Topography and relationship-specific social touching in individuals displaying body image disturbances

Interpersonal touch is intimately related to the emotional bond between the touch giver and the touch receiver. Which bodily regions we touch in those individuals in our social network is relationship specific. Perception of interpersonal touch is altered in psychiatric disorders characterised by body image disturbances (BIDs). Here, we examined whether the ‘imagined’ experience of social touch in individuals with BIDs is body topography- and relationship-specific. By using an interactive media mobile App, the Virtual Touch Toolkit, high versus low levels of BIDs participants completed heatmaps of full-body virtual avatars, to indicate the body regions they find soothing/unpleasant to be touched by a loved one versus an acquaintance. Self-reports of interoceptive awareness and dysmorphic concerns were also measured. Overall, imagined touch was rated as the most soothing when received from a loved one, and also when this was delivered to ‘social’ body regions. The importance of the social relationship for the imagined tactile interactions was particularly evident for the high levels of BIDs group, with greater problems with interoceptive awareness predicting higher soothing touch ratings when this was received by a loved one. Despite the evidence that imagined bodily contacts between meaningful people is the most pleasant for socially acceptable bodily regions, our findings may suggest a greater sensitivity to relation-specific bodily patterns of social touch particularly in the high level of BIDs group. Heightened interoceptive awareness may also play a key role in this experience of bodily affective contacts. Future research for body-oriented therapy for BIDs is encouraged to systematically probe the efficacy of imagined social touch interaction protocols which use more plausible, ecological, scenarios where touch is delivered by loved ones and to socially acceptable bodily regions.


The current study
Here, we took advantage of an imagined social touch interaction procedure by specifically manipulating the identity of the person delivering the touch to recreate more plausible scenarios of real-life affective tactile interactions.We also sought to establish whether imagined responses to social touch, which as reported by Suvilehto and colleagues 47 are relationship-specific and 'linearly dependent' upon the body regions one receives touch to, also extend to individuals reporting varying levels of BIDs.Specifically, we focused on healthy individuals with low and high levels of BIDs, as research on subclinical populations also has the advantage of indicating whether somatosensory disturbances anticipate the onset of AN, therefore giving a direction for preventive measures.By doing so, this research will provide a basis for future research focusing on clinical populations, including AN, in order to understand the links with the pathology associated with eating disorder and social touch responses.
To this aim, and to address the limitations of correlational designs employed by previous studies 47 , we used a novel mobile application i.e., 'Virtual Touch Toolkit' 57 whereby individuals were instructed to interact with a 3D avatar of a human silhouette creating heatmaps indicating regions of the body they find soothing or unpleasant to be touched.Different touch interaction contexts can be selected from a menu.In the present study, participants created touch heatmaps for touch from 'a loved one' compared to an 'acquaintance' .To identify individuals with low and high BIDs, participants also completed standardised self-reports of eating disorder symptomatology.Recent findings in healthy populations also revealed that lower levels of interoceptive awareness and greater levels of dysmorphic concerns are associated with lower preference for CT optimal touch (compared to CT nonoptimal touch) when given by an experimenter (stranger) 58 .Accordingly, the contribution of body dysmorphic concerns, which commonly manifest in the general population, specifically in women 59,60 , and of interoceptive awareness towards soothing/unpleasant evaluations of social touch to socially acceptable body regions, was also measured using standardized self-report questionnaires.
Recent findings have shown that the closer the affective relationship between two individuals, the more social touching they are willing to accept from each other and the more pleasant they experience each other's touch 47 .Accordingly, we expected to replicate the findings of this relationship-specific social touch, such that individuals would rate touch received from a loved one as more soothing than touch received by an acquaintance.Crucially, we seek to extend these results by looking at the effect of social relationship on touch pleasantness, depending on where the touch is delivered, that is on socially (un)acceptable body regions and in individuals reporting varying levels of BIDs.Based on recent findings with (healthy) populations that a reduced preference for social touch (from a stranger experimenter) is linearly associated with lower interoceptive awareness and higher dysmorphic Imagined social touch ratings: individual bodily regions.The mean soothing/unpleasant ratings for all 13 bodily regions when touched by a loved one as compared to an acquaintance and for the two groups of low and high levels of BIDs respectively, are reported in Table 2.
From a visual inspection of the relation-specific full-body avatars maps (see Fig. 1), both high and low levels of BIDs groups rated touch from a loved one as soothing regardless of the body zone.Body zones such as the abdomen and groin were rated as slightly less soothing compared to body zones such as the arm and hands.For an acquaintance, the abdomen was rated as the most unpleasant for both high and low levels of BIDs groups.Similarly, both groups rated the groin, upper leg, buttocks, shoulders/back, feet, legs, face, and head as unpleasant.The two groups differed in their ratings for the upper arm, lower arm, and hands, with the high levels of BIDs group rating these regions as more soothing compared to the low levels of BIDs group, who demonstrated more unpleasantness of touch from an acquaintance to these regions, except for the hands.
Imagined social touch ratings: intimate versus social body regions.Low levels of BIDs group.The 2-way ANOVA for the low levels of BIDs group revealed a significant main effect of Body Zone [F(1,34) = 56.557,p < 0.001, ηp 2 = 0.625].Social body zones were rated as significantly more soothing than intimate body zones which instead were rated unpleasant (8.27 ± 2.89 vs. − 17.43 ± 4.14, p < 0.001).There was also a significant main effect of relationship [F(1,34) = 71.262,p < .001, ηp 2 = 0.677], with touch from a loved one being rated as significantly more soothing than touch received from an acquaintance (28.29 ± 5.62 vs. − 37.45 ± 4.28, p < 0.001).However, the 2-way interaction of body zone × relationship was not significant [F(1,34) = 3.199, p = 0.083, ηp 2 = 0.086], Table 1.Mean and standard deviation (in brackets) of demographics and self-report questionnaires scores for the low levels of BIDs group (n = 35) compared to the high levels of BIDs group (n = 34).EDI-3 eating disorder inventory 3; EDRC eating disorder risk composite; DCQ dysmorphic concern questionnaire.In summary, overall imagined touch was perceived as the most soothing when the individual giving the touch was familiar to the touch receiver i.e., a loved one, as compared to an individual less familiar to the touch giver, such as an acquaintance.Touch to intimate regions was perceived as the most unpleasant as opposed to touch to social regions.However, as demonstrated by the significant 2-way interaction, the effect of social relationship was dependent upon 'where' the touch was received, thus suggesting that information about the identity of the touch giver is pivotal in determining bodily maps of socially acceptable touch in participants demonstrating high levels of BIDs.

Multiple regression analyses.
By means of a series of multiple regression analyses, we assessed whether individuals' differences in symptoms of dysmorphic concerns (DCQ) and of interoceptive awareness (interoceptive deficit EDI-3) could predict participants' responses to imagined touch delivered to intimate/social body regions and depending on the social relationship with the toucher.To this aim, we ran linear multiple regressions to explore whether DCQ and interoceptive awareness scores were significant predictors of 'Touchability Index' (TI) for intimate body regions when touched by a loved one compared to a stranger, for the whole sample but also separately in the two groups of BIDs.
The linear multiple regression analysis calculated to predict TI for intimate body regions touched by a loved one from symptoms of dysmorphic concerns and of interoceptive awareness for the whole sample was significant [F (2,66) = 3.456, p = 0.037, R 2 = 0.308], with interoceptive awareness emerging as the only significant predictor (p = 0.023).However, this finding seems to be specifically driven by the high levels of BIDs group.The linear multiple regression analysis calculated to predict TI for intimate body regions touched by a loved one from symptoms of dysmorphic concerns and interoceptive awareness was significant in the high Levels of BID group [F (2,31) = 4.199, p = 0.024, R 2 = 0.462], with interoceptive awareness emerging as the only marginally significant predictor (see Table 3).The regression equation for social body regions touched by a loved one only approached significance, with interoceptive awareness being a marginally significant predictor [F (2,31) = 3.148, p = 0.057, R 2 = 0.411, see Table 3].Similarly, no significant regression equations were found for any of the TI conditions (intimate and social regions) with dysmorphic concerns and interoceptive awareness in the whole sample or separately for the low levels of BIDs group.In summary, for participants displaying high levels of BIDs, (greater difficulties in) interoceptive awareness was associated with higher soothing ratings for intimate and social body regions when touched by a loved one.

Discussion
By using a factorial design, this research is the first to systematically investigate soothing and unpleasant ratings to imagined social touch when delivered to intimate body regions by a loved one (vs.a distant acquaintance), specifically in individuals displaying varying levels of BIDs.To achieve this, the Virtual Touch Toolkit, an interactive media mobile application for promoting wellbeing through social touch 57 was employed to quantify relationship-specific maps of bodily regions 'where' social touch is perceived is pleasant, depending on the social relationship with the touch giver ('who').Furthermore, we wanted to understand the contributions of individual differences in appearance-related dysmorphic concerns and interoceptive awareness difficulties, i.e., two key traits associated with the risk, maintenance, and illness symptomatology of AN 62,63 , to relationship-specific differences in where on the body social touch is rated as pleasant.
Overall and as anticipated, results demonstrated that touch from a loved one (a romantic partner) is evaluated as more soothing compared to touch from an unfamiliar person i.e., an acquaintance from whom the touch was instead perceived as highly unpleasant.These findings corroborate evidence obtained by previous studies using similar approaches.For instance, research by Suvilehto et al. [47][48][49] shows that the social relationship www.nature.com/scientificreports/shared between the touch giver and the receiver influences perceived pleasantness of social touch, indicating that relationship-specific social touch is closely related to the maintenance and establishment of social bonds in nonhuman primates 64 but also in humans.If the touch giver is closer and more familiar to the touch receiver, the more soothing this touch is perceived and the more areas are evaluated as pleasant 47,48,[53][54][55] .On the contrary, if the touch is given by a stranger, then this is largely perceived as unpleasant, with the body regions that an individual can be touched being more restricted 47 .Our study extends these findings by examining relationship and body site specific differences as a function of individual differences in interoceptive awareness and dysmorphic concerns.
For individuals reporting low levels of BIDs, independently from the bodily regions one is allowed to be touched, we found that, on average, imagined touch from a loved one was rated as significantly more soothing than touch received from an acquaintance.Furthermore, imagined touch to social body zones was rated as significantly more soothing than intimate body zones, which instead was rated unpleasant.Yet, the interaction between social relationship and touch to socially acceptable bodily regions was not significant, which suggests the two factors may mediate subjective soothing of imagined touch by at least partly independent mechanisms, and therefore, prompting for a social relationship tuning and bodily regions' independence of social touch mechanisms.These findings may seem partially in contrast with those reported by Suvilehto and colleagues [47][48][49] according to which the social relationship shared between the touch giver and the touch receiver intimately influences perceived pleasantness of social touch, with the bodily areas where touching is allowed being 'linearly dependent' on the emotional bond with the toucher 64 .Nonetheless, we may point to some dissimilarities between Suvilehto et al. ' investigation 47 and our study which pertain to methodological differences.For instance, in the study by Suvilehto et al. 47 , first the reasons for social touching across different social relationships was explored (for e.g., "greeting" or "comforting").Then, participants reported when they had last seen each network member.The authors found that emotionally closer individuals in inner layers of the social network were allowed to touch wider bodily areas for more reasons.However, frequency of social contact with an individual did not predict the areas acceptable for social touch.Taken together these results provide further evidence to the relatively extensive literature of the effects of contextual factors on social touch, according to which the experience of social touch is strongly modified by a variety of toucher-related and situational factors, including relationship status and group membership (see Saarinen et al. 56 for a review).Furthermore, it should be noted that family members may use touch to express a wider array of emotions via touch than strangers.Strangers commonly convey universal or prosocial emotions via touch whereas family members express also social control and negative affective states such as pride, envy, or psychological control or dominance, punishment, farewell, hurting, or scaring 47,65,66 .Following this reasoning, it might be possible that in the case of our study, individuals' understanding of the communicative intentions (i.e., emotions or others' mental states) of the tactile interaction might have been hindered somehow by the lack of any relevant contextual cues, thus in turn modulating the hedonic processing of touch when received by a meaningful person and specifically to socially acceptable bodily regions.Nonetheless, our explanation is not conclusive and future studies using the Virtual Touch App should focus on probing social touch responses whilst carefully looking at the meaning and exposure to social touch occurs.
Two competing hypotheses can be formulated for the imagined social touch experience in individuals displaying high levels of BIDs.One possibility in keeping with previous investigations focusing on AN patients which revealed that the more severe the BIDs, the more uncomfortable and less likely individuals with AN engage with physical intimacy 67 , was that individuals reporting high levels of BIDs would find touch unpleasant regardless of the social relevance of the touch giver and at all bodily regions.This was not the case for the present study.On the contrary, individuals displaying high levels of BIDs evaluated imagined touch from a loved one at social body Table 3. Unstandardized coefficients from the linear multiple regression models of dysmorphic concerns and emotional awareness predictors of the touchabiliy at intimate and social bodily regions when touched by a loved one versus an acquaintance, respectively.EDI-3 eating disorder inventory-3; DCQ dysmorphic concern questionnaire.www.nature.com/scientificreports/regions as the most soothing touch, compared to all other conditions.Furthermore, unpleasantness ratings were specifically evident when touch was imagined from an acquaintance and when it was delivered to an intimate body region.Therefore, in line with the second hypothesis and as demonstrated by the significant interaction of social relationship and bodily regions, here, we show that bodily regions are rated as soothing strictly depending on the social relationship with the touch giver, thus suggesting that subjective pleasantness of imagined touch may stem from dependent mechanisms.Therefore, our findings may align with the results obtained by the study of Tagini and colleagues 29 which demonstrates a 'preserved' experience of imagined affective touch (although by a stranger) in women with AN when using an imaginary social touch procedure.However, it should be noted that a crucial limitation of Tagini et al. 's investigation 29 is the lack of differentiation between imaginary affective touch delivered by a loved one, compared to a stranger.The 'preserved' experience of imagined affective touch when delivered by a stranger in women with AN in their research setting may not be comparable to the experimental protocol adopted in our study.Moreover, it might not be sufficiently veridical of real-life scenarios where tactile interactions normally involve meaningful people.One additional point of novelty of our study is that in individuals displaying high levels of BIDs (but also in the whole sample), higher levels of interoceptive awareness, i.e., greater difficulties with being aware of the connection between body sensations and emotional states, were associated with greater soothing evaluations of imagined touch when delivered by a significant individual and specifically to intimate bodily regions (although it should be noted that statistical results for social bodily regions reveal a similar trend).Recent research has shown that affective touch is crucial for the healthy development of infants but also for the emotional regulation of adults 2 .In older infants, it has been shown that in addition to self-soothing behaviours like thumb sucking, infant's physiological arousal can be regulated by soothing, touch-based behaviours by their caregivers 68,69 .Accordingly, positive interpersonal tactile interactions seem able to "bind" together inner feelings about the state of the body with external perceptions of the body and the world 70 .
On the other hand, it is known that individuals suffering from AN experience interoceptive difficulty and affective regulation (including alexithymia and poor emotional clarity) 71 .Here, we complement the research in clinical populations by extending the results of the key role of interoceptive awareness problems in meaningful affective tactile interactions to individuals displaying high levels of BIDs.Consistent with the idea of the role of interoceptive deficits in maintaining EDs symptomatology [72][73][74] , problems with interoceptive awareness may play a role in maintaining psychopathology by lack of recognition of the severity of the illness and homeostasis 75 .Accordingly, we may speculate that sensitivity to relationship-specific bodily patterns of social touch in individuals with high levels of BIDs might be mediated by greater problems with interoceptive awareness, which in turn may play a role in the experience of bodily affective contacts, a hypothesis which warrants further investigation.Nevertheless, our interpretation of the results may not entirely explain the direction of the association between (greater) interoceptive awareness problems and (higher) soothing responses to social touch by a meaningful person, and further exploration of the factors which might have mediated this relationship are needed.For example, a suitable candidate for future research explorations would be (insecure) attachment style.Interoceptive awareness and the accurate assessment of one's interoceptive states has been thought to develop through early attachment experiences 76 .For instance, in the case of anxious attachment style, a fear of abandonment and rejection yet desire for closeness from significant others is observed 77 .A recent study by Ferraro and Taylor 78 also reported that interpersonal relationships distinguished by either an under or over reliance on others for comfort and reassurance, are negatively associated with the conscious perception of internal states and understanding how these sensations might indicate emotional states.A further study by Krahe and colleagues 79 looking at the sensitivity to CT-optimal touch and adult attachment styles, reported that higher scores in attachment anxiety were associated with reduced pleasantness discrimination of CT-optimal (compared to non-CT optimal touch).On the other hand, attachment style was not related to cardiac (interoceptive) accuracy as measured by the heartbeat perception task 80 , an interoceptive measure profoundly different from the one used in our study.Accordingly, the results we obtained in our study might be an 'epiphenomenon' of a particular (insecure) attachment style in our participants displaying high levels of BIDs.In future, it would be of interest for prospective research to account for the impact of interoceptive awareness difficulties on soothing touch responses by a caregiver by comparing individuals' attachement styles in clinical and non-clinical samples with EDs.
Nevertheless, it could be that individuals with high levels of BIDs might be better 'attuned' to the social relevance of the touch giver and the body sites a specific individual is allowed to touch, thus pointing to a (potentially) higher sensitivity to relation-specific bodily patterns of social touch.If this was proved to be the case, our results can provide useful hints for future research, but also in clinical settings, particularly for mindful awareness in body-oriented therapy (MABT).MABT is a mindfulness-based approach specifically designed to teach interoceptive awareness and related skills for self-care and emotion regulation.Specifically, MABT involves a focus on sensation guided by the use of 'touch' to support learning interoceptive awareness, for example by asking the client what is noticed in response to physical pressure on an area where there is expected sensation, like in the case of physical tension or apparent discomfort 81 .
In light of the observation that individuals with high levels of BIDs may have a greater sensitivity to touch, specifically depending on 'who' is touching them and 'where' they are touched, which in turn is associated with greater problems with interoceptive awareness, we can suggest at least two reasons as to why this information could prove useful in the clinical practice.One reason pertains to the ability of building 'trust' in the client/ therapist relationship, which is one of the most important clinical elements for the client's successful engagement in accessing interoceptive awareness.Secondly, our results could be useful for facilitating the client's trust in their own body, by connecting to the body and the emotions they can feel safe.Accordingly, imaginary methods like the Virtual Touch Toolkit might be combined with body-oriented therapies to provide at the beginning of the therapeutic journey a 'safe' space where client and therapist may explore together feelings of interpersonal contacts during a proposed exercise.This way, the therapy could be modified so that touch to a proximal body area, away from a negatively experienced/unpleasant 'targeted area' for interoceptive awareness, is used instead to promote interoceptive engagement.Alternatively, client self-touch could be used in situations which, or by clinicians for whom, touch is perceived as not appropriate 81 .Ultimately, by promoting a positive experience of somatic wellbeing, the therapist can motivate a client to engage in further therapeutic work and can lead to further development of inner resources for daily life and increased emotion regulation.

Limitations
Our findings should also be viewed considering the study's limitations.Firstly, individuals who participated in our study were only at risk of BIDs and did not have a formal diagnosis of an eating disorder like AN.Given that our participants are not a clinical population, it might be the case that they may not struggle with maintaining relationships or do not display atypical responses to social touch like individuals with AN do.Future studies should concentrate on examining soothing experience of interpersonal contacts in clinical samples of women suffering from AN, so to provide more conclusive evidence on the role of social relationship in meaningful affective interactions.Also, further research focusing on social touch experiences with clinical and non-clinical samples should consider levels of exposure to positive touch and being in a relationship in which touch is given daily 10,82 .For instance, previous research has revealed that (healthy) individuals in satisfying relationships experience and rate touch as more pleasant than those in less satisfying relationships 10,82,83 .Accordingly, it could be that individual differences in the degree of exposure to touch, as well as who are in a relationship or married, experience greater exposure to touch and are more likely to tolerate and rate this touch as more soothing than those who are single 82 .
A caveat of our findings' interpretation of a role of interoceptive awareness deficits in relationship-specific maps of bodily regions of social touch allowance, is that the conclusions drawn here, relate only to self-reported interoceptive deficits measured by the Interoceptive Awareness subscale of the EDI.For instance, the EDI has been criticised as an assessment of interoception, given that it primarily considers the emotional rather than its somatic aspect 84 and it also fails to differentiate between a confusion or lack of clarity regarding internal experiences and non-acceptance of affective arousal 85 .Future research should use objective and subjective measures of interoception to overcome this limitation.
Furthermore, it is possible that gender differences might have played a role in this mechanism.With these regards, studies on gender differences in affective touch demonstrate that men are more confident in touching than women 86 (see also 87 for a review).A study by Trotter and colleagues 88 which examined sex differences using the touch experiences and attitudes questionnaire has confirmed that overall women valued touch more positively than men except for touch towards strangers, which was more comfortable for men than for women 88 .More recently, Sorokowska and colleagues 89 collected a large and heterogenous sample across 45 different countries, whereby participants indicated whether they had employed different touch actions (embrace, hug, kiss, stroke) towards different person groups (partner, child, female friend, male friend) in the last week.An affective touch diversity score derived from the sum of reported interactions was greater in women than in men.As for our study, preliminary analyses suggest this is not the case.Here, gender does not seem to modulate relationship-specific maps of bodily regions of social touch allowance, depending on the levels of BIDs.Indeed, whilst no gender difference was found for touch received to social areas, women rated touch to intimate areas as less pleasant than men did.These effects were comparable in the two levels of BIDs groups (see Supplemental materials for an additional analyses on the effect of gender on soothing/unpleasant ratings, depending on social relationship and body zones, Fig. S1).Nevertheless, we believe these results should be interpreted with caution given the small number of men, compared to women recruited in our samples, as well as within the two groups of BIDs.In future, the designation of touch zones by same versus opposite-gender of the touch giver through the proposed digital Virtual touch toolkit could shed more light on the aspect of societal gender norms and provide quantifiable evidence about touch boundaries, specifically in the case of individuals suffering from eating disorders.
Finally, touch deprivation during the Covid-19 pandemic could also have played a role in explaining findings for this study 90,91 .It should be noted that data collection for this study began during the Covid-19 pandemic and as such the unpleasantness towards touch from an acquaintance may be consequent to fear of touching another and social distancing to avoid infection, a fear instilled towards individuals unknown to us 92 .Accordingly, it could have been that fear and unpleasantness towards touch may have manifested post pandemic, altering how individuals respond to touch from someone less familiar 92 .

Conclusions
Findings from this study corroborate previous results that soothing responses to imagined social touch are crucially dependent upon the social relationship shared between the touch giver and the touch receiver, as well as the bodily regions the touch giver is allowed to touch.Importantly, we add to the current literature by providing first causative (compared to correlational) evidence that in individuals with high levels of BIDs, ratings of soothing tactile experience crucially depend upon the interaction of 'who' is delivering the touch and 'where' on the body the touch giver is allowed to touch.Importantly, interoceptive awareness deficits might play a role in this mechanism by modulating this greater sensitivity to relationship-specific bodily patterns of social imagined touch in individuals with high levels of BIDs.Accordingly, it might be plausible that participants displaying high levels of BIDs may be better 'attuned' to the social relevance and the body regions a specific individual is allowed to touch, with greater interoceptive awareness deficits supporting this relation-specific bodily patterns of imagined social touch, a hypothesis which warrants further consideration in future studies.
Given the successful application of the Virtual Touch Toolkit for the assessment of individuals with high levels of BIDs' responses to imagined social touch in the current study, future research might benefit from the use of this Toolkit as an intervention tool capable of probing the possible interaction between the interpersonal (high vs. low levels of BIDs).The EDRC score which is calculated based on 3 of the subscales: body dissatisfaction, drive for thinness and Bulimia was used to assign a participant to one of two groups: high levels of BIDs versus low levels of BIDs group, based on a median split procedure.Typically for this questionnaire a cut off of 18 or below is indicative of no eating disorder risk and a score of 32 or above demonstrates high eating disorder risk.Following a previous study by our group 58 , we focused on the subscale 'Interoceptive Deficits' as a measure of 'interoceptive awareness' to explore the relationships between subjective experience of social touch at different body sites and when received by a loved one compared to a stranger, with self-reports of interoceptive awareness 61 .The EDI-3 was validated in clinical and non-clinical samples and has shown good internal consistency (α = between 0.75 and 0.92 for each subscale), and excellent sensitivity and specificity 98 .This questionnaire has largely been used previously with non-clinical 99,100 and subclinical populations 58 and has shown to be successful in identifying individuals at risk of an EDs 100 .
Dysmorphic concern questionnaire.The dysmorphic concern questionnaire (DCQ) 101 is a short, 7-item questionnaire used to measure an individual's concern towards their physical appearance.Items focus on the belief of being misshapen or malformed despite others' opinion; belief in bodily malfunction (e.g., malodour); consultation with cosmetic specialists; spending excessive time worrying about appearance; and spending a lot of time covering up perceived defects in appearance.Participants were asked to rate each item on a Likert scale from a minimum of 0 ("not at all") to a maximum of 4 ("much more than most people").Total scores range from 0 to 28 with a critical value of 9 usually indicating clinical concern 99 .It should be noted that, compared to traditional scales measuring EDs risk (for example, the eating disorder examination-questionnaire 102,103 ), the DCQ measure different sets of psychopathological features at least in university student populations 104 .Therefore, this scale was included to determine whether higher levels of dysmorphic concerns (separately from EDs symptomatology as measured by the EDI-3) were associated with greater unpleasantness to social touch at different body sites and when received by a loved one, compared to a stranger.The DCQ has been shown good internal consistency with α = 0.80 101 .
General procedure.This study was conducted both online and, in the lab, and used Qualtrics software, Version 60,939 of the Qualtrics Research Suite (Copyright © 2015 Qualtrics., Provo, UT, USA.http:// www.qualt rics.com).This way 53 participants completed the study online and 16 participants completed the study in the lab.Importantly, both versions of the study used the same weblink to keep it consistent.Due to Covid-19 restrictions, we decided it was necessary to move from online to lab-based data collection, this was due to the Figure 3. "My body in your hands" exercise.Using a user-defined avatar, participants were given the tools to indicate their perceived pleasantness (soothing) of social touch across intimate (e.g., groin) and socialbody parts (e.g., shoulder) when touched by a loved ones and an acquaintance, respectively.The image represents a male silhouette, with the option of selecting a female silhouette.Blue-leaning colours represent more soothing (pleasant) touch, whilst red-leaning colours represent less pleasant touch.

Figure 1 .
Figure 1.Relationship-specific soothing/unpleasant ratings for individual body zones, for the two groups of low vs. high levels of body image disturbances (BIDs), respectively.The image represents a female silhouette, with the option of selecting a male silhouette.Blue-leaning colours represent more soothing (pleasant) touch, whilst red-leaning colours represent less pleasant touch.

Figure 2 .
Figure 2. Mean (M) and standard error of the mean (S.E.M.) for soothing/unpleasant ratings for imagined touch delivered to each bodily regions (intimate vs. social) and for each relationship (acquaintance vs. loved one) for (A) low levels of body image disturbances (BIDs) group versus (B) high levels of BIDs group, respectively.

Low levels of BIDs (n = 35) High levels of BIDs (n = 34) Low vs. high level of BIDs
thus suggesting that low levels of BIDs group did not differ in their soothing ratings for touch to intimate and social body regions, depending on the social relationship with the touch giver.The lack of an interaction also suggests that social relationship and touch to bodily regions may mediate subjective pleasantness of imagined touch by at least partly independent mechanisms (see Fig.2A).

Table 2 .
Mean (standard error of the mean in brackets) of soothing/unpleasant ratings for the implicit task for the two groups of Low (n = 35) and high levels of BIDs (n = 34).Scores depict ratings of imagined touchability for 13 bodily regions, according to the social relationship between the touch receiver and the touch giver (loved one vs. an acquaintance).