How do individuals with body dysmorphic disorder (BDD) perceive their own cognition? A qualitative investigation into subjective cognition in BDD

Cognition is implicated in the aetiology and maintenance of body dysmorphic disorder (BDD); however, there is almost no research concerning individuals’ perception of their cognition. Understanding real-world, subjective cognitive experiences will improve understanding of the functional impacts of BDD and could alter treatment approaches. This study aimed to examine the subjective impressions of the prominence, type and impact of cognitive impairments experienced by adults with BDD. Participants responded to a global, online self-report survey asking qualitative questions regarding cognitive experiences in BDD (N = 316). Data was analysed using Interpretative Phenomenological Analysis (IPA). Five superordinate themes were identified: (1) the cognitive experiences of BDD, (2) functional impairment, (3) relationship between cognitive impairment and BDD, (4) social and emotional impacts, and (5) strategies. Individuals recognise impaired cognition as relating to their experience of illness. Many individuals report impairments across multiple specific cognitive domains (attention, memory, executive function, social cognition and processing speed) and some perceive themselves as generally ‘cognitively flawed’. The self-reported social and emotional consequences of cognitive impairments in BDD are significant and many individuals report functional impairment. Being aware of patients’ perceptions of their cognitive impairments may help clinicians tailor or modify their strategies. Questioning of cognitive experiences should form part of patient assessments.