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 stu...

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Main Authors: Nora Kuck, Lara Cafitz, Paul-Christian Bürkner, Laura Hoppen, Sabine Wilhelm, Ulrike Buhlmann
Format: Article
Language:English
Published: BMC 2021-06-01
Series:BMC Psychiatry
Subjects:
Online Access:https://doi.org/10.1186/s12888-021-03185-3
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author Nora Kuck
Lara Cafitz
Paul-Christian Bürkner
Laura Hoppen
Sabine Wilhelm
Ulrike Buhlmann
author_facet Nora Kuck
Lara Cafitz
Paul-Christian Bürkner
Laura Hoppen
Sabine Wilhelm
Ulrike Buhlmann
author_sort Nora Kuck
collection DOAJ
description 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.
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spelling doaj.art-46fe80a0abe84a73bf8bc568834ef6842022-12-21T19:16:01ZengBMCBMC Psychiatry1471-244X2021-06-0121111610.1186/s12888-021-03185-3Body dysmorphic disorder and self-esteem: a meta-analysisNora Kuck0Lara Cafitz1Paul-Christian Bürkner2Laura Hoppen3Sabine Wilhelm4Ulrike Buhlmann5Department of Psychology and Sport Science, University of MünsterDepartment of Psychology and Sport Science, University of MünsterCluster of Excellence SimTech, University of StuttgartDepartment of Psychology and Sport Science, University of MünsterDepartment of Psychiatry, Massachusetts General Hospital / Harvard Medical SchoolDepartment of Psychology and Sport Science, University of MünsterAbstract 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.https://doi.org/10.1186/s12888-021-03185-3Body dysmorphic disorderBody imageSelf-esteemAppearance concernsMeta-analysis
spellingShingle Nora Kuck
Lara Cafitz
Paul-Christian Bürkner
Laura Hoppen
Sabine Wilhelm
Ulrike Buhlmann
Body dysmorphic disorder and self-esteem: a meta-analysis
BMC Psychiatry
Body dysmorphic disorder
Body image
Self-esteem
Appearance concerns
Meta-analysis
title Body dysmorphic disorder and self-esteem: a meta-analysis
title_full Body dysmorphic disorder and self-esteem: a meta-analysis
title_fullStr Body dysmorphic disorder and self-esteem: a meta-analysis
title_full_unstemmed Body dysmorphic disorder and self-esteem: a meta-analysis
title_short Body dysmorphic disorder and self-esteem: a meta-analysis
title_sort body dysmorphic disorder and self esteem a meta analysis
topic Body dysmorphic disorder
Body image
Self-esteem
Appearance concerns
Meta-analysis
url https://doi.org/10.1186/s12888-021-03185-3
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