Institute of Psychology, Clinical Psychology, and Psychotherapy, University of Münster.
Massachusetts General Hospital, Harvard Medical School.
J Abnorm Psychol. 2021 May;130(4):365-376. doi: 10.1037/abn0000673.
Individuals with body dysmorphic disorder (BDD) often lack insight into the nature of their perceived appearance flaws that are slight, if they exist at all. Despite the generally held assumption that insight fluctuates over time within individuals with BDD, its temporal instability and associated features remain unstudied. We examined insight as a multidimensional, contextually embedded, and dynamic factor using ecological momentary assessment (EMA), further assessing affect and self-esteem as potentially associated states. Thirty individuals with BDD and 30 mentally healthy controls (HCs) completed 6 days of EMA (M = 8.54 assessments per day, N = 3075 assessments in total). Multilevel analyses revealed substantial intraindividual fluctuations of insight dimensions (across 30 min to hours) that were more pronounced for individuals with BDD than for HCs. Poorer insight correlated with higher negative affect, lower positive affect, and lower self-esteem at concurrent time points in the BDD group. Considering all predictors at the same time point, poorer insight was characterized by lower self-esteem and, partly, negative affect in the BDD group. Across time, self-esteem and insight influenced each other reciprocally, with comparatively stronger effects for the prediction of poorer insight by previously lower self-esteem. These findings demonstrate that insight is a highly variable phenomenon in BDD, further suggesting a clinically and etiologically relevant link between self-esteem and insight in symptom maintenance. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
个体的身体变形障碍（BDD）通常缺乏对自己感知到的轻微外观缺陷的本质的洞察力，如果这些缺陷存在的话。尽管人们普遍认为，BDD 个体的洞察力会随着时间的推移而波动，但它的时间不稳定性及其相关特征仍未得到研究。我们使用生态瞬时评估（EMA）来检查洞察力作为一个多维、情境嵌入和动态的因素，进一步评估情感和自尊作为潜在的相关状态。30 名 BDD 患者和 30 名心理健康对照组（HCs）完成了 6 天的 EMA（M=每天 8.54 次评估，N=总共 3075 次评估）。多层次分析显示，洞察力维度存在显著的个体内波动（跨越 30 分钟到几小时），BDD 患者比 HCs 更为明显。较差的洞察力与 BDD 组同时点的更高的负性情绪、更低的正性情绪和更低的自尊相关。在考虑同一时间点的所有预测因素时，较差的洞察力特征是 BDD 组的自尊较低，部分是负性情绪。随着时间的推移，自尊和洞察力相互影响，以前较低的自尊对较差的洞察力的预测作用更强。这些发现表明，洞察力在 BDD 中是一个高度可变的现象，进一步表明自尊和洞察力在症状维持方面存在临床和病因学上的相关联系。
