Abstract
ObjectiveBody 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.MethodsA 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.ResultsTwenty-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.ConclusionsThe 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.
Highlights
Body dysmorphic disorder (BDD) is characterized by a preoccupation with perceived appearance defects and repetitive behaviors intended to hide, fix or check them
Twelve effect sizes were based on clinician-rated measures of BDD symptoms whereas 14 relied on self-report measures
Addressing self-esteem and corresponding core beliefs is of high importance in the treatment of BDD
Summary
Body dysmorphic disorder (BDD) is characterized by a preoccupation with perceived appearance defects and repetitive behaviors intended to hide, fix or check them. Affected individuals may excessively check their body areas of concern, seek reassurance, camouflage or groom, compare their own physical appearance to that of others, exercise to the point of injury, or even seek cosmetic surgery [1]. The question arises how strongly the negative evaluation in the domain of physical appearance in BDD is accompanied by general feelings of unworthiness and a low self-esteem. Data on self-esteem and BDD symptoms in cosmetic surgery settings have been collected (e.g., [14,15,16]). More pronounced BDD symptoms were related to lower self-esteem in these studies. Various authors assessed BDD symptoms and self-esteem but did not report effect sizes, and so far, no meta-analysis or review has systematically analyzed and integrated these studies
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