Victimization, social anxiety, and body dysmorphic concerns: appearance-based rejection sensitivity as a mediator

Appearance-based rejection sensitivity mediates the relationship between Instagram addiction and dysmorphic concerns in young adult women

INTRODUCTION

Dysmorphic concerns refer to excessive preoccupations with one's physical characteristics. There is a need to better understand the factors associated with these experiences, especially in young adult women. Given emergent research suggesting a link between the use of Instagram, dysmorphic concerns, and appearance pressures, we tested a mediation model in which appearance-based rejection sensitivity mediated the relationship between Instagram addiction and dysmorphic concerns.

METHODS

In this cross-sectional study, 300 young adult women from Romania with mean age of 22.19 years (SD = 2.07) and who possessed an Instagram account were asked to complete an online survey consisting of measures of dysmorphic concerns, Instagram addiction, and appearance-based rejection sensitivity.

RESULTS

Correlational analyses revealed that all three variables were positively and moderately inter-correlated. Mediation analysis supported the hypothesis that appearance-based rejection sensitivity mediates the relationship between Instagram addiction and dysmorphic concerns.

CONCLUSIONS

Implications of this study are discussed in terms of the urgency of prevention and intervention strategies, especially given the link between dysmorphic concerns and more extreme manifestations of severity, such as body dysmorphic disorder.

Psychological correlates of body dissatisfaction in Swiss youth over a one-year study-period

Introduction

It is well known that young individuals often report pronounced negative perceptions and attitudes towards their own body or intense fear of being not muscular enough. There is much less data available, however, on the role of psychological mechanisms on these perceptions and attitudes, such as emotion regulation difficulties, correlates of alexithymia, and appearance-related rejection sensitivity.

Methods

We therefore set out to assess associations between these psychological mechanisms, and body image as well as muscle dysmorphic symptoms. Our sample was recruited as part of a larger-scale study aiming at assessing correlates of mental health (with a focus on eating disorder symptoms) in German speaking Switzerland. The first wave (T1), starting in April 2021, included 605 participants (80% female, 19.6 ± 2.5 years) who completed the online-questionnaire and were reassessed in a second wave (T2), one year later.

Results

Results indicated that at both waves, emotion regulation difficulties [DERS-SF] and appearance-based rejection sensitivity [ARS-D] were both positively cross-sectionally associated with body dissatisfaction [BSQ-8C] and muscle dysmorphic symptoms [MDDI] at the first assessment time-point and one year later at follow-up assessment. Moreover, alexithymia [TAS-20] was positively cross-sectionally associated with muscle dysmorphic symptoms at both waves. We further observed high absolute and relative level stabilities for all variables involved across the one-year study period.

Discussion/Conclusion

Even though the effects for some associations were rather small, our findings underline the relevance of such mechanisms in the development of body dissatisfaction and to a lesser extent of muscle dysmorphia symptoms over the period of one year. Additional research is necessary to replicate these findings in other youth samples.

The Effect of Appearance Anxiety on Social Anxiety among College Students: Sequential Mediating Effects of Self-Efficacy and Self-Esteem

Social anxiety is a serious psychological problem prevalent among Chinese college students, and appearance anxiety plays an important role in its development. Although some studies have explored the relationship between the two, the mediating mechanism is unclear. This study constructed a sequential mediation model based on the cognitive-behavioral theory of body image disorder and social phobia to explore the mediating role of self-efficacy and self-esteem. A total of 234 college students were recruited using the convenience sampling method, including 68 males (29.10%) and 166 females (70.90%), with an average age of 21.25 years (SD = 1.75). Data were collected using the Social Appearance Anxiety Scale, the General Self-Efficacy Scale, the Self-Esteem Scale, and the Interaction Anxiety Scale. The study's results demonstrated a significant and positive predictive relationship between appearance anxiety and social anxiety (effect = 0.21, SE = 0.04, 95% CI = [0.13, 0.29], p < 0.001). Appearance anxiety not only directly affects social anxiety but also has three indirect paths affecting social anxiety: the independent mediating effect of self-efficacy (effect = 0.03, SE = 0.01, 95% CI = [0.00, 0.06], p < 0.001), the independent mediating effect of self-esteem (effect = 0.03, SE = 0.02, 95% CI = [0.01, 0.07], p < 0.001), and the serial mediation effect of self-efficacy and self-esteem (effect = 0.01, SE = 0.01, 95% CI = [0.00, 0.03], p < 0.001). Direct and indirect effects accounted for 73.81% and 26.19% of the total effect, respectively. These findings provide new perspectives on the intervention with and treatment of social anxiety in college students.

Reconsidering the role of interpersonal stress in eating pathology: Sensitivity to rejection might be more important than actual experiences of peer stress

Rejection sensitivity (i.e., the tendency to anxiously expect, readily perceive, and overreact to real or perceived rejection) is theorized to play a role in the onset and maintenance of disordered eating. Although rejection sensitivity has repeatedly been associated with eating pathology in clinical and community samples, the pathways through which this psychological trait influences eating pathology have been not fully established. The current study investigated peer-related stress, which can be influenced by rejection sensitivity and is associated with eating pathology, as a mechanism linking these constructs. In two samples of women - 189 first-year undergraduate students and 77 community women with binge eating - we examined whether rejection sensitivity was indirectly associated with binge eating and weight/shape concerns via ostracism and peer victimization, both cross-sectionally and longitudinally. Our hypotheses were not supported: there were no indirect associations between rejection sensitivity and eating pathology via interpersonal stress in either sample. However, we did find that rejection sensitivity was directly associated with weight/shape concerns in both samples and with binge eating in the clinical sample in cross-sectional (but not longitudinal) analyses. Our findings suggest that the association between rejection sensitivity and disordered eating is not dependent on actual experiences of interpersonal stress. That is, simply anticipating or perceiving rejection may be sufficient to play a role in eating pathology. As such, interventions targeting rejection sensitivity may be helpful in the treatment of eating pathology.

Absent mindfulness: mediation analyses of the relationship between adverse childhood experiences and disordered eating among young adults

Recent evidence has indicated that adverse childhood experiences (ACEs) involving abuse, neglect, and other potentially traumatic occurrences are predictive of disordered eating among young adults. Previous findings have suggested that ACEs and disordered eating were both inversely related to mindfulness. No known studies have examined the extent to which mindfulness mediates the link between ACEs and disordered eating. This study was conducted among a sample of 144 young adults in the U.S. between the ages of 18 and 26 years. Primary study variables included ACEs, mindfulness, and disordered eating. Univariate and multivariable regression analyses assessed the link between ACEs and disordered eating. Mediation analyses examined whether mindfulness mediated the link between ACEs and disordered eating. Multivariable analyses statistically adjusted for the covariates of age, sex, race/ethnicity, and income. Findings suggested ACEs were inversely related to mindfulness (B = -0.04, SE = 0.01; 95% CI = -0.07, -0.01; p < 0.05), mindfulness was inversely related to disordered eating (B = -1.27, SE = 0.23; 95% CI = -1.74, -0.80; p < 0.0001), and ACEs were positively related to disordered eating before (B = 0.17, SE = 0.04; 95% CI = 0.09, 0.26; p = 0.0001) and after (B = 0.13, SE = 0.04; 95% CI = 0.05, 0.21; p = 0.002) adjusting for mindfulness. Mediation analysis results indicated that the link between ACEs and disordered eating was significantly mediated by mindfulness (B = 0.05, SE = 0.02; 95% CI = 0.01, 0.09; p < 0.05). Evidence produced in this study confirmed existing findings concerning the positive association between ACEs and disordered eating among young adults, and these outcomes helped fill a knowledge gap regarding whether mindfulness mediates the link between ACEs and disordered eating. Future intervention studies should identify health-enhancing mindfulness approaches and then test whether the adoption of mindfulness practices can alleviate and prevent disordered eating among young adults with high ACEs.

Appearance anxiety and social anxiety: A mediated model of self-compassion

Background

Previous studies have focused on the comorbidity of appearance anxiety and social anxiety, but few studies have focused on the protective role of self-compassion as underlying this mechanism, in young people like University students. With the increase of prevalence of appearance anxiety and social anxiety in this age group, it is necessary to explore factors that can buffer against the symptoms of these disorders. Therefore, the aims of this study were to research the effect of appearance anxiety and social anxiety, then to examine whether self-compassion has a protective effect on social anxiety.

Method

The study was cross-sectional and conducted online from October 2021 to November 2021 in Jilin Province, China. A total of 63 Universities in the province participated in this study, totaling 96,218 participants, of which 40,065 were males (41.64%) and 56,153 females (58.36%), the mean age of the sample was 19.59 (±1.74). The Appearance Anxiety Scale-Brief Version was used to measure appearance anxiety. The Social Anxiety subscale of the Self-Consciousness Scale was used to measure social anxiety. The Self-Compassion Scale-Short Form was used to measure self-compassion. A structural equation model (SEM) was run to examine the mediating effect of self-compassion on the relationship between appearance anxiety and social anxiety.

Result

Overall, appearance anxiety was positively associated with social anxiety [β = 0.334, 95% CI = (0.328, 0.341), p < 0.001], and self-compassion could mediate the effect of appearance anxiety on social anxiety [β = 0.128, 95% CI = (0.124, 0.132), p < 0.001]. Self-compassion played a partial mediating role between appearance anxiety and social anxiety.

Conclusion

Individuals with high appearance anxiety are also at higher risk of social anxiety, but self-compassion can buffer against this relationship. These findings begin to explore novel approaches to treat social anxiety and can provide valuable insights for self-compassion training.

Are you looking at me? A longitudinal vignette study of adolescent appearance rejection sensitivity and coping with peer evaluation

Appearance rejection sensitivity (ARS) refers to anxiously over-expecting rejection because of perceived appearance flaws. ARS has been associated with poorer mental health, which suggests coping with stress may be negatively affected by ARS. In this study, we investigated if ARS was related to adolescents' emotions and ways of coping with negative appearance evaluation two years later (T2). Other potential correlates of emotions and ways of coping were also tested, including peer appearance teasing, social anxiety, and gender, as well as reports of victimization, social status, and attractiveness gathered from peers. At Time 1 (T1), 329 adolescents (M = 13.9 years, 54% girls) self-reported their ARS, experience of appearance teasing, and social anxiety. T1 appearance victimization, popularity, and attractiveness were measured using peer nominations, and peer likeability was measured with peer ratings. At T2, participants' emotions and coping were measured using vignettes portraying appearance evaluation by peers. In regression models, T1 ARS, appearance teasing, social anxiety and female gender were associated with more T2 negative emotions, social withdrawal, rumination, and (except for social anxiety) thoughts about appearance change. ARS was not significantly associated with T2 positive thinking or support seeking. No peer-report measure was significantly associated with T2 outcomes.

Longitudinal study of social anxiety symptoms and appearance rejection in predicting body dysmorphic symptoms: Appearance-based rejection sensitivity as a mediator

Previous findings from cross-sectional studies suggest that social anxiety symptoms and negative peers' experiences regarding appearance were predictors of body dysmorphic symptoms through appearance-based rejection sensitivity. However, little is known about longitudinal relations and parental appearance rejection on body dysmorphic symptoms. Therefore, this study aims to examine the longitudinal mediation of appearance-based rejection sensitivity with social anxiety symptoms, remembered peers', maternal, and paternal appearance-based rejection as predictors, and body dysmorphic symptoms as an outcome. The study included 277 university students who completed questionnaires in two-measurements points 5 months apart. The results indicated that social anxiety symptoms predicted changes in body dysmorphic symptoms through appearance-based rejection sensitivity. In addition, remembered childhood peers' appearance-based rejection predicted both directly and indirectly changes in body dysmorphic symptoms over time. Maternal and paternal appearance-based rejection were not predictors of appearance-based rejection sensitivity or body dysmorphic symptoms. Findings support rejection sensitivity theory and the long-lasting impact of negative peers' experiences for impaired body dysmorphic symptoms. However, further research regarding remembered parental negative experiences is needed.

Peer victimization and weight/shape concerns in adolescents: Examining the moderating role of appearance-based rejection sensitivity

Peer victimization has been related to weight/shape concerns in adolescents. However, a dearth of research has examined potential moderators of this association. The present study examined the concurrent and prospective associations between two types of peer victimization, appearance-based and non-appearance-based, and weight/shape concerns among adolescents, and whether these associations were moderated by appearance-based rejection sensitivity. Participants were 897 adolescents, aged 11-19 years (M = 14 years 8 months, SD = 1 year 4 months), who completed a range of self-report measures as part of the EveryBODY study, one year apart. Both forms of victimization were associated with concurrent, but not prospective weight/shape concerns. Additionally, the concurrent association between appearance-related victimization and weight/shape concerns was dependent on appearance-based rejection-sensitivity, with stronger associations at lower levels of appearance-based rejection-sensitivity. These findings support previous research linking peer victimization with concurrent weight/shape concerns in adolescents. However, the impact of peer victimization on increased weight/shape concerns was not observed.

Adverse childhood experiences and body dysmorphic symptoms: A meta-analysis

Adverse childhood experiences (ACEs) are considered a risk factor for the development of various forms of mental disorders, including body dysmorphic disorder (BDD). The aim of the present work was to examine the association between ACEs and BDD symptomatology and to identify features of studies that might moderate this association. We conducted a three-level meta-analysis of 27 articles that included 9167 participants. Results showed that the types of ACE examined (total ACE, abuse, neglect, teasing, and bullying) were positively associated with BDD symptomatology. Specifically, a low to moderate association was found for ACE overall, defined as abuse, neglect, bullying, or teasing (r = 0.289, 95% confidence interval (CI) [.240,.337), for bullying (r = 0.282, 95% CI [.206,.354]), and for abuse (r = 0.223, 95% CI [.169,.276]) were found; and a moderate to large association was found for experienced teasing (r = 0.423, 95% CI [.360,.482]). In addition, moderator analyses of the association between ACE and BDD symptomatology resulted in a predictive model in which the type of ACE, type of sample, and gender of participants moderated the magnitude of the association between ACEs and BDD symptomatology.

Face-to-Face and Cyber-Victimization: A Longitudinal Study of Offline Appearance Anxiety and Online Appearance Preoccupation

Most adolescents and young adults navigate seamlessly between offline and online social environments, and interactions in each environment brings with it opportunities for appearance concerns and preoccupation, as well as victimization and teasing about appearance. Yet, research has concentrated primarily on face-to-face victimization and its role in offline appearance anxiety symptoms in adolescents and young adults. To extend this to include cyber-victimization and online behaviors indicative of appearance anxiety, the present longitudinal study investigated the risk of face-to-face and cyber-victimization for offline appearance anxiety and online appearance preoccupation. Participants were 650 adolescents age 15 to 19 years (M_age = 17.3 years, 59% female) who completed two surveys over one-year. Correlations identified both forms of victimization as associated with offline appearance anxiety and online appearance preoccupation. Yet, in a structural equation model, face-to-face peer victimization, but not cyber-victimization, was uniquely associated with increased offline appearance anxiety and online appearance preoccupation from T1 to T2. Offline appearance anxiety and online appearance preoccupation strongly covaried and were bidirectionally associated over time. Female gender and age were associated with more anxiety and preoccupation. When gender moderation was tested, only the stability in appearance anxiety was moderated, with greater stability in females than males. Overall, offline and online appearance anxieties are highly interrelated and share a common risk factor in face-to-face appearance-related victimization by peers.

Is health behavior among university students determined by actual body shape or by body image? A European study

BACKGROUND

Appropriate body image self-perceptions provide a good help to increase the feeling of personal well-being, thus having an important impact on health. Universities, having an important role in shaping of the future workers, represent an important setting to approach health issues.

OBJECTIVE

This study determined to what extent different types of students in higher education (four categories of students were created: "self-secure", "perfect", "destructive" and "apologetic") are likely to adopt different health risk behaviors.

METHODS

A cross-sectional study in a sample of students from five European Universities in the 2016/2017 academic year was conducted. Based on the combination of body image perception and body mass index, four types of students were identified: "self-secure" (overweight students with a good self-esteem); "perfect" (underweight students with a good self-esteem); "destructive" (overweight students with a poor self-esteem); "apologetic" (underweight students with a poor self-esteem).

RESULTS

The study reveals that the defined types of students differed in terms of risk behavior. When the control was included, the "self-secure" student type had a reduced likelihood of being on a diet (22.3%) and physically active (17.8%) than other students (p <  0.001).

CONCLUSIONS

The results of this paper raise concerns about the future because the body dissatisfaction of the college student could be a big impact in long term whether at collective, personally or even professionally.

A cascade of rejection and appearance preoccupation: Adolescents' body dysmorphic symptoms and appearance rejection sensitivity over 4 years

Adolescence is a high-risk period for body image disturbance and appearance concerns. In a cascade model, we examined interrelations of body dysmorphic symptoms (BDS) with appearance rejection sensitivity (ARS) and tested gender moderation. Participants were 397 Australian adolescents (T1 Mage = 11.7, SD = 0.91; 56% girls) who completed six surveys over 4 years. In a random-intercept cross-lag model, two (of five possible) paths showed ARS predicted higher subsequent BDS, and three (of five possible) paths showed BDS predicted higher subsequent ARS. Girls reported more BDS and ARS than boys, and random intercepts of BDS and ARS were correlated with the correlation stronger in girls than boys. Cross-lag BDD-ARS associations over the six waves were not significantly moderated by gender. Overall, girls are at higher risk of appearance concerns than boys, but BDD-ARS cascade effects do not differ between girls and boys.

Cybervictimization and Adolescent Internet Addiction: A Moderated Mediation Model

Previous research indicates that cybervictimization can lead to adolescent Internet addiction; however, there is a gap in the knowledge about the mediating and moderating variables facilitating this relationship. This study examines the role of rejection sensitivity as a mediator in this relationship and the role of parent–adolescent communication as a moderator for this mediation effect among Chinese adolescents. Participants were 1006 adolescents (M = 13.16 years, SD = 0.67), who completed the questionnaires anonymously. The questionnaires assessed the four variables of interest. Descriptive statistics and structural equation modeling were used for data analysis. The results show that the positive association between cybervictimization and adolescent Internet addiction is mediated by rejection sensitivity. Moreover, this indirect effect is stronger for adolescents with low parent–adolescent communication than for those with high parent–adolescent communication.

Body dysmorphic disorder in children and young people

The incidence of body dysmorphic disorder (BDD) in young people is increasing. Causes of BDD are related to the prevalence of social media and adolescent development, especially the role that brain neuroplasticity has on influencing perception. There are long-term impacts of BDD, including depression and suicide. Prevention and promotion of positive body image are part of the nurse's role; treatment can prevent unnecessary aesthetic surgical interventions.

Emotion regulation and support from others: Buffering of body dysmorphic symptoms in adolescent and young adult men but not women

INTRODUCTION

Adolescents and young adults who overemphasize the social values placed on an attractive appearance may develop body dysmorphic symptoms (BDS), defined as over-preoccupation with perceived appearance flaws and repetitive behaviors to conceal the flaws. Further, research has found that a heightened expectation of judgement and rejection by others because of appearance (i.e., appearance-based rejection sensitivity [appearance-RS]) is both a maintaining and an aggravating factor in BDS. This study focused on emotion regulation (ER), appearance-related support from others and self-acceptance, expecting they would buffer the negative impact of appearance-RS on BDS.

METHODS

Participants included 782 Australian high school and young university students, aged 14-28 years (M = 17.94 years, 40% male) who completed a survey to report their BDS, appearance-RS, ER, appearance-related support from others and self-acceptance.

RESULTS

Multiple regression analyses revealed that youth reported more BDS when they were higher in appearance-RS but reported less self-acceptance, ER, and support from others. Further, the association between appearance-RS and BDS was weaker when young people reported higher (relative to lower) ER and support from others. However, when three-way interactions with gender were tested, these buffering effects were only significant for young men.

CONCLUSION

Findings suggest that ER and appearance-related support from important others are promising targets for intervention, given they could mitigate the risk of appearance-RS in young men. However, further research is needed to consider additional factors that buffer against the negative effects of appearance-RS on BDS for young women.

Unique associations of social media use and online appearance preoccupation with depression, anxiety, and appearance rejection sensitivity

Social media (SM) can create a climate of social comparison and preoccupation with appearance, which can pose risks for emotional problems, such as depression and social anxiety. In this study, 763 adolescents and young adults reported time spent and intensity of social media use and preoccupation with both general and appearance-related (AR) social media activities and content. Associations were investigated with markers of depression and social anxiety symptoms and appearance sensitivities - appearance anxiety and appearance rejection sensitivity (appearance-RS). Social media use was positively associated with symptoms of depression, social anxiety, appearance anxiety, and appearance-RS. General and AR preoccupation had unique and positive associations with depression and social anxiety symptoms and with appearance sensitivities. AR preoccupation was also found to strengthen the relationship between time spent on social media and appearance-RS. Although there were gender differences on all measures, with young women scoring higher on all measures, there was no evidence that gender moderated the effects of AR social media preoccupation. Findings support emerging evidence that social media engagement and behavior, particularly activities involving appearance comparisons and judgements, may be more of a risk to depression and social anxiety symptoms and appearance sensitivities than simply the frequency of social media use.

The Multidimensional Youth Body Dysmorphic Inventory: Development and Preliminary Validation

A new measure specifically designed for adolescents to assess body dysmorphic disorder (BDD) symptoms is needed to identify youth who could benefit from intervention to reduce their BDD-related symptomology. To address this gap, the Multidimensional Youth Body Dysmorphic Inventory (MY BODI) was developed and the psychometric properties were evaluated. Following development and expert assessment, Australian secondary school students (N = 582; 55% female; M_age = 13.62, SD = 1.59, aged 11 to 18 years, grades 7 to 12) completed a survey with the new items and validation measures. Results from the factor analysis supported a 3-factor, 21-items measure, which aligned with the DSM-5 diagnostic criteria of Impairment/avoidance, Preoccupation/repetitive behaviours, and Insight/distress. Supporting the convergent validity of the measure, the MY BODI total score and sub-scale scores correlated with measures of BDD symptoms, including the Appearance Anxiety Inventory (AAI) and Body Dysmorphic Disorder Questionnaire-Adolescent Version (BDDQ-A). This study provides preliminary validation of the MY BODI, a self-report measure of BDD symptoms and symptom severity, using a response set aimed to facilitate more reliable reporting, which may identify risk for BDD, and symptoms of BDD.

Body Dysmorphic Disorder in Adolescents

Background and Objectives:

Body Dysmorphic Disorder (BDD) is characterized by an abnormal preoccupation with alleged misshapen body parts. There is often poor insight and effort is made to hide the imagined defects, and consultation may be sought seeking unnecessary cosmetic surgery or procedures. It is underdiagnosed and established treatment protocols are lacking. The disease has a chronic and undulating course and is seriously compromises quality of life. Despite the fact that the prime age of onset of BDD is during adolescence relatively little has been written about it during this phase of life. This review aims to comprehensively cover the present understanding of BDD, including clinical features, epidemiology, psychopathology, nomenclature, comorbidity and management.

Methods:

A literature search was undertaken using suitable key words on Google Scholar, MEDLINE & PsychoINFO up to June 2018 limited to articles in English.

Results:

he prevalence of BDD is variable in the general and psychiatric population with equal gender distribution. Both sexes are equally affected. It is associated with poor functioning and a chronic course. There is considerable comorbidity and diagnostic overlap between BDD and obsessive-compulsive disorder, major depressive disorder, social anxiety disorder, anorexia nervosa, schizophrenia spectrum disorders and personality disorders. Psychiatric consultation is often late. Selective Serotonin Reuptake Inhibitors (SSRIs) and Cognitive Behavior Therapy (CBT) are currently the first line modalities for treatment. Internet based CBT, Acceptance and commitment therapy, and repetitive Transcranial Magnetic Stimulation (rTMS) are emerging treatment options.

Conclusions:

BDD is a complex disorder with still lot of uncertainty about its diagnostic placement, treatment approaches, especially for refractory patients, and prognosis. Further study is needed to clarify its prevalence, especially in adolescents; to fully understand its neurobiological aspects, to determine its exact relation to obsessive compulsive related disorders, and to develop better treatment approaches.

Prevalence and clinical characteristics of body dysmorphic disorder in adolescent inpatient psychiatric patients-a pilot study

Background: Body dysmorphic disorder (BDD) is preoccupation with perceived body defects leading to distress and impairment in social functioning. Most of adolescent BDD literature has been done on patients within the outpatient setting with prior versions of DSM with dearth of information about BDD and comorbid psychiatric conditions among adolescents within the inpatient setting. Aims: This pilot study evaluated the prevalence rate, clinical characteristics in adolescent BDD compared to non-BDD adolescents in a psychiatric in patient setting in addition to their comorbid issues like anxiety, OCD, ADHD and substance abuse. Methods: Forty-five consecutively admitted adolescent patients participated with 17 meeting the DSM 5 criteria for BDD while 28 did not. Patients were asked four questions designed around the DSM-5 criteria for BDD after which they were asked to complete questionnaires like BDDQ child and adolescent version, BDDM, Multiaxial Anxiety Scale for Children, Children's Depression Inventory, Y-BOCS and Vanderbilt ADHD rating scales. Results: Seventeen participants had BDD. Mean age of BDD patients was 13.1 while non-BDD was 12.4. Male patients with BDD were seven (41%) while female BDD patients were 10 (58.8%). Anxiety, depression, OCD and substance use disorders were common comorbid diagnoses. Majority of patients in the BDD group classified their BDD as a severe problem with more BDD, patient's considering suicide because of their BDD. Discussion: BDD is present in adolescents admitted in inpatient psychiatric hospital with more female patients endorsing BDD versus their male counterparts. Patients with BDD are more likely to endorse more comorbid psychiatric issues such as anxiety, OCD, ADHD and substance abuse.

Appearance Teasing and Mental Health: Gender Differences and Mediation Effects of Appearance-Based Rejection Sensitivity and Dysmorphic Concerns

Appearance teasing is a common phenomenon in social interactions, especially in adolescence. Several studies have shown its negative impact on mental health as well as on body image. While these findings prove stable in various contexts, less evidence is available for possible gender differences in these relationships. In particular, the role of two important body image variables - appearance-based rejection sensitivity (ARS) and dysmorphic concerns - and their contribution to mental health impairments has not been assessed in gender-specific process models. In a cross-sectional survey-study (N = 501; 407 f, 94 m), we retrospectively assessed early appearance teasing experiences, as well as current ARS, dysmorphic concerns, depression, anxiety, and self-esteem. We analyzed gender differences in these variables and their interrelations. We then examined the mediating role of ARS and dysmorphic concerns in explaining mental health variables in adulthood due to early appearance teasing in gender-specific serial-mediation models. The results show high ratios of early teasing experiences, but no significant gender difference regarding the frequency of early appearance teasing. While teasing experiences were significantly related to body image variables in adulthood in both genders (rs > 0.32; ps < 0.010), we observed significant relations with mental health outcomes in women (rs > 0.30; ps < 0.001) but not in men (rs < 0.20; ps > 0.250). Serial mediation models show that ARS and dysmorphic concerns mediate the effects of appearance teasing on mental health in all outcomes in women (ΔR2 > 0.17), but not in men (ΔR2 < 0.03). Findings remained stable when controlling for Body-Mass-Index, age, and relationship-status. The findings show similar frequencies of appearance teasing and associated negative effects on body image in men and women. Specifically, in women, the effects of teasing on mental health were stronger and mediated by ARS and dysmorphic concerns. Overall, the results point to the relevance of ARS for etiological models of body image disorders and female mental health. However, men did not show the same relationships of teasing and mental health. Differential resilience factors regarding the negative effects of early appearance teasing could be an important target for future research.

Prevalence of bullying in a pediatric sample of body dysmorphic disorder

Little is known about etiological factors in Body dysmorphic disorder (BDD). Cognitive behavioral and diathesis-stress models have implicated teasing and bullying as significant early environmental stressful triggers. Due to these implications, this study aimed to assess the emergence of BDD in children during early development, and to see if bullying experiences played a role in its development. A total of 219 children ages 7 to 10 were screened for psychopathology. Children were separated into four groups including a BDD group, an OCD group, a clinical control group (consisting of depressive disorders, attention deficit hyperactivity disorder, oppositional defiant disorder, and anxiety disorders not otherwise specified), and a non-clinical control group. Children were given questionnaires to evaluate their bullying and victimization experiences. It was hypothesized that children with BDD would experience more instances of victimization than children with OCD, clinical controls, and non-clinical controls. Contrary to the hypothesis, results indicated that children with BDD symptoms were significantly more likely to be perpetrators of bullying than the other groups [F (3, 27.082) = 17.892, p < .001]. In addition to scoring high on the bullying questionnaires, children with BDD scored high on victim questionnaires as well, suggesting a link between these two peer interpersonal conflicts. The results of this study suggest that bullying behavior might be an unknown characteristic in young children with emerging BDD pathology.

A prospective study of adolescents' body dysmorphic symptoms: Peer victimization and the direct and protective roles of emotion regulation and mindfulness

In this study, we examined whether peer appearance-related victimization was associated with adolescents' increasing body dysmorphic disorder (BDD) symptoms over 12 months. Also, given emotion regulation and mindfulness have been associated with less body dissatisfaction, we expected that they would protect against the negative impact of peer victimization on BDD symptoms. Participants were 367 Australian adolescents (M_age=13years). In multiple regressions, two aspects of emotion regulation, strategies and clarity, and two components of mindfulness, acting with awareness and being non-judgmental, were uniquely associated with fewer BDD symptoms at T2 relative to T1. There was evidence that one mindfulness component, observing, was a risk factor for more BDD symptoms. Further, acting with awareness and observing moderated the prospective relationship between victimization and BDD symptoms; low acting with awareness and high observing were risks for symptoms regardless of victimization, whereas high acting with awareness and low observing appeared protective of BDD symptoms, but only for adolescents who reported lower victimization.

Appearance-based rejection sensitivity as a mediator of the relationship between symptoms of social anxiety and disordered eating cognitions and behaviors

Previous research has established a robust relationship between symptoms of social anxiety and disordered eating. However, the mechanisms that may underpin this relationship are unclear. Appearance-based rejection sensitivity (ABRS)-the tendency to anxiously expect and overreact to signs of appearance-based rejection-may be a crucial explanatory mechanism, as ABRS has been shown to maintain social anxiety symptoms and predict disordered eating. We therefore tested whether ABRS mediated the relationship between social anxiety symptoms and various indices of disordered eating (over-evaluation of weight/shape, restraint, binge eating, compulsive exercise, and vomiting). Data from community-based females (n=299) and males (n=87) were analyzed. ABRS was shown to mediate the relationship between social anxiety and the over-evaluation, restraint, binge eating, and compulsive exercise frequency, but not vomiting. These effects also occurred for both females and males separately. Findings demonstrated that ABRS may be an important mechanism explaining why socially anxious individuals report elevated symptoms of disordered eating. Future research testing all proposed mediating variables of the social anxiety-disordered eating link in a single, integrative model is required to identify the most influential mechanisms driving this relationship.

Early adolescents' body dysmorphic symptoms as compensatory responses to parental appearance messages and appearance-based rejection sensitivity

Body dysmorphic disorder (BDD) is marked by high distress and behavioral and functional impairments due to preoccupation with perceived appearance anomalies. Our aim was to examine parental correlates of offspring's symptoms characteristic of BDD, testing both direct associations and indirect associations via appearance-based rejection sensitivity (appearance-RS). Surveys were completed by 302 Australian adolescents (9-14 years) and their parents. Findings indicated parents' weight and appearance teasing and child-report (but not parent-report) of parental negative attitudes about weight and appearance were uniquely associated with offspring's heightened BDD-like symptoms, and associations were partially indirect via adolescents' appearance-RS. Findings support theory that identifies parents as socializers of children's appearance concerns, and show that BDD-like symptoms may be partly elevated because of the mediating role of appearance-RS. We propose that BDD symptoms could partly emerge as compensatory responses to parents' appearance messages, and the associated bias to expect and perceive rejection based on one's appearance.

Du magst mich nicht, weil ich hässlich bin!

Zusammenfassung. Theoretischer Hintergrund: Viele Personen befürchten Zurückweisungen aufgrund ihres Aussehens. Übermäßige „aussehensbezogene Zurückweisungssensitivität“ (ARS) kann jedoch zur Entstehung und Aufrechterhaltung von – insbesondere körperfokussierter – Psychopathologie beitragen. Fragestellung: ARS ist im deutschsprachigen Raum wenig untersucht, da Erhebungsinstrumente fehlen. Daher war die Validierung einer deutschen „Appearance-based-Rejection-Sensitivity-Scale“ (ARS-D; Park, 2007 ) Ziel der Studie. Methode: Nach Übersetzung des englischen Originals wurde die psychometrische Güte der ARS-D in einer Online-Befragung getestet (n = 391). Ermittelt wurden Itemcharakteristika, Faktorstruktur, Reliabilität und Konstruktvalidität. Ergebnisse: Die ARS-D zeigte bei einfaktorieller Struktur sehr gute Reliabilitätsindizes. Die psychometrischen Eigenschaften ließen sich bei einer auf 12 Items gekürzten Skalenvariante (Original: 15 Items) weiter verbessern. Signifikante Korrelationen mit körperdysmorpher Besorgnis, Essstörungssymptomatik und Depressivität (rs > .30) indizieren Konstruktvalidität. Schlussfolgerungen: Die ARS-D ist zur Erfassung und weiteren Erforschung der Rolle aussehensbezogener Zurückweisungssensitivität bei verschiedenen Störungsbildern geeignet.

Validation of Spanish Language Evaluation Instruments for Body Dysmorphic Disorder and the Dysmorphic Concern Construct

Dysmorphic concern (DC) refers to excessive preoccupation with a slight or imagined defect in physical appearance with social avoidance and behavior directed at controlling the defect in appearance. This study attempted to adapt the factor structure of two instruments that cover the DC construct, the Dysmorphic Concern Questionnaire (DCQ) and the Body Dysmorphic Disorder Examination Self-Report (BDDE-SR), to Spanish and establish their psychometric properties. A total of 920 subjects (62.7% women, Mage = 32.44 years) participated. Exploratory and Confirmatory Factor Analysis of both scales found adequate goodness of fit indices. A one-dimensional structure was found for the DCQ and two first-order factors (dissatisfaction/preoccupation with body image (BI) and BI avoidance behavior) were identified for the BDDE-SR. The psychometric test-retest reliability and validity properties (content, convergent, and discriminant) were satisfactory. It is suggested that the DC construct includes both cognitive and behavioral aspects and may represent a continuum of severity with Body Dysmorphic Disorder at the end.

A longitudinal study of 340 young people with or without a visible difference: The impact of teasing on self-perceptions of appearance and depressive symptoms

Previous research in both the general population and in those with a visible facial difference has identified potential associations between teasing, dissatisfaction with appearance and emotional distress. However, most studies are based on cross-sectional and retrospective methodology, restricting the interpretation of findings. The present study explored the longitudinal impact of perceived teasing on satisfaction with appearance and depressive symptoms in young people with and without a visible congenital condition. Routine psychological assessments were conducted at ages 10 and 16 years (N=340). Experiences of teasing after the age of 10 significantly impacted on appearance evaluations and depressive symptoms in adolescent females. The impact of teasing on adolescent males was possibly counteracted by reports of more positive social experiences. Early identification of perceived teasing in all children to prevent the development of emotional problems and dissatisfaction with appearance is of vital importance.

Maternal Rejection and Idealized Value of Appearance: Exploring the Origins of Body Dysmorphic Concerns Among Young Adults

Body dysmorphic disorder is a clinical disorder characterized by a preoccupation with an imagined or exaggerated defect in one's appearance (American Psychological Association, 2013), causing impaired functioning. Cognitive-behavioral models of body dysmorphic disorder have been proposed, whereby social anxiety and parental rejection may be predisposing factors, whereas maladaptive cognitive biases, such as appraisals of rejection, may serve as maintenance factors. The primary aim of this study was to test the role that perceived parental rejection in childhood may play in understanding the development of body dysmorphic symptoms. Furthermore, this study examined whether idealized values of appearance act as a mediator between perceived maternal rejection and body dysmorphic symptoms. The sample comprised 239 Australian undergraduate psychology students. Social anxiety, appearance-based rejection sensitivity, maternal rejection, and idealized values of appearance uniquely predicted body dysmorphic symptoms. Furthermore, the relationship between maternal rejection and body dysmorphic symptoms was partially mediated by idealized values of appearance. Findings support cognitive-behavioral models of body dysmorphic disorder.