Ulrike Buhlmann

University of Münster | WWU · Clinical Psychology and Psychotherapy

Numerous randomized controlled trials have shown cognitive behavior therapy (CBT) to be effective in treating social anxiety disorder (SAD). Yet, less is known about the effectiveness of CBT for SAD conducted by psychotherapists in training in routine clinical practice. In this study, 231 patients with SAD were treated with CBT under routine condit...

Burnout symptoms are prevalent among university students. This study examined students’ understudied profiles of burnout symptoms and their relation to procrastination, dropout intentions, and study- and life satisfaction. We used cross-sectional data from two online-studies conducted in Germany in April 2020 amid the COVID-19 pandemic (Nstudy1 = 5...

Anorexia nervosa (AN) is a severe eating disorder characterized by excessive weight loss and lack of recognition of the seriousness of the current low body weight. Individuals with AN frequently exhibit an enhanced inflammatory state and altered blood levels of cytokines and chemokines. However, the expression of chemokine receptors in AN and the a...

The COVID-19 pandemic challenges the well-being and academic success of many students. Yet, little is known about students’ study satisfaction during the COVID-19 pandemic, a multilayered construct which accounts for students’ subjective cognitive well-being and academic success. Besides, previous studies on study satisfaction are mostly cross-sect...

Body dysmorphic disorder (BDD) is an impairing condition characterized by excessive appearance concerns that frequently begin in adolescence, thus making this phase an eminent target for prevention and early intervention. We developed a cognitive-behavioral app-based program (AINA) intended for prevention and early intervention of BDD. As part of t...

Background Negative illness representations such as self-blame impede treatment-seeking behavior and therapy motivation in individuals with eating disorders (EDs). However, only one study so far has investigated how different explanatory models influence these beliefs in EDs. We aimed to expand these findings by introducing an explanatory model bas...

Previous neuroimaging studies in body dysmorphic disorder (BDD) have focused on discordances in visual processing systems. However, little is known about brain functional aberrations in individuals with BDD during emotional face processing. An fMRI paradigm with negative emotional faces was employed in 20 individuals with BDD and 43 mentally health...

Hintergrund: Die Körperdysmorphe Störung (KDS) ist eine schwerwiegende psychische Störung, die mit starker Scham sowie Leidensdruck und Funktionseinschränkungen einhergeht. Kognitive Verhaltenstherapie stellt die aktuell wirksamste evidenzbasierte Behandlungsmethode dar. Aufgrund zahlreicher Behandlungsbarrieren kommen KDS-Betroffene jedoch selten...

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 disord...

Background Cognitive behavioral therapy (CBT) is a well-established treatment for people suffering from obsessive-compulsive disorder (OCD) and technology-based CBT applications are an emerging treatment option for people with OCD. These applications involve treatment protocols with automated content delivery and relatively low clinical contact. Wh...

Social support is an important determinant of help-seeking in the context of mental health. Previous evidence shows differences in the relation between social support and help-seeking between more collectivistic vs. more individualistic cultures. Especially the cultural informed role of the family might play a key role in help-seeking decisions. St...

Body image concerns revolving around body ideals (thin ideal, muscular ideal) are widespread among women. Whereas a stronger preoccupation with ideal physical appearance is often assumed for narcissistic women, previous empirical findings have been mixed. Following a tripartite structure of agentic, antagonistic, and neurotic narcissism facets, we...

Objective Body dysmorphic disorder (BDD) is associated with low self-esteem. The aim of this meta-analysis was to examine the strength of the cross-sectional relationship between BDD symptom severity and global self-esteem in individuals with BDD, mentally healthy controls, community or student samples, and cosmetic surgery patients. Moreover, the...

The current study tested the novel hypothesis that elevated facial appearance concern reflects a heightened tendency to judge facial appearance in terms of attractiveness, rather than in terms of attractiveness-irrelevant dimensions. Seventy-three females, reporting either high or low facial appearance concerns, were exposed to an individualised st...

Individuals with body dysmorphic disorder (BDD) often lack insight into the nature of their perceived appearance flaws that are slight, if they exist at all. Despite the generally held assumption that insight fluctuates over time within individuals with BDD, its temporal instability and associated features remain unstudied. We examined insight as a...

Globally the burden due to mental disorders is continuously increasing. Still, professional help-seeking behavior is not fully understood. To conceive cultural determinants of helpseeking is crucial to reduce personal and social costs of (untreated) mental disorders. The current study investigates mental health stigma and help-seeking attitudes in...

Body image concerns revolving around body ideals (thin ideal, muscular ideal) are widespread among women. Whereas a stronger preoccupation with ideal physical appearance is often assumed for narcissistic women, previous empirical findings have been mixed. Following a tripartite structure of agentic, antagonistic, and neurotic narcissism facets, we...

Objective The aim of this meta-analysis was to examine the strength of the cross-sectional relationship between body dysmorphic disorder (BDD) symptom severity and global self-esteem in individuals with BDD, mentally healthy controls, community or student samples, and cosmetic surgery patients. Moreover, the role of depressive symptom severity in t...

The recent outbreak of the coronavirus disease (Covid-19) has plunged countries across the world into crisis. Both in the general population and in specific subgroups such as infected people or health care workers, studies have reported increased symptoms of anxiety, depression and stress. However, the reactions of individuals with mental disorders...

Body dysmorphic disorder (BDD), together with its subtype muscle dysmorphia (MD), has been relocated from the Somatoform Disorders category in the DSM-IV to the newly created Obsessive-Compulsive and Related Disorders category in the DSM-5. Both categorizations have been criticized, and an empirically derived classification of BDD is lacking. A com...

Objective Appearance‐related interpretation bias is postulated to play a role in the maintenance of body dissatisfaction (BD), a risk factor for body dysmorphic disorder (BDD), and eating disorders (ED). Cognitive bias modification for interpretation (CBM‐I) has been shown to reduce maladaptive interpretation bias and symptoms in various emotional...

Background: Although effective treatments are available, most individuals with body dysmorphic disorder (BDD) do not receive an appropriate diagnosis or treatment. We aimed to examine treatment utilization and barriers to treatment, and to identify associated socio-demographic and clinical characteristics. Methods: German individuals completed a...

Background Body dysmorphic disorder (BDD) is often characterized by poor insight into the disorder up to delusional beliefs about perceived flaws or defects in one’s own physical appearance, which are only slightly or not visible to others. Although insight has often been studied in BDD, research on insight comparing different psychological disorde...

The current study intends to investigate whether the therapeutic process is impeded by stigma and how stigma develops over the course of cognitive behavioral psychotherapy treatment. 60 German psychotherapy inpatients were asked on a weekly basis about two facets of stigma: self‐stigma and perceived public stigma. That information was linked to add...

Objective: Appearance-related interpretation bias is postulated to play a role in the maintenance of body dissatisfaction, a risk factor for body dysmorphic disorder (BDD) and eating disorders (ED). Cognitive Bias Modification for Interpretation (CBM-I) has been shown to reduce interpretation bias and symptoms in emotional disorders. This study inv...

Body image disturbance is associated with several mental disorders. Previous research on body image has focused mostly on women, largely neglecting body image in men. Moreover, only a small number of studies have conducted gender comparisons of body image over the lifespan and included participants aged 50 years and older. With regard to measuremen...

Ecological momentary assessment (EMA) has been shown to be a valid and sensitive measure of treatment effects in obsessive‐compulsive disorder (OCD). As part of a clinical trial, this EMA study deals with a comparison of two treatment conditions, i. e., cognitive restructuring (CR) and detached mindfulness (DM). EMA data from n = 39 OCD patients wa...

Gazing rituals and selective attention to perceived flaws during gazing are considered as maintaining factors in cognitive-behavioral models for body dysmorphic disorder (BDD). This study investigated different durations of BDD-like gazing at different facial stimuli (an unfamiliar face, the participant's own face, and the participant's own reflect...

The Narcissistic Admiration and Rivalry Concept (NARC) distinguishes between an agentic dimension (admiration) and an antagonistic dimension (rivalry) of grandiose narcissism. Both can be measured with the Narcissistic Admiration and Rivalry Questionnaire (NARQ). In a population sample (N = 2,513), we first examined how admiration and rivalry are r...

Individuals with contamination concerns show aberrant interpretational and attentional processes. Yet, it is unclear whether threat-related associations play a causal role in anxiety symptoms and attentional bias. The objective of our study was to investigate if training implicit associations affects stress reactivity and attention in the context o...

Rituals, such as gazing at faces, are common in body dysmorphic disorder (BDD) and appear in cognitive-behavioral models as a maintaining factor. Rituals are also common in obsessive-compulsive disorder (OCD). In contrast to OCD, the proposed associations between rituals and intrusive thoughts/appearance preoccupation have not been empirically inve...

As part of a larger clinical trial, this ecological momentary assessment (EMA) study pursued the main goal of demonstrating that the EMA method is sensitive to treatment effects of detached mindfulness (DM) and cognitive restructuring (CR) for obsessive‐compulsive disorder (OCD). A second goal was to provide a descriptive analysis of OCD symptoms a...

Interpretation biases are suggested to be transdiagnostic phenomenona, but have rarely been compared across disorders and current concerns. We investigated explicit, decision-based and implicit, reaction time-based interpretation bias in body dysmorphic disorder (BDD; N = 29), social anxiety disorder (SAD; N = 36), generalized anxiety disorder (GAD...

Background Childhood maltreatment is a leading environmental risk factor for an unfavourable course of disease in major depressive disorder. Both maltreatment and major depressive disorder are associated with similar brain structural alterations suggesting that brain structural changes could mediate the adverse influence of maltreatment on clinical...

Objective Whereas research has demonstrated the efficacy of cognitive restructuring (CR) for obsessive-compulsive disorder (OCD), little is known about the efficacy of specific metacognitive interventions such as detached mindfulness (DM). Therefore, this study compared the efficacy of CR and DM as stand-alone interventions. Design We conducted a...

Adherence and competence ratings (DM). This Excel data set contains all adherence and competence ratings for the detached mindfulness condition. (XLSX)

CONSORT checklist. This checklist gives information on how this publication complies with the CONSORT guidelines. (DOC)

Adherence and competence ratings (CR). This Excel data set contains all adherence and competence ratings for the cognitive restructuring condition. (XLSX)

Study protocol (Original). This document includes the original German study protocol that was approved of by the ethics committee. (DOCX)

Study protocol (English translation). This document includes the English translation of the original German study protocol that was approved of by the ethics committee. (DOCX)

Main data set. This Excel data set contains data on all variables relevant for the results reported in this publication. (XLSX)

The role of OCD-specific metacognitions (thought fusion beliefs, beliefs about rituals, beliefs about stop signals) has been accentuated in Wells’ (2001) Metacognitive Model. This study aimed at investigating the applicability of the model in OCD symptom dimensions. Participants completed a web-based survey comprising multiple questionnaires to ass...

Background: Neurobiological studies implicate the amygdala and related limbic/paralimbic structures, such as the ventromedial prefrontal cortex (VMPFC), in anger and aggression. Previous studies of self-generated anger using Positron Emission Tomography (PET) have consistently documented a lack of amygdala activation during anger. Objective: We inv...

Prior research has not yet investigated the prevalence of body dysmorphic disorder (BDD) in adolescents and young adults based on criteria from the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5). In the current study, the point prevalence of BDD, comorbid symptoms, and associated features, such as appearance-related su...

Objective The present meta-analysis investigates whether the antibiotic D-cycloserine (DCS), a partial agonist at the glutamatergic N-methyl-D-aspartate receptor, can augment the effect of behavior therapy in humans with anxiety and obsessive-compulsive disorders. Method A keyword-based computer search was conducted using common electronic databas...

Appendix. (PDF)

Individuals with body dysmorphic disorder (BDD) and obsessive–compulsive disorder (OCD) are categorized within the same major diagnostic group and both show regional brain hyperactivity in the orbitofrontal cortex (OFC) and the basal ganglia during symptom provocation. While recent studies revealed that degree connectivity of these areas is abnorma...

Body dysmorphic disorder (BDD) is characterized by preoccupation with perceived flaws in one's own appearance. Several risk factors such as aesthetic perceptual sensitivity have been proposed to explain BDD's unique symptomatology. Although research on facial discrimination is limited so far, the few existing studies have produced mixed results. Th...

Background: Social anxiety disorder (SAD) and body dysmorphic disorder (BDD) are characterized by fears of negative evaluation by others (related to one's own incompetence or flawed appearance, respectively). Previous research has shown that individuals with SAD and BDD exhibit difficulty identifying facial expressions and interpretive biases for...

Lack of insight and delusional thinking are hallmarks of a series of psychological disorders such as psychotic disorders and body dysmorphic disorder (BDD). The purpose of the present study was to evaluate the German version of the clinician-administered Brown Assessment of Beliefs Scale (BABS; Eisen et al., 1998), which consists of 7 items assessi...

Overactive performance monitoring, indexed by greater error-related brain activity, has been frequently observed in individuals with obsessive-compulsive disorder (OCD). Similar alterations have been found in individuals with major depressive and generalized anxiety disorders. The main objective was to extend these findings by investigating perform...

In this study, we investigated the specificity of implicit-shame associations across individuals diagnosed with body dysmorphic disorder (n = 30), obsessive-compulsive disorder (n = 30), and social anxiety disorder (n = 29) and individuals in a mentally healthy control group (n = 33). All participants completed a series of Implicit Association Test...

There are few effective treatments for body dysmorphic disorder (BDD) and a pressing need to develop such treatments. We examined the feasibility, acceptability, and efficacy of a manualized modular cognitive-behavioral therapy for BDD (CBT-BDD). CBT-BDD utilizes core elements relevant to all BDD patients (e.g., exposure, response prevention, perce...

Cognitive-behavioral models of body dysmorphic disorder (BDD) suggest the disorder is characterized by several interpretive, attentional, and perceptual biases that contribute to its maintenance or even development. In addition, the role of aesthetic sensitivity has been discussed in BDD. However, previous research examining the ability to identify...

Charakteristisch fur die korperdysmorphe Storung (KDS) ist eine ubermasige Beschaftigung mit einem wahrgenommenen Makel oder Defekt im korperlichen Aussehen (z. B. Hautunreinheiten, Falten, Asymmetrien im Gesichtsbereich), die mit einer signifikanten Beeintrachtigung im sozialen und/oder beruflichen Leben einhergeht. Menschen, die an einer KDS leid...

Eine Reihe psychischer Störungen wird im Hinblick auf den DSM-5 aufgrund ihrer Ähnlichkeit, aber auch in Abgrenzung zur Zwangsstörung, als so genannte Zwangsspektrumsstörungen diskutiert. Im Speziellen wird die Einführung einer separaten Kategorie Zwangs- und verwandte Störungen diskutiert, der sowohl die Zwangsstörung als auch Zwangsspektrumsstöru...

Hauptmerkmal der korperdysmorphen Storung (KDS) ist eine ubermasige Beschaftigung mit einem wahrgenommenen Makel oder Defekt im korperlichen Aussehen (z. B. ausdunnendes Haar, Falten, Grose oder Form der Nase), was zu signifikanten Beeintrachtigungen in sozialen oder beruflichen Lebensbereichen fuhrt. Besteht eine leichte korperliche Anomalie, ist...

In this paper we present an assessment method designed to detect specific individual severity profiles of obsessive–compulsive areas of dysfunction. This method is based on the Obsessive Compulsive Symptoms Rating Scale (OCSRS; Wilhelm and Steketee 2006), a comprehensive self-report instrument that measures the severity of a wide variety of symptom...

Individuals with body dysmorphic disorder (BDD) are excessively concerned about perceived defects in their appearance (e.g., blemishes on their skin). BDD is a severe mental disorder often associated with increased suicidality as well as significant social and occupational interference (e.g., J Clin Psychiatry 2005;66:717-725). Recently, investigat...

Individuals with Body Dysmorphic Disorder (BDD) have distressing or impairing preoccupations with imagined or slight defects in their appearance (e.g., nose too big). BDD is a severe psychiatric disorder often associated with high rates of suicidality as well as social and occupational impairment (Phillips, Coles et al., 2005). Researchers have onl...

Individuals with body dysmorphic disorder (BDD) are excessively concerned about imagined or slight defects in their appearance (e.g., asymmetrical facial features). Cognitive-behavioral models of BDD propose that several factors, including dysfunctional appearance-related beliefs and life experiences, such as teasing, contribute to the avoidance be...

Individuals with body dysmorphic disorder (BDD) are characterized by excessive concerns about perceived defects or flaws in their appearance, most commonly, facial features. Previous research has shown that BDD sufferers, relative to mentally healthy controls, are characterized by emotion recognition deficits (particularly a bias to misinterpret ne...

Cognitive-behavioral models of body dysmorphic disorder (BDD) suggest the disorder is characterized by exaggerated beliefs about the significance of appearance. However, previous studies assessing automatic associations regarding the importance of attractiveness failed to find any differences between individuals with BDD and healthy control partici...

Despite increased awareness of body dysmorphic disorder (BDD) during the past two decades, it is still a relatively unknown and understudied disorder. Its hallmark is a preoccupation with perceived defects or flaws in one's own appearance, often tied to the face (eg, nose, skin). BDD sufferers often think about their appearance "flaws" for up to se...

Body dysmorphic disorder (BDD) is characterized by perceived defects in one's appearance, accompanied by severe distress and interference in the person's life. To date, mental health care for BDD is still in the early phases of development, and although recent research on psychotropic medication and cognitive-behavioral therapy has been promising (...

Although body dysmorphic disorder (BDD) has been described in the literature for more than a century, there has been only a limited focus on the development of cognitive behavioral treatments for BDD. Our case report provides a detailed description of a course of cognitive behavioral treatment (CBT) for an individual with BDD. The patient was treat...

Body dysmorphic disorder (BDD) is characterised by a preoccupation with perceived defects in one's appearance, which leads to significant distress and/or impairment. Although several studies have investigated the prevalence of BDD, many studies have methodological limitations (e.g., small sample sizes and student populations), and studies on the pr...

Evidence suggests that the antibiotic d-cycloserine (DCS) enhances the treatment effects of exposure and response prevention (ERP) for Obsessive-Compulsive Disorder (OCD). Further, evidence suggests that the effects of DCS diminish partway through treatment, but it is unclear to what extent. In an effort to evaluate these issues, the current study...

The current study examined the efficacy of cognitive therapy (CT) in reducing symptoms of obsessive-compulsive disorder (OCD). Twenty-nine individuals with OCD were assigned according to therapist availability to a 12-week wait period or the immediate start of 22 sessions (over 24 weeks) of flexible, modular CT. After 12 weeks of treatment, the CT...

ZusammenfassungHintergrund: Die Körperdysmorphe Störung (KDS) zeichnet sich durch eine übermäßig starke Beschäftigung mit eingebildeten oder leichten Makeln oder Defekten in der körperlichen Erscheinung aus. Es gibt bislang wenig deutschsprachige Erhebungsinstrumente zur Erfassung der KDS. Aus diesem Grund war das Ziel der vorliegenden Studie, eine...

Body dysmorphic disorder (BDD) is characterized by imagined or slight defects in one's appearance. We evaluated implicit and explicit biases among individuals diagnosed with BDD (n=21), individuals with subclinical BDD symptoms (n=21), and healthy control participants (n=21). Specifically, we used the Implicit Association Test [IAT; Greenwald, A. G...