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Title: Self-focused attention and appearance-related comparisons in body dysmorphic disorder
Author: Turner, Mark
Awarding Body: King's College London (University of London)
Current Institution: King's College London (University of London)
Date of Award: 2012
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Background: Self-focused attention (S-FA), appearance-related comparisons (ARCs) and self-serving appearance-related biases are relevant to cognitive-behavioural models of, and therefore distress maintenance in, BDD despite them being underresearched. To the author’s knowledge, there are no previous published investigations looking at the nature and specificity of A-RCs, beliefs held about the functions of A-RCs, or experiments investigating self-serving A-RCs biases in people with BDD relative to healthy controls. It was also felt that a more fine grained investigation of self-esteem looking at self-competence and self-liking in people with BDD was warranted. Hypotheses: Hypothesis 1 explored the nature (frequency, direction (attractiveness of A-RCs targets) and automaticity) of A-RCs. More frequent, generally more upwards (to more attractive others) and more automatic A-RCs were hypothesised in people with BDD relative to healthy controls. Hypothesis 2 explored the specificity of A-RCs in people with BDD relative to healthy controls. It was hypothesised that the more frequent A-RCs would not be attributable to more general constructs related to comparing. Beliefs about the functions of A-RCs in people with BDD relative to healthy controls were also explored. Hypothesis 3 investigated a self-serving A-RCs bias, hypothesising that healthy controls, but not people with BDD, would hold this sort of bias contingent on S-FA. Hypothesis 4 investigated self-esteem, hypothesising that self-liking would be disproportionately lower than selfcompetence in people with BDD relative to healthy controls. Method: 23 people with BDD (10 females, 13 males) and 20 healthy controls (10 females, 10 males) matched approximately on age and sex were recruited while using rigorous screening criteria. Hypotheses 1 and 2 used standardised and newly devised questionnaires to explore A-RCs in people with BDD relative to healthy controls. Hypothesis 3 was tested (BDD, n=22; healthy controls, n= 20) using a novel mixed experimental design to investigate the self-serving A-RCs bias, which included employing a manipulation of implicit S-FA as a repeated-measures variable. Hypothesis 4 used the well-established Rosenberg Self-Esteem Scale, divided into self-competence and self-liking, to look at the extent of between group differences. Results: Hypothesis 1 was fully supported. A-RCs were significantly more frequent, generally more upwards, and more automatic in people with BDD relative to healthy controls. Hypothesis 2 was also fully supported. The significantly higher frequency of A-RCs in people with BDD, relative to healthy controls, could not be attributed to general social comparison orientation, upwards social comparison orientation, or self-esteem. People with BDD also held significantly stronger agreement with beliefs about A-RCs as serving functions of self-evaluation, self-loathing (a way to confirm beliefs about physical unattractiveness) and social threat management relative to healthy controls. Hypothesis 3 was not supported, with no A-RCs bias, contingent on S-FA, being found in healthy controls or people with BDD. Hypothesis 4 was also not supported with both self-competence and self-liking being found to be significantly and equally lower in people with BDD relative to healthy controls. Discussion: The author discusses results with particular reference to the theory of social comparison processes as well as literature on clinical anxiety and cognitive behavioural models of BDD. The discussed limitations of the present investigation include the absence of a clinical control group, not matching groups on objective attractiveness, and the study’s ecological validity. Clinical implications cover suggested guidance for addressing A-RCs in cognitive-behavioural therapy and with mindfulness. More comprehensive investigations of A-RCs biases in people with BDD are covered as future directions for research.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (D.Clin.Psy.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available