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 multidimensional, contextually embedded, and dynamic factor using ecological momentary assessment (EMA), further assessing affect and self-esteem as potentially associated states. Thirty individuals with BDD and 30 mentally healthy controls (HCs) completed 6 days of EMA (M = 8.54 assessments per day, N = 3075 assessments in total). Multilevel analyses revealed substantial intraindividual fluctuations of insight dimensions (across 30 min to hours) that were more pronounced for individuals with BDD than for HCs. Poorer insight correlated with higher negative affect, lower positive affect, and lower self-esteem at concurrent time points in the BDD group. Considering all predictors at the same time point, poorer insight was characterized by lower self-esteem and, partly, negative affect in the BDD group. Across time, self-esteem and insight influenced each other reciprocally, with comparatively stronger effects for the prediction of poorer insight by previously lower self-esteem. These findings demonstrate that insight is a highly variable phenomenon in BDD, further suggesting a clinically and etiologically relevant link between self-esteem and insight in symptom maintenance. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

中文翻译：

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身体变形障碍洞察力的时间动态：生态瞬时评估研究。

患有躯体变形障碍 (BDD) 的个体通常缺乏对他们感知到的轻微外观缺陷的本质的洞察力，如果它们存在的话。尽管普遍认为 BDD 患者的洞察力会随着时间的推移而波动，但其时间不稳定性和相关特征仍未得到研究。我们使用生态瞬时评估 (EMA) 将洞察力作为多维、上下文嵌入和动态因素进行了研究，进一步评估了作为潜在关联状态的情感和自尊。30 名 BDD 患者和 30 名心理健康对照者 (HC) 完成了 6 天的 EMA（M = 每天 8.54 次评估，N = 总共 3075 次评估）。多层次分析揭示了洞察力维度（跨越 30 分钟到数小时）的大量个体内部波动，这对于 BDD 个体比对于 HC 个体更为明显。在 BDD 组的同时时间点，较差的洞察力与较高的负面影响、较低的积极影响和较低的自尊相关。考虑到同一时间点的所有预测因素，在 BDD 组中，洞察力较差的特点是自尊心较低，部分是负面影响。随着时间的推移，自尊和洞察力相互影响，对于以前较低的自尊对较差洞察力的预测效果相对更强。这些发现表明，洞察力在 BDD 中是一种高度可变的现象，进一步表明自尊与症状维持中的洞察力之间存在临床和病因学相关的联系。