The Impact of Bullying on Body Dysmorphic Disorder: A Systematic Review and Meta-Analysis

Bullying has been considered a substantial risk factor toward various psychological disorders such as dissatisfaction with body image and body dysmorphic symptoms. This meta-analysis examines the strength and the nature of association between these aforementioned variables and its mental health consequences. A systematic review and meta-analysis were conducted on examining association between bullying and body dysmorphic symptoms, body image dissatisfaction, psychological distress, and self-esteem. Effect sizes were calculated using Hedges' g and pooled odds ratios (OR) under a random-effects model. Moderators and heterogeneity were explored using moderator analysis and meta-regression. The subgroup analyses (Cross-sectional versus Longitudinal Study Design) were carried out to determine the difference between study types. The meta-essentials excel workbook dichotomous (binary) was used to estimate Ors conduct meta-analysis. The forest and funnel plots were plotted to determine the statistical significance. The review of 38 Studies that explore the relationship between these variables at different time points to illustrate the effects on overall body dissatisfaction, low self-esteem, psychological distress, anxiety, depression, and suicidal ideation. Gender differences demonstrated that female participants were found more vulnerable to body dissatisfaction and eating disorders than male who were more likely to have anxiety regarding muscularity and strength. Five studies assessing body dysmorphic disorder (BDD) revealed a pooled OR of 6.30 (95% CI [2.25, 17.62], I² = 55.35% p < 0.001), indicating a significantly increased likelihood of body dysmorphic symptoms among bullied adolescents, but significant heterogeneity among studies (cross-sectional studies I² = 0.00%; longitudinal studies I² = 86.17%). The high heterogeneity in longitudinal studies is due to differential diagnosis methods and small number of studies (k = 2). Furthermore, body image dissatisfaction also showed a significant negative association with bullying exposure (g = -1.38, 95% CI [-1.54, -1.23], p < 0.001). Similar patterns were observed with secondary outcomes with bullying attributing to psychological distress (g = -1.24) and lower self-esteem (g = -1.12). Considerable moderators were the study design, setting, and type of bullying, with cyberbullying and appearance-specific bullying having the greatest effects. Younger age of adolescent was found to be predictive of large effect sizes by meta-regression, as well as high quality of study. The sensitivity analysis supported the strength of the results, and the adjusted estimates showed that no publication bias (Egger regression test estimate = 4.96, p = 0.471; Trim and Fill method, p-value = 0 missing study; Begg and Mazumdar test, p-value = 1.00). Physical appearance and cyberbullying impact the body dysmorphic symptoms development negatively, body image dissatisfaction, psychological distress, and self-esteem. Bullying and body dysmorphic disorder are also found associated. The absence of publication bias suggests the results were valid and reliable, but meta-analysis findings are based on inclusion of a small number of longitudinal studies and majorly from cross-sectional studies. To maintain diagnosis consistency and methodological robustness in evidence synthesis, future researchers should undertake more longitudinal cohort studies utilizing standardized or validated BDD diagnosis scales. Although qualitative (systematic) synthesis shows a temporal relationship between bullying and BDD, but cross-sectional research-based evidence unable to determine the causal relationship. Future longitudinal or randomized controlled studies are encouraged to confirm and generalize findings.