Abstract
BACKGROUND: Real world studies and psychological literature often do not consolidate existing data with theoretical models on body dysmorphic disorder (BDD). OBJECTIVE: This systematic review aims to refine and empirically support the conceptual understanding of BDD through an updated theoretical framework. METHODS: We systematically searched PubMed, Embase, CENTRAL, Scopus, and Web of Science from database inception to 26 November 2023 for studies reporting factors predisposing or associated with a diagnostic and statistical manual of mental disorders IV/V confirmed diagnosis of BDD. Data analysis was performed qualitatively or via random effects meta-analysis, followed by a critical appraisal and integration with existing theories. RESULTS: Twenty four studies comprising 961 BDD patients and 230,076 healthy controls were analyzed. Marriage is a protective factor (pooled risk ratio 0.67, P = .004) not well-explored in current literature. Factors including teasing, physical and sexual abuse, higher explicit beliefs about attractiveness, lower self-esteem, psychological conditions were not pooled due to heterogeneity. These findings are consistent with cognitive behavioral models of BDD and were integrated to create an updated theoretical framework, while highlighting evidence gaps. CONCLUSION: Understanding and recognizing patients with BDD is important as successful therapies need to correct the underlying psychological component. Further research should explore relationships between cognitive and behavioral aspects of BDD.