title: Visual hot spots: an eye tracking study of attention bias in body dysmorphic disorder.
abstract: Attentional biases have been implicated in the development and maintenance of BDD. In particular, a visual attention bias toward one's unattractive features and others' attractive features (negative bias), might underlie BDD symptoms. Healthy individuals typically pay more attention to others' unattractive and their own attractive features (positive bias). This study used eye tracking to examine visual attention in individuals with BDD relative to healthy controls (HC). We also explored the role of avoidance in attention bias. Participants with BDD and primary face/head concerns (n = 19) and HC (n = 20) completed computerized tasks and questionnaires. Eye movement data (i.e., fixations, dwell time) were recorded while participants viewed images of their own and a control face (selected for average attractiveness and neutral expression). Participants rated distress and perceived most and least attractive features of their own and another face. BDD participants demonstrated a negative mean total bias score compared to HC (fixation: p = 0.24; dwell: p = 0.08). Age (fixation: p = 0.006; dwell: p = 0.03) and gender (fixation: p = 0.03; dwell: p = 0.03) moderated the relationship. Avoidance was associated with a positive bias in BDD. Results suggest individuals with BDD overfocus on negative attributes, a potential factor in the disorder's etiology and maintenance. Conversely, HC had a more balanced focus on their traits. Elucidating the role of attention bias could help to identify risk and maintenance factors in BDD.
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, United States. Electronic address: jlgreenberg@mgh.harvard.edu.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Greenberg
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, United States.
authors.forename: Lillian
authors.initials: L
authors.lastname: Reuman
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, United States.
authors.forename: Andrea S
authors.initials: AS
authors.lastname: Hartmann
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, United States.
authors.forename: Irina
authors.initials: I
authors.lastname: Kasarskis
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, United States.
authors.forename: Sabine
authors.initials: S
authors.lastname: Wilhelm
mesh_terms: D000293:Adolescent; D000328:Adult; D001288:Attention; D057215:Body Dysmorphic Disorders / Q000523:psychology*; D001828:Body Image / Q000523:psychology*; D016022:Case-Control Studies; D005145:Face; D005260:Female; D005403:Fixation, Ocular / Q000502:physiology; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests / Q000592:standards; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D012649:Self Concept; D011795:Surveys and Questionnaires / Q000592:standards; D014796:Visual Perception; D055815:Young Adult
keywords: Attention bias; BDD; Body dysmorphic disorder; Eye tracking; Obsessive-compulsive spectrum