Veale+and+Riley+-+Period+2

**Background:** She might have BDD
 * Veale and Riley - Mirror Gazing (2001)**
 * Body Dysmorphic Disorder - A mental illness in which a person has symptoms of a medical illness, but these can’t be explained by an actual physical disorder
 * People with BDD are preoccupied with an imagined physical defect or a minor defect that others often cannot see.
 * It is also known as dysmorphophobia, the fear of having a deformity
 * It shares certain traits with anorexia nervosa and OCD
 * Affects men and women equally
 * Usually begins in the teen years or early adulthood
 * The most common areas of concern for BDD patients:
 * Skin imperfections: wrinkles, scars, acne, and blemishes
 * Hair: head or body hair or absence of hair
 * Facial Features: ver often this involves the nose, but it also might involve the shape and size of any other feature
 * Body Weight: sufferers may obsess about their weight or muscle tone
 * BDD symptoms:
 * Engaging in repetitive and time-consuming behaviors, such as mirror gazing, picking at the skin, and trying to hide or cover up the perceived defect
 * Constantly asking for reassurance that the defect is not visible or too obvious
 * Repeatedly measuring or touching the perceived defect
 * Experiencing problems at work or school, or in relationships due to the inability to stop focusing about the perceived defect
 * Feeling self-conscious, not wanting to go out in public, feeling anxious when around other people
 * Repeatedly consulting with medical specialists, such as plastic surgeons or dermatologists, to find ways to improve his or her appearance
 * The exact cause of BDD is no known.
 * This study was prompted by a patient with (BDD) who reported to one of the authors that he had just spent 6 hours staring at himself in front of a series of mirrors.

**Aim:**
 * To better understand of the psychopathology of mirror gazing in order to better define BDD & develop new strategies for cognitive behavioral therapies for BDD patients

**Participant Group:**
 * 52 patients with BDD who reported mirror gazing to be a feature of their problem. If they said yes to this question then they were given a “Mirror Gazing Questionnaire”
 * A group of 55 controls that were chosen from personal contracts
 * The groups were a matched pair design, matched by age and sex

**Procedure:**
 * 52 participants with BDD who reported mirror gazing to be a feature of their problem were recruited to take a “Mirror Gazing Questionnaire”
 * Then 55 controls were selected
 * The groups were age and se matched
 * In the Mirror Gazing Questionnaire the subjects were asked if they had a long session in front of the mirror on most days (self-repot)
 * Then if answered yes, they were asked about a typical mirror session
 * Same questions were asked about a typical short session
 * You could answer the questionnaire with 1 (Strongly agree) to 5 (Strongly disagree)

**Results:**
 * More BDD patients reported that they had a “long session” in front of the mirror each day
 * And BDD patients used a mirror for far longer
 * 87% of BDD patients 80% of controls reported that they had one or more “short sessions”
 * However there was no difference between BDD patients and controls for the duration of each short session
 * BDD patients checked mirrors more frequently
 * BDD patients were:
 * More likely to support the beliefs listed in Table 2 on the handout
 * More likely to use the mirror if they were feeling depressed
 * BDD patients did have some insight into their behavior. They were more likely to agree with the statements:
 * “Looking in a mirror so often and for so long distorts my judgment about how attractive I am"
 * “Every mirror I look in I see a different image”
 * BDD patients were more likely:
 * to compare what they see in front of a mirror with an image in their mind of how they think they should ideally look
 * try to see something different in the mirror
 * Distress before, after or resisting a check
 * For both short & long mirror sessions, BDD patients were significantly more distressed than before any gazing
 * For long mirror sessions, the BDD patients were more distressed after mirror gazing
 * BDD patients were more distressed if they resisted gazing in the mirror
 * Focus of attention in mirror
 * For long sessions BDD patients were more likely to focus their attention on an internal impression or feeling (rather than their external reflection)`
 * This was not true for short sessions
 * BDD patients more likely to focus their attention on specific parts of their appearance
 * Preference for natural light
 * No significant difference was found
 * Types of mirrors
 * For short sessions, both BDD patients and controls used shop windows
 * For long sessions, BDD patients were more likely to use a series of mirrors with different profiles
 * However, BDD patients spontaneously reported using a wide variety of reflective surfaces (car mirrors, windows, car bumpers, cutlery, TV screens, reflective table tops, glass watch faces, the back of CDs, etc)
 * Mirror avoidance
 * BBD patients found mirror gazing time consuming & distressing & avoided all mirrors at times
 * BDD patients reported that they avoided only certain mirrors
 * Four types of selective avoidance of mirrors
 * 1. Selective avoidance of looking at a specific “defect” in the mirror
 * 2. Selective avoidance of specific mirrors
 * 3. Using mirrors only in private but avoiding mirrors or reflective surfaces in public
 * 4. Flipping between avoidance and gazing
 * (A patient who picked his skin would stay inside checking his skin until it healed. When he was satisfied he would go out, but then he would avoid mirrors. Finally the urge to check in the mirror & pick his skin would overwhelm him and the cycle would begin again)

Strengths and Weaknesses: Strengths: Weaknesses:
 * It was controlled
 * They asked the same questions to all participants
 * Collected qualitative and quantitative data
 * Lab study
 * ecological validity is not good

** Conclusions: **
 * BDD patients
 * have hope that they will look different from their internal body image
 * are uncertain about their body image & demand to know exactly how they look
 * believe they will feel worse if they resist gazing
 * are driven by a desire to camouflage their appearance or excessively groom to make themselves look their best or to feel ‘comfortable’
 * use an “internal impression of how they feel” when they look in the mirror

**Outcomes:**
 * As a result of this study, therapeutic strategies have been changed to help BDD patients to stop mirror gazing