2026 ECNP Congress

PS02-2083

A comprehensive investigation of social cognition in body dysmorphic disorder

Katrina Holmes à Court — E. Byrne, R. Iyer, W.L. Toh, S.L. Rossell · Swinburne University of Technology, Centre for Mental Health, Hawthorn, Australia

2026 ECNP Congress

Body dysmorphic disorder (BDD) involves distressing preoccupation with perceived appearance flaws and is associated with significant social avoidance and impaired interpersonal functioning [1]. Social cognition, the ability to perceive, interpret, and respond to social information, is a plausible contributor to these difficulties, yet evidence in BDD is sparse and often limited to single domains. Previous studies have reported mixed findings, with some identifying emotion recognition deficits for anger and disgust [2], while others found while others found intact performance [3]. A systematic review highlighted the absence of comprehensive, multi-domain social-cognitive assessment in BDD [4]. This study aimed to characterise the social-cognitive profile of individuals with BDD across theory of mind (ToM), emotion recognition, pragmatic inference, and empathy.

Sixty-one adults with BDD (mean age = 31.77, SD = 9.60; 86.9% female; mean BDD symptom severity on the Yale-Brown Obsessive Compulsive Scale Modified for BDD = 29.98, SD = 6.75) and 61 healthy controls (mean age = 30.39, SD = 11.48; 72.1% female) completed a comprehensive social cognition battery: The Awareness of Social Inference Test-Short (TASIT-S), Hinting Task, Reading the Mind in the Eyes Test, Bell-Lysaker Emotion Recognition Task, Penn Emotion Recognition Test (ER-40), and Questionnaire of Cognitive and Affective Empathy (QCAE). Data were analysed using mixed-model analysis of variance with Holm-Bonferroni correction and Cohen’s d effect sizes. Approximately 40% of the BDD group were taking serotonin-based antidepressants (selective serotonin reuptake inhibitors or serotonin-norepinephrine reuptake inhibitors); however, medication status did not significantly affect any outcome.

Results revealed a selective, domain-specific profile rather than global impairment. The BDD group showed enhanced TASIT-S ToM performance, d = 0.48, 95% CI [0.11, 0.85] and superior pragmatic inference in detecting sarcasm and lies, d = 0.61, 95% CI [0.24, 0.98]. Heightened anger recognition was observed on the ER-40 with a significant Group × Emotion interaction, F(4,436) = 3.77, p = .005, anger d = 0.67, 95% CI [0.29, 1.06] and elevated cognitive empathy driven by perspective taking, d = 0.49, 95% CI [0.09, 0.89]. Conversely, the BDD group showed impaired inferential ToM on the Hinting Task, d = −0.42, 95% CI [−0.78, −0.06]. General emotion recognition (Bell-Lysaker Emotion Recognition Task, TASIT-S Part 1) and affective empathy did not differ between groups. No social-cognitive measure was associated with BDD symptom severity, insight, or mood after correction for multiple comparisons.

These findings indicate that social cognition in BDD follows a threat-sensitive pattern rather than a deficit-based one. The profile involves heightened detection of interpersonal threat cues such as anger and deception, and enhanced performance in contextually rich social scenarios, combined with impaired higher-order inferential reasoning from minimal cues. This dissociation was independent of clinical severity and medication, suggesting it reflects a core cognitive tendency rather than a symptom consequence. The profile identifies automatic threat hypervigilance and higher-order inferential reasoning as distinct targets for psychological intervention in BDD.

References

  1. Veale, D. (2004). Body dysmorphic disorder. Postgraduate Medical Journal, 80(940), 67–71.
  2. Buhlmann, U., McNally, R. J., Etcoff, N. L., Tuschen-Caffier, B., & Wilhelm, S. (2004). Emotion recognition deficits in body dysmorphic disorder. Journal of Psychiatric Research, 38(2), 201–206.
  3. Pikoos, T. D., Malcolm, A., Castle, D. J., & Rossell, S. L. (2024). A hierarchy of visual processing deficits in body dysmorphic disorder: A conceptual review and empirical investigation. Cognitive Neuropsychiatry, 29(2), 116–140.
  4. Holmes à Court, K., Malcolm, A., Toh, W. L., & Rossell, S. L. (2025). A systematic review of neurocognition and social cognition in body dysmorphic disorder. Australian & New Zealand Journal of Psychiatry, 59(3), 224–247.