Mental Images in Body Integrity Identity Disorder (BIID) and in Body Dysmorphic Disorder (BDD): An Exploratory Study

Abstract

Little is known about mental images (cognitive representations with sensory qualities) in body integrity identity disorder (BIID). This study aimed to determine whether individuals with BIID experience mental images and, if so, whether they differ to those experienced by individuals with body dysmorphic disorder (BDD) and healthy controls. A semi-structured interview on mental images and their qualities was delivered to a sample of 22 individuals with BIID and 19 with BDD, and 22 healthy controls. Both the BIID (n = 15, 68.2%) and BDD (n = 14, 73.7%) groups reported significantly more mental images than healthy controls (n = 3, 13.6%), but no differences between the two clinical groups were found. While mental images in BDD were focused on 'flawed' body parts, images in BIID involved the desired handicap. Mental images in BIID were experienced as less distressing and more sexually arousing compared to BDD. No further differences were found between the groups (e.g., regarding sensory multimodality, dominance of a specific body part). Although the two groups reported a similar frequency of mental images, images appear to serve different functions across conditions. Clinically, it may be necessary to target the positive mental images in BIID to improve treatment outcome.

Could Brain–Computer Interface Be a New Therapeutic Approach for Body Integrity Dysphoria?

“…In order to provide an in-depth evaluation of BID and its manifestations, it may be helpful to first differentiate from other similar conditions such as body dysmorphic disorder (BDD) and somatoparaphrenia, among others ( Table 1 ). BID shares similarities with BDD, because individuals with BID are also found to be preoccupied with certain aspects of their body ( Grocholewski et al, 2018 ). However, there are some key differences.…”

“…Preoccupation with certain aspects of the body (Grocholewski et al, 2018) Dysphoria experienced by individuals with BDD is derived from their concerns over how a part of their body physically appears to others (First and Fisher, 2012). Specifically, individuals with BDD believe that some aspect of their physical appearance is defective and as such is a source of intense embarrassment, shame, and low self-esteem -Reduced volume of the orbito-frontal cortex and the anterior cingulate, and larger volume of the thalamus (Atmaca et al, 2010) -Frontostriatal and temporoparietal occipital circuits for visual-spatial processing (Mufaddel et al, 2013) Somatoparaphrenia Denial of ownership over a limb (Gerstmann, 1942), and more often concerns the left body part (McGeoch et al, 2011).…”