How Body Image and Social Anxiety Combine to Amplify Social Exclusion: New Temple University Research (2025)

SocialAnxiety.co Research Summary | Based on research from the Adult Anxiety Clinic of Temple University

Research Attribution: This article summarizes findings from Butler, R.M., Kaplan, S.C., & Heimberg, R.G. (2025), “Social anxiety and weight interact with body salience to affect experiences of social exclusion,” published in Anxiety, Stress, & Coping, 38, 313–325. The research was conducted at the Adult Anxiety Clinic of Temple University, Department of Psychology and Neuroscience. SocialAnxiety.co is an independent psychoeducation platform and is not affiliated with Temple University.

Why This Research Matters

Social Anxiety Disorder is defined by fear of negative evaluation. But negative evaluation is not a uniform threat — it has specific triggers. For many people, one of the most potent triggers is the fear that their body is being judged.

This is not the same as body dysmorphic disorder. It is not vanity. It is the intersection of two well-documented psychological vulnerabilities: the social-evaluative fear central to SAD and the body-related stigma that individuals at higher weights experience daily. When these two vulnerabilities coexist in the same person, what happens?

Researchers Rachel Butler, Simona Kaplan, and Richard Heimberg at Temple University’s Adult Anxiety Clinic set out to answer this question with an experimental design that isolates each variable. Their 2025 paper, published in Anxiety, Stress, & Coping, reveals that social anxiety and weight do not simply add together — they interact, and the interaction is moderated by how visible the person’s body feels at the moment of social rejection.

This research comes from the lab that has shaped social anxiety treatment for four decades. Prof. Richard Heimberg founded the Adult Anxiety Clinic and co-developed the Rapee-Heimberg cognitive-behavioral model — one of the two foundational theoretical frameworks for understanding SAD alongside the Clark and Wells (1995) model. His work has produced the most-cited body of research on social anxiety in clinical psychology.

The Core Findings: A Three-Way Interaction

The Study Design

The researchers recruited 186 undergraduate women and measured two baseline variables: self-reported social anxiety levels and body mass index (BMI). One week later, participants were randomly assigned to one of two conditions designed to manipulate body salience — how aware and self-conscious a person feels about their physical appearance:

High body salience condition: Participants had a full-body photograph taken before the social task
Low body salience condition: Participants had only a face photograph taken

After the photograph manipulation, all participants played Cyberball — a well-validated social exclusion paradigm in which the participant believes they are playing an online ball-tossing game with two other people. In reality, the other “players” are computer-controlled and gradually stop throwing the ball to the participant. The participant is systematically excluded.

Before and after Cyberball, participants reported their state anxiety, self-esteem, and negative affect.

What They Found

Finding 1: Social anxiety alone predicted worse reactions to exclusion.

Participants with higher baseline social anxiety experienced greater increases in anxiety and negative affect after being socially excluded, compared to those with lower social anxiety. This confirms what cognitive models predict — socially anxious individuals are more sensitive to rejection cues.

Finding 2: Weight alone did not directly predict exclusion reactions.

BMI by itself was not significantly associated with post-exclusion emotional outcomes. Being at a higher weight did not automatically make social exclusion feel worse.

Finding 3: The three-way interaction changed everything.

When social anxiety, higher weight, and high body salience were all present simultaneously, the emotional impact of exclusion was significantly amplified. Specifically:

Among participants with high social anxiety and higher BMI, those in the full-body photo condition (high body salience) showed the greatest increases in anxiety and decreases in self-esteem after exclusion
The same participants in the face-only photo condition (low body salience) did not show this amplified response
Among participants with low social anxiety, body salience and BMI did not significantly interact to affect exclusion outcomes

The conclusion: It is not social anxiety alone, not weight alone, and not body awareness alone that produces the worst outcomes. It is the specific combination of all three — being socially anxious, being at a higher weight, and being made acutely aware of one’s body — that creates a vulnerability far greater than any single factor predicts.

The Clinical Mechanism: Why This Interaction Occurs

The Rapee-Heimberg Model and “The Audience’s Image”

The Rapee-Heimberg cognitive-behavioral model of social anxiety describes a specific cognitive process at the core of SAD: the person constructs a mental representation of how they believe the audience perceives them. This mental image — what Heimberg describes as “your image of my image of you” — is invariably negative, distorted, and focused on perceived flaws.

In face-to-face social anxiety, this audience image is already biased toward the worst. The person imagines that others see someone who is awkward, visibly nervous, or incompetent.

Butler, Kaplan, and Heimberg’s research reveals what happens when body weight is added to this mental image. For a socially anxious person at a higher weight, the constructed audience image now includes an additional dimension of perceived judgment: not only “they think I’m awkward” but “they think I’m awkward and they’re judging my body.”

The full-body photograph condition was designed to activate this body-related component of the audience image. When the participant had just seen and been made aware of their full body, that body became a salient feature of their self-representation — and therefore a salient feature of the imagined audience’s evaluation.

The Safety Behavior Implication

This finding has direct implications for avoidance patterns. If body salience amplifies social anxiety responses, then socially anxious individuals at higher weights may develop body-specific avoidance behaviors:

Avoiding social situations where their full body is visible (swimming, gym environments, form-fitting dress codes)
Wearing oversized clothing as a safety behavior — not for comfort, but to minimize body salience
Choosing seated positions that reduce body visibility
Avoiding photographs — particularly full-body photographs — in social contexts
Declining social invitations where eating will occur (restaurants, dinner parties) due to combined body and behavioral scrutiny

These avoidance patterns may appear to be purely weight-related, but the research suggests they are driven by the interaction between social anxiety and body awareness. Treating them as weight issues alone — without addressing the underlying social-evaluative fear — is likely to be insufficient.

The Exercise Avoidance Connection

This study builds on earlier work from the same research team. Horenstein, Kaplan, Butler, and Heimberg (2021) demonstrated that social anxiety moderates the relationship between body weight and exercise avoidance. Among individuals with higher social anxiety, increasing BMI was associated with greater desire to avoid exercise. Among individuals with low social anxiety, this relationship was not significant.

The implication is a clinical cascade: social anxiety makes body visibility threatening → body visibility is high in exercise environments → socially anxious individuals at higher weights avoid exercise → exercise avoidance removes a proven intervention for both anxiety and weight management → both conditions potentially worsen.

What This Means for Treatment

Standard social anxiety assessments (LSAS, SPIN) evaluate fear and avoidance across social situations — but they do not specifically assess body-related social-evaluative fear. This research suggests that clinicians treating socially anxious patients — particularly women at higher weights — should ask directly about body-specific avoidance:

“Are there social situations you avoid specifically because of concerns about how your body will be perceived?”
“Do you make decisions about clothing, seating, or positioning based on minimizing how much of your body others can see?”
“Have you avoided exercise environments, swimming, or physical activities because of social anxiety about your body?”

Exposure Hierarchies Should Include Body Salience

For patients whose social anxiety interacts with body image concerns, exposure therapy should incorporate graduated body salience challenges — not as a body image intervention, but as a social anxiety exposure:

Wearing form-fitting clothing in a social setting
Attending a group exercise class
Allowing a full-body photograph to be taken in a social context
Eating in a public setting without the safety behavior of choosing “acceptable” foods

These exposures target the specific three-way interaction identified in the research: reducing the amplification effect that body salience produces when combined with social anxiety.

Combined Treatment Protocols May Be Needed

For patients where social anxiety and body image concerns are both clinically significant, treatment that addresses only one domain may produce incomplete results. The research supports considering whether both the social-evaluative fear (addressed through CBT for SAD) and the body-specific component (potentially addressed through body image interventions or acceptance-based approaches) need to be targeted.

About the Researchers

Richard G. Heimberg, Ph.D. is the Thaddeus L. Bolton Professor Emeritus of Psychology at Temple University and founder of the Adult Anxiety Clinic of Temple. He is the most-cited researcher on social anxiety disorder in clinical psychology, with over 450 publications. He co-developed the Rapee-Heimberg cognitive-behavioral model and co-authored Managing Social Anxiety: A Cognitive-Behavioral Therapy Approach (now in its 3rd edition), the most research-validated self-help program for SAD. He is past president of the Association for Behavioral and Cognitive Therapies and recipient of multiple lifetime achievement awards.

Rachel M. Butler, Ph.D. is at the Social Sciences Division, Transylvania University, Lexington, KY. Her research examines the intersection of social anxiety with body image, weight stigma, and gender identity, with a particular focus on vulnerable populations.

Simona C. Kaplan, Ph.D. is at the Department of Psychology and Neuroscience, Temple University. The current study is derived from her doctoral dissertation research, which examined how body mass index, implicit weight bias, and body salience interact with social anxiety.

How Body Image and Social Anxiety Combine to Amplify Social Exclusion: New Temple University Research (2025)

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Why This Research Matters