Body dysmorphic disorder and self-esteem: a meta-analysis

Abstract

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 role of depressive symptom severity in this relationship and other moderating factors were investigated. Methods A keyword-based literature search was performed to identify studies in which BDD symptoms and global self-esteem were assessed. Random effects meta-analysis of Fisher’s z-transformed correlations and partial correlations controlling for the influence of depressive symptom severity was conducted. In addition to meta-analysis of the observed effects, we corrected the individual correlations for variance restrictions to address varying ranges of BDD symptom severity across samples. Results Twenty-five studies with a total of 6278 participants were included. A moderately negative relationship between BDD symptom severity and global self-esteem was found (r = −.42, CI = [−.48, −.35] for uncorrected correlations, r = −.45, CI = [−.51, −.39] for artifact-corrected correlations). A meta-analysis of partial correlations revealed that depressive symptom severity could partly account for the aforementioned relationship (pr = −.20, CI = [−.25, −.15] for uncorrected partial correlations, pr = −.23, CI = [−.28, −.17] for artifact-corrected partial correlations). The sample type (e.g., individuals with BDD, mentally healthy controls, or community samples) and diagnosis of BDD appeared to moderate the relationship only before artifact correction of effect sizes, whereas all moderators were non-significant in the meta-analysis of artifact-corrected correlations. Conclusions The findings demonstrate that low self-esteem is an important hallmark of BDD beyond the influence of depressive symptoms. It appears that negative evaluation in BDD is not limited to appearance but also extends to other domains of the self. Altogether, our findings emphasize the importance of addressing self-esteem and corresponding core beliefs in prevention and treatment of BDD.

Personality, self-appraisals, and body conscious emotions as predictors of symptoms of body dysmorphia and restrictive disordered eating

“…Moreover, sub-clinical body dysmorphia shared significantly stronger negative correlations with self-esteem and self-perceived attractiveness than sub-clinical restrictive disordered eating shared with self-esteem and self-perceived attractiveness. The negative correlations between both sub-clinical restrictive disordered eating and sub-clinical body dysmorphia and self-perceived attractiveness and self-esteem are consistent with research showing that both anorexia nervosa (Blechert et al, 2011), and body dysmorphic disorder (Kuck et al, 2021), relate to low levels of self-esteem. The positive correlation between sub-clinical restrictive disordered eating and BIS sensitivity is consistent with previous studies (du Rocher et al, 2021;Wilson et al, 2019), as is the positive correlation between sub-clinical body dysmorphia and BIS sensitivity (Schieber et al, 2013).…”

“…For example, body dysmorphic disorder relates to an underestimation of one's own attractiveness (relative to objective observers' ratings; Buhlmann, Etcoff, & Wilhelm, 2008), and anorexia nervosa relates to a belief that a lower body mass index (BMI) is more attractive (Tovee et al, 2000). Both anorexia nervosa (Blechert et al, 2011) and body dysmorphic disorder (Kuck et al, 2021) relate to low levels of self-esteem. Collectively, these studies on the perception of attractiveness and levels of self-esteem suggest that self-appraisals play an important role in the proposed body image disorders.…”

The Body Dysmorphic Disorder Questionnaire—Aesthetic Surgery: Are We Screening the Troublesome Patients?

“…The development of psychiatric conditions, such as BDD, can be influenced by low self-esteem. 35,36 Self-esteem usually increases with age. 36 Bjornsson et al examined the age of BDD's onset and found that individuals who developed BDD early in life had more severe BDD symptoms and a higher risk for other psychiatric conditions including borderline personality disorder, anxiety disorders, suicidal attempts, and psychiatric hospitalization.…”

A smartphone app for the prevention and early intervention of body dysmorphic disorder: Development and evaluation of the content, usability, and aesthetics

“…Across modules, AINA pursues the aim of fostering awareness of resources and (re-)defining and enhancing self-esteem. Relatedly, recent meta-analytic evidence revealed a moderately negative relationship between BDD symptoms and self-esteem and suggested that low self-esteem is an important hallmark of BDD beyond the influence of depressive symptoms ( Kuck et al, 2021 ). It seems that individuals with BDD build their self-esteem predominantly on their appearance.…”