The Self as an Aesthetic Object : Body Image, Beliefs About the Self, and Shame in a Cognitive-Behavioral Model of Body Dysmorphic Disorder

This chapter describes a cognitive-behavioral model of body dysmorphic disorder (BDD), focusing on a core concept of “processing of the self as an aesthetic object.” This concept refers to the experience of being intensely self-focused on a distorted and negative “felt sense” of how one appears to others, and of anticipating or experiencing negative evaluation and rejection because of how one looks. The model proposes that this “felt sense” is informed by intrusive imagery derived from aversive memories, which many individuals with BDD experience. Appearance may become an “idealized value” (i.e., something of primary importance in defining the self and its worth). According to the model, the negative “felt sense” of how the person looks is interpreted in terms of a threat to the self as a whole (e.g., being unacceptable or unlovable). Behavioral responses designed to minimize the threat to the self (e.g., having cosmetic surgery, checking disliked features in the mirror, and avoiding being seen by others) are postulated to instead exaggerate the sense of threat and reinforce the processing of the self as an aesthetic object. Implications for therapeutic intervention are discussed.