(PS10-A3) Appearance-related Safety Behaviors Predict Symptoms of Body Dysmorphic Disorder Following Internet-based Treatment

Recent experimental evidence has found that appearance related safety behaviors (i.e., practices meant to avoid a perceived feared outcome) likely play a crucial role in maintaining symptoms of body dysmorphic disorder (BDD). The present study sought to determine if these behaviors predicted BDD symptom severity following treatment. Participants (N = 50) with BDD were randomized to either eight sessions of interpretation bias modification or progressive muscle relaxation. Both treatments led to reductions in BDD symptom severity and appearance-related safety behaviors, though moderate levels of safety behaviors still persisted at both posttreatment and follow-up. To ensure missing data did not bias findings, path analysis using full information maximum likelihood was used. Importantly, post-treatment appearance related safety behaviors significantly predicted BDD symptom severity at three-month follow-up (β = .28, p = .036) even after covarying for posttreatment BDD symptom severity (β = .48, p < .001). Further, analyses were re-conducted to examine whether these behavior would predict the cognitive symptoms of BDD to ensure that these behaviors were not simply predicting the behavioral items on the measure of BDD symptom severity. Consistent with prior findings, appearance-related safety behaviors predicted the cognitive symptoms of BDD (β = .36, p = .005). Taken together, the present findings suggest appearance related safety behaviors maintain BDD symptoms after effective non-behavioral treatments and provide further evidence for their importance in the treatment of BDD.