Interpretation Bias Across Body Dysmorphic, Social Anxiety and Generalized Anxiety Disorder—A Multilevel, Diffusion Model Account

Abstract

Background Interpretation biases are suggested to be transdiagnostic phenomena, but have rarely been compared across different disorders and current concerns. Methods We investigated explicit, decision-based, and more implicit, reaction time-based interpretation bias in individuals with body dysmorphic disorder (BDD; N = 29), social anxiety disorder (SAD; N = 36), generalized anxiety disorder (GAD; N = 22), and non-clinical controls (NC; N = 32), using an adapted Word Sentence Association Paradigm (WSAP). Results Results indicated that interpretation bias occurred transdiagnostically, while content-specific bias patterns varied meaningfully across groups. BDD and SAD shared explicit and, more inconsistently, implicit interpretation biases for appearance-related and social situations. The GAD group exhibited an explicit and implicit negative interpretation bias for general situations, and an additional implicit lack of positive bias. Mechanistic Wiener diffusion model analyses revealed that interpretation bias patterns were mainly driven by speeded information uptake, potentially mirroring disorder-specific associative memory organization. Conclusions These findings have important implications for understanding interpretation biases as both etiological and treatment factors.

Symptom association between social anxiety disorder, appearance anxiety, and eating disorders among Chinese University students: A network analysis to conceptualize comorbidity

“…Several studies have suggested that appearance anxiety can positively predict SAD among normal samples, and even among eating disorder samples ( 8 , 13 , 14 ). In turn, SAD symptoms also predict appearance anxiety and other body image disorders ( 13 , 15 ). Furthermore, appearance anxiety is highly correlated with eating disorders such as anorexia nervosa and bulimia nervosa ( 16 ), and appearance-related comments can increase appearance anxiety and directly or indirectly affect eating disorders ( 17 – 19 ).…”

Perceived Stigmatization among Dermatological Outpatients Compared with Controls: An Observational Multicentre Study in 17 European Countries

“…For example, perceived stigmatization may lead to enhanced appearance concerns. However, body dysmorphic disorder is common in skin conditions ( 14 ) and one of its core features is the continuous awareness of others looking at appearance defects, which could lead to misinterpretation of ambiguous social situations ( 33 ) and thereby increased reporting of perceived stigmatization. Similarly, higher levels of distress and presence of suicidal ideation may lead to a negative evaluation of social interactions ( 34 ), resulting in greater self-reported perceived stigmatization.…”

Temporal dynamics of insight in body dysmorphic disorder: An ecological momentary assessment study.

“…In addition, they believe others to be critical (Buhlmann, et al, 2006) and fear rejection (Kelly et al, 2014). Thus, individuals with BDD are regularly confronted with situations in which they are biased to negative and appearance-related interpretations (Buhlmann et al, 2002; Dietel et al, 2021). Due to the overimportance of appearance for the self (Veale, 2004), it seems plausible that low self-esteem fosters maladaptive beliefs.…”