The Role of Social Comparison in Appearance-Related Psychopathology: Preregistered Analyses from a Randomized Controlled Trial of a Smartphone Intervention

Excessive appearance concerns represent a transdiagnostic construct that is likely maintained by appearance-related safety behaviors (ARSBs). ARSBs consist of mirror checking, camouflaging and other behaviors which are used to prevent negative evaluation based on appearance. Social comparison is one additional type of ARSB that has been given substantial research attention and has been hypothesized to contribute to a range of disorders. We leveraged data ( N = 203) from a previously published randomized controlled trial of two digital interventions to examine whether changes in social comparisons explain treatment effects on clinical outcomes in women elevated in appearance concerns. Participants were randomized to one of two interventions where participants were either instructed to reduce ARSBs or general unhealthy behaviors. Relative to control, targeting ARSBs led to lower social comparisons, and these changes mediated the effect of treatment on appearance concerns, eating disorder symptoms, social anxiety, and appearance importance. Changes in comparisons also predicted changes in symptom outcomes, regardless of treatment condition. These findings provide novel evidence for the potential role of social comparisons in appearance-related psychopathology. Further work will be necessary to confirm the maintaining role this behavior plays in symptoms of appearance-related psychopathology.