Appearance-based rejection sensitivity in body dysmorphic disorder and eating disorders Potential of the feature for disorder differentiation

Abstract

Background Body dysmorphic disorder (BDD) and eating disorders (ED) share a variety of symptoms, which complicates a differential diagnosis. The psychopathology of both disorders points to appearance-based rejection sensitivity (ARS) as a possible discriminating feature. Objective The study aimed to provide evidence for an improvement of the differential diagnosis between BDD and ED. Therefore, the two disorders were compared with reference to the ARS scores. Based on previous empirical literature, people with BDD were expected to show a higher ARS score than people with an ED. Furthermore, BDD was tested to explain more variance on ARS than ED, even if confounding variables (social anxiety symptoms, body mass index, sex) are held constant. Material and methods A community sample (n & x202f;= 736) filled out an online survey including the appearance-based rejection sensitivity scale, the Liebowitz social anxiety scale, the eating disorder examination questionnaire and a DSM-5 screening on BDD. Results Participants with a comorbid positive BDD-ED screening reached the highest ARS scores but similar scores as participants with a positive ED screening. Both groups yielded significantly higher scores than participants with a positive BDD screening, which in turn had significantly higher scores than symptomfree participants. Regression analysis confirmed a greater explanation of variance on ARS by ED than by BDD when confounding variables were held constant. Conclusion The ARS could not be confirmed as a distinguishing feature between BDD and ED in the sense of the hypothesis. Nevertheless, high scores on ARS could be an indication for both ED and BDD symptoms and very high scores for comorbid BDD-ED symptoms. Thus, this should be considered in the diagnostic process and in therapy.