Effects of body-related checking behavior in lab and field: Comparison studies in bulimia nervosa, body dysmorphic disorder, and illness anxiety disorder

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Body-related checking behavior (CB) is a symptom and potentially maintaining factor of different mental disorders such as bulimia nervosa (BN), body dysmorphic disorder (BDD), and illness anxiety disorder (IAD). In various cognitive-behavioral models of the disorders, CB is supposed to occur predominantly in states of negative emotional activation and to decrease it in the short term, which, in turn, reinforces CB. So far, empirical evidence is scarce and the few existing studies yielded conflicting findings. While for IAD, current evidence tentatively suggests an immediate reduction of negative emotions, for BN and BDD, in most studies an increase in negative emotions was found. The conflicting findings might be due to different disorder-specific functionality of CB as well as to varying settings, measurement points, and dependent variables. Therefore, the present project aims to compare the aforementioned disorders with regard to the emotional, cognitive, and physiological consequences of CB, taking into account these potentially confounding variables. Additionally, for each clinical group a healthy control group is included in order to examine (disorder-specific) pathogenic significance of CB. In order to maximize external validity, in the observational study in the field (study 1), naturally occurring CB will be examined regarding its effects on emotions and cognitions before, during and at multiple points after the CB-episodes. In contrast, the experimental study in the lab (study 2) aims to maximize internal validity and investigates the course of emotions and cognitions during an experimentally induced and standardized CB-episode after negative mood induction. Self-report is supplemented by the assessment of physiological parameters such as heart rate and its variability as well as skin conductance. While these first two studies focus on the immediate effects of a single CB-episode, the experimental study in the field (study 3) examines the impact of a multiple-day increase of CB-frequency on emotions, cognitions as well as disorder-specific and general psychopathology. Therefore, the proposed project allows for the first time to shed light on possible transdiagnostically effective as well as disorder-specific reinforcement mechanisms of CB. These results are clinically relevant as an understanding of probably dysfunctional CB would inform the development of transdiagnostic as well as disorder-specific interventions to reduce CB.