The cross-sectional relationship between body dysmorphic disorder and perfectionism: a meta-analysis

Perfectionism has been theoretically implicated in the development and maintenance of body dysmorphic disorder (BDD), but a quantitative synthesis of its cross-sectional relationship with BDD symptom severity is lacking. The present meta-analysis therefore examines the strength and consistency of this relationship across existing studies. A random-effects meta-analysis of 34 studies comprising a total of 13 107 participants was conducted. Studies were included if they assessed BDD symptoms and perfectionism using validated instruments. Subgroup analyses were used to examine perfectionism dimensions, sample characteristics, and diagnostic subtypes. Partial correlations controlling for depression were examined. The results revealed a moderate and statistically significant correlation between BDD symptoms and perfectionism (r = .32, 95% CI [0.28, 0.36]). The association remained stable across age groups, sample types, and genders, and was comparable in individuals with muscle dysmorphia (r = .34). A separate meta-analysis focusing on individuals with elevated BDD symptoms yielded a comparable effect size (r = .35, 95% CI [0.22, 0.47]). Controlling for depressive symptoms attenuated the relationship, indicating that part of the association may be attributable to shared depressive symptomatology. Significant heterogeneity (I² = 81%) and evidence of publication bias were detected, although the findings were comparable across several sensitivity analyses. The results highlight the relevance of both perfectionistic concerns and perfectionistic strivings as correlates of BDD-related distress and support its consideration within transdiagnostic models. The protocol for this meta-analysis was pre-registered on PROSPERO (Preregistration ID: CRD42024551099).