From shame to dysmorphic concern and anxiety: the role of body image-related psychological flexibility

Abstract

ABSTRACT Objective Body image-related psychological flexibility is considered an important positive process in the field of body image, associated with lower levels of psychological distress. The present study hypothesised body image flexibility as a relevant construct in the study of body dysmorphic disorder (BDD). A mediation model was proposed, exploring if body image flexibility mediated the relationship between shame – a core construct of BDD symptomatology – and dysmorphic concern and anxiety while controlling for age and BMI. Methods The sample comprised 477 Portuguese-speaking participants from the general population – male and female, who completed a set of self-report measures. Results Females presented significantly higher levels of dysmorphic concern (d = .42). All main variables under study were significantly correlated, with dysmorphic concern presenting positive correlations with internal shame, external shame, and anxiety, and a negative and weak correlation with body image flexibility. Path analysis results indicated that body image flexibility mediated the relationship between shame, in its internal dimension, and dysmorphic concern and anxiety, explaining 34% of the variance of dysmorphic concern and 24% of anxiety. The model was invariant across biological sex. Conclusions Our results support the pervasive association between internal shame and dysmorphic concern, and indicate body image flexibility as a relevant emotional process in this relationship.