Most work on the psychobiology of body dysmorphic disorder (BDD) has focused on “proximal” mechanisms: the possible cognitive-affective processes, neuronal circuitry, and genetic variants involved in underpinnings of this disorder. Evolutionary medicine has, however, emphasized that a comprehensive biologic approach to medical and psychiatric disorders should also address “distal” mechanisms. These are the adaptive processes that have underpinned phylogeny and ontogeny, and that are therefore relevant to a comprehensive understanding of biologic states and traits. Evolutionary accounts of disease have emphasized constructs such as co-evolution, constraints, defenses, mismatch, reproductive success, and tradeoffs. This chapter discusses how concepts from evolutionary theory may be useful in developing a more comprehensive model of BDD, and how this may in turn be useful for guiding aspects of clinical assessment and intervention.
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