(PS7-C66) Associations of Sexual and Racial/ethnic Minority Status with Symptom Severity, Shame-proneness, Depression, and Suicide Risk in Body Dysmorphic Disorder

Background: Body dysmorphic disorder (BDD) is characterized by persistent concerns about physical appearance and affects individuals with a range of identities. According to the minority stress model (Meyer, 2003), individuals with one or more marginalized aspects of identity (e.g., members of sexual or racial/ethnic minority groups) are vulnerable to stress generated from prejudice-based events, expectations of rejection, internalized prejudice, and more. In the context of BDD, such stress may contribute to or exacerbate symptoms. Accordingly, the present study tested the hypothesis that sexual and racial/ethnic minority statuses in BDD would relate positively to BDD severity, general shame-proneness, depression severity, and lifetime suicide risk severity. Understanding these associations could inform strategies to reduce adverse and high-risk outcomes for minority individuals with BDD.

Method: Adults with a primary psychiatric diagnosis of BDD; moderate to severe BDD symptoms; and current alcohol use, cannabis use, and/or suicidal ideation (N = 84, 74% women) completed a demographics survey and measures of BDD severity, general shame-proneness, depression severity, and lifetime suicide risk severity as part of a broader study. Sexual minority individuals self-reported a sexual orientation other than heterosexual (n = 36, 43%); racial/ethnic minority individuals self-reported a racial/ethnic identity other than solely White and non-Hispanic (n = 33, 39%). We used multiple linear regressions to examine how sexual and racial/ethnic minority statuses related to BDD severity, general shame-proneness, and depression severity. We used ordinal and logistic regressions to examine how minority status variables related to severity of lifetime suicidal ideation and lifetime suicide attempt (yes/no), respectively. Age was included as a covariate in all regressions.

Results: Racial/ethnic minority individuals were over three times more likely to have made a lifetime suicide attempt compared to non-Hispanic, White individuals (OR = 3.18, 95% CI [1.20, 8.71], p = .021); racial/ethnic minority status was also marginally significantly related to severity of lifetime suicidal ideation (OR = 2.11, 95% CI [0.91,4.99], p = .08). All other associations of sexual and racial/ethnic minority status with outcomes studied were nonsignificant (ps > .27).

Conclusion: In this high-risk sample of adults with BDD plus substance use and/or suicidal ideation, levels of BDD severity, general shame-proneness, and depression severity were moderate to high regardless of sexual and racial/ethnic identity. Racial/ethnic minority individuals were significantly more likely to have made a prior suicide attempt and had lifetime suicidal ideation that was marginally significantly more severe than their majority counterparts. Results underscore the need to better understand the role that racial/ethnic minority stressors may play in elevating risk for suicide in BDD. Such understanding may help identify new strategies and enhance existing strategies to mitigate risk. Future research should also re-examine how sexual and racial/ethnic identity relate to the outcomes studied here in a sample more diverse in gender identity, race, and ethnicity.