{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T08:51:37Z","timestamp":1791622297831,"version":"4.3.4"},"reference-count":29,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T00:00:00Z","timestamp":1791590400000},"content-version":"vor","delay-in-days":39,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T00:00:00Z","timestamp":1788220800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clin Psychology and Psychoth"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>\n                    Body\u2010focused repetitive behaviour disorders (BFRBDs), including trichotillomania (TTM) and skin\u2010picking disorder (SPD), typically emerge during adolescence. These disorders have been conceptualized within emotion regulation models, in which body\u2010focused repetitive behaviours (BFRBs) may function as attempts to regulate aversive emotional states. Although anxiety frequently co\u2010occurs with BFRBDs, its association with BFRB severity is generally modest, highlighting the need to examine affective and regulatory processes. This cross\u2010sectional study examined the associations among social anxiety, shame\u2010proneness, emotion regulation difficulties and BFRB severity using a serial mediation model. Participants were 107 adolescents aged 12\u201318\u2009years (80.4% female) who met DSM\u20105 criteria for TTM or SPD and were recruited from a tertiary child and adolescent psychiatry clinic. Diagnoses were established using semi\u2010structured clinical interviews. The analysis controlled for age and sex. Social anxiety was positively correlated with shame, emotion regulation difficulties and BFRB severity (\n                    <jats:italic>r<\/jats:italic>\n                    \u2009=\u20090.28\u20130.31, all\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.01). In the serial model, social anxiety was associated with greater shame, which was associated with greater emotion regulation difficulties; in turn, emotion regulation difficulties were associated with greater BFRB severity. The total indirect effect (\n                    <jats:italic>B<\/jats:italic>\n                    \u2009=\u20090.162, 95% CI [0.038, 0.337]) and the serial indirect effect through both mediators (\n                    <jats:italic>B<\/jats:italic>\n                    \u2009=\u20090.117, 95% CI [0.040, 0.257]) were significant, whereas neither single\u2010mediator indirect effect was significant. The direct association remained significant (\n                    <jats:italic>B<\/jats:italic>\n                    \u2009=\u20090.302,\n                    <jats:italic>p<\/jats:italic>\n                    \u2009=\u20090.022), consistent with partial statistical mediation. These findings support the proposed theory\u2010based model but do not establish temporal or causal ordering.\n                  <\/jats:p>","DOI":"10.1002\/cpp.70350","type":"journal-article","created":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T08:45:22Z","timestamp":1791621922000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Social Anxiety Symptoms and Body\u2010Focused Repetitive Behaviour Severity in Adolescents: A Serial Mediation Analysis of Shame and Emotion Regulation Difficulties"],"prefix":"10.1002","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6586-2838","authenticated-orcid":false,"given":"Duygu Kinay","family":"Ermis","sequence":"first","affiliation":[{"name":"Department of Child and Adolescent Psychiatry University of Health Sciences, Basaksehir Cam and Sakura City Hospital  Istanbul Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6056-0075","authenticated-orcid":false,"given":"Efruz Pirdo\u011fan","family":"Ayd\u0131n","sequence":"additional","affiliation":[{"name":"Department of Psychiatry \u015ei\u015fli Etfal Training and Research Hospital  Istanbul Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3727-852X","authenticated-orcid":false,"given":"Nurdan","family":"Kasar","sequence":"additional","affiliation":[{"name":"Department of Child and Adolescent Psychiatry University of Health Sciences, Basaksehir Cam and Sakura City Hospital  Istanbul Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5082-3991","authenticated-orcid":false,"given":"Omca","family":"G\u00fcney","sequence":"additional","affiliation":[{"name":"Department of Child and Adolescent Psychiatry University of Health Sciences, Basaksehir Cam and Sakura City Hospital  Istanbul Turkey"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,10]]},"reference":[{"issue":"18","key":"e_1_2_12_2_1","first-page":"104","article-title":"Ergenler i\u00e7in \u00d6zbilin\u00e7lilik Duygulan\u0131mlar\u0131 Testi: Ge\u00e7erlik ve G\u00fcvenirlik \u00c7al\u0131\u015fmas\u0131","volume":"11","author":"Algedik P.","year":"2019","journal-title":"OPUS International Journal of Society Researches"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpsychires.2024.11.062"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/00004583\u2010199704000\u201000018"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.psychres.2016.10.080"},{"key":"e_1_2_12_6_1","volume-title":"\u00c7ocuklarda Anksiyete Bozukluklar\u0131n\u0131 Tarama \u00d6l\u00e7e\u011fi ge\u00e7erlik ve g\u00fcvenirlik \u00e7al\u0131\u015fmas\u0131","author":"\u00c7akmak\u00e7\u0131 M.","year":"2004"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2023.11.010"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40359\u2010023\u201001199\u2010y"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12144\u2010025\u201008206\u2010y"},{"key":"e_1_2_12_10_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40359\u2010025\u201003096\u2010y"},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.2196\/53831"},{"key":"e_1_2_12_12_1","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1017\/CBO9780511551963.011","volume-title":"Adolescent Emotional Development and the Emergence of Depressive Disorders","author":"Gilbert P.","year":"2008"},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00787\u2010019\u201001359\u20109"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.2340\/00015555\u20102565"},{"key":"e_1_2_12_15_1","volume-title":"Introduction to Mediation, Moderation, and Conditional Process Analysis: A Regression\u2010Based Approach","author":"Hayes A. 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