Mirror, mirror on the wall, who is the ugliest of them all? The psychopathology of mirror gazing in body dysmorphic disorder

Patients with Body Dysmorphic Disorder (BDD) may spend many hours in front of a mirror but little is known about the psychopathology or the factors th at maintain the behaviour. A self-report mirror gazing questionnaire was us ed to elicit beliefs and behaviours in front of a mirror. Two groups were c ompared, which consisted of 55 controls and 52 BDD patients. Results: Prior to gazing, BDD patients are driven by the hope that they will look differe nt; the desire to know exactly how they look; a belief that they will feel worse if they resist gazing and the desire to camouflage themselves. They w ere more likely to focus their attention on an internal impression or feeli ng (rather than their external reflection in the mirror) and on specific pa rts of their appearance. They were also more likely to practise showing the best face to pull in public or to use "mental cosmetic surgery" to change their body image than controls. BDD patients invariably felt worse after mi rror gazing and were more likely to use ambiguous surfaces such as the back s of CDs or cutlery for a reflection. Conclusion: Mirror gazing in BDD cons ists of a series of complex safety behaviours. It does not follow a simple model of anxiety reduction that occurs in the compulsive checking of obsess ive-compulsive disorder. The implications for treatment are discussed. (C) 2001 Elsevier Science Ltd. All rights reserved.