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Individual Oral Paper

Obsessive Compulsive and Related Disorders

Along the Treatment Cascade of Eating Disorders

2 - (IOP 34) Examining Effects of Appearance-related Preoccupations and Safety Behaviors in Body Dysmorphic Disorder: An Ecological Momentary Assessment Study

Sunday, November 23, 2025
10:15 AM - 10:30 AM CST
Location: Celestin G, Level 3
Keywords: Body Dysmorphic Disorder, Change Process / Mechanisms, Technology / Mobile Health
Recommended Readings: Fang, A., & Wilhelm, S. (2015). Clinical features, cognitive biases, and treatment of body dysmorphic disorder. Annual Review of Clinical Psychology, 11(1), 187-212. https://doi.org/10.1146/annurev-clinpsy-032814-112849,   Patel, T. A., & Cougle, J. R. (2024). An experimental examination of appearance-related safety behaviors in a clinical sample of women. Journal of Psychopathology and Clinical Science, 133(5), 368–377. https://doi.org/10.1037/abn0000926,   ,   ,  

    Author(s)

  • Nicola Hohensee, Ph.D.

    Postdoctoral Associate
    University of Münster & Yale University
    Münster, Nordrhein-Westfalen, Germany

    • Co-Author(s)

  • Fanny A. Dietel, Ph.D. (she/her/hers)

    Postdoctoral clinical research fellow
    University of Osnabrueck, Germany
    Osnabrueck, Niedersachsen, Germany

  • JS

    Johanna Schulte, Ph.D.

    Coordinator for Academic Modules in MSc Psychology: Clinical Psychology and Psychotherapy
    University of Münster
    Münster, Nordrhein-Westfalen, Germany

  • PD

    Philipp Doebler, None

    Full Professor
    TU Dortmund University - Department of Statistics
    Dortmund, Nordrhein-Westfalen, Germany

  • NK

    Nadja Klein, Other

    Full Professor
    Karlsruhe Institute of Technology
    Karlsruhe, Baden-Wurttemberg, Germany

  • UB

    Ulrike Buhlmann, Ph.D.

    Professor of Psychology
    University of Muenster
    Münster, Nordrhein-Westfalen, Germany

Body dysmorphic disorder (BDD) is characterized by excessive appearance-related preoccupation and safety behaviors (e.g., mirror gazing, body checking). Cognitive-behavioral models suggest that these processes reinforce selective attention to and dysfunctional beliefs about appearance, thus maintaining BDD symptoms. To date, experimental and cross-sectional self-report studies provide empirical support for these mechanisms.
In this study, we examined the dynamics, contextual embedment and function of appearance-related processes in daily life. Specifically, we investigated the effect of appearance-related preoccupation and safety behaviors on body dissatisfaction, conviction about appearance flaws and negative affect using ecological momentary assessment (EMA). A total of n = 30 individuals with BDD (MAge = 27.7, SDAge = 7.8, 73.3% female) and n = 30 mentally healthy controls (HC; MAge = 27.3, SDAge = 7.5, 73.3% female) completed self-report measures after up to two event-based prompts (i.e., matutinal and nightly assessments before and after bedtime) and up to eight random prompts daily over the course of six consecutive days (on average 8.71 assessments per day). Out of N = 3075 unique assessments, n = 875 assessments captured self-reports right after engaging in appearance-related preoccupations and safety behaviors.
Multilevel regression analyses using a Bayesian estimation approach indicated increases in body dissatisfaction and conviction in individuals with BDD after engaging in any appearance-related process (i.e., appearance-related preoccupation, gazing, other safety behavior such as body checking). Following preoccupation and gazing, individuals with BDD reported additionally higher negative affect. The HC reported increased body dissatisfaction and conviction after engaging in any appearance-related behavior as well, but no changes in negative affect following any behavior. The findings demonstrate the negative effect of appearance-related preoccupation, gazing and other safety behaviors for symptom maintenance in individuals with BDD in an ecologically more valid context.

Learning Objectives:

At the end of this session, the learner will be able to:
  1. Describe daily life effects of appearance-related preoccupation and safety behaviors in individuals with body dysmorphic disorder.