Is appearance-related social comparison a causal mechanism underlying appearance-related psychopathology among young adult women? An experimental test.

Appearance-related social comparisons (ARSCs) have been identified as a maladaptive process related to appearance concerns and symptoms of body dysmorphic disorder (BDD), social anxiety disorder (SAD), and eating disorders (EDs). The aim of the present study was to test the effects of fading (i.e., systematically reducing or eliminating) these behaviors using a non-treatment experimental design in which the study's purpose was concealed from participants. Women with elevated (i.e., upper quartile) appearance concerns (N = 100) were randomized to either a one-month text message-based ARSC fading condition (n = 50) or a ARSC self-monitoring control condition (n = 50). We found that relative to control, ARSC fading led to lower appearance concerns, appearance importance, BDD symptoms, ED symptoms, and trait anxiety. Further, changes in ARSCs mediated the effect of condition on appearance concerns, BDD symptoms, and ED symptoms. Compared to control, the ARSC fading group also demonstrated less reactivity to one of two in vivo appearance-related stressor tasks. We also explore the incremental role ARSCs contribute to outcomes over related behaviors (e.g., checking, avoidance, reassurance seeking). Importantly, few participants correctly guessed the purpose of the study, and their removal from analyses did not affect study findings. This study provides novel evidence for the importance of ARSCs in the maintenance of appearance-related psychopathology.