Pattison, Laura; (2024) Body dysmorphic disorder and its associations with shame, adverse childhood experiences, and self-compassion. Doctoral thesis (D.Clin.Psy), UCL (University College London).

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Abstract

Background: Body dysmorphic disorder (BDD) and its subtype, muscle dysmorphic disorder (MDD), are relatively common and impairing conditions. Previous systematic reviews have indicated a possible association of body image difficulties with gender and sexual minority status. However, no systematic review to date has explored the relationship between BDD/MDD and gender or sexual identity. Aims: We aimed to determine whether BDD/MDD symptoms were more common in gender and sexual minority groups compared with cisgendered and heterosexual people. Methods: We synthesised the current literature using systematic review methodology. PsycINFO, PubMed, ProQuest Psychology Database, and MEDLINE were systematically searched from inception to October 2023, using relevant keywords. The search identified 12 studies meeting inclusion criteria. The Newcastle-Ottawa Scale was used to assess their methodological quality. Results: Results indicated a tentative, positive association between minoritised sexual orientation and BDD, though this was not consistent across studies and effect sizes were small. Most studies found no significant associations between sexual orientation and MDD symptoms. With respect to gender, there was evidence that BDD symptoms are more common among individuals who identify as female, transgender or nonbinary, compared to males. In contrast, MDD symptoms were generally found to be highest in cisgender men, with some evidence to suggest that transgender and nonbinary individuals have comparable difficulties with certain symptoms such as appearance intolerance and drive for size. Conclusions: BDD may be associated with minority sexual orientation, or with female or minoritised gender. MDD may be associated with male gender but not sexuality; muscle-related appearance intolerance may also be elevated in transgender or nonbinary people. However, results must be interpreted with caution due to the small number of eligible studies and variability in both research quality and operationalisation of variables between studies. There is a need for future research to further examine these associations and any underlying mechanisms of association.

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