Network analysis of body anxiety, appearance anxiety, and body dysmorphic disorder tendency among female college students

Zhong Nan Da Xue Xue Bao Yi Xue Ban. 2026 Aug 28;51(8):1631-1641. doi: 10.11817/j.issn.1672-7347.2026.250349.

ABSTRACT

OBJECTIVES: Against the backdrop of widespread societal pursuit of physical attractiveness, body dysmorphic disorder tendency is relatively common among young people and is particularly prevalent among female college students, frequently co-occurring with body anxiety and appearance anxiety. However, the symptom-network associations among these 3 constructs remain unclear. This study aims to investigate the symptom-network structure of body anxiety, appearance anxiety, and body dysmorphic disorder tendency among female college students and to identify the core nodes within the network.

METHODS: From April to May 2025, stratified quota sampling was used to recruit 1 990 female students from the first through fourth academic years at 3 undergraduate institutions in Jiangsu Province. The Youth Appearance Anxiety Scale (YAAS) was used to assess body anxiety and appearance anxiety. The Body Dysmorphic Disorder Tendency Scale (BDDTS) was used to assess body dysmorphic disorder tendency. Network analysis was performed using JASP version 0.96.0.

RESULTS: Among the 1 990 participants, the scores for appearance anxiety, body anxiety, and body dysmorphic disorder tendency were 19.11±6.70, 31.28±13.45, and 9.65±3.21, respectively. Regarding network connections, the appearance-anxiety item “I become self-conscious and my facial expression becomes unnatural when others pay attention to my appearance” was connected to the body dysmorphic disorder tendency item “I feel distressed because I cannot get rid of the thought that I look ugly” (edge weight=0.09). The appearance-anxiety item “I feel uneasy when I am with people who are better-looking than me” was connected to the body shape-anxiety item “I am always worried that my body shape will be compared with that of others” (edge weight=0.09). In addition, the body shape-anxiety item “I am always worried that others will make negative comments about my body shape” was connected to the body dysmorphic disorder tendency item “I feel distressed because I cannot get rid of the thought that I look ugly” (edge weight=0.09). In terms of centrality, the nodes with the highest expected influence within appearance anxiety, body anxiety, and body dysmorphic disorder tendency were “I become self-conscious and my facial expression becomes unnatural when others pay attention to my appearance” (expected influence index=0.744), “I am always worried that others will make negative comments about my body shape” (expected influence index=1.222), and “I feel distressed because I cannot get rid of the thought that I look ugly” (expected influence index=0.735), respectively.

CONCLUSIONS: Within appearance anxiety, “fear of being noticed” and, within body anxiety, “worry about negative evaluation” are key bridge nodes linking these two forms of anxiety with body dysmorphic disorder tendency, whereas the belief that one’s “appearance is ugly” represents a core node in the symptom network of body dysmorphic disorder tendency. Therefore, interventions targeting body dysmorphic disorder tendency should prioritize the core body-image cognition of “appearance is ugly” and may also focus on alleviating “fear of being noticed” and “worry about negative evaluation” to help interrupt the progression from anxiety symptoms to body dysmorphic disorder tendency.

PMID:42935194 | DOI:10.11817/j.issn.1672-7347.2026.250349