Personality traits and disorders in people with body dysmorphic disorder (BDD): A systematic review

Body dysmorphic disorder (BDD) consists of distressing or impairing preoccupation with non-existent or slight defects in one's physical appearance. It is accompanied by repetitive behaviours (i.e., rituals, compulsions) such as reassurance-seeking as well as social avoidance due to fear of being seen or negatively judged by others. BDD often co-occurs with other psychiatric disorders, and some of the symptoms of BDD can be difficult to differentiate from characteristics of certain personality disorders (PDs). This can contribute to misdiagnosis of BDD, which has important treatment implications. This review sought to synthesise the evidence on personality traits and disorders in people with BDD. Data from 26 studies was synthesised, including assessments of 1382 participants with a current diagnosis of BDD (912 female, 470 male). Individuals with BDD were found to report low self-esteem, high levels of shame and rejection sensitivity, significant interpersonal problems, and social inhibition. The most common comorbid PD reported was avoidant PD, followed by obsessive-compulsive PD. Future studies are needed to understand the manner in which personality factors contribute to the aetiology and maintenance of BDD, particularly their influence on treatment-seeking and potential obfuscation of a diagnosis of BDD.