Direct and Indirect Effects of Body Dysmorphic Concern on Psychotic Symptoms Through Suicidal Ideation in Patients With First‐Episode Schizophrenia

BACKGROUND: Body dysmorphic concerns (BDC) are closely connected to the severity of psychotic symptoms in people diagnosed with schizophrenia. At the same time, there is evidence suggesting that BDC is related to alarmingly increased rates of suicidality, and suicidality is a predictor of increased psychotic symptoms. Investigating these pathways may provide insight into the complex interaction between psychopathology and psychotic symptoms, and inform future intervention strategies. Using a clinical sample of outpatients with first-episode schizophrenia and a non-clinical sample of healthy adults, the objectives of this study were twofold: (1) to explore the nature and prevalence of BDC symptoms in both samples and (2) to examine the mediating influence of suicidal thoughts on the association between BDC and psychotic symptoms in the patients' sample. METHODS: The research was cross-sectional, performed over a period of 6 months, from 1 July 2024 to 31 December 2024. Our target population consisted of two groups: (1) a group of clinically-stable outpatients recruited at the first episode of schizophrenia and who have less than 3 months of lifetime exposure to antipsychotic medication and (2) a group of healthy controls. A total of 103 patients and 109 controls were included for final analysis. RESULTS: Our results indicated that patients were at higher risk for experiencing body dysmorphic disorder (41.7%) than controls (16.5%). Mediation analysis showed that the effect of BDC on psychotic symptoms severity was partially mediated by suicidal ideation (indirect effect: Beta = 0.281; Boot SE = 0.122; Boot CI 0.034; 0.520). On one hand, BDC directly correlated with greater levels of psychotic symptoms. On the other hand, dysmorphic concerns significantly correlated with more suicidality, which was, in turn, correlated with more intense psychotic symptoms. CONCLUSION: Our findings suggest that the improvement of BDC symptoms coupled with suicide risk assessment and intervention should be integrated into strategies designed to aid the management of psychotic symptoms in schizophrenia.