Two Studies on the Role of Appearance Concerns in Social Anxiety and Depression

Appearance concerns are a core feature of multiple psychiatric disorders, including body dysmorphic disorder and eating disorders; however, some have argued that they may also play a key role in social anxiety and depression. The present study sought to determine whether reductions in appearance concerns explain reductions in social anxiety and depression in two separate studies. Two studies examined the effects of fading appearance-related safety behaviors (ARSB; i.e., behaviors meant to avoid or reduce a perceived feared outcome related to appearance) experimentally (Study 1) or in a treatment context (Study 2). In Study 1 (N = 94), we found that changes in appearance concerns fully accounted for the effect of fading ARSBs on social anxiety and depression in a clinical sample of women; further, pre- to mid-manipulation changes in appearance concerns (across conditions) predicted residual change in social anxiety at post. In Study 2, among a large community sample of women (N = 203) who participated in a 1-month smartphone-based treatment for appearance concerns, we found that pre- to posttreatment changes in appearance concerns mediated the effect of ARSB fading on social anxiety at 1-month follow-up. Additionally, we found that regardless of condition, changes in appearance concerns predicted residual change in depression one-month later. Taken together, the present findings suggest that appearance concerns may maintain symptoms of social anxiety and depression, and changes in appearance concern may indirectly lead to changes in these outcomes.