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Abstract
A growing literature demonstrates that intrusive imagery features across several psychopathologies and reflects idiosyncratic fears of the individual. In some cases it appears to maintain disorder-specific behaviours. Surprisingly, limited research has focused on imagery in body dysmorphic disorder (BDD), a disorder in which negative imagery is thought to be critical in disorder maintenance (Veale, 2004). The overarching aim of the current thesis was to address this gap in the BDD literature by investigating the phenomenology of negative intrusive imagery and its association with pathological cognitions and processes. In Study 1, I documented appearance-related intrusive imagery reported by undergraduates high in dysmorphic concern, and explored the predictive value of image suppression on dysmorphic concern. Images were frequent and negative, often utilised the observer perspective, and were highly social in nature. Image suppression also predicted dysmorphic concern. In Study 2, I similarly documented intrusive imagery reported by clinical BDD participants. Results were comparable to Study 1, where images were also frequent, negative, often utilised the observer perspective, and were highly social in nature. A comparison of image content with literature-derived themes also confirmed that reports reflected typical BDD concerns and behaviours. In Study 3, I experimentally induced negative intrusive images in undergraduates, and found that image suppression reduced intrusion frequency, duration and discomfort. The study also showed that dysmorphic concern is associated with increased vividness and discomfort during intrusions, and with increased disgust and internalisation of distorted information about appearance. In Study 4, I investigated the relationship between dysmorphic concern and selective attention to faces, attractive and unattractive appearance-related stimuli, and disgusting stimuli. Dysmorphic concern was positively associated with attention to faces and attractive stimuli when attention occurred within conscious awareness, and was positively associated with attention to disgusting stimuli when attention occurred more automatically. This program of research provided much needed qualitative documentation of intrusive imagery within the context of BDD and offers some insights into the ways in which intrusive images may maintain this debilitating disorder. Clinical implications of these findings are also discussed, particularly with respect to the utility of treatment strategies directly targeting imagery.