Mental imagery of the self in body dysmorphic disorder: A mixed methods systematic review

This systematic review sought to identify the characteristics and proposed mechanisms of imagery in body dysmorphic disorder, synthesising qualitative and quantitative data from thirty-seven studies including EMDR studies using Meta-Integration.

Article Abstract

“Mental imagery has been identified as a key feature of the onset, maintenance and treatment of psychological disorders. Research on the role of mental imagery in body dysmorphic disorder (BDD), a condition hallmarked by negative sensory appraisals of the self, has been increasingly recognised in theoretical perspectives and psychological interventions. However, the scope and implications of this work have not yet been reviewed. This systematic review sought to identify the characteristics and proposed mechanisms of imagery in BDD, synthesising qualitative and quantitative data using Meta-Integration. Quality was assessed using the Mixed Methods Appraisal Tool. Thirty-seven studies were identified among 33 publications. Study quality was mixed with significant methodological heterogeneity. Mental imagery in BDD is consistently reported to be vivid, emotionally intense, recurrent and important in the maintenance and potentially the onset of BDD. These findings concur with theoretical frameworks of BDD (and other related conditions) which highlight the causal role of imagery and encourage the use of imagery-based interventions. Crucial areas for future work include stronger causal tests, unpacking mechanisms, attention to individual differences and intersectionality and exploring the potential for imagery-based approaches for innovations in treatment and prevention across the lifespan, particularly in adolescence when BDD first develops.

Summary:

• Mental imagery of the self in BDD is common, recurrent, intrusive, vivid and often depicts clients’ body areas of concern in an exaggerated third-person manner or replays distressing memories linked to negative beliefs.
• These images can be triggered by everyday situations, and individuals with BDD may engage in complex strategies to avoid or disengage from the perceived threat imposed by imagery.
• Mental imagery may, in this way, be important in the maintenance and development of BDD, with clear implications for intervention efforts.
• Practitioners should consider assessing the content and experience of imagery in clients with BDD, which can serve as opportune entry-points for deepening formulation throughout therapy.
• Novel applications of imagery work within evidence-based therapies are emerging and appear both feasible and clinically relevant.”

—Description from publisher

Article Access

Open Access

Hill, S., Hotton, M., Wallace, M., Veale, D., & Lauu-Zhu, A. (2026). Mental imagery of the self in body dysmorphic disorder: A mixed methods systematic review. Clinical Psychology & Psychotherapy, 33(1), e70229. https://doi.org/10.1002/cpp.70229(opens in new tab)