Katrina Holmes À Court, Malcolm Amy, Toh Wei Lin, Rossell Susan L
Centre for Mental Health, Swinburne University of Technology, Melbourne, VIC, Australia.
Psychiatry, St Vincent's Hospital, Melbourne, VIC, Australia.
Aust N Z J Psychiatry. 2025 Mar;59(3):224-247. doi: 10.1177/00048674241309747. Epub 2025 Jan 7.
Neurocognitive underpinnings are implicated in the aetiology and maintenance of body dysmorphic disorder (BDD); however, inconsistent findings across a range of neurocognitive domains suggest that a comprehensive synthesis of the literature using a hierarchical framework of neurocognition is needed.
A final search across OVID Medline, PsycNET, Scopus and Web of Science databases was conducted on 20 June 2024 to identify research that examined performance on behavioural tasks of objective neurocognition in BDD. Risk of bias was assessed using the Newcastle-Ottawa Scale. Fifty-four studies aligned with the following inclusion criteria: (1) full-text; (2) peer-reviewed; (3) published in English; (4) employed a neurocognitive task with an objective outcome and (5) involved a case-controlled paradigm consisting of BDD and healthy control samples. Findings were synthesised according to neurocognitive sub-domains viewed as a hierarchy from basic to higher-level domains.
Neurocognitive differences in BDD relative to controls were identified at almost all levels of the hierarchy, most consistently in the upper domains of executive function and social cognition. Vulnerabilities were also demonstrated in the sub-domains of visual perception of faces, Gestalt processing, selective attention to faces and verbal memory. Methodological limitations or the influence of neurocognitive sub-groups may contribute to inconsistencies across the literature.
Although neurocognitive differences appear central to BDD, a picture of neurocognitive heterogeneity emerged with the salience of stimuli important and a likely bias to local-over-global processing demonstrated across the domains.
神经认知基础与身体变形障碍（BDD）的病因及维持有关；然而，一系列神经认知领域的研究结果不一致，这表明需要使用神经认知的层次框架对文献进行全面综合。
于2024年6月20日对OVID Medline、PsycNET、Scopus和Web of Science数据库进行了最终检索，以确定研究BDD客观神经认知行为任务表现的研究。使用纽卡斯尔-渥太华量表评估偏倚风险。54项研究符合以下纳入标准：（1）全文；（2）经过同行评审；（3）以英文发表；（4）采用具有客观结果的神经认知任务；（5）涉及由BDD和健康对照样本组成的病例对照范式。研究结果根据从基本到高级领域的神经认知子领域层次进行综合。
在层次结构的几乎所有层面都发现了BDD相对于对照组的神经认知差异，在执行功能和社会认知的高级领域最为一致。在面部视觉感知、格式塔处理、对面部的选择性注意和言语记忆等子领域也发现了易损性。方法学局限性或神经认知亚组的影响可能导致文献中的不一致。
尽管神经认知差异似乎是BDD的核心，但出现了神经认知异质性的情况，刺激的显著性很重要，并且在各个领域都显示出局部优于整体处理的可能偏差。
