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A new study published in Cognitive Behaviour Therapy has found that appearance-related safety behaviors—such as repeatedly checking one’s appearance in the mirror, asking others for reassurance, or avoiding social situations out of fear of being judged—are not just a concern for women. These behaviors are also common in men and play a similar role in maintaining psychological distress related to appearance. But a simple digital intervention led to improvements in anxiety, eating disorder symptoms, and depression, with benefits persisting one month later.
While appearance concerns are central to several psychiatric conditions, including body dysmorphic disorder, eating disorders, and social anxiety, most interventions have focused on women. There has been limited research on how these concerns affect men and how treatment might work for them. The authors aimed to evaluate whether the psychological patterns surrounding these behaviors were consistent across gender and whether men would benefit from an appearance-focused digital intervention developed in earlier studies involving women.
“We have been studying appearance anxiety among women and naturally wanted to extend our work to men,” said study authors Tapan Patel, a PhD candidate, and Professor Jesse Cougle. “While anxiety around appearance may differ across gender, there is enough support in prior research to suggest that men would also likely benefit from our research in developing and testing treatments for appearance anxiety.”
In their first study, the researchers surveyed 840 undergraduate students to assess the presence and psychological relevance of appearance-related safety behaviors in both men and women. Participants completed a range of validated questionnaires measuring how often they engaged in these behaviors, as well as symptoms of social anxiety, depression, and disordered eating. The researchers used statistical modeling to test whether the patterns of responses to the appearance behavior scale were similar for both genders.
They found that men and women both engage in these safety behaviors, although women reported using them more frequently. For example, women were more likely to avoid reflective surfaces, check their body parts, and seek reassurance. However, when it came to how these behaviors related to psychological symptoms—such as anxiety, depression, and eating concerns—the pattern was nearly identical across genders. The behaviors functioned the same way in men and women, contributing to distress regardless of how often they were used.
“Individuals who are anxious about their appearance engage in behaviors that actually maintain their anxiety,” Patel and Cougle told PsyPost. “These can include excessive mirror checking, asking others how you look, and avoiding situations because of fear that you will be negatively evaluated due to your appearance. This research suggests that while these behaviors may differ in frequency between men and women, they do function the same.”
Based on this, the researchers moved to the next phase of their investigation. Their second study tested whether a smartphone-based intervention aimed at reducing appearance-related safety behaviors could help men with elevated appearance concerns. Forty men from the United States, most of whom identified as gay or bisexual, were recruited for a one-month open trial.
“We recruited men elevated in appearance anxiety as we anticipated they would benefit most from our treatment, but an unexpected finding was that our sample of men identified as mostly non-heterosexual,” Patel and Cougle noted. “We did not expect this to occur, but there are likely a number of reasons why this happened, such as greater emphasis on a specific type of appearance among the gay and bisexual community.”
Participants received daily text messages encouraging them to track and reduce behaviors like mirror checking, asking for reassurance, and avoiding situations out of fear of being judged for their appearance. Each day, participants filled out a checklist to monitor their behavior.
Before, during, and after the intervention, the men completed a series of questionnaires measuring their anxiety about appearance, social anxiety, depression, and disordered eating symptoms. The researchers also followed up one month after the intervention to see if any improvements were sustained.
After one month of behavior tracking and daily encouragement to reduce these habits, participants reported significant reductions in appearance anxiety, social anxiety, depression, and disordered eating symptoms. The improvements persisted at the one-month follow-up. In fact, men showed a greater drop in their use of appearance-related safety behaviors than a comparison group of women who had participated in a similar study. However, both groups experienced similar improvements in other psychological outcomes, suggesting that the intervention was equally effective across genders.
Notably, the men in this study reported fewer completions of daily checklists and had higher dropout rates than the women in the comparison study. This suggests that while the intervention can be effective for men, it may need to be adjusted to improve engagement. The researchers speculate that men might have benefited early in the process and lost interest in completing daily forms, or they may have been less motivated to complete the final assessments due to the minimal incentives provided.
“We tested a digital intervention that targets these behaviors among men elevated in appearance concerns and found it to be similarly effective to when we have tested it in women,” Patel and Cougle explained.
As with all research, there are some limitations to consider. “A major limitation of Study 1 is that it was completely comprised of college students, and a caveat of Study 2 (treatment pilot) is that attrition was high, especially when compared to women who participated in this treatment,” Patel and Cougle said.
Despite these caveats, the study adds important new evidence to the growing body of research on body image and mental health. It shows that appearance-related safety behaviors are a meaningful target for psychological intervention in men, not just women. It also suggests that simple, scalable treatments—such as daily text messages encouraging people to reduce these behaviors—can make a real difference in how people feel about themselves and their appearance.
Going forward, the researchers suggest that larger studies with more diverse samples should be conducted to explore how sexual orientation and gender identity might influence treatment outcomes. They also advocate for adapting the intervention into an app or integrating more interactive components to improve user engagement. If confirmed in randomized controlled trials, the intervention could be rolled out more broadly as a stand-alone or add-on treatment for those struggling with appearance concerns.
“Our long term goals are to include men in our future randomized controlled trials evaluating this treatment,” Patel and Cougle explained. “Additionally, we plan to explore ways to improve the treatment as well as continue to search for who benefits most from the treatment and how it can be tailored to help the most amount of people.”
The study, “Characterizing gender differences in appearance-related safety behaviors and their relationship with clinical symptoms,” was authored by Tapan A. Patel and Jesse R. Cougle.
