Department of Psychology and Sport Science, University of Münster, Münster, North Rhine-Westphalia, Germany.
Cluster of Excellence SimTech, University of Stuttgart, Stuttgart, Baden-Württemberg, Germany.
BMC Psychiatry. 2021 Jun 15;21(1):310. doi: 10.1186/s12888-021-03185-3.
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.
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.
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.
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.
体像障碍（BDD）与低自尊有关。本研究的目的是检验 BDD 症状严重程度与 BDD 患者、心理健康对照者、社区或学生样本以及整容手术患者的整体自尊之间的横断面关系的强度。此外，还研究了抑郁症状严重程度在这种关系中的作用以及其他调节因素。
通过关键词搜索，确定了评估 BDD 症状和整体自尊的研究。对 Fisher z 转换相关系数进行随机效应荟萃分析，并对抑郁症状严重程度的影响进行偏相关分析。除了对观察到的效应进行荟萃分析外，我们还纠正了个体相关性，以解决样本间 BDD 症状严重程度的差异范围。
共纳入 25 项研究，总计 6278 名参与者。发现 BDD 症状严重程度与整体自尊之间存在中度负相关（未校正相关系数 r = -.42，CI [-.48，-.35]，校正后的相关系数 r = -.45，CI [-.51，-.39]）。偏相关分析的荟萃分析表明，抑郁症状严重程度可以部分解释上述关系（未校正偏相关系数 pr = -.20，CI [-.25，-.15]，校正后的偏相关系数 pr = -.23，CI [-.28，-.17]）。样本类型（如 BDD 患者、心理健康对照者或社区样本）和 BDD 的诊断似乎仅在未校正效应量的荟萃分析中调节这种关系，而在校正后的荟萃分析中，所有调节因素均不显著。
研究结果表明，低自尊是 BDD 的一个重要特征，不受抑郁症状的影响。BDD 中的负面评价不仅限于外表，还延伸到自我的其他领域。总之，我们的研究结果强调了在预防和治疗 BDD 中重视自尊和相应核心信念的重要性。
