Body dysmorphic disorder (BDD) is a severe mental illness associated with extremely negative consequences. Most notably, the degree of unemployment, social dysfunction, comorbid major depressive disorder, and suicidality appear higher in BDD than in most other psychological disorders, including related disorders like obsessive compulsive disorder (OCD). Together, these outcomes produce substantial psychological and economic costs to the individual, as well as significant economic costs to society, making BDD a serious public health concern. Surprisingly, scant research has studied risk factors that may help to explain these elevated negative outcomes in BDD, as compared to other disorders. The present study addresses this gap by testing shame as a central risk factor for more severe outcomes in those with BDD vs. healthy individuals and individuals with OCD. Clinical anecdotes discuss shame as a central, destructive emotion in BDD, and broader emotions research links shame to each of the negative outcomes that are elevated among those with BDD. However, no scientific research has investigated the degree of shame in BDD vs. healthy individuals or those with related disorders (e.g., OCD), nor is there research examining how shame relates to the severe outcomes in BDD.
Aim 1 is to conduct the first empirical evaluation of general shame as a central, robust risk factor accounting for more severe outcomes (i.e., social and occupational impairment, depression, suicidality) in BDD vs. healthy control participants and participants with OCD. Additionally, information about the specific nature of shame within BDD has important clinical implications. In particular, body shame appears central and nearly universal to BDD. Thus, it may be that, beyond the more universal experience of body shame in BDD, it is individuals with elevated general shame who are at greatest risk for the most severe negative outcomes in BDD.
Aim 2 is, thus, to evaluate whether general shame is a stronger risk factor than body shame for the negative outcomes documented within BDD. Participants will be recruited for the three groups (BDD, OCD comparison, healthy control) through advertisements posted on online BDD, OCD, or non-mental health related forums, support groups, and clinic websites. Participants will provide self-report data through a secure online website. To verify the well-established self-report screening measures, a randomly selected subsample from each group will be called to complete a diagnostic interview via phone. An Internet-based approach was chosen because of the severe avoidance and impairment in BDD, the primary group of interest (e.g., 30% may be housebound). Thus, samples recruited from clinics or research labs would likely be biased, with less severe outcomes and shame. In keeping with NIMH Strategic Objective 2.3, the overarching goal of this project is to identify shame as a malleable and robust risk factor for serious and costly outcomes in BDD, a disorder of high public health concern. This information has the potential to provide new targets for BDD treatment and to minimize the painful and costly consequences that BDD sufferers currently experience.

Public Health Relevance

This quasi-experimental study investigates general shame as a central, robust risk factor accounting for the more severe negative outcomes (i.e., occupational impairment, social impairment, depression, and suicidality) observed in body dysmorphic disorder (BDD), as compared to healthy control individuals and individuals with obsessive compulsive disorder. Moreover, it investigates the specific nature of shame within those with BDD, by investigating whether general shame or body-specific shame accounts for a greater portion of the variance in severe negative outcomes. By investigating risk factors to the severe outcomes in BDD, this project aims to provide new targets for treatment in BDD, thereby minimizing the painful and costly outcomes that BDD sufferers currently experience.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Predoctoral Individual National Research Service Award (F31)
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Special Emphasis Panel (ZRG1-F16-L (20))
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Rubio, Mercedes
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George Mason University
Schools of Arts and Sciences
United States
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Weingarden, Hilary; Renshaw, Keith D; Davidson, Eliza et al. (2017) Relative relationships of general shame and body shame with body dysmorphic phenomenology and psychosocial outcomes. J Obsessive Compuls Relat Disord 14:1-6
Weingarden, Hilary; Curley, Erin E; Renshaw, Keith D et al. (2017) Patient-identified events implicated in the development of body dysmorphic disorder. Body Image 21:19-25
Weingarden, Hilary; Renshaw, Keith D; Tangney, June P et al. (2016) Development and Validation of the Body-Focused Shame and Guilt Scale. J Obsessive Compuls Relat Disord 8:9-20
Weingarden, Hilary; Renshaw, Keith D; Wilhelm, Sabine et al. (2016) Anxiety and Shame as Risk Factors for Depression, Suicidality, and Functional Impairment in Body Dysmorphic Disorder and Obsessive Compulsive Disorder. J Nerv Ment Dis 204:832-839
Weingarden, Hilary; Renshaw, Keith D (2015) Shame in the obsessive compulsive related disorders: a conceptual review. J Affect Disord 171:74-84