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Open research questions in Body Image and Dysmorphia Studies

53 unresolved questions extracted from the limitations and future-work sections of 1,013 Body Image and Dysmorphia Studies papers in our library. Each links back to the study that raised it.

What the literature leaves open

  • The findings of this study should be interpreted in light of several limitations, which also point toward important direc- tions for future research. First, the cross-sectional design precludes analysis of the Skindex-Mini’s responsiveness to change—a key attribute for a tool intended to monitor treatment efficacy over time. Longitudinal studies are urgently needed to establish the instrument’s sensitivity in detecting clinically meaningful improvements following pharmacological, surgical, or psychological interventions. Such studies would also enable the determination of minimal clinically important differences (MCID), further enhancing the utility of the Skindex-Mini as an outcome measure in both clinical practice and interventional research. Second, the sample was characterized by a high proportion of female respondents (81%), which may affect general- izability. Research consistently indicates that women tend to report higher HRQoL impairment and may differ in emotion regulation patterns and illness perception compared to men; thus, the psychometric performance observed here should be confirmed in more gender-balanced cohorts. Future validation studies should also prioritize recruitment of more diverse clinical populations, including community-based samples, patients managed exclusively in primary care settings (who may have milder disease), and those requiring hospitalization for severe dermatological conditions. Multi-center studies incor- porating these diverse care settings would substantially strengthen the generalizability of our findings. Third, as identified through our IRT analysis, the Skindex-Mini demonstrates reduced measurement precision at higher levels of impairment. This suggests that while the instrument is excellent for screening and detecting mild-to-moderate HRQoL burden, it may be less sensitive to changes among patients with severe impairment—an important consideration when using the scale to monitor treatment response in severely affected populations. Although the three items cover symptom, emotional, and activity-related aspects of burden, the ultra-brief format necessarily limits content breadth. Accordingly, the Skindex-Mini should not be interpreted as a fully comprehensive representation of dermatology-specific HRQoL; rather, it may be best understood as a brief indicator of dermatology-related burden, with particular sensitivity to emotional and interpersonal impairment. Future research might explore whether this lim- itation could be addressed through the addition of one or two carefully selected items designed to capture the specific experiences of patients with profound HRQoL impairment, while maintaining the ultra-brief nature of the instrument. A modular approach could be considered, wherein the core three-item Skindex-Mini is administered universally, with optional follow-up items triggered only for patients who screen positive, allowing for more detailed assessment without burdening all patients. Fourth, the hierarchical regression analysis was limited by a reduced effective sample size (N = 128 after listwise dele- tion) relative to the number of predictors (k = 14), resulting in a cases-to-predictors ratio of approximately 9:1. This raises concerns about statistical power and the stability of coefficient estimates. While multicollinearity was within acceptable limits (VIF range = 1.201–3.871) and model diagnostics were satisfactory, the risk of Type II errors cannot be excluded. Future studies with larger samples and lower rates of missing data are needed to confirm the independent predictors identified here. Finally, while the high negative predictive value of the Skindex-Mini makes it suitable for rapid clinical screening, its performance in multinational research contexts should continue to be evaluated to ensure cross-cultural comparability. Comparative studies across different linguistic and cultural versions of the Skindex-Mini would help establish whether the instrument functions equivalently across populations, enabling its use in international trials and cross-cultural epidemiolog- ical research. In conclusion, the Hungarian Skindex-Mini is a psychometrically robust, ultra-brief instrument that provides a valid and reliable indicator of dermatology-related burden, although its brevity necessarily limits the breadth of HRQoL content PLOS One | https://doi.org/10.1371/journal.pone.0350749 June 23, 2026 16 / 19 captured. Its strong performance, combined with its exceptional feasibility, positions it as a valuable tool for both clinical practice and research, capable of bringing the patient’s voice into routine dermatologic care.

    Reliability and construct validity of the Hungarian version of Skindex-Mini · 2026 · DOI

  • Future research should prioritize large, well-designed RCTs with standardized protocols and validated psychiatric primary endpoints to clarify the magnitude and duration of psychodermatological effects. Longitudinal neuroimaging studies are needed to further elucidate causal mechanisms linking peripheral muscle modulation to limbic activity over time. Investigation of dose-response relation- ships, optimal injection intervals, and individual moderators such as baseline symptom severity, personality traits, and biological sex may facilitate more personalized and evidence-based application within psychodermatology.

    Beyond aesthetic outcomes: psychodermatological benefits of botulinum toxin treatment in the upper facial third. A narrative review · 2026 · DOI

  • This study faces some limitations, like others. First, it relied on a self-administered questionnaire to collect data on IFC procedures. This method can introduce bias and may be impacted by recall or selection bias, which could lead to underestimations. Second, concerns about social desirability and specific medical institutions limit the ability to generalize findings to the broader population. Third, another limitation is 127 The Journal of medical and Oral Biosciences CC BY-SA 4.0 Attribution-ShareAlike 4.0 https://creativecommons.org/licenses/by-sa/4.0/ Jalil Ibrahim Saleh et l., JMOB. (2026), 3; (2): 118-131 the reliance on honest responses. Fear of stigma may have led some students to withhold information about any cosmetic procedures they underwent. Despite these challenges, the study still provides useful insights into how university students perceive the acceptance of cosmetic procedures.

    Prevalence of Minimal Invasive of Facial Cosmetics among Undergraduate Students at Ishtar Medical Institute, Baghdad, Iraq · 2026 · DOI

  • Although multiple-baseline designs are useful for determin- ing the feasibility of a treatment early in its development, and the current sample size was consistent with other mul- tiple baseline studies, the sample was small. Secondary out- comes were also uncontrolled, limiting conclusions about these effects. Notably, recruitment of the small sample was slow, taking place over approximately 18 months. Similarly, in their larger study of 140 adolescents with BDD, Rautio et al. (2022a, b), enrolment took place over 5 years. This could suggest clinical trials for adolescent BDD are limited in terms of recruitment feasibility. However, these chal- lenges must be balanced with the potential risk of neglect- ing an important area of research. Given individuals with BDD experience a 3-fold increased risk of death by suicide (Rautio et al., 2024), continued research efforts, including large RCTs with waitlist control conditions evaluating the efficacy of telehealth treatment approaches, are certainly warranted. Because treatment was evaluated as an overall protocol, it is unclear whether the addition of specific treatment mod- ules (e.g., peer relationship skills) improved outcomes over standard CBT. These modules were included based on lit- erature that is largely cross-sectional, limiting conclusions about the direction of relationships between peer relation- ship factors, social media use, family functioning, executive functioning and BDD in adolescents. Longitudinal studies are much needed to provide further clarity and to assist with refining current treatments to appropriately target risk and maintenance factors. Future studies should also examine whether changes in factors such as family accommodation, Research on Child and Adolescent Psychopathology (2026) 54:63 1 3 63 Page 14 of 17 peer relationship dynamics, and executive functioning occur following this modified CBT approach. The sample was predominantly white, cis-gender girls, therefore future research is needed to test whether the treatment’s effectiveness generalises to boys and ethnic and gender minorities. As the families had volunteered for research, and many were already engaging with mental health professionals when referred to the study, they were potentially a more motivated and educated sample, limit- ing the generalisability of findings. The trial therapist rated their own adherence to the treatment protocol; a more opti- mal approach would have been to have independent raters evaluate treatment adherence. A last observation carried for- ward (LOCF) approach was used to manage missing data in the current study which has several limitations including the assumption of stability. As p-values were not adjusted, potentially inflating the type 1 error rate, conclusions should be interpreted with caution. Adolescents, parents and post-treatment assessors were also aware of the purpose of the study and knew that a treat- ment assumed to be effective was being delivered. Further, pre-treatment diagnostic assessments and treatment sessions were conducted by the first author. Therefore, participants and assessors may have had a positive bias in their treatment outcome ratings. Several participants received other treat- ments between the post-treatment and 2-month follow-up assessments, which limits the validity of 2-month follow- up outcomes. Finally, treatment credibility and expectancy were not measured. Adult BDD research has found that higher treatment credibility is associated with a lower risk of dropout from remotely delivered BDD treatment (Bern- stein et al., 2023), highlighting the need for future research in adolescent samples. Attrition was high, and those who dropped out early did not complete treatment satisfaction questionnaires, which limits conclusions about efficacy and acceptability. Qualitative interviews with stakeholders (i.e., young people with BDD and their families), which were not utilised in the current study, should also be conducted in future studies to help inform participant retention and outcomes.

    Developmentally Tailored Telehealth-Delivered Cognitive-Behavioural Therapy for Adolescents with Body Dysmorphic Disorder: A Multiple Baseline Design · 2026 · DOI

  • In Nigeria, there is a need for further investigation into how self-esteem and social comparison specifically contribute to BDD symptoms in private universities that face unique social and cultural pressures.

    Self-Esteem and Social Comparison: A Study of Body Dysmorphic Symptoms among Private University Students in Nigeria · 2025 · DOI

  • BACKROUND: Internalized stigma, adoption of negative attitudes, and societal stereotypes regarding acne vulgaris (AV) have not been previously studied.

    Internalized stigma in acne vulgaris and its relationship with quality of life, general health, body perception, and depression · 2020 · DOI

  • DISCUSSION: We found preliminary support for MD as a clinically valid presentation, but insufficient evidence to determine whether it is best categorized as a specifier of BDD or unique psychiatric condition.

    Muscle dysmorphia: A systematic and meta‐analytic review of the literature to assess diagnostic validity · 2020 · DOI

  • Body dysmorphic disorder (BDD) is a relatively common psychiatric condition of which the prevalence has not been fully investigated in the non-clinical population, and in particular among men having sex with men (MSM).

    Prevalence and Co-Occurrence of Different Types of Body Dysmorphic Disorder Among Men Having Sex with Men · 2020 · DOI

  • Because little is known about how body image is associated with social engagement and depressive symptoms among aging women, four aspects of body image: satisfaction with cosmetic features, body function, physical appearance, and weight were assessed among women aged 65 and older (n = 123).

    Is social engagement linked to body image and depression among aging women? · 2016 · DOI

  • The author poses the equity question of how to handle patients unable to afford cosmetic surgery within a framework accepting beauty as a proper medical goal, but provides no guidance on what specific allocation criteria or policies should govern this hierarchy. Research is needed on how healthcare systems should operationalize resource allocation policies when cosmetic and therapeutic medicine goals compete.

    The Cosmetic Medicine Revolution, the Goals of Medicine, and Bioethics · 2016 · DOI

  • The paper identifies that distinguishing between medicine and business is 'fading away' due to autonomy-centered ethics, but does not specify how to operationalize or measure this boundary erosion in contemporary medical practice. Empirical metrics or frameworks for assessing the degree to which specific medical practices have adopted business versus professional governance models are absent.

    The Cosmetic Medicine Revolution, the Goals of Medicine, and Bioethics · 2016 · DOI

  • The paper distinguishes between physician-patient relationships in cosmetic medicine versus therapeutic medicine but does not empirically examine how the consumer model actually manifests differently in cosmetic versus therapeutic settings. Comparative empirical studies of physician-patient interaction patterns, informed consent processes, and decision-making authority in cosmetic versus non-cosmetic medicine are needed.

    The Cosmetic Medicine Revolution, the Goals of Medicine, and Bioethics · 2016 · DOI

  • The author critiques Pellegrino's universality claim regarding illness and suffering as culturally-defined concepts, but does not provide comparative empirical data on how different cultures operationalize and conceptualize suffering in medical contexts. A systematic cross-cultural analysis of illness definitions across multiple societies is needed to support the claim that suffering is entirely culturally constructed rather than having universal components.

    The Cosmetic Medicine Revolution, the Goals of Medicine, and Bioethics · 2016 · DOI

  • The paper argues that cosmetic medicine goals should be hierarchically ranked based on cultural and social context for resource allocation, but provides no concrete methodology for establishing this hierarchy across different healthcare systems or cultural settings. Empirical research is needed to determine how physicians and societies actually construct and prioritize goals of cosmetic medicine relative to therapeutic medicine in practice.

    The Cosmetic Medicine Revolution, the Goals of Medicine, and Bioethics · 2016 · DOI

  • There are other characteristics that remain unclear such as including mirror or surface checking (Baghurst, 2012; Murray & Baghurst, 2013) and anabolic steroid use (Baghurst & Kissinger, 2009; Baghurst & Lirgg, 2009).

    Reevaluation of Physique Protection as a Characteristic of Muscle Dysmorphia · 2014

  • While there has been a significant amount of research conducted on growth hormone (GH) in the field of medicine, very few studies have actually examined the experience from the vantage point of adults who were treated for short stature as children.

    Why does growth hurt? The dual role of normalization and stigmatization in the experience of growth hormone treatment · 2010 · DOI

  • Using scales developed to assess two dimensions of perceived stigma and two management strategies, we find that a large majority of the TMPDS patients in our sample feels estranged from others and not understood because of their experiences with facial pain.

    The Stigma of Chronic Facial Pain and Its Impact on Social Relationships · 1989 · DOI

  • Discussion pointed out that: ( u ) suggestion, “r6le- playing,” or variables other than visual-esthetic ones did not account for the differences obtained; ( b ) there seems at present to be no single visual- esthetic quality that can account for the differences among all three groups ; ( c ) the effects may possibly have been obtained by the rooms’ affecting the subject-examiner relationship.

    Effects of Esthetic Surroundings: I. Initial Effects of Three Esthetic Conditions Upon Perceiving “Energy” and “Well-Being” in Faces · 1956 · DOI

  • Separate pre-clinical studies testing perceptual and attentional interventions and non-invasive neuromodulation suggest that these visual processing abnormalities may be modifiable, but their combined effects on neural connectivity and perceptual processing remain unclear.

    Effects of theta burst stimulation on neural connectivity and visual perception following attention modification of own-face viewing in body dysmorphic disorder · 2026 · DOI

  • Implications for Practitioners: Further studies on body esteem and sociocultural pressures could enable practitioners to better understand how to support individuals with visual impairments in coping with an unhealthy social environment and with feelings of unhappiness related to their appearance.

    Sociocultural Pressures, Internalization, and Body Esteem in Congenitally Blind, Late-Blind, and Sighted Men and Women · 2024 · DOI

  • However, difficulties in recruitment have meant that research has not yet fully explored how men construct the loss of head hair (baldness), perhaps because it is considered “feminine” to disclose body dissatisfaction experiences to a researcher or other people.

    “Just Shave It Off” · 2021 · DOI

  • This suggests a negotiation of the boundary between medical and non-medical settings that is carried out by the beauty workers, and creates a “gray zone” that needs to be explored.

    Ethnographic Account · 2020 · DOI

  • Although research has explained various psychological factors leading to body dissatisfaction in male, limited research has examined the potential mediating effect of the anxiety male experience to align with societal conceptions of masculine appearance.

    Examining body dissatisfaction in college men through the exploration of appearance anxiety and internalization of the mesomorphic ideal · 2020 · DOI

  • Few investigations have acknowledged and explored the individual’s personal motivations and experiences of her action and choice with regards to aesthetic surgery.

    Beauty and the Cosmetic Secret · 2019 · DOI

  • Abstract Little is known about mental images (cognitive representations with sensory qualities) in body integrity identity disorder (BIID).

    Mental Images in Body Integrity Identity Disorder (BIID) and in Body Dysmorphic Disorder (BDD): An Exploratory Study · 2018 · DOI

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53 open questions have been extracted from the limitations and future-work passages of 1,013 Body Image and Dysmorphia Studies papers in our library. Each one below links back to the study that raised it, so you can read the original claim in context.

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