Investigation of the Role of Sociocultural Attitudes Towards Physical Appearance on Psychological Symptoms and Functioning in Adolescents with Anxiety/Depression: Preliminary Findings

Introduction: This study investigated the relational patterns of sociocultural appearance attitudes, appearance anxiety, and appearance-related social media consciousness on psychological symptoms and daily functioning in adolescents with anxiety and/or depression. It also evaluated parent–adolescent informant discrepancies regarding functional impairment.

Methods: This cross-sectional study included 103 clinical adolescents (aged 12–18, 73.8% female) receiving pharmacotherapy and their parents. Standardized diagnostic interviews (K-SADS-PL-DSM-5-T) and psychometric measures (RCADS, AAI, ASMCS, SATAQ-4R, and WFIRS self/parent forms) were utilized. Data were analyzed using path analysis, EBICglasso network analysis, ANCOVA, and McNemar tests. All p-values were adjusted using the Benjamini–Hochberg FDR method (p_FDR).

Results: Path analysis indicated that thin-ideal internalization predicted appearance-related social media consciousness (β = 0.35, p_FDR = 0.003), which subsequently predicted appearance anxiety (β = 0.50, p_FDR < 0.001). The direct path from appearance anxiety to functioning was non-significant; instead, appearance anxiety exhibited a statistically significant but distinctively weak indirect link with functioning mediated via anxiety/depression severity (β = 0.05, p_FDR = 0.046). In the network analysis, appearance anxiety emerged as the descriptively prominent central and bridge node. While adolescents reported higher overall functional impairment (86.4%) than parents (75.7%), this cumulative discrepancy represented only a marginal statistical trend (χ² = 4.00, p_FDR = 0.064). However, domain-specific informant discrepancies remained highly significant within family, school, and social domains (p_FDR < 0.01). Finally, parents were more likely to notice their children's anxiety about their appearance when it started to affect their self-esteem (F = 11.04, p_FDR = 0.044).

Conclusion: These preliminary findings highlight appearance anxiety as a critical, transdiagnostic node linked to internalizing distress and functional decline. Significant informant discrepancies reveal a critical parental blind spot regarding adolescent internalizing processes, emphasizing the necessity of incorporating structured adolescent self-reports in clinical pediatric decision making.