Thompson, Freddie; (2025) What’s Love Got To Do With It: Body Dysmorphic Disorder and Romantic Relationships. Doctoral thesis (D.Clin.Psy), UCL (University College London).

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Abstract

BACKGROUND: Body Dysmorphic Disorder (BDD) is a distressing condition that is associated with marked impairment in functioning, including in family life, friendship and romantic relationships. Understanding the lived experience of BDD from multiple perspectives has important theoretical and clinical implications. The current review aimed to provide a comprehensive and up-to-date synthesis of the qualitative literature exploring the lived experience of individuals with BDD from the perspective of either the sufferers themselves or their significant others. METHODS: Seven databases were searched (PsycINFO, Medline, Web of Science, CINAHL, Scopus, Eric (Ebsco) and ProQuest). Papers were eligible for the review if they included first-hand accounts of the lived experience of BDD from the person with BDD or a significant other, adopted a qualitative or mixed-methods design, and were written in English. The National Institute for Health and Care Excellence (NICE, 2012) quality appraisal tool was used to measure the quality of the included studies. Thematic synthesis was used to analyse data across studies and identify descriptive and analytic themes. RESULTS: The searches identified 4,178 records, of which 16 studies were identified as being eligible for inclusion. Almost all were rated as high quality. Overall, 162 participants contributed data towards the review, of whom the vast majority were individuals with BDD and only 5 were significant others. We identified four themes, including (1) ‘BDD is a consuming, restrictive and distressing experience’, (2) ‘BDD erodes your identity and sense of self’, (3) ‘Relational pain and barriers to connection’, and (4) ‘Acceptance, support and recovery.’ Studies consistently highlighted the distressing nature of the BDD experience, and the crucial role that others can play in the development, maintenance and recovery from BDD. Findings also shed light on differences and similarities between experiences of muscle dysmorphia and other forms of BDD. CONCLUSIONS: Our review highlights the relevance of the cognitive behavioural model of BDD (Veale, 2001) in explaining how different components of BDD interact in a vicious cycle that affects daily functioning and relationships. Objectification Theory (Fredrickson & Roberts, 1997) helps explain how appearance can become central to identity in cultures that overvalue the physical self. Intersectionality (Crenshaw, 1989) is a useful concept to understand how overlapping identities shape appearance-related concerns. Given the central role of relationships in the development, maintenance, and recovery of BDD, future research and treatment should more directly address relational factors.

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