring, insomnia symptoms, body image disturbance and coping with body image challenges. Symptoms of insomnia and sleep-associated monitoring behaviour were independently related to increased reports of body image disturbance, cognitive distortions of body image, appearance fixing (i.e. altering appearance by covering, camouflaging or correcting the perceived defect), avoidance (i.e. attempt to escape or avert stressful body image situations) and reduced levels of positive rationale acceptance (i.e. acceptance of the challenging event and positive self-care or rationale self-talk about one’s appearance). More crucially, sleep-related monitoring on awakening, cognitive distortion of body image and negative coping strategies related to body image (i.e. appearance fixing, avoidance, rationale acceptance) mediated the relationship between reports of body image disturbance and insomnia symptoms. The current findings expand upon previous research demonstrating consistent relationships between poor sleep and increased dissatisfaction with cutaneous features, by providing novel evidence that body image disturbances are associated with symptoms of insomnia. More crucially, we highlight the role of particular cognitive and behavioural mechanisms pertaining to sleep (i.e. selective attention for physical signs of poor sleep) and body image (i.e. avoidance and rationale acceptance) which may be targeted as part of cognitive behavioural treatments.

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Chloe Peters

Papers

Self-disgust as a potential mechanism underlying the association between body image disturbance and suicidal thoughts and behaviours

Homogeneity of cognitive and behavioural processes underlying the relationship between insomnia and body image disturbance.