Rejection sensitivity mediates the relationship between social anxiety and body dysmorphic concerns

Abstract

The goal of this study was to examine the role of rejection sensitivity in the relationship between social anxiety and body dysmorphic concerns. To test our hypothesis that rejection sensitivity mediates the link between social anxiety and body dysmorphic concerns, we administered self-report questionnaires to 209 student volunteers. Consistent with our prediction, rejection sensitivity partially mediated the relationship between social anxiety symptoms and body dysmorphic concerns. The implications of the overlap between these constructs are discussed.

Introduction

Body dysmorphic concerns are characterized by preoccupations with one's physical appearance as being extremely ugly or flawed, in the absence of a real, physical deformity or anomaly. Although this construct has been described in the literature for centuries, it has only recently begun to receive greater empirical attention (Phillips, 2005). This concern manifests in persistent thoughts about one's physical appearance, as well as time-consuming behaviors to hide, fix, or check one's appearance (Phillips, Menard, Fay, & Weisberg, 2005). As a result of perceiving appearance flaws as a physical problem, individuals with body dysmorphic concerns often present to medical professionals (e.g., cosmetic surgeons, dermatologists) to improve or correct their appearance (Crerand, Phillips, Menard, & Fay, 2005).

People with body dysmorphic concerns often avoid social situations (Phillips, 2005). Social avoidance is also a prominent and characteristic feature of people with high social anxiety (Hofmann, 2007). Indeed, research suggests that social anxiety and body dysmorphic concerns are highly overlapping constructs (Coles et al., 2006, Fang and Hofmann, 2010, Kelly et al., 2010). Studies have demonstrated that individuals who report having body dysmorphic concerns also endorse high social anxiety (Coles et al., 2006). Both constructs are related to a fear of negative evaluation, as well as negative self-focused thoughts, such as being inadequate or worthless (Phillips et al., 2010). Consistent with having negative beliefs about themselves, individuals with social anxiety and body dysmorphic concerns tend to be biased to interpret ambiguous social situations in a negative manner, even when positive or neutral interpretations are available (Amir et al., 1998, Buhlmann et al., 2002). Furthermore, evidence suggests that thoughts of reference are common to individuals with heightened social anxiety, as well as individuals with heightened body dysmorphic concerns (Meyer and Lenzenweger, 2009, Phillips, 2004). For example, people with high social anxiety and body dysmorphic concerns both tend to perceive others as talking about them in a mocking manner. These similarities may point to low insight as a common shared aspect of the two constructs (Fang & Hofmann, 2010). Thus, there appears to be empirical support for the notion that social anxiety and body dysmorphic concerns may be highly related constructs.

Despite existing research suggesting that social anxiety and body dysmorphic concerns are overlapping, these two constructs also show important differences. One major difference is that body dysmorphic concerns are usually characterized by compulsive behaviors (i.e. to check one's physical appearance), which are not typically found in individuals with sole social anxiety concerns (Phillips, 2005, Phillips et al., 2010). Furthermore, there is evidence to suggest that body dysmorphic concern may only be strongly associated with a fear of negative evaluation regarding physical appearance (Phillips, 2005). Therefore, more research is needed to clarify the similarities and differences between these related constructs.

It has been suggested that rejection sensitivity may be associated with both social anxiety and body dysmorphic concerns (Coles et al., 2006). The purpose of the current study was to investigate the role of rejection sensitivity, as one potential mechanism by which social anxiety and body dysmorphic concerns may be associated. Rejection sensitivity refers to a sense of personal inadequacy and misinterpretation of the behavior of others, which contributes to fear and discomfort when rejection is perceived (Harb, Heimberg, Fresco, Schneier, & Liebowitz, 2002). This construct is closely related to a fear of negative evaluation by others and a fear of embarrassment, which are the primary shared features between social anxiety concerns and body dysmorphic concerns. However, rejection sensitivity is distinguishable from fear of negative evaluation in that the latter refers to a broader construct related to anxious apprehension of others’ evaluations (Watson & Friend, 1969), rather than a specific concern about anticipating rejection from others, which better characterizes the former. Although data show that heightened rejection sensitivity is associated with social anxiety and body dysmorphic concern as independent constructs (Calogero et al., 2010, Harb et al., 2002, Phillips et al., 1996), studies have not yet investigated whether rejection sensitivity serves as a link between the two constructs.

Specifically, the current study had the following aims. First, we examined whether social anxiety is associated with body dysmorphic concerns after controlling for rejection sensitivity. Second, we examined whether rejection sensitivity mediated the relationship between social anxiety and body dysmorphic concerns. Consistent with previous research (Calogero et al., 2010, Harb et al., 2002), we hypothesized that rejection sensitivity would be positively associated with body dysmorphic concerns, and that social anxiety would remain to be significantly associated with body dysmorphic concerns, even after controlling for rejection sensitivity. In other words, we predicted that rejection sensitivity would partially mediate the relationship between social anxiety and body dysmorphic concerns.