Journal of Anxiety Disorders 22 (2008) 540–547
Facial attractiveness ratings and perfectionism in body
dysmorphic disorder and obsessive-compulsive disorder
Ulrike Buhlmann, Nancy L. Etcoff, Sabine Wilhelm
Massachusetts General Hospital and Harvard Medical School, United States
Received 28 February 2007; received in revised form 14 May 2007; accepted 17 May 2007
Individuals with body dysmorphic disorder (BDD) suffer from a preoccupation about imagined or slight appearance flaws. We
evaluated facial physical attractiveness ratings and perfectionistic thinking among individuals with BDD (n = 19), individuals withobsessive-compulsive disorder (OCD; n = 21), and mentally healthy control participants (n = 21). We presented participants withphotographs displaying faces varying in facial attractiveness (attractive, average, unattractive) and asked them to rate them in termsof their physical attractiveness. We further examined how the participants evaluated their own physical attractiveness, relative toindependent evaluators (IEs). As predicted, BDD participants perceived their own attractiveness as significantly lower than did theIEs, and they rated photographs from the category ‘‘Attractive’’ as significantly more attractive than did the other groups. Furthermore, both clinical groups were characterized by more perfectionistic thinking than controls. These findings mostly supportcognitive-behavioral models of BDD that suggest that individuals with BDD exhibit perfectionistic thinking and maladaptiveattractiveness beliefs. # 2007 Elsevier Ltd. All rights reserved.
Keywords: Body Dysmorphic Disorder; Obsessive-Compulsive Disorder; Physical attractiveness; Facial attractiveness; Perfectionism; Self-discrepancy
Body dysmorphic disorder (BDD) is a chronic and
hours a day. Avoidance of everyday activities, and
debilitating disorder characterized by distress about
engagement in ritualistic behaviors, such as mirror
checking, grooming, and comparing one’s own appear-
ance with other people’s appearance may lead to
BDD are often preoccupied with flaws in their skin, hair,
nose, ears, or other body parts that are either completely
imaginary or, if there is a slight physical defect, their
Recent research on maladaptive beliefs and attitudes
concern is excessive. These concerns often compel
BDD sufferers to think about their appearance for many
has led to the development of cognitive-behavioralmodels of the etiology and maintenance of BDD (e.g.,model,
* Corresponding author at: Body Dysmorphic Disorder Clinic,
for example, proposes that individuals with BDD
Simches Research Building, Department of Psychiatry, Massachusetts
misinterpret visual input from normal features or minor
General Hospital, 185 Cambridge Street, Boston, MA 02114, United
appearance flaws, leading to worry, anxiety, shame, and
States. Tel.: +1 617 724 6146; fax: +1 617 643 3080.
maladaptive coping rituals, such as mirror checking,
0887-6185/$ – see front matter # 2007 Elsevier Ltd. All rights reserved.
U. Buhlmann et al. / Journal of Anxiety Disorders 22 (2008) 540–547
excessive grooming behaviors, frequent asking for
), supporting the idea that perfectionism is
reassurance, or comparing their own appearance with
associated with psychopathology. Moreover, it has been
others’. According to this model, most people dislike
found that individuals with BDD endorse beliefs, such as
some aspects of their appearance, but individuals with
‘‘I have to have perfection in my appearance’’
BDD focus on these details, exaggerating their
perceived or slight defects in appearance. Moreover,
To our knowledge, facial attractiveness ratings and
perfectionism have not yet been examined in BDD. In
maladaptive beliefs about their attractiveness, such as
the current study, we investigated whether BDD
higher attractiveness standards and perfectionistic
sufferers exhibit higher levels of perfectionism than
thinking, which lead to a negative self-evaluation and
control participants. Further, we investigated whether
low self-esteem. Moreover, higher levels of perfection-
BDD participants exhibit idiosyncratic or stricter
ism may partly explain why individuals with BDD focus
ratings for physical attractiveness than control partici-
excessively on, and suffer from, their ‘‘imperfect’’
pants (and in particular whether these standards apply in
general or only for themselves). Additionally, we
According to the self-discrepancy theory (
investigated whether these phenomena are typical only
discrepancies between the actual self and the
for BDD or whether they characterize a broader
‘‘self-guides’’ (ideal and ought/should self) are expected
spectrum of psychological disorders, such as OCD.
to result in negative emotions. Thus, given that
Based on clinical observations that BDD sufferers are
individuals with BDD often compare their own
often characterized by thoughts, such as ‘‘As long as I
don’t look perfect, I won’t be able to be happy,’’ we
expected that BDD participants would show levels of
thinking and discrepancies between one’s own perceived
inflated perfectionistic thinking, as has been shown in
attractiveness and the perceived ‘‘ideal looking appear-
ance’’ lead to more unfavorable social comparisons with
However, because OCD is not characterized by a
others. This, in turn, may result in more negative
preoccupation with one’s physical appearance, we
emotions and low self-esteem. Initial support for this
hypothesized that OCD participants, unlike BDD
participants, would exhibit attractiveness ratings similar
to mentally healthy control participants.
duals with BDD exhibited significant discrepanciesbetween their actual self and their ‘‘ideal’’ and ‘‘should’’
selves. So far, the current models of BDD arepredominately based on clinical observations. While
there is some evidence that attention, interpretations ofsituations as well as emotion recognition are biased in
The BDD group was comprised of 19 participants (six
men) who met current DSM-IV ) criteria for
BDD as determined by structured clinical interviews
(Structured Clinical Interview for DSM-IV – Outpatient
). The BDD participants had one or more of the
following concerns: facial skin (n = 14), hair (n = 5),
breasts (n = 1), eyes (n = 1), and shape of nose (n = 1).
if they see themselves as unattractive or as ‘‘not attractive
Although the BDD was the primary diagnosis in all cases
enough.’’ Furthermore, it has not been evaluated how
(based on symptom severity), some BDD participants
individuals with BDD evaluate the appearance of others.
had the following co-morbid diagnoses: major depres-
These questions relate to the broader concept of
sion (n = 7), agoraphobia without panic disorder (n = 1),
perfectionism. Higher levels of perfectionism have been
and social phobia (n = 1). Thirteen BDD participants
found in a series of disorders, such as depression (e.g.,
were on a stable dose of psychotropic medication at the
time of testing: fluoxetine (n = 7), paroxetine (n = 2),
fluvoxamine (n = 3), and clomipramine (n = 1).
The OCD group was comprised of 21 participants
(10 men) who met current DSM-IV ) criteria
U. Buhlmann et al. / Journal of Anxiety Disorders 22 (2008) 540–547
The participants had one or more of the following
the surrounding head, neck, and shoulders. The photos
symptoms: contamination fears (n = 9), aggressive
were taken of 18 females and 18 males who varied in
obsessions (n = 5), sexual obsessions (n = 2), fear of
physical attractiveness (six attractive, six average, and
making mistakes (n = 1), obsessions about guilt (n = 1),
six unattractive facial photographs). Facial attractive-
religious obsessions (n = 1), rumination (n = 1), check-
ness of each stimuli used in the study was carefully
ing (n = 15), hand washing (n = 9), counting compul-
classified by four independent evaluators (IEs) as
sions (n = 2), hoarding (n = 1), and rereading (n = 1).
‘‘unattractive,’’ ‘‘average,’’ or ‘‘attractive.’’ The IEs
Although the OCD was the primary diagnosis in all
were completely independent and not involved in the
cases (based on symptom severity), some OCD
study otherwise. Only photographs with an inter-rater
participants had the following co-morbid diagnoses:
reliability of Kappa ! .97 were included. Moreover, the
major depression (n = 2), alcohol abuse (n = 1), panic
participants were asked to have their own facial
disorder without agoraphobia (n = 1), and chronic
photograph taken with a 2.6 megapixel digital camera.
motor tic (n = 1). Nine OCD participants were
All facial photographs were presented on high quality
unmedicated at the time of testing. The remaining 11
photo paper (6 in. Â 8 in.) in a randomized order.
participants were on a stable dose of the followingpsychotropic medications: fluoxetine (n = 4), parox-
etine (n = 3), sertraline (n = 3), and fluvoxamine(n = 1). Data on medication status were missing for
All participants completed the Beck Depression
The mentally healthy control group consisted of 21
group completed the Body Dysmorphic Disorder
participants (nine men). SCID interviews confirmed the
Modification of the Yale-Brown Obsessive-Compulsive
absence of any psychiatric history. As evident from
, the groups did not differ with respect to age and
The Beck Depression Inventory (BDI) is a 21-item
education, ps > .83, and gender, x2(2) = 1.1, p = .58.
inventory that measures the severity of depression. Each
All of the participants were Caucasian. The patients
item has a series of four self-evaluative statements that
groups were recruited at the OCD Clinic at the
indicate the severity of a particular symptom. The total
Massachusetts General Hospital (MGH). Control
participants were recruited through flyers posted in
The Body Dysmorphic Disorder Modification of the
the Boston community. All participants were native
YBOCS (BDD-YBOCS) is a widely used 12-item
clinician-administered modified version of the Yale-Brown Obsessive-Compulsive Scale
). It measures the severity of BDD symptomsduring the past week. The total score ranges from 0 to
The Frost Multidimensional Perfectionism Scale is a
The experimental material consisted of 36 black and
commonly used 35-item self-report measure developed
white head-shot photographs of individuals with neutral
facial expressions. All photographs used in this study
displayed Caucasian faces. Photographs were standar-
subscales that assess the following dimensions: (1)
dized by isolating the face in an ellipse and graying out
concern over mistakes (e.g., people will think less of me
Table 1Means of psychometric and questionnaire data
Notes. BDD-YBOCS: Body Dysmorphic Disorder Modification of the Yale-Brown Obsessive-Compulsive Disorder Scale; BDI: Beck DepressionInventory; BDI data of one OCD participant were missing; means sharing letters do not differ ( ps > .05, as determined by ANOVAs and follow upBonferroni-corrected t-tests).
U. Buhlmann et al. / Journal of Anxiety Disorders 22 (2008) 540–547
if I make a mistake), (2) doubts over actions (e.g., even
attractiveness on a Likert-scale from 1 (very unat-
if I do things carefully, I often feel that it is not quite
tractive) to 7 (very attractive). The experimenter
done right), (3) personal standards (e.g., I set higher
emphasized that they ought to rate the photographs
goals for myself than most people), (4) parental
(including their own) in terms of how attractive they
expectations (e.g., my parents wanted me to be best
personally think the individuals displayed on the
at everything), (5) parental criticism (e.g., as a child, I
photographs are and not what other people might think.
was punished for doing things less than perfectly), and
Of note, the experimenter left the room after the
(6) organization (e.g., I try to be a neat person). The last
instructions had been fully explained, and the
subscale (organization) was not included in the total
participants then completed the tasks. Afterwards,
score. The total score ranges from 0 to 140. All
the participants completed the BDI and FMPS and were
measures used in this study have good psychometric
asked if they would agree to have their photograph
rated by IEs in terms of their physical attractiveness. Finally, they were paid and debriefed about the purpose
The study protocol was approved by the Partners
Human Research Committee, which oversees researchat MGH. Written informed consent of the participants
was obtained after the nature of the procedures hadbeen fully explained. All participants were tested
One-way analyses of variance (ANOVAs) indicated
individually. The study consisted of two appointments.
a group difference in the FMPS total score, F(2,
At the first appointment, participants read and signed
58) = 5.12, p = .009. Bonferroni-corrected t-tests indi-
the informed consent form prior to receiving a SCID
cated that control participants had lower overall
interview. The experimenter (U.B.) also administered
perfectionism scores than BDD participants, p = .04,
the BDD-YBOCS with the BDD participants at the first
and OCD participants, p = .01, whereas both patient
appointment. Participants were told that the purpose of
groups did not differ in their level of perfectionism,
the study was to increase knowledge about individual
preferences. After that, the participants’ facial photo-
We also found significant group differences for the
graphs were taken. At the second appointment (2 days
FMPS subscales ‘‘Concern over Mistakes,’’ F (2,
later), before the experimental trials, a short practice
58) = 9.98, p < .001, and ‘‘Doubting of Actions,’’
session was given that consisted of presenting the
F (5, 58) = 21.54, p < .001. Both patient groups had
participants with six additional facial photographs (two
significantly more concerns over mistakes than
of each category). Participants in the BDD group
controls, ps = .001, but no difference was observed
received the photographs in different random orders,
between the patient groups, p > .99. Interestingly,
and participants in the OCD and control group were
scores on the FMPS subscale ‘‘Doubting of Actions’’
yoked to the BDD participants. Furthermore, they were
showed several significant results. OCD participants
asked to rate each photograph in terms of its physical
had significantly higher scores than BDD participants,
Table 2Means of the Frost Multidimensional Perfectionism Scale
Notes. BDD: body dysmorphic disorder; OCD: obsessive-compulsive disorder; Control: Mentally healthy controls; FMPS: Frost MultidimensionalPerfectionism Scale; means sharing letters do not differ ( ps > .05, as determined by ANOVAs and follow up Bonferroni-corrected t-tests).
U. Buhlmann et al. / Journal of Anxiety Disorders 22 (2008) 540–547
p = .01, and control participants, p < .001, and BDD
3.3. Perception of one’s own facial attractiveness
participants had significantly higher scores thancontrol
To investigate whether the groups differed in their
differences were found for the other subscales (see
ratings of their own facial attractiveness, we submitted
the data for a one-way ANOVA and found a significantdifference among the groups, F(2, 56) = 3.91, p = .03.
Bonferroni-corrected t-tests indicated that BDD parti-cipants rated their own facial photograph as less
3.2.1. Idiosyncratic ratings of attractiveness
attractive than did controls, p = .048, or OCD partici-
To analyze whether the BDD participants had more
pants, p = .048. No difference was obtained between
idiosyncratic ratings of beauty, we calculated Spear-
OCD participants and controls, p > .99.
man’s Rho rank order correlation (excluding the ratingsof the participants’ own facial photographs). We found
3.4. Relation between one’s own rating and the
significant rank order correlations among all groups.
Spearman’s Rhos > .75, ps < .001, indicating that thegroups did not differ in terms of their rank order of
To further investigate how the participants rated their
own attractiveness compared to the other facialphotographs, we computed paired t-tests, separately
for each group. In the BDD group, we found that the
Four BDD participants refused to have their photo
participants rated their own facial photographs as
taken, and their attractiveness ratings were given only
slightly less attractive than photographs from the
for the other photographs. Facial attractiveness scores
category ‘‘Average.’’ This difference, however, fell
were submitted to a two-factor (Groups by Facial
short of significance, t(14) = À1.87, p = .08. Addition-
Attractiveness Category) ANOVA with repeated mea-
ally, BDD participants rated their own photograph as
sures on Facial Category (Average, Attractive, Unat-
significantly less attractive than they rated photographs
tractive). As expected, the analysis yielded a significant
main effect for Facial Category, F(2, 116) = 635.70,
p < .001, and significantly more attractive than they
p < .001, and a significant Groups by Facial Category
rated photographs from the category ‘‘Unattractive,’’
interaction, F(4, 116) = 3.82, p = .006. The main effect
for Groups, however, was not significant, F(2,
OCD participants rated their own photographs
slightly more attractive than they rated photographs
As evident from , Bonferroni-corrected t-tests
from the category ‘‘Average,’’ t(20) = 1.77, p = .09,
indicated that BDD participants rated photographs from
although this difference was not statistically significant.
the category ‘‘Attractive’’ as significantly more attrac-
Like the BDD group, they rated their own photographs
tive than did controls, p = .001, and OCD participants,
as significantly less attractive than they rated photo-
p = .02. As expected, there was no difference between
graphs from the category ‘‘Attractive,’’ t(20) = À3.80,
OCD participants and controls, p = .88. No significant
p = .001, and significantly more attractive than they
group differences were obtained for any other facial
rated photographs from the category ‘‘Unattractive,’’
Table 3Mean ratings of the physical attractiveness categories
Notes. Own photograph: rating of the participant’s own photograph by him/herself (BDD group: n = 15); IE ratings: rating of the participant’s ownphotograph by the independent evaluators (BDD group: n = 13, OCD group: n = 16, Controls: n = 19, p-value determined through Wilcoxon tests);means sharing letters do not differ ( ps > .05; as determined by ANOVAs and follow up Bonferroni-corrected t-tests).
U. Buhlmann et al. / Journal of Anxiety Disorders 22 (2008) 540–547
Control participants rated their own photographs as
ized by stricter ratings for physical attractiveness for
equally attractive to the photographs they rated from the
themselves. That is, they rated the attractiveness of their
category ‘‘Average,’’ t(20) = 0.97, p = .34. Moreover,
own faces as significantly lower than did controls or
like the other groups, they rated their own photographs
OCD participants, although all groups perceived
as significantly less attractive than they rated photo-
themselves to be in the average range. All groups rated
graphs from the category ‘‘Attractive,’’ t(20) = À3.83,
their own attractiveness as significantly lower than they
p < .002, and significantly more attractive than they
rated photographs from the category ‘‘Attractive’’ and
rated photographs from the category ‘‘Unattractive,’’
rated their own attractiveness as significantly higher
than they rated photographs from the category‘‘Unattractive.’’ The difference between BDD partici-
3.5. Physical attractiveness ratings of participants’
pants’ ratings of their own facial attractiveness and the
ratings for the category ‘‘Average’’ fell short ofsignificance, indicating that BDD participants rated
Four IEs who were blind to the group assignation
their own facial attractiveness somewhat, but not
examined the physical attractiveness of those partici-
statistically, lower, than they rated photographs from
pants who agreed to have their photograph evaluated
the category ‘‘Average.’’ This is somewhat surprising
(BDD: n = 13; OCD: n = 16; Controls: n = 19). Overall,
given that BDD patients often describe themselves as
we found no differences for the physical attractiveness
‘‘ugly’’ in clinical settings. Given that BDD is
ratings for any group, F(2, 47) = .03, p = .98. This
associated with higher levels of perfectionism, it is
indicates that the participants’ level of physical
possible that individuals with BDD perceive the label
attractiveness, as rated by the IEs, was the same among
‘‘Average’’ as more undesirable and negative than do
the groups. We further computed Wilcoxon compar-
individuals without BDD. Most importantly, BDD
isons to investigate how the participants’ ratings
participants perceived their physical attractiveness as
less attractive than the IEs (a pattern which was not
Within the BDD group, the IEs rated the partici-
observed in the OCD and control groups), which
pants’ photographs significantly more attractive than
supports the clinical assumption that other people do not
did the BDD participants, Z = 2.01, p = .04. Within the
share the BDD sufferers’ evaluation of perceived
OCD group, the IEs rated the participants’ photographs
appearance flaws. Thus, it would be interesting to
equally attractive as the participants themselves,
further examine whether individuals with BDD value
Z = 1.14, p = .26. Within the control group, similar to
aesthetics and beauty more than individuals without
the OCD group, no difference was obtained between the
BDD, which may lead them to be more sensitive and
IEs’ ratings and the participants’ ratings, Z = 1.42,
responsive to attractiveness, which, in turn, may lead
them to rate attractive people as even more attractive,more desirable, and closer to ‘‘perfection’’ than other
Moreover, our findings are consistent with
The aim of the present study was to examine facial
self-discrepancy theory. Specifically, perfectio-
attractiveness ratings and perfectionistic thinking in
nistic thinking and discrepancies between the percep-
order to evaluate cognitive-behavioral models of BDD.
tion of one’s own appearance versus how other people’s
Results indicate that individuals with BDD did not have
attractiveness is perceived may lead to more unfavor-
more idiosyncratic ratings of beauty, compared to
able social comparisons with others and consequently to
individuals with OCD and healthy control participants.
negative emotions and low self-esteem (e.g., the beauty
That is, they did not rate the facial photographs of
people varying in physical attractiveness any different
In support of our hypothesis, we also found that BDD
than did the other groups. However, BDD participants
participants as well as OCD participants showed higher
rated attractive faces as more attractive than the other
overall levels of perfectionism than did controls. In
groups. Further, individuals with BDD were character-
particular, both clinical groups exhibited more concernsover mistakes than controls. The ‘‘Concern overMistakes’’ subscale reflects negative reactions to
imperfections, a tendency to interpret imperfections
To examine whether co-morbid depression had influenced our
as equivalent to failure, and a tendency to believe that
results, we re-ran the analyses, including the BDI as a covariate. Thepattern of results did not change.
one will lose the respect of others as a result of
U. Buhlmann et al. / Journal of Anxiety Disorders 22 (2008) 540–547
imperfection. Thus, future research needs to explore
everyone agreed to have their photograph evaluated by
whether concerns about imperfections (perhaps in the
the IEs. Thus, those results have to be interpreted with
form of minor appearance flaws or a perceived
some cautions and larger scale studies are needed to
appearance defect) and self-worth have become
replicate and further investigate this matter. For example,
interwoven. This could explain why individuals with
it is possible that those participants who did not agree to
BDD are very concerned when they perceive their hair
have their picture taken or rated by the IEs were more
as thinning or their skin as scarred.
severely impaired, which may have affected our results.
In addition, OCD participants had the highest levels
In addition, given that our results rely on self-report
of doubting of action, followed by BDD participants,
measures, it would be interesting to examine the
who, in turn, had higher levels of doubting than
underlying cognitions when rating physical attractive-
controls. This result is also consistent with the clinical
ness. For example, it is possible that individuals with
picture of both disorders, which are characterized by the
BDD, relative to individuals without BDD, might prove
assumption that certain actions need to be done very
more forgiving when confronted with others who have
carefully, and need to be repeated over and over. In
appearance flaws, or who are less attractive. At the same
BDD these actions are usually done with the intention to
time they might be very impressed by attractive faces
check on, hide or improve appearance, whereas OCD is
manifesting in cognitions, such as ‘‘I wish I would look as
characterized by other compulsions. To our knowledge,
pretty as she does,’’ more so than individuals without
this is the first study investigating perfectionism in BDD
BDD, which might, in turn, influence their perception of
relative to individuals without BDD, and the findings
are consistent with our clinical experience that when
Overall, the findings are mainly supportive of
individuals with BDD think that they do not look ‘‘just
cognitive-behavioral models of BDD, which suggest
perfect’’ they are dissatisfied with their appearance.
that individuals with BDD are characterized by
This study has some limitations. Although the
perfectionistic thinking and maladaptive beliefs about
majority of our BDD participants (n = 16, based on 14
participants with facial skin concerns, one participant
). Future research needs to address how percep-
with nose concerns, and one participant with concerns
tions of one’s own and other people’s attractiveness can
related to the eyes) endorsed concerns related to their
be changed through cognitive-behavioral therapy. For
face, three participants did not endorse these concerns.
example, it is possible that over the course of the
Thus, it is possible that the results would have been
treatment, techniques, such as challenging the utility of
slightly different if we had only included BDD
perfectionistic thinking, perceptual (mirror) retraining,
participants with facial concerns. Furthermore, due to
and decreasing rituals, such as comparing influence the
the highly sensitive nature of a facial perception study for
BDD sufferer’s perception of his or her own and other
individuals with BDD, it was impossible to obtain facial
photographs of all BDD participants. Furthermore, alarge number of individuals in the clinical groups were on
a stable dose of psychotropic medication at the time of thetesting and future research needs to explore the possible
This research was supported, in part, by a graduate
impact of medication on attractiveness ratings. Also,
fellowship of the Gottlieb Daimler – and Karl Benz-
although our results did not change after controlling for
Foundation, Germany, awarded to Ulrike Buhlmann.
depression as a covariate, the possible influence ofdepression cannot entirely be controlled using an analysis
of covariance (see It would beinteresting to replicate our study using (1) nondepressed
American Psychiatric Association (1994). Diagnostic and statistical
individuals with either BDD or OCD and (2) a psychiatric
manual of mental disorders, 4th ed. Washington, DC: AmericanPsychiatric Association Press.
control group with a depressive disorder. It should also be
Ashbaugh, A., Antony, M. M., Liss, A., Summerfeldt, L. J., McCabe,
noted that all participants of the current study were
R. E., & Swinson, R. P. (2007). Changes in perfectionism follow-
Caucasian, and all stimuli displayed Caucasian faces.
ing cognitive-behavioral treatment for social phobia. Depression
Thus, future research is needed to disentangle the
possible influence of ethnic differences in the perception
Beck, A. T., & Steer, R. A. (1987). Beck Depression Inventory
Manual. San Antonio, TX: The Psychological Corporation.
of and/or preference for facial photographs of varying
Buhlmann, U., Etcoff, N. L., & Wilhelm, S. (2006). Emotion recogni-
ethnic backgrounds. In addition, out of those BDD
tion bias for contempt and anger in body dysmorphic disorder.
participants who agreed to have their photo taken, not
Journal of Psychiatric Research, 40, 105–111.
U. Buhlmann et al. / Journal of Anxiety Disorders 22 (2008) 540–547
Buhlmann, U., McNally, R. J., Etcoff, N. L., Tuschen-Caffier, B., &
Hewitt, P. L., Flett, G. L., & Ediger, E. (1996). Perfectionism and
Wilhelm, S. (2004). Emotion recognition deficits in body
depression: Longitudinal assessment of a specific vulnerability
dysmorphic disorder. Journal of Psychiatric Research, 38,
hypothesis. Journal of Abnormal Psychology, 105, 276–280.
Higgins, E. T. (1987). Self-discrepancy: A theory relating self and
Buhlmann, U., McNally, R., Wilhelm, S., & Florin, I. (2002a).
affect. Psychological Review, 94, 319–340.
Selective processing of emotional information in body dys-
Juster, H. R., Heimberg, R. G., Holt, C. S., & Frost, R. O. (1996).
morphic disorder. Journal of Anxiety Disorders, 16, 289–298.
Social phobia and perfectionism. Personality and Individual
Buhlmann, U., Wilhelm, S., McNally, R. J., Tuschen-Caffier, B.,
Baer, L., & Jenike, M. A. (2002b). Interpretive biases for
Miller, G. A., & Chapman, J. P. (2001). Misunderstanding analysis of
ambiguous information in body dysmorphic disorder. CNS
covariance. Journal of Abnormal Psychology, 110, 40–48.
Phillips, K. A., Didie, E. R., Menard, W., Pagano, M. E., Fay, C., &
Buhlmann, U., Teachman, B. A., Gerbershagen, A., Kikul, J., & Rief,
Weisberg, R. B. (2006). Clinical features of body dysmorphic
W. (in press). Implicit and explicit self-esteem and attractiveness
disorder in adolescents and adults. Psychiatry Research, 141,
beliefs among individuals with body dysmorphic disorder. Cog-
Phillips, K. A., Hollander, E., Rasmussen, S. A., Aronowitz, B. R.,
Buhlmann, U., & Wilhelm, S. (2004). Cognitive factors in body
DeCaria, C., & Goodman, W. K. (1997). A severity rating scale for
dysmorphic disorder. Psychiatric Annals, 34, 922–926.
body dysmorphic disorder: Development, reliability and validity
Enns, M. W., & Cox, B. J. (1999). Perfectionism and depression
of a modified version of the Yale-Brown Obsessive-Compulsive
symptom severity in major depressive disorder. Behaviour
Scale. Psychopharmacology Bulletin, 33, 17–22.
Research and Therapy, 37, 783–794.
Phillips, K. A., McElroy, S. L., Keck, P. E., Pope, H. G., Jr., & Hudson,
First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (1995).
J. I. (1993). Body dysmorphic disorder: 30 cases of imagined
Structured clinical interview for DSM-IV Axis I Disorders-patient
ugliness. American Journal of Psychiatry, 150, 302–308.
edition. New York: Biometrics Research Department, New York
Phillips, K. A., Pinto, A., & Jain, S. (2004). Self-esteem in body
dysmorphic disorder. Body Image, 1, 385–390.
Frost, R. O., Marten, P., Lahart, C., & Rosenblate, R. (1990). The
Shroff, H., Reba, L., Thornton, L. M., Tozzi, F., Klump, K. L.,
dimensions of perfectionism. Cognitive Therapy and Research,
Berrettini, W. H., et al. (2006). Features associated with excessive
exercise in women with eating disorders. International Journal of
Frost, R. O., & Steketee, G. (1997). Perfectionism in obsessive-
compulsive patients. Behaviour Research and Therapy, 35,
Veale, D. (2004). Advances in a cognitive behavioural model of body
dysmorphic disorder. Body Image, 1, 113–125.
Goodman, W. K., Price, L. H., Rasmussen, S. A., Mazure, C.,
Veale, D., Boocock, A., Gournay, K., Dryden, W., Shah, F., Willson,
Fleischmann, R. L., Hill, C. L., et al. (1989). The Yale-Brown
R., et al. (1996). Body dysmorphic disorder: A survey of 50 cases.
Obsessive-Compulsive Scale (Y-BOCS). Archives of General
British Journal of Psychiatry, 169, 196–201.
Veale, D., Kinderman, P., Riley, S., & Lambrou, C. (2003). Self-
Halmi, K. A., Tozzi, F., Thornton, L. M., Crow, S., Fichter, M. M.,
discrepancy in body dysmorphic disorder. British Journal of
Kaplan, A. S., et al. (2005). The relation among perfectionism,
obsessive-compulsive personality disorder and obsessive-compul-
Wilhelm, S. (2006). Feeling good about the way you look: A program
sive disorder in individuals with eating disorders. International
for overcoming body image problems. New York: Guilford Press.
Journal of Eating Disorders, 38, 371–374.
Wilhelm, S., & Neziroglu, F. (2002). Cognitive theory of body
Hewitt, P. L., & Flett, G. L. (1993). Dimensions of perfectionism, daily
dysmorphic disorder. In: R. O. Frost & G. Steketee (Eds.),
stress, and depression: A test of the specific vulnerability hypoth-
Cognitive approaches to obsessions and compulsions: Theory,
esis. Journal of Abnormal Psychology, 102, 58–65.
assessment and treatment (pp. 203–214). Oxford: Elsevier Press.
Corrections in Etz Hayim, Various Printings 2nd (2001), 3rd (2002), 4th (2003), 6th (2006), 11th (2013) Element on Page Locale within Element Correction Made Type of problem addressed Inserted letter zayin — replacing « l’mah.ikim » with « l’mah.azikim ». Replaced letter h.et with letter hei. Making room for new Table of Torah ReadingsInserted: «Table of Torah Re