Bridging Body Image Disturbance and Body Dysmorphic Disorder Symptoms: A Symptom Network Study Among University...

Body image disturbance (BID) and body dysmorphic disorder (BDD) are common among university students and may impair emotional, social, and academic functioning. However, symptom-level links between BID and body dysmorphic symptoms remain unclear, particularly in non-Western student populations. This study used network analysis to examine central and bridge symptoms connecting BID and BDD symptoms among Bangladeshi university students.

A cross-sectional survey was conducted among 1401 university students in Bangladesh. Participants completed the Body Image Disturbance Questionnaire (BIDQ; seven items) and the Body Dysmorphic Disorder Screener for DSM-5 (BDDS-5; 11 core symptom items). A Gaussian graphical model was estimated using EBICglasso with an ordinal correlation matrix computed using cor_auto. Node centrality, bridge centrality, and predictability were examined. Network stability was assessed using bootstrapping, and gender differences were evaluated using the Network Comparison Test.

The estimated network showed distinct but interconnected BIDQ and BDDS-5 symptom communities. The most central symptoms were comparing appearance with others, academic/professional impact, and feeling bad or miserable about appearance. Overall, the strongest bridge symptoms were academic/professional impact (bridge strength = 0.757), concern about a specific appearance feature (0.577), and interference with social life (0.442). The network showed acceptable stability (CS coefficient for node strength = 0.52). Global network strength did not differ significantly between males and females (7.86 vs. 8.13; p = 0.140), but network structure differed significantly (M = 0.230, p = 0.041). Among males, the strongest bridge symptoms were social/occupational impairment, academic/professional impact, and specific appearance concern; whereas specific appearance concern, social interference, trouble focusing due to appearance, and appearance-related emotional distress were for females.

This symptom-level network analysis highlights academic/professional impairment, specific appearance concern, and social interference as key links between BID and BDD symptoms. Findings may inform targeted, gender-sensitive interventions for university students and extend body image network research to a large Bangladeshi sample.