Cross-Cultural Differences in the Network Structure of Social Anxiety and Body Dysmorphic Symptoms

Examining the Network Structure of Social Anxiety and Body Dysmorphic Symptoms in American, German, and Japanese: A Cross-Cultural Study

This study will examine cross-cultural differences in the network structure of social anxiety and body dysmorphic symptoms across Germany, the United States, and Japan.

Study Overview

• Status: Completed
• Conditions: Depression; Anxiety; Body Dysmorphic Disorders
• Intervention / Treatment: Other: Cross sectional study

Detailed Description

This study will investigate the network structure of social anxiety, body dysmorphic symptoms, depressive symptoms, and shame across Germany, the United States, and Japan. Social anxiety disorder and body dysmorphic disorder frequently co-occur and share several clinical features beyond fear of negative evaluation (Coles et al., 2006; Dietel et al., 2021; Fang et al., 2011). Both conditions have also been found to exhibit high comorbidity with major depressive disorder (Acarturk et al., 2008; Grant et al., 2005; Gunstad & Phillips, 2003; Phillips et al., 1998). Cognitive-behavioral therapy targeting social anxiety disorder or body dysmorphic disorder has been shown to significantly alleviate depressive symptoms (e.g., Enander et al., 2016; Noda et al., 2023; Ritter et al., 2023). Shame has also been implicated in the development of depressive symptoms, as well as social anxiety disorder and body dysmorphic disorder (Kim et al., 2011). Comparing the symptom networks of social anxiety, body dysmorphic symptoms, and depression-and identifying central symptoms within each cultural context-may contribute to the development of transdiagnostic treatments with cross-cultural applicability.

• Study Type: Observational
• Enrollment (Actual): 1523

Contacts and Locations

Study Locations

• Germany
  • Hessen
    • Marburg, Hessen, Germany, 35032
      • Department of Psychology

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult
• Accepts Healthy Volunteers: Yes

• Sampling Method: Probability Sample

Study Population

German, American, and Japanese individuals

Description

Inclusion Criteria:

• German, American, and Japanese citizens over 18 years old.

Exclusion Criteria:

• Individuals who do not obtain consent

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
German, American, and Japanese citizens over 18 years old	Other: Cross sectional study; This study is a cross-cultural study, not an intervention study. A total of 1,523 participants (484 from Germany, 548 from the United States, and 491 from Japan) were recruited.

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Brief version of Fear of Negative Evaluation scale	The Brief version of Fear of Negative Evaluation scale measures fear of negative evaluation. The scale consists of 12 items, including eight for the straightforwardly worded items and four for the reverse worded items. Each item is rated on a 5-point scale ranging from 1 (not characteristic of me) to 5 (extremely characteristic of me), with higher scores indicating greater fear of negative evaluation. It is recommended that the straightforwardly worded items (8 items) are used for the assessment of fear of negative evaluation. The total score, based on all 12 items, ranges from 12 to 60. When using only the straightforwardly worded items, the total score ranges from 8 to 40.	From March 2025 to April 2025
Mini-Social Phobia Inventory	The Mini-social phobia inventory measures social anxiety and avoidance behavior. The scale contains three items rated on a 5-point scale from 0 (not at all) to 4 (extremely), with higher scores indicating greater social anxiety symptoms. The total score ranges from 0 to 12.	From March 2025 to April 2025
Appearance Anxiety Inventory.	The Appearance Anxiety Inventory measures symptoms of body dysmorphic disorder. The scale contains ten items rated on a 5-point scale from 0 (not at all) to 4 (all the time), with higher scores indicating greater symptoms of body dysmorphic disorder. The total score ranges from 0 to 40, with scores of 19 or above indicating caseness.	From March 2025 to April 2025
Patient Health Questionnaire-9	The Patient Health Questionnaire-9 assesses depressive symptoms. It consists of nine items, each rated on a 4-point scale ranging from 0 (not at all) to 3 (nearly every day), with higher scores indicating more severe depressive symptoms. The total score ranges from 0 to 27.	From March 2025 to April 2025
External and Internal Shame Scale	The External and Internal Shame Scale measures external shame and internal shame. It consists of eight items, each rated on a 5-point scale ranging from 0 (never) to 4 (always), with higher scores indicating greater levels of shame. The total score ranges from 0 to 32.	From March 2025 to April 2025
Auckland individualism and collectivism scale	The Auckland individualism and collectivism scale measures individualism (competitiveness, uniqueness, and responsibility) and collectivism (advise and harmony). The scale consists of 26 items, each rated on a 6-point scale ranging from 1 (never or almost never) to 6 (always), with higher scores indicating greater levels of the respective construct. The total score ranges from 26 to 156.	From March 2025 to April 2025
Demographic data	Age, location, ethnicity, education history, sexual orientation, biological sex, Gender identity, etc.	From March 2025 to April 2025

Other Outcome Measures

Outcome Measure	Measure Description	Time Frame
LGBTQIA+ minority stress questionnaire	The LGBTQIA+ minority stress questionnaire measures level of stress of LGBTQIA+ minority. The scale contains 19 items rated on a 5-point scale from 0 (strongly disagree) to 4 (strongly agree), with higher scores indicating greater level of stress of LGBTQIA+ minority. The total score ranges from 0 to 76.	From March 2025 to April 2025

Collaborators and Investigators

• Sponsor: Philipps University Marburg

Study record dates

Study Major Dates

• Study Start (Actual): March 31, 2025
• Primary Completion (Actual): April 2, 2025
• Study Completion (Actual): April 2, 2025

Study Registration Dates

• First Submitted: March 28, 2025
• First Submitted That Met QC Criteria: April 29, 2025
• First Posted (Actual): May 8, 2025

Study Record Updates

• Last Update Posted (Actual): May 8, 2025
• Last Update Submitted That Met QC Criteria: April 29, 2025
• Last Verified: April 1, 2025

More Information

Terms related to this study

• Keywords: Cross-cultural study
• Additional Relevant MeSH Terms: Mental Disorders; Somatoform Disorders; Anxiety Disorders; Body Dysmorphic Disorders
• Other Study ID Numbers: 2025-01k-rev

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No