Etiology
The etiology of BDD is likely to be multifactorial, with both genetic and environmental contributions. Heritability of BDD symptoms is estimated to be 37% to 49%.[9] BDD has shared genetic vulnerability with obsessive-compulsive disorder (OCD). There are also genetic influences that are specific to BDD symptoms (i.e., not shared with OCD).[10][11][12]
Specific genes have not been determined. Environmental causes have not been determined, but possible contributors are a history of teasing or bullying, and childhood abuse, neglect, or trauma.[13][14][15][16]
Pathophysiology
The pathophysiology of BDD is unknown. The disorder appears to involve visual processing abnormalities, with excessive focus on details and reduced visual processing in primary and secondary visual systems for low-frequency holistic visual information (i.e., difficulty seeing the big picture).[17][18] These abnormalities are similar to, but more severe than, those in anorexia nervosa.[19] BDD is also characterized by abnormalities in corticostriatal circuitry that are similar to those seen in obsessive-compulsive disorder, as well as brain connectivity abnormalities and compromised white matter integrity in the brain.[17][20][21][22] Multiple studies have documented deficits and biases in cognitive and emotional processing (for example, interpretation of information, emotion recognition, attention, executive function, and neurocognition).[23] However, it is unknown whether any of these factors contribute to the pathophysiology of BDD or whether they are simply correlates of BDD symptoms.
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