Abstract
In this study of young adolescents’ (N = 188, M age = 11.93, 54.8 % females) body dysmorphic disorder (BDD) symptoms, we examined a theoretically-derived model to determine if symptoms could be explained by appearance-related teasing, general peer victimization, and social anxiety. BDD symptoms were assessed as distressing preoccupation with perceived appearance defects, social avoidance, and repeated grooming and appearance checking. Associations were expected to occur via the social-perceptual bias known as appearance-based rejection sensitivity (appearance-RS). The source of appearance teasing was also considered (same-sex vs. cross-sex peers), and age and gender moderation were assessed. As predicted, in a structural equation model, BDD symptoms were higher when adolescents self-reported more appearance teasing and higher social anxiety. Moreover, it was appearance teasing by cross-sex peers, rather than same-sex peers, that was uniquely associated with elevated BDD symptoms. These associations were partially mediated by appearance-RS. Notably, peer-reported general victimization was not associated with BDD symptoms. There was no evidence for gender moderation, but some age moderation was found, with stronger associations usually found among older compared to younger adolescents. The findings suggest that appearance-related social adversity, particularly cross-sex teasing, is linked with greater concerns about rejection due to appearance and, in turn, heightened BDD symptoms. This has important implications for understanding the development and treatment of BDD. Continued research to identify the social experiences and interpretative biases that contribute to BDD symptomology is needed.
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References
Albertini, R. S., & Phillips, K. A. (1999). Thirty-three cases of Body Dysmorphic Disorder in children and adolescents. Journal of the American Academy of Child and Adolescent Psychiatry, 38, 453–459. doi:10.1097/00004583-199904000-00019.
Beck, A. T. (2008). The evolution of the cognitive model of depression and its neurobiological correlates. The American Journal of Psychiatry, 165, 969–977. doi:10.1176/appi.ajp.2008.08050721.
Bjornsson, A. S., Didie, E. R., Grant, J. E., Menard, W., Stalker, E., & Phillips, K. A. (2013). Age at onset and clinical correlates in body dysmorphic disorder. Comprehensive Psychiatry, 54, 893–903. doi:10.1016/j.comppsych.2013.03.019.
Bowker, J. C., Thomas, K. K., Spencer, S. V., & Park, L. E. (2013). Examining appearance-based rejection sensitivity during early adolescence. Journal of Research on Adolescence, 23, 375–388. doi:10.1111/jora.12003.
Bowlby, J. (1988). A secure base: Parent–child attachment and health human development. USA: Basic Books.
Breslau, N., Chilcoat, H. D., Kessler, R. C., Peterson, E. L., & Lucia, V. C. (1999). Vulnerability to assaultive violence: further speculation of the sex difference in post-traumatic stress disorder. Psychological Medicine, 29, 813–821.
Buhlmann, U., McNally, R. J., Wilhelm, S., & Florin, I. (2002a). Selective processing of emotional information in body dysmorphic disorder. Anxiety Disorders, 16, 289–298. doi:10.1016/S0887-6185(02)00100-7.
Buhlmann, U., Wilhelm, S., McNally, R. J., Tuschen-Caffier, B., Baer, L., & Jenike, M. A. (2002b). Interpretive biases for ambiguous information in body dysmorphic disorder. CNS Spectrums, 7, 435–443.
Buhlmann, U., McNally, R. J., Etcoff, N. L., Tuschen-Caffier, B., & Wilhelm, S. (2004). Emotion recognition deficits in body dysmorphic disorder. Journal of Psychiatric Research, 38, 201–206. doi:10.1016/S0022-3956(03)00107-9.
Buhlmann, U., Etcoff, N. L., & Wilhelm, S. (2006). Emotion recognition bias for contempt and anger in body dysmorphic disorder. Journal of Psychiatric Research, 40, 105–111. doi:10.1016/j.jpsychires.2005.03.006.
Buhlmann, U., Cook, M. C., Fama, J. M., & Wilhelm, S. (2007). Perceived teasing experiences in body dysmorphic disorder. Body Image, 4, 381–385. doi:10.1016/j.bodyim.2007.06.004.
Buhlmann, U., Wilhelm, S., Glaesmer, H., Mewes, R., Brahler, E., & Rief, W. (2011). Perceived appearance-related teasing in body dysmorphic disorder: a population-based survey. International Journal of Cognitive Therapy, 4, 342–348. doi:10.1521/ijct.2011.4.4.342.
Buhlmann, U., Marques, L. M., & Wilhelm, S. (2012). Traumatic experiences in individuals with body dysmorphic disorder. The Journal of Nervous and Mental Disease, 200, 95–98. doi:10.1097/NMD.0b013e31823f6775.
Collins, W. A. (2003). More than myth: the developmental significance of romantic relationships during adolescence. Journal of Research on Adolescence, 13, 1–24. doi:10.1111/1532-7795.1301001.
Collins, W. A., & Laursen, B. (2004). Changing relationships, changing youth: Interpersonal contexts of adolescent development. The Journal of Early Adolescence, 24, 55–62. doi:10.1177/0272431603260882.
Collins, W. A., Welsh, D. P., & Furman, W. (2009). Adolescent romantic relationships. Annual Review of Psychology, 60, 631–652. doi:10.1146/annurev.psych.60.110707.163459.
Compian, L. J., Gowen, L. K., & Hayward, C. (2009). The interactive effects of puberty and peer victimization on weight concerns and depression symptoms among early adolescent girls. The Journal of Early Adolescence, 29, 357–375. doi:10.1177/0272431608323656.
Crick, N. R., & Grotpeter, J. K. (1995). Relational aggression, gender, and social-psychological adjustment. Child Development, 66, 710–722. doi:10.1111/j.1467-8624.1995.tb00900.x.
Downey, G., Khouri, H., & Feldman, S. J. (1997). Early interpersonal trauma and later adjustment: the mediational role of rejection sensitivity. In D. Cicchetti & S. L. Toth (Eds.), Developmental perspectives on trauma: Theory, research, and intervention (pp. 85–114). New York: University of Rochester Press.
Downey, G., Lebolt, A., Rincon, C., & Freitas, A. L. (1998). Rejection sensitivity and children’s interpersonal difficulties. Child Development, 69, 1074–1091. http://www.jstor.org/stable/1132363
Fang, A., & Hofmann, S. G. (2010). Relationship between social anxiety disorder and body dysmorphic disorder. Clinical Psychology Review, 30, 1040–1048. doi:10.1016/j.cpr.2010.08.001.
Fang, A., Asnaani, A., Gutner, C., Cook, C., Wilhelm, S., & Hofmann, S. G. (2011). Rejection sensitivity mediates the relationship between social anxiety and body dysmorphic disorder. Journal of Anxiety Disorders, 25, 946–949. doi:10.1016/j.janxdis.2011.06.001.
Fang, A., Sawyer, A. T., Aderka, I. M., & Hofmann, S. G. (2013). Psychological treatment of social anxiety disorder improves body dysmorphic concerns. Journal of Anxiety Disorders, 27, 684–691. doi:10.1016/j.janxdis.2013.07.005.
Felix, E. D., & McMahon, S. D. (2006). Gender and multiple forms of peer victimization: How do they influence adolescent psychosocial adjustment? Violence and Victims, 21, 707–724. doi:10.1891/0886-6708.21.6.707.
First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (1995). Structured clinical interview for DSM-IV Axis I Disorders-Patient edition. New York: Biometrics Research Department, New York Psychiatric Institute.
Gifford-Smith, M. E., & Brownell, C. A. (2003). Childhood peer relationships: social acceptance, friendships, and peer networks. Journal of School Psychology, 41, 235–284. doi:10.1016/S0022-4405(03)00048-7.
Grocholewski, A., Kliem, S., & Heinrichs, N. (2012). Selective attention to imagined facial ugliness is specific to body dysmorphic disorder. Body Image, 9, 261–269. doi:10.1016/j.bodyim.2012.01.002.
Grogan, S. (2008). Body image: Understanding body dissatisfaction in men, women, and children. New York: Routledge.
Hartmann, A. S., Greenberg, J. L., & Wilhelm, S. (2013). The relationship between anorexia nervosa and body dysmorphic disorder. Clinical Psychology Review, 33, 675–685. doi:10.1016/j.cpr.2013.04.002.
Haynie, D. L., & Piquero, A. R. (2006). Pubertal development and physical victimization in adolescence. Journal of Research in Crime and Delinquency, 43, 3–35. doi:10.1177/0022427805280069.
Kaplan, R. A., Rossell, S. L., Enticott, P. G., & Castle, D. J. (2013). Own-body perception in body dysmorphic disorder. Cognitive Neuropsychiatry, 18, 594–614. doi:10.1080/13546805.2012.758878.
Kelly, M. M., Walkers, C., & Phillips, K. A. (2010). Social anxiety and its relationship to functional impairment in body dysmorphic disorder. Behavior Therapy, 41, 143–153. doi:10.1016/j.beth.2009.01.005.
La Greca, A. M. (1999). Manual for the Social Anxiety Scales for Children and Adolescents. Miami: Author.
La Greca, A. M., & Stone, W. L. (1993). Social anxiety scale for children-revised: factor structure and concurrent validity. Journal of Clinical Child Psychology, 22, 17–27. doi:10.1207/s15374424jccp2201_2.
Ladd, G. W., & Kochenderfer-Ladd, B. (2002). Identifying victims of peer aggression from early to middle childhood: analysis of cross-informant data for concordance, estimation of relational adjustment, prevalence of victimization, and characteristics of identified victims. Psychological Assessment, 14, 74–96. doi:10.1037//1040-3590.14.1.74.
Lavell, C. H., Zimmer-Gembeck, M. J., Farrell, L. J., & Webb, H. (2014). Victimization, social anxiety, and body dysmorphic concerns: Appearance-based rejection sensitivity as a mediator. Body Image: An International Journal of Research, 11, 391–395. doi:10.1016/j.bodyim.2014.06.008.
London, B., Downey, G., Bonica, C., & Paltin, I. (2007). The causes and consequences of rejection sensitivity. Journal of Research on Adolescence, 17, 481–506. doi:10.1111/j.1532-7795.2007.00531.x.
Lunde, C., Frisen, A., & Hwang, C. P. (2006). Is peer victimization related to body esteem in 10-year-old girls and boys? Body Image, 3, 25–33. doi:10.1016/j.bodyim.2005.12.001.
O’Brien, C. (2011). Young people’s comparisons of crossgender and same-gender bullying in British secondary schools. Educational Research, 53, 257–301. doi:10.1080/00131881.2011.598658.
Osman, S., Cooper, M., Hackmann, A., & Veale, D. (2004). Spontaneously occurring images and early memories in people with body dysmorphic disorder. Memory, 12, 428–436. doi:10.1080/09658210444000043.
Park, L. E. (2007). Appearance-based rejection sensitivity: Implications for mental and physical health, affect and motivation. Personality and Social Psychology Bulletin, 33, 490–504. doi:10.1177/0146167206296301.
Park, L. E., & Harwin, M. J. (2010). Visible versus non-visible rejection: consequences of appearance-based rejection sensitivity. Journal of Research in Personality, 44, 128–132. doi:10.1016/j.jrp.2009.10.001.
Paxton, S. J., Eisenberg, M. E., & Neumark-Sztainer, D. (2006). Prospective predictors of body dissatisfaction in adolescent girls and boys: a five-year longitudinal study. Developmental Psychology, 42, 888–899. doi:10.1037/0012-1649.42.5.888.
Phillips, K. A. (1991). Body dysmorphic disorder: the distress of imagined ugliness. The American Journal of Psychiatry, 148, 1138–1149.
Phillips, K. A., & Menard, W. (2006). Suicidality in body dysmorphic disorder: a prospective study. The American Journal of Psychiatry, 163, 1280–1282. doi:10.1176/appi.ajp.163.7.1280.
Phillips, K. A., McElroy, S. L., Keck, P. E., Pope, H. G., & Hudson, J. I. (1993). Body dysmorphic disorder: 30 cases of imagined ugliness. The American Journal of Psychiatry, 150, 302–308.
Phillips, K. A., Hollander, E., Rasmussen, S. A., Aronowitz, B. R., DeCaria, C., & Goodman, W. K. (1997). A severity rating scale for body dysmorphic disorder: development, reliability, and validity of a modified version of the Yale-brown obsessive compulsive scale. Psychopharmacology Bulletin, 33, 17–22.
Phillips, K. A., Menard, W., Fay, C., & Weisberg, R. (2005). Demographic characteristics, phenomenology, comorbidity, and family history in 200 individuals with body dysmorphic disorder. Psychosomatics, 46, 317–325. doi:10.1176/appi.psy.46.4.317.
Phillips, K. A., Didie, E. R., Menard, W., Pagano, M. E., Fay, C., & Weisberg, R. B. (2006). Clinical features of body dysmorphic disorder in adolescents and adults. Psychiatry Research, 141, 305–314. doi:10.1016/j.psychres.2005.09.014.
Pimlott-Kubiak, S., & Cortina, L. M. (2003). Gender, victimization, and outcomes: reconceptualizing risk. Journal of Consulting and Clinical Psychology, 71, 528–539. doi:10.1037/0022-006X.71.3.528.
Rudolph, J., & Zimmer-Gembeck, M. J. (2014). Parent relationships and adolescents’ depression and social anxiety: indirect associations via emotional sensitivity to rejection threat. Australian Journal of Psychology, 66, 110–121. doi:10.1111/ajpy.12042.
Thompson, J. K., Cattarin, J., Fowler, B., & Fisher, E. (1995). The perception of teasing scale (POTS): a revision and extension of the physical appearance related teasing scales (PARTS). Journal of Personality Assessment, 65, 146–157. doi:10.1207/s15327752jpa6501_11.
Tremblay, R. E. (2000). The development of aggressive behavior during childhood: what have we learned in the past century? International Journal of Behavioral Development, 24, 129–141.
Veale, D. (2004). Advances in a cognitive behavioral model of body dysmorphic disorder. Body Image, 1, 113–125. doi:10.1016/S1740-1445(03)00009-3.
Veale, D., Eshkevari, E., Kanakam, N., Ellison, N., Costa, A., & Werner, T. (2014). The appearance anxiety inventory: validation of a process measure in the treatment of body dysmorphic disorder. Behavioural and Cognitive Psychotherapy, 42, 605–616. doi:10.1017/S1352465813000556.
Webb, H. J., & Zimmer-Gembeck, M. J. (2014). The role of friends and peers in adolescent body dissatisfaction: a review and critique of 15 years of research. Journal of Research on Adolescence, 24, 564–590. doi:10.1111/jora.12084.
Webb, H. J., Zimmer-Gembeck, M. J., & Donovan, C. L. (2014). The appearance culture between friends and adolescent appearance-based rejection sensitivity. Journal of Adolescence, 37, 347–358. doi:10.1016/j.adolescence.2014.02.008.
Zimmer-Gembeck, M. J. (1999). Stability, change, and individual differences in involvement with friends and romantic partners among adolescent females. Journal of Youth and Adolescence, 28, 419–438. doi:10.1023/A:1021612907073.
Zimmer-Gembeck, M. J. (2002). The development of romantic relationships and adaptations in the system of peer relationships. Journal of Adolescent Health, 31, 216–225. doi:10.1016/S1054-139X(02)00504-9.
Zimmer-Gembeck, M. J., & Nesdale, D. (2013). Anxious and angry rejection sensitivity, social withdrawal, and retribution in high and low ambiguous situations. Journal of Personality, 81, 29–38. doi:10.1111/j.1467-6494.2012.00792.x.
Zimmer-Gembeck, M. J., Siebenbruner, J., & Collins, W. A. (2001). Diverse aspects of dating: associations with psychosocial functioning from early to middle adolescence. Journal of Adolescence, 24, 313–336. doi:10.1006/jado.2001.0410.
Zimmer-Gembeck, M. J., Trevaskis, S., Nesdale, D., & Downey, G. (2013). Relational victimization, loneliness and depressive symptoms: Indirect associations via self and peer reports of rejection sensitivity. Journal of Youth and Adolescence, 43, 568–582. doi:10.1007/s10964-013-9993-6.
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Webb, H.J., Zimmer-Gembeck, M.J., Mastro, S. et al. Young Adolescents’ Body Dysmorphic Symptoms: Associations with Same- and Cross-Sex Peer Teasing via Appearance-based Rejection Sensitivity. J Abnorm Child Psychol 43, 1161–1173 (2015). https://doi.org/10.1007/s10802-014-9971-9
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DOI: https://doi.org/10.1007/s10802-014-9971-9