Cognitive Therapy and Research

, Volume 32, Issue 2, pp 213–225 | Cite as

Implicit and Explicit Self-Esteem and Attractiveness Beliefs among Individuals with Body Dysmorphic Disorder

  • Ulrike Buhlmann
  • Bethany A. Teachman
  • Anke Gerbershagen
  • Julia Kikul
  • Winfried Rief
Original article


Body Dysmorphic Disorder (BDD) is characterized by a preoccupation about imagined or slight defects in one’s appearance. In the present study, we evaluated explicit and implicit biases among individuals diagnosed with BDD (n = 15), individuals with subclinical BDD symptoms (n = 20), and healthy control participants (n = 20). Specifically, we used the Implicit Association Test [(IAT; Greenwald, McGhee, & Schwartz, (1998) Journal of personality and social psychology, 74, 1464] to measure automatic associations related to self-esteem (evaluations of the self vs. others as good vs. bad) and the importance of attractiveness (evaluations of attractiveness vs. kindness as important vs. meaninglessness). Results indicated that, as predicted, BDD participants had significantly lower implicit self-esteem, relative to healthy control participants, and the subclinical BDD participants were intermediate between these groups. Further, lower implicit self-esteem was positively related to each of the other implicit and explicit BDD-relevant indicators, including explicit beliefs about attractiveness. However, no group differences were observed on the implicit importance of attractiveness task. These findings mostly support cognitive-behavioral models of BDD that suggest vulnerable persons exaggerate the significance of appearance for self-evaluation.


Body dysmorphic disorder Body image Self-esteem Importance of attractiveness Implicit associations 


  1. American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders (4th ed.) Washington, DC: American Psychiatric Association.Google Scholar
  2. Allen, A., & Hollander, E. (2004). Similarities and differences between body dysmorphic disorder and other disorders. Psychiatric Annals, 34, 927–933.Google Scholar
  3. Asendorpf, J. B., Banse, R., & Mücke, D. (2002). Double dissociation between implicit and explicit personality self-concept: The case of shy behavior. Journal of Personality and Social Psychology, 83, 380–393.PubMedCrossRefGoogle Scholar
  4. Beck, A. T., & Clark, D. A. (1997). An information processing model of anxiety: automatic and strategic processes. Behaviour Research and Therapy, 35, 49–58.PubMedCrossRefGoogle Scholar
  5. Beck, A. T., & Steer, R. A. (1987). Manual for the revised Beck Depression Inventory. San Antonio, TX: Psychological Corporation.Google Scholar
  6. Biby, E. L. (1998). The relationship between body dysmorphic disorder and depression, self-esteem, somatization, and obsessive-compulsive disorder. Journal of Clinical Psychology, 54, 489–499.PubMedCrossRefGoogle Scholar
  7. Bohne, A., Keuthen, N. J., Wilhelm, S., Deckersbach, T., & Jenike, M.A. (2002). Prevalence of symptoms of body dysmorphic disorder and its correlates: A cross-cultural comparison. Psychosomatics, 43, 486–490.PubMedCrossRefGoogle Scholar
  8. Buhlmann, U., Etcoff, N. L., & Wilhelm, S. (2006). Emotion recognition bias for contempt and anger in body dysmorphic disorder. Journal of Psychiatric Research, 40, 105–111.PubMedCrossRefGoogle Scholar
  9. Buhlmann, U., McNally, R. J., Etcoff, N. L., Tuschen-Caffier, B., & Wilhelm, S. (2004). Emotion recognition deficits in body dysmorphic disorder. Journal of Psychiatric Research, 38, 201–206.PubMedCrossRefGoogle Scholar
  10. Buhlmann, U., Wilhelm, S., McNally, R. J., Tuschen-Caffier, B., Baer, L., & Jenike, M. A. (2002). Interpretive biases for ambiguous information in body dysmorphic disorder. CNS Spectrums, 7, 435–443.PubMedGoogle Scholar
  11. Buhlmann U., & Wilhelm, S. (2004). Cognitive factors in body dysmorphic disorder. Psychiatric Annals, 34, 922–926.Google Scholar
  12. de Jong, P. (2002). Implicit self-esteem and social anxiety: Differential self-positivity effects in high and low anxious individuals. Behaviour Research and Therapy, 40, 501–508.PubMedCrossRefGoogle Scholar
  13. Draine, S. (1999). Inquisit (Version 1.33) [Computer software]. Seattle, WA: Millisecond Software.Google Scholar
  14. Fazio, R. H., & Olson, M. A. (2003). Implicit measures in social cognition: Their meaning and use. Annual Review of Psychology, 54, 297–327.PubMedCrossRefGoogle Scholar
  15. Ferring, D., & Filipp, S.-H. (1996). Messung des Selbstwertgefühls: Befunde zur Reliabilität, Validität und Stabilität der Rosenberg-Skala. Diagnostica, 42, 284–292.Google Scholar
  16. Greenwald, A. G., & Banaji, M. R. (1995). Implicit social cognition: Attitudes, self-esteem, and stereotypes. Psychological Review, 102, 4–27.PubMedCrossRefGoogle Scholar
  17. Greenwald, A. G., & Farnham, S. D. (2000). Using the Implicit Association Test to measure self-esteem and self-concept. Journal of Personality and Social Psychology, 79, 1022–1038.PubMedCrossRefGoogle Scholar
  18. Greenwald, A. G., McGhee, D. E., & Schwartz, J. L. K. (1998). Measuring individual differences in implicit cognition: The implicit association test. Journal of Personality and Social Psychology, 74, 1464-1480.PubMedCrossRefGoogle Scholar
  19. Greenwald, A. G., Nosek, B. A., & Banaji, M. R. (2003). Understanding and using the implicit association test: I. An improved scoring algorithm. Journal of Personality and Social Psychology, 85, 197–216.PubMedCrossRefGoogle Scholar
  20. Hautzinger, M., Bailer, M., Worall, H., & Keller, F. (1995). Beck Depressionsinventar. Bern: Huber.Google Scholar
  21. McNally, R. J. (1995). Automaticity and the anxiety disorders. Behaviour Research and Therapy, 33, 747–754.PubMedCrossRefGoogle Scholar
  22. Nosek, B. A. (2005). Moderators of the relationship between implicit and explicit evaluation. Journal of Experimental Psychology: General, 134, 565–584.CrossRefGoogle Scholar
  23. Petrie, T. A., Rogers, R. L., Johnson, C. E., & Diehl, N. (1996). Development and validation of the Beliefs About Attractiveness Scale-Revised. Paper presented at the 104th Annual Convention of the American Psychological Association. Toronto, Canada.Google Scholar
  24. Phillips, K. A., Didie, E. R., Menard, W., Pagano, M. E., Fay, C., & Weisberg, R. B. (2006). Clinical features of body dysmorphic disorder in adolescents and adults. Psychiatry Research, 141, 305–314.PubMedCrossRefGoogle Scholar
  25. Phillips, K. A., Hollander, E., Rasmussen, S. A., Aronowitz, B. R., DeCaria, C., & Goodman, W. K. (1997). A severity rating scale for body dysmorphic disorder: development, reliability, and validity of a modified version of the Yale-Brown Obsessive Compulsive Scale. Psychopharmacology Bulletin, 33, 17–22.PubMedGoogle Scholar
  26. Phillips, K.A., Pinto, A., & Jain, S. (2004). Self-esteem in body dysmorphic disorder. Body Image, 1, 385–390.PubMedCrossRefGoogle Scholar
  27. Phillips, K. A., McElroy, S. L., Keck, P. E. Jr., Pope, H. G. Jr. & Hudson, J. I. (1993). Body dysmorphic disorder: 30 cases of imagined ugliness. American Journal of Psychiatry, 150, 302–308.PubMedGoogle Scholar
  28. Rosenberg, M. (1989). Society and the Adolescent Self-Image. Revised edition. Middletown, CT: Wesleyan University Press.Google Scholar
  29. Tanner, R. J., Stopa, L., & De Houwer, J. (2006). Implicit views of the self in social anxiety. Behaviour Research and Therapy, 44, 1397–1409.Google Scholar
  30. Teachman, B. A. (2005). Information processing and anxiety sensitivity: Cognitive vulnerability to panic reflected in interpretation and memory biases. Cognitive Therapy and Research, 29, 483–503.CrossRefGoogle Scholar
  31. Teachman, B. A. & Allen, J. P. (in press). Development of social anxiety: Social interaction predictors of implicit and explicit fear of negative evaluation. Journal of Abnormal Child Psychology. Google Scholar
  32. Teachman, B., Gapinski, K., Brownell, K., Rawlins, M., & Jeyaram, S. (2003). Demonstrations of implicit anti-fat bias: The impact of providing causal information and evoking empathy. Health Psychology, 22, 68–78.PubMedCrossRefGoogle Scholar
  33. Teachman, B. A., Gregg, A., & Woody, S. (2001). Implicit processing of fear-relevant stimuli among individuals with snake and spider fears. Journal of Abnormal Psychology, 110, 226–235.PubMedCrossRefGoogle Scholar
  34. Teachman, B. A., & Woody, S. (2003). Automatic processing among individuals with spider phobia: Change in implicit fear associations following treatment. Journal of Abnormal Psychology, 112, 100–109.PubMedCrossRefGoogle Scholar
  35. Teachman, B. A., Woody, S. R., & Magee, J. C. (2006). Implicit and explicit appraisals of the importance of intrusive thoughts. Behaviour Research and Therapy, 44, 785–805.PubMedCrossRefGoogle Scholar
  36. Veale, D., Boocock, A., Gournay, K., Dryden, W., Shah, F., Willson, R., & Walburn, J. (1996). Body dysmorphic disorder: A survey of fifty cases. British Journal of Psychiatry, 169, 196–201.PubMedCrossRefGoogle Scholar
  37. Wilhelm, S., & Neziroglu, F. (2002). Cognitive Theory of Body Dysmorphic Disorder. In Frost RO, Steketee G (Eds.), Cognitive approaches to obsessions and compulsions: Theory, assessment and treatment. (pp. 203–214). Oxford: Elsevier Press.Google Scholar
  38. Wilhelm, S. (2006). Feeling good about the way you look: A program for overcoming body image problems. New York, NY: Guilford Press.Google Scholar
  39. Wittchen, H. U., Zaudig, M., & Fydrich, T. (1997). Strukturiertes Klinisches Interview für DSM-IV-(SKID-I und SKID-II). Göttingen: Hogrefe.Google Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  • Ulrike Buhlmann
    • 1
  • Bethany A. Teachman
    • 2
  • Anke Gerbershagen
    • 3
  • Julia Kikul
    • 3
  • Winfried Rief
    • 3
  1. 1.Body Dysmorphic Disorder ClinicMassachusetts General Hospital and Harvard Medical SchoolBostonUSA
  2. 2.University of VirginiaCharlottesvilleUSA
  3. 3.Marburg UniversityMarburgGermany

Personalised recommendations