Background: Vitiligo is a common skin disorder characterized by the loss of skin pigment, which can significantly impact individuals' health-related quality of life (HRQoL), particularly in women. Body dysmorphic disorder (BDD) and depressive symptoms are common psychological comorbidities associated with vitiligo. Objectives: This study aimed to investigate the relationship between BDD, depressive symptoms, and HRQoL in women with vitiligo. Methods: A cross-sectional study was conducted in Ahvaz, Iran, in 2023, involving a sample of 152 women with vitiligo. The study population included all women with vitiligo who presented to dermatology or cosmetic clinics in Ahvaz during that year. Data were collected using the MOS 36-item Short-Form Health Survey (SF-36), the Multidimensional Body-Self Relations Questionnaire (MBSRQ), and the Beck Depression Inventory (BDI). Pearson's correlation and regression analyses were used to assess the relationships between variables. Data analysis was conducted using SPSS-27 software. Results: Women with vitiligo had a mean health-related quality of life score of (58.13 ± 11.50). Their mean score on the body dysmorphic disorder assessment was (99.61 ± 37.33), and the mean depressive symptom score was (20.25 ± 4.47). Significant negative correlations were found between BDD and HRQoL, as well as between depressive symptoms and HRQoL, in women with vitiligo (P < 0.001). Multiple regression analysis showed that BDD and depressive symptoms independently predicted HRQoL (P < 0.001). Conclusions: Body dysmorphic disorder and depressive symptoms are significantly associated with impaired HRQoL in women with vitiligo. Screening for and treating BDD and depressive symptoms may improve HRQoL in this population.