# The Relationship Between Body Dysmorphic Symptoms, Depressive Symptoms and Suicidality – A Mediation Analysis

## TL;DR

This study finds that body dysmorphic disorder symptoms are directly linked to suicidality, even when depression is accounted for.

## Contribution

The study reveals that BDD symptoms contribute to suicidality independently of depressive symptoms.

## Key findings

- BDD symptoms are directly associated with increased suicidality.
- Depressive symptoms only partially explain the link between BDD and suicidality.
- More severe BDD symptoms predict higher levels of depression.

## Abstract

Body dysmorphic disorder (BDD) is characterized by an excessive preoccupation with perceived appearance flaws, often accompanied by repetitive behaviors such as frequent mirror checking. It is further associated with severe occupational and social impairments, depression, and high levels of suicidality, including suicidal thoughts, suicide attempts and completed suicide. Given the high rates of depression and suicidality found in BDD, this study aimed to examine whether BDD symptoms may also be directly linked to suicidality, independent of depressive symptoms.

A mediation analysis was conducted to investigate the relationships between BDD symptoms, depression, and suicidality. Cross-sectional data were collected through an online self-test for BDD, assessing BDD symptoms, depression and suicidality. A total of 1,256 participants (aged 18–71; 72% female) met DSM-5 criteria for BDD (based on self-report).

Depressive symptoms partially mediated the relationship between BDD symptoms and suicidality. However, a direct association between BDD symptoms and suicidality was also observed, indicating that suicidality in individuals with BDD is not solely attributable to comorbid depressive symptoms.

The findings underscore the need for thorough suicidality assessments in individuals with BDD, regardless of the presence of depressive symptoms. This further highlights the importance of targeted interventions to address suicidality in this population.

BDD is associated with high suicidality.More severe BDD symptoms predict higher levels of depression.Depressive symptoms can only partly explain the relationship between BDD symptoms and suicidality.BDD symptoms directly contribute to increased suicidality after controlling for depressive symptoms.

BDD is associated with high suicidality.

More severe BDD symptoms predict higher levels of depression.

Depressive symptoms can only partly explain the relationship between BDD symptoms and suicidality.

BDD symptoms directly contribute to increased suicidality after controlling for depressive symptoms.