A cascade of rejection and appearance preoccupation: Adolescents’ body dysmorphic symptoms and appearance rejection sensitivity over 4 years
Corresponding Author
Melanie J. Zimmer-Gembeck
School of Applied Psychology and Menzies Health Institute of Queensland, Griffith University, Southport, Queensland, Australia
Correspondence should be addressed to Melanie J. Zimmer-Gembeck, School of Applied Psychology and Menzies Health Institute of Queensland, Griffith University, Parklands Dr, G40_7.86, Southport QLD 4222, Australia (email: [email protected]).
Search for more papers by this authorJulia Rudolph
School of Applied Psychology and Menzies Health Institute of Queensland, Griffith University, Southport, Queensland, Australia
Search for more papers by this authorJuliane Pariz
School of Applied Psychology and Menzies Health Institute of Queensland, Griffith University, Southport, Queensland, Australia
Search for more papers by this authorCorresponding Author
Melanie J. Zimmer-Gembeck
School of Applied Psychology and Menzies Health Institute of Queensland, Griffith University, Southport, Queensland, Australia
Correspondence should be addressed to Melanie J. Zimmer-Gembeck, School of Applied Psychology and Menzies Health Institute of Queensland, Griffith University, Parklands Dr, G40_7.86, Southport QLD 4222, Australia (email: [email protected]).
Search for more papers by this authorJulia Rudolph
School of Applied Psychology and Menzies Health Institute of Queensland, Griffith University, Southport, Queensland, Australia
Search for more papers by this authorJuliane Pariz
School of Applied Psychology and Menzies Health Institute of Queensland, Griffith University, Southport, Queensland, Australia
Search for more papers by this authorAbstract
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.
Conflicts of interest
The authors have no conflicts of interest to disclose.
Open Research
Data availability statement
The data that support the findings of this study are available from the corresponding author upon reasonable request.
References
- Albert, D., Chein, J., & Steinberg, L. (2013). The teenage brain: Peer influences on adolescent decision making. Current Directions in Psychological Science, 22, 114–120. https://doi.org/10.1177/0963721412471347
- Alleva, J. M., Sheeran, P., Webb, T. L., Martijn, C., & Miles, E. (2015). A meta-analytic review of stand-alone interventions to improve body image. PLoS One, 10(9), E0139177. https://doi.org/10.1371/journal.pone.0139177
- American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5®). Washington, DC: American Psychological Association.
10.1176/appi.books.9780890425596 Google Scholar
- Anson, M., Veale, D., & de Silva, P. (2012). Social evaluative versus self-evaluative appearance concerns in body dysmorphic disorder. Behaviour Research and Therapy, 50, 753–760. https://doi.org/10.1016/j.brat.2012.09.003
- Bentler, P. M., & Bonett, D. G. (1980). Significance tests and goodness of fit in the analysis of covariance structures. Psychological Bulletin, 88, 588–606. https://doi.org/10.1037/0033-2909.88.3.588
- Bird, E. L., Halliwell, E., Diedrichs, P. C., & Harcourt, D. (2013). Happy Being Me in the UK: A controlled evaluation of a school-based body image intervention with pre-adolescent children. Body Image, 10, 326–334. https://doi.org/10.1016/j.bodyim.2013.02.008
- 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. https://doi.org/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. https://doi.org/10.1111/jora.1200310.1111/jora.12003
- Browne, M. W., & Cudeck, R. (1992). Alternative ways of assessing model fit. Sociological Methods & Research, 21, 230–258. https://doi.org/10.1177/0049124192021002005
- Buhlmann, U., & Wilhelm, S. (2004). Cognitive factors in body dysmorphic disorder. Psychiatric Annals, 34, 922–926. https://doi.org/10.3928/0048-5713-20041201-14
- Calogero, R. M., Park, L. E., Rahemtulla, Z. K., & Williams, K. C. D. (2010). Predicting excessive body image concerns among British university students: The unique role of appearance-based rejection sensitivity. Body Image, 7, 78–81. https://doi.org/10.1016/j.bodyim.2009.09.005
- Casey, B. J., Jones, R. M., & Somerville, L. H. (2011). Braking and accelerating of the adolescent brain. Journal of Research on Adolescence, 21, 21–33. https://doi.org/10.1111/j.1532-7795.2010.00712.x
- Densham, K., Webb, H. J., Zimmer-Gembeck, M. J., Nesdale, D., & Downey, G. (2017). Early adolescents’ body dysmorphic symptoms as compensatory responses to parental appearance messages and appearance-based rejection sensitivity. Body Image, 23, 162–170. https://doi.org/10.1016/j.bodyim.2017.09.005
- Downey, G., & Feldman, S. I. (1996). Implications of rejection sensitivity for intimate relationships. Journal of Personality and Social Psychology, 70, 1327–1343. https://doi.org/10.1037/0022-3514.70.6.1327
- Downey, G., Lebolt, A., Rincón, C., & Freitas, A. L. (1998). Rejection sensitivity and children's interpersonal difficulties. Child Development, 69, 1074–1091. https://doi.org/10.1111/j.1467-8624.1998.tb06161.x
- Duncan, N., Zimmer-Gembeck, M. J., & Furman, W. (2019). Sexual harassment and appearance-based peer victimization: Unique associations with emotional adjustment by gender and age. Journal of Adolescence, 75, 12–21. https://doi.org/10.1016/j.adolescence.2019.06.016
- Ekore, J. O. (2012). Gender differences in perception of sexual harassment among university students. Gender & Behavior, 10, 4358–4369.
- Enander, J., Ivanov, V. Z., Mataix-Cols, D., Kuja-Halkola, R., Ljótsson, B., Lundström, S., … Rück, C. (2018). Prevalence and heritability of body dysmorphic symptoms in adolescents and young adults: A population-based nationwide twin study. Psychological Medicine, 48, 2740–2747. https://doi.org/10.1017/S0033291718000375
- Gao, S., Assink, M., Cipriani, A., & Lin, K. (2017). Associations between rejection sensitivity and mental health outcomes: A meta-analytic review. Clinical Psychology Review, 57, 59–74. https://doi.org/10.1016/j.cpr.2017.08.007
- Grogan, S. (2007). Body image: Understanding body dissatisfaction in men, women and children ( 2nd ed.). London, UK: Routledge.
10.4324/9780203004340 Google Scholar
- Gruber, J., & Fineran, S. (2016). Sexual harassment, bullying, and school outcomes for high school girls and boys. Violence against Women, 22, 112–133. https://doi.org/10.1177/1077801215599079
- Hamaker, E. L., Kuiper, R. M., & Grasman, R. P. P. P. (2015). A critique of the cross-lagged panel model. Psychological Methods, 20, 102–116. https://doi.org/10.1037/a0038889
- Holmqvist, K., & Frisén, A. (2010). Body dissatisfaction across cultures: Findings and research problems. European Eating Disorders Review, 18(2), 133–146. https://doi.org/10.1002/erv.965
- Hu, L., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling, 6(1), 1–55. https://doi.org/10.1080/10705519909540118
- Hurst, K., & Zimmer-Gembeck, M. J. (2019). Family-based treatment with cognitive behavioural therapy for anorexia. Clinical Psychologist, 23, 61–70. https://doi.org/10.1111/cp.12152
- Kaplan, D. (2000). Structural equation modeling: Foundations and extensions. Thousand Oaks, CA: Sage.
- Kelly, M. M., Didie, E. R., & Phillips, K. A. (2014). Personal and appearance-based rejection sensitivity in body dysmorphic disorder. Body Image, 11(3), 260–265. https://doi.org/10.1016/j.bodyim.2014.03.004
- Kelly, M. M., & Phillips, K. A. (2017). Update on body dysmorphic disorder: Clinical features, epidemiology, pathogenesis, assessment, and treatment. Psychiatric Annals, 47, 552–558. https://doi.org/10.3928/00485713-20171004-02
- 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, 11(4), 391–395. https://doi.org/10.1016/j.bodyim.2014.06.008
- Masten, A. S., & Cicchetti, D. (2010). Developmental cascades. Development and Psychopathology, 22, 491–495. https://doi.org/10.1017/S095457941000022210.1017/S0954579410000222
- Mastro, S., Zimmer-Gembeck, M. J., Webb, H. J., Farrell, L., & Waters, A. (2016). Young adolescents' appearance anxiety and body dysmorphic symptoms: Social problems, self-perceptions and comorbidities. Journal of Obsessive-Compulsive and Related Disorders, 8, 50–55. https://doi.org/10.1016/j.jocrd.2015.12.001
- Mataix-Cols, D., Fernández de la Cruz, L., Isomura, K., Anson, M., Turner, C., Monzani, B., … Krebs, G. (2015). A pilot randomized controlled trial of cognitive-behavioral therapy for adolescents with body dysmorphic disorder. Journal of the American Academy of Child & Adolescent Psychiatry, 54, 895–904. https://doi.org/10.1016/j.jaac.2015.08.011
- Neziroglu, F., Borda, T., Khemlani-Patel, S., & Bonasera, B. (2018). Prevalence of bullying in a pediatric sample of body dysmorphic disorder. Comprehensive Psychiatry, 87, 12–16. https://doi.org/10.1016/j.comppsych.2018.08.014
- Neziroglu, F., Khemlani-Patel, S., & Veale, D. (2008). Social learning theory and cognitive behavioral models of body dysmorphic disorder. Body Image, 5(1), 28–38. https://doi.org/10.1016/j.bodyim.2008.01.002
- Park, L. E. (2007). Appearance-based rejection sensitivity: Implications for mental and physical health, affect, and motivation. Personality and Social Psychology Bulletin, 33(4), 490–504. https://doi.org/10.1177/0146167206296301
- Park, L. E., Calogero, R. M., Young, A. F., & DiRaddo, A. M. (2010). Appearance-based rejection sensitivity predicts body dysmorphic disorder symptoms and cosmetic surgery acceptance. Journal of Social and Clinical Psychology, 29, 489–509. https://doi.org/10.1521/jscp.2010.29.5.489
- Presnell, K., Bearman, S. K., & Stice, E. (2004). Risk factors for body dissatisfaction in adolescent boys and girls: A prospective study. International Journal of Eating Disorders, 36, 389–401. https://doi.org/10.1002/eat.20045
- Ricciardelli, L. A., & Yager, Z. (2015). Adolescence and body image: From development to preventing dissatisfaction. London, UK: Routledge Ltd.
10.4324/9781315849379 Google Scholar
- Roberts, C., Zimmer-Gembeck, M. J., & Farrell, L. J. (2019). The Multidimensional Youth Body Dysmorphic Inventory (MY BODI): Development and preliminary validation. Child Psychiatry & Human Development, 50(6), 927–939. https://doi.org/10.1007/s10578-019-00893-6
- Roberts, C., Zimmer-Gembeck, M. J., Lavell, C., Miyamoto, T., Gregertsen, E., & Farrell, L. J. (2018). The Appearance Anxiety Inventory: Factor structure and associations with appearance-based rejection sensitivity and social anxiety. Journal of Obsessive-Compulsive and Related Disorders, 19, 124–130. https://doi.org/10.1016/j.jocrd.2018.10.004
- Roberts, R. E., Fisher, P. W., Turner, J. B., & Tang, M. (2015). Estimating the burden of psychiatric disorders in adolescence: The impact of subthreshold disorders. Social Psychiatry and Psychiatric Epidemiology, 50, 397–406. https://doi.org/10.1007/s00127-014-0972-3
- Satorra, A., & Bentler, P. M. (2010). Ensuring positiveness of the scaled difference chi-square test statistic. Psychometrika, 75, 243–248. https://doi.org/10.1007/s11336-009-9135-y
- Schneider, S. C., Mond, J., Turner, C. M., & Hudson, J. L. (2017). Subthreshold body dysmorphic disorder in adolescents: Prevalence and impact. Psychiatry Research, 251, 125–130. https://doi.org/10.1016/j.psychres.2017.01.085
- Schneider, S. C., Turner, C. M., Mond, J., & Hudson, J. L. (2017). Prevalence and correlates of body dysmorphic disorder in a community sample of adolescents. Australian & New Zealand Journal of Psychiatry, 51, 595–603. https://doi.org/10.1177/0004867416665483
- Selig, J. P., & Little, T. D. (2012). Autoregressive and cross-lagged panel analysis for longitudinal data. In B. Laursen, T. D. Little & N. A. Card (Eds.), Handbook of developmental research methods (pp. 265–278). New York, NY: The Guilford Press.
- Shankman, S. A., Lewinsohn, P. M., Klein, D. N., Small, J. W., Seeley, J. R., & Altman, S. E. (2009). Subthreshold conditions as precursors for full syndrome disorders: A 15-year longitudinal study of multiple diagnostic classes. Journal of Child Psychology and Psychiatry, 50, 1485–1494. https://doi.org/10.1111/j.1469-7610.2009.02117.x
- Swami, V., Frederick, D. A., Aavik, T., Alcalay, L., Allik, J., Anderson, D., … Zivcic-Becirevic, I. (2010). The attractive female body weight and female body dissatisfaction in 26 countries across 10 world regions: Results of the International Body Project I. Personality and Social Psychology Bulletin, 36, 309–325. https://doi.org/10.1177/0146167209359702
- Veale, D. (2004). Advances in a cognitive behavioral model of body dysmorphic disorder. Body Image, 1(1), 113–125. https://doi.org/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. Behavioral and Cognitive Psychotherapy, 42, 605–616. https://doi.org/10.1017/S1352465813000556
- Veale, D., Gledhill, L. J., Christodoulou, P., & Hodsoll, J. (2016). Body dysmorphic disorder in different settings: A systematic review and estimated weighted prevalence. Body Image, 18, 168–186. https://doi.org/10.1016/j.bodyim.2016.07.003
- Webb, H., & Zimmer-Gembeck, M. J. (2015). Body image attitudes and body change strategies within best friend dyads and friendship groups: Implications for adolescent appearance-rejection sensitivity. Social Development, 24, 1–19.10.1111/sode.1208
- Webb, H. J., & Zimmer-Gembeck, M. J. (2016). A longitudinal study of appearance-based rejection sensitivity and the peer appearance culture: The role of friends’ body image, dieting, and weight. Journal of Applied Developmental Psychology, 43, 91–100. https://doi.org/10.1016/j.appdev.2016.01.004
- 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(4), 347–358. https://doi.org/10.1016/j.adolescence.2014.02.008
- Webb, H. J., Zimmer-Gembeck, M. J., Farrell, L., Waters, A., Nesdale, D., & Downey, G. (2017). "Pretty pressure" from peers, parents, and the media: A longitudinal study of appearance-based rejection sensitivity. Journal of Research on Adolescence, 27, 718–735. https://doi.org/10.1111/jora.12310
- Webb, H. J., Zimmer-Gembeck, M. J., & Mastro, S. (2016). Stress exposure and generation: A conjoint longitudinal model of body dysmorphic symptoms, peer acceptance, popularity, and relational victimization. Body Image, 18, 14–18. https://doi.org/10.1016/j.bodyim.2016.04.010
- Webb, H. J., Zimmer-Gembeck, M. J., Waters, A. M., Farrell, L. J., Nesdale, D., & Downey, G. (2017). “Pretty pressure” from peers, parents, and the media: A longitudinal study of appearance-based rejection sensitivity. Journal of Research on Adolescence, 27, 718–735. https://doi.org/10.1111/jora.12310
- Weingarden, H., & Renshaw, K. D. (2016). Body dysmorphic symptoms, functional impairment, and depression: the role of appearance-based teasing. The Journal of Psychology, 150(1), 119–131.10.1080/00223980.2015.1012144
- Wolf, E. J., Harrington, K. M., Clark, S. L., & Miller, M. W. (2013). Sample size requirements for structural equation models: An evaluation of power, bias, and solution propriety. Educational and Psychological Measurement, 76, 913–934. https://doi.org/10.1177/0013164413495237
- Yager, Z., Diedrichs, P. C., Ricciardelli, L. A., & Halliwell, E. (2013). What works in secondary schools? A systematic review of classroom-based body image programs. Body Image, 10(3), 271–281. https://doi.org/10.1016/j.bodyim.2013.04.001
- Zimmer-Gembeck, M. J., Webb, H. J., Farrell, L. J., & Waters, A. M. (2018). Girls' and boys' trajectories of appearance anxiety from age 10 to 15 years are associated with earlier maturation and appearance-related teasing. Development and Psychopathology, 30(1), 337–350. https://doi.org/10.1017/S0954579417000657