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Previous research has indicated that lifetime body image concerns are associated with increased odds of paranoid ideation. In this study, we sought to replicate and extend this finding by exploring how paranoia relates to different aspects of body image concern using a comprehensive, cross-sectional design. Women without a mental health diagnosis (n = 119) completed online questionnaires assessing paranoia, shape and weight concerns, and figure ratings for how they "think" their body looks and how they "feel" in their body. Participant's "actual" figure ratings were estimated from height and weight; discrepancy scores were then calculated for "actual-think" and "actual-feel" figure ratings. Correlational analyses, and mediation models testing paranoia as a mediator between "actual-feel" and shape and weight concerns, were conducted. Paranoia was significantly correlated with increased shape and weight concerns, and with "feeling" larger. Paranoia significantly mediated paths from feeling larger to increased shape or weight concerns. There were no significant associations of paranoia with "actual-think" ratings. Limitations include that height and weight data could not be objectively confirmed, and only women were included in the study. Further research is needed to understand mechanisms by which paranoia may influence shape and weight concerns and vice versa, and how "feeling" larger may feed paranoia. Future research should investigate these relationships among clinical eating disorder groups.

Although the inclusion of individuals with lived experience is encouraged within the research process, there remains inconsistent direct involvement in many mental health fields. Within the eating disorders field specifically, there is a very strong and increasing presence of lived experience advocacy. However, due to a number of potential challenges, research undertaken in consultation or in collaboration with individuals with lived experience of an eating disorder is scarce. This paper describes the significant benefits of the inclusion of individuals with lived experience in research. The specific challenges and barriers faced in eating disorders research are also outlined. It is concluded that in addition to existing guidelines on working with lived experience collaborators in mental health research, more specific procedures are required when working with those with eating disorders.

BACKGROUND: Childhood maltreatment and trauma may be risk factors for the development of body dysmorphic disorder (BDD). However, the limited research to date on these topics has been constrained by either the absence of a matched healthy control group or non-comprehensive assessments. METHODS: This study assessed the prevalence and severity of childhood maltreatment and other traumatic events in 52 BDD participants (56% female) and 57 matched controls (51% female) with no history of mental illness, using the Childhood Trauma Questionnaire and a checklist assessing broader traumatic events. RESULTS: In comparison with controls, participants with BDD showed a higher prevalence of emotional abuse (61.5% vs. 33.3%) and physical neglect (59.6% vs. 28.1%), as well as more severe overall maltreatment, emotional abuse, and emotional and physical neglect. BDD participants were also more likely to meet cut-offs for multiple types of maltreatment and reported an elevated number and variety of broader traumatic childhood events (e.g., life-threatening illness). In BDD, increasingly severe maltreatment was correlated with greater severity of BDD symptoms, anxiety and suicidal ideation. CONCLUSIONS: These data suggest that childhood maltreatment and exposure to other traumatic events are common and severe in BDD and are cross-sectionally associated with the severity of clinical symptoms. Adversity linked to maladaptive family functioning during childhood may therefore be especially relevant to people with BDD and could relate to social and emotional processing problems in the disorder.

Anorexia nervosa (AN) is associated with poor sleep and altered circadian rhythms. Evidence is unclear as to whether these features relate to ongoing psychiatric symptoms of AN, or are merely concomitant with low weight. In this study, we sought to evaluate subjective sleep quality and sleep–wake preferences in a sample of individuals with lifetime AN. Furthermore, we aimed to examine whether sleep quality would significantly predict AN symptom severity, after accounting for demographic features and negative emotions (depression, anxiety and stress). Adults with a lifetime diagnosis of AN (n = 96) or no lifetime psychiatric diagnoses (NC; n = 246) completed an online survey assessing demographics, sleep quality, circadian sleep–wake preferences, eating disorder symptoms, and negative emotions. AN participants reported significantly poorer sleep quality overall, including increased sleep disturbances, use of sleep medications, and daytime dysfunction, as compared to NC participants. Groups did not differ significantly in circadian sleep–wake preferences. Regression analysis showed that among AN participants, sleep quality and negative emotions significantly predicted AN symptom severity, while sex and body mass index (BMI) did not. The findings demonstrate that poor sleep quality was associated with more severe symptoms of AN, even when accounting for negative emotions and BMI. Future research should investigate causal interactions between sleep quality and AN symptom severity longitudinally and across different recovery stages. Level III—Cohort and case–control analytic studies.

There are currently no validated biomarkers for anorexia nervosa (AN), though recent literature suggests an increased research interest in this area. Biomarkers are objective, measurable indicators of illness that can be used to assist with diagnosis, risk assessment, and tracking of illness state. Related to biomarkers are endophenotypes, which are quantifiable phenomena that are distinct from symptoms and which link genes to manifest illness. In this scoping review, we sought to provide a summary of recent research conducted in the pursuit of biomarkers and endophenotypes for AN. The findings indicate that a number of possible biomarkers which can assess the presence or severity of AN independently of weight status, including psychophysical (e.g., eye-tracking) and biological (e.g., immune, endocrine, metabolomic, neurobiological) markers, are currently under investigation. However, this research is still in early phases and lacking in replication studies. Endophenotype research has largely been confined to the study of several neurocognitive features, with mixed evidence to support their classification as possible endophenotypes for the disorder. The study of biomarkers and endophenotypes in AN involves significant challenges due to confounding factors of illness-related sequalae, such as starvation. Future research in these areas must prioritise direct evaluation of the sensitivity, specificity and test-retest reliability of proposed biomarkers and enhanced control of confounding physical consequences of AN in the study of biomarkers and endophenotypes.

ObjectiveCurrent understanding of cognitive functioning in body dysmorphic disorder (BDD) is limited, owing to few studies, small sample sizes, and assessment across only limited cognitive domains. Existing research has also shown inconsistent findings, with both intact and impaired cognition reported in BDD, which might point toward cognitive heterogeneity in the disorder. This study aimed to examine the cognitive profile of BDD in a large sample across eight cognitive domains, and to explore whether cognitive subgroups might be identified within BDD.MethodsCognitive domains of inhibition/flexibility, working memory, speed of processing, reasoning and problem-solving, visual and verbal learning, attention/vigilance and social cognition were assessed and compared between 65 BDD patients and 70 healthy controls. Then, hierarchical clustering analysis was conducted on the BDD group’s cognitive data.ResultsGroup-average comparisons demonstrated significantly poorer cognitive functioning in BDD than healthy controls in all domains except for attention/vigilance and social cognition. Cluster analysis identified two divergent cognitive subgroups within our BDD cohort characterised by i) broadly intact cognitive function with mild selective impairments (72.3%), and ii) broadly impaired cognitive function (27.7%). However, the clusters did not significantly differ on clinical parameters or most sociodemographic characteristics.ConclusionCognitively diverse subgroups were identified within BDD, yet these were obscured in group-average comparisons. However, subgroup profiles of cognitive functioning seem unrelated to the clinical presentation of BDD. Further research into the underlying mechanisms of cognition in BDD is warranted.Significant OutcomesCognitive function varies widely among people with body dysmorphic disorder (BDD) and includes subgroups characterised by broadly intact or broadly impaired cognitive profiles.However, reduced performances in visual learning and working memory as relative to healthy participants were identified across both BDD cognitive subgroups to differing degrees.Clinical characteristics were not significantly different among the two BDD cognitive subgroups; what role cognitive functioning may play in the aetiology or presentation of BDD remains unclear.LimitationsThe output of clustering analysis is sensitive to the choice of variables entered and requires replication with analogous measures of cognition.Psychiatric comorbidities and medications could have impacted cognitive performances in the BDD group in an unaccounted-for manner.Data availability statementAuthor elects to not share data.

Background and objectives Previous research has indicated that body dysmorphic disorder (BDD) and obsessive-compulsive disorder (OCD) often demonstrate similar cognitive impairments across multiple domains. However, findings for both disorders have not consistently shown impaired cognition. As such, BDD and OCD might share an overlapping pattern of cognitive heterogeneity, characterised by subgroups with different cognitive profiles. Methods To evaluate this possibility, we compared 26 BDD, 24 OCD, and 26 healthy control participants on a comprehensive eight-domain cognitive battery. Then, cluster analysis was performed on the BDD and OCD participants’ combined data to explore for cognitive subgroups. Results No significant differences were found between the three groups’ cognitive functioning, except for poorer visual learning in OCD relative to healthy controls. Cluster analysis produced two cognitive subgroups within the combined BDD and OCD data, characterised by intact cognition (52%) and broadly impaired cognition (48%). Each subgroup comprised both BDD and OCD participants, in similar proportions. The subgroups did not differ in clinical or demographic features. Limitations Sample sizes were moderate. Future research should investigate clustering patterns both in larger groups and separately in BDD and OCD samples to determine replicability. Conclusions These findings suggest that BDD and OCD may involve similar patterns of cognitive heterogeneity, and further imply that individuals with either disorder can show a wide range of cognitive profiles, thus necessitating a nuanced approach to future cognitive research in BDD and OCD.

Background Identity disruption and internalised shame may be important factors in explaining possible psychological mechanisms that underlie body dysmorphic disorder (BDD). These factors have also been linked to obsessive-compulsive disorder (OCD), a condition closely related to BDD. However, these factors have not been specifically examined in BDD, nor contrasted between BDD and OCD. Methods We compared identity functioning and internalised shame among 26 BDD, 22 OCD and 26 healthy control participants, and examined clinical correlates in both disorders. Results Findings demonstrated increased identity disruption and internalised shame in BDD and OCD relative to controls, and increased internalised shame in BDD relative to OCD. In both disorders, shame and identity disruption was correlated with suicidal ideation, depression, stress, and anxiety. In BDD only, increased identity disruption correlated with poorer insight, and increased internalised shame correlated with more severe BDD symptoms and poorer illness insight. Conclusions These data suggest that internalised shame may have important and specific relevance to BDD, and more general relevance to OCD. Moreover, identity disruption may represent an area meriting further research attention in both BDD and OCD. Clinical implications include the potential benefits of addressing internalised shame and identity problems in the treatment of both disorders.

There has not been a comprehensive comparison of differences between men and women with body dysmorphic disorder (BDD) for approximately two decades. Major social and technological changes over this time may have changed patterns of bodily concerns and symptom profile among men and women with BDD, thus warranting an updated assessment of gender differences. BDD symptomatology, insight, and associated clinical and sociodemographic characteristics were compared between 49 women and 27 men with BDD. Skin was the most common concern for both men and women. Women showed more concerns than men about the appearance of their legs. Men were more concerned about muscularity/body build. Women demonstrated significantly more severe distress associated with BDD behaviours, and poorer illness insight than men. Age at BDD onset, illness duration, as well as mean severity of depression, anxiety, stress, and social anxiety were similar across the genders. These data suggest that the most common body areas of concern in people with BDD have not dramatically changed over the past two decades. However, the finding of worse insight among women is novel, and suggests a need for further investigation.