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Appearance-based rejection sensitivity as a mediator of the relationship between symptoms of social anxiety and disordered eating cognitions and behaviors

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Abstract

Previous research has established a robust relationship between symptoms of social anxiety and disordered eating. However, the mechanisms that may underpin this relationship are unclear. Appearance-based rejection sensitivity (ABRS)—the tendency to anxiously expect and overreact to signs of appearance-based rejection—may be a crucial explanatory mechanism, as ABRS has been shown to maintain social anxiety symptoms and predict disordered eating. We therefore tested whether ABRS mediated the relationship between social anxiety symptoms and various indices of disordered eating (over-evaluation of weight/shape, restraint, binge eating, compulsive exercise, and vomiting). Data from community-based females (n = 299) and males (n = 87) were analyzed. ABRS was shown to mediate the relationship between social anxiety and the over-evaluation, restraint, binge eating, and compulsive exercise frequency, but not vomiting. These effects also occurred for both females and males separately. Findings demonstrated that ABRS may be an important mechanism explaining why socially anxious individuals report elevated symptoms of disordered eating. Future research testing all proposed mediating variables of the social anxiety-disordered eating link in a single, integrative model is required to identify the most influential mechanisms driving this relationship.

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... Moreover, in community-based samples, appearance-based rejection-sensitivity predicts eating disorder symptomology and thoughts (Park, 2007) and body image concerns (Calogero et al., 2010), even after controlling for factors such as selfesteem, self-rated attractiveness, and self-worth (Park, 2007). Appearance-based rejection sensitivity has also been investigated as a mechanism to explain the co-occurrence of social anxiety and disordered eating in a community sample (Linardon et al., 2017). To date there are no studies that have shown how appearance-based rejection sensitivity differs across eating disorder subtypes. ...
... appearance-based rejection-sensitivity and disordered eating (Linardon et al., 2017); and building our understanding of how appearance-based rejection-sensitivity might develop. Conversely, the only ToM-decoding relationship that was mediated by appearance-based rejection-sensitivity was between ToM-decoding and body dissatisfaction in the East-Asian group. ...
Article
The current study tested a new interpersonal model of disordered eating behaviours, whereby maladaptive schemas and theory of mind decoding (ToM-decoding) were related with disordered eating attitudes (body dissatisfaction) and behaviours (binging/purging and food restriction) through the mediating variable appearance-based rejection-sensitivity. A secondary aim was to test whether this model differed between two cultural groups: Caucasian Australian women (N = 197, ages ranging 17–43, M = 19.25, SD = 3.10), and Asian women living in East-Asia (N = 195, ages ranging 18–40, M = 28.60, SD = 5.15). Participants completed an online survey assessing the variables of interest. While the model showed acceptable fit for both groups, invariance testing demonstrated that the model worked differently in each group. Appearance-based rejection-sensitivity mediated the effect of maladaptive schemas on body dissatisfaction and disordered eating in both groups, but only mediated the effect of ToM-decoding on body dissatisfaction in the East-Asian group. Overall, the significant indirect pathways were greater in strength and number for the Caucasian-Australian group. These findings indicate that while the relationships between maladaptive schemas, appearance-based rejection-sensitivity, and disordered eating attitudes and behaviours are present in both cultures, ToM-decoding may only play a role for East-Asian participants.
... Relatively little research has been conducted to investigate associations of interpersonal problems with driven exercise. A study found that appearance-related social rejection may account for the relationship between social anxiety and driven exercise (Linardon et al., 2017), indicating that driven exercise might serve as a coping mechanism. Higher levels of driven exercise were associated with feeling more distant to siblings, significant others and roommates in an ego-network analysis (a social network that is focused on one actor instead of specific groups or the complete network) of college students (Patterson & Goodson, 2018). ...
Article
Background This preregistered (https://osf.io/g9ajb) study sought to integrate the current literature on trait compulsivity into maintenance models of driven exercise in anorexia nervosa (AN). We tested whether compulsivity increases the likelihood of driven exercise via interpersonal and affect-regulatory pathways. Methods We used multilevel structural equation modeling to test the hypothesis that trait compulsivity predicts a stronger within-person link between affect-regulatory difficulties or interpersonal sensitivity and driven exercise in female adolescents and adults with AN. We used data from five assessments across inpatient treatment and 6-months follow-up of 207 adult and adolescent patients with AN (1036 datapoints). Results In line with our hypotheses, patients who generally experienced more affect-regulatory difficulties or stronger interpersonal sensitivity tended to engage in more driven exercise. Moreover, high levels of trait compulsivity amplified the effect of interpersonal sensitivity on driven exercise across time. Contrary to our hypotheses, the link between affect regulation and driven exercise was not moderated by compulsivity. Similar effects on general ED psychopathology were found, but no cross-level moderation of compulsivity. Limitations Due to sample size, potential age- and subtype-dependent effects were not analyzed. Conclusion Our results suggest that driven exercise coincides with self-reported experiences of interpersonal sensitivity and that this link varies as a function of compulsivity such that the within-person coupling is stronger among those scoring high on compulsivity. To derive clinically useful functional models of driven exercise, future studies might use intensive longitudinal data to investigate its momentary associations with affect and interpersonal sensitivity in the context of compulsive traits.
... Previous studies have supported the acute negative impact of actual or perceived appearance-based rejection on self and body evaluation and DE symptoms (e.g., De Paoli et al., 2017;Rieger et al., 2010). Theoretically, individuals with higher levels of appearance-RS may become motivated to engage in DE behaviours to enhance their perceived attractiveness, and thus, lessen anxious expectations surrounding appearance-based rejection (Linardon, Braithwaite, Cousins, & Brennan, 2017;Park & Pinkus, 2009). Therefore, it is plausible that appearance-RS may moderate the relationships between dating app use and BD, DE, and negative mood; such that the relationships may be stronger for women with higher trait-level appearance-RS. ...
Article
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Dating apps may potentially serve as an environment that subjects young women to the harmful effects of appearance-related pressure. The current study assessed for the first time whether women's dating app use predicted body dissatisfaction (BD), urges to engage in disordered eating (DE), and negative mood in daily life. We also examined the unique effects of women's dating app partner preferences (i.e., seeking idealised versus non-idealised physical characteristics) on the aforementioned outcomes, and whether appearance-based rejection sensitivity (appearance-RS) moderated the effects of dating app use. Participants (N = 296; 100% women) first completed a baseline survey assessing lifetime dating app usage (i.e., current or former usage), partner preferences, and appearance-RS, followed by a 7-day smartphone-facilitated ecological investigation into momentary experiences of BD, DE urges (i.e., binge-eating/purging, dietary restraint, and exercise), and negative mood. Ninety-four women (32%) reported lifetime dating app usage, which, relative to non-use, predicted greater daily urges for binge-eating/purging and negative mood. However, appearance -RS failed to moderate these effects. Among dating app users, partner preferences were not a significant predictor of the central outcomes. These findings extend previous research by examining the unique effects of dating app use on everyday BD, DE urges, and negative mood. Replication and extension are encouraged.
... Auch für ESS konnten Zusammenhänge mit der ARS nachgewiesen werden (Schmidt und Martin 2017;Park 2007). Darüber hinaus mediierte in einer Studie von Linardon et al. (2017) die ARS den Zusammenhang zwischen sozialer Angst und gezügeltem Essverhalten, Essanfällen sowie zwanghaftem Sporttreiben, nicht aber selbst induziertem Erbrechen. Aufgrund der stärkeren Psychopathologie von KDS hinsichtlich sozialphobischer Symptome (Hrabosky et al. 2009;Kollei et al. 2012;Rosen und Ramirez 1998) (Pudel und Ellrott 2005). ...
... Both social anxiety and shame are regarded as important factors in eating disorders, and eating disorder patients have been found to have higher scores in internalised shame in comparison to those with anxiety and depression, with shame a significant contributor to social anxiety (Grabhorn, Stenner et al. 2006). Appearance-based rejectionsensitivity also appears to be an important mechanism in the greater vulnerability for socially anxious individuals to develop elevated levels of disordered eating (Linardon, Braithwaite et al. 2017). It may be that perceived rejection based on one's appearance and shame may therefore lead to disordered eating in an attempt to cope. ...
Conference Paper
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Weight-stigma and internalised weight-stigma are risks for EDs and suicidality. Suicidal ideation in current and lifetime EDs is directly and indirectly effected by perceived-burdensomeness. Similarly, research has linked weight-based discrimination with perceived-burdensomeness and increased suicidal ideation. Weight self-stigma has been linked with weight change, indicating the negative effects of weight self-stigma, and emphasising the central role of fear of being stigmatised by others in this process. Self-discrepancy and negative self-schemas may also include fear of an imagined fat/larger self, or fear of returning to a larger/fat body weight. Considering these factors in the relationship between weight stigma, fear of fatness, and disordered eating, it may be that fear-of-fatness and perceived burdensomeness in EDs more closely align with fear of weight-based discrimination. Pervasive, systemic devaluation of individuals in fat/larger bodies may foster internalised beliefs that one is worthless or a burden on society that praises thinness, dehumanises, pathologizes, and positions larger bodies as a moral/personal failure. This may compound minority stress and weight bias internalisation for those who face intersectional oppressions and experiences of their bodies and identities as a marginalised other. Fear of additional (weight-based) marginalisation may influence ED vulnerability for certain populations, including those who may experience intersectional marginalisation, and those in larger bodies. Insecure attachment, social anxiety, and fear of negative evaluation are also highly prevalent in EDs. It may be that these factors relate to increased awareness of the threat of weight-based marginalisation and therefore, heighten ED risk. This paper will explore the literature on ‘fear of fatness’, ‘feeling fat’, and negative ‘fat talk’ in EDs as related to internalised weight stigma, marginalisation (i.e., race/ethnicity, genders, sexualities, disability), perceived burdensomeness, and fear of stigmatisation. It will argue for the consideration of ‘fear of fatness’ and ‘feeling fat’ as central to ED within a broader context of body politics, weight-based discrimination and disordered eating as a means of coping with fear of (further) social discrimination.
... Emotionally intelligent individuals may be less afraid of being evaluated negatively, thus decreasing the risk of ED. Previous studies have indicated a close relationship between social anxiety and ED [86][87][88][89][90][91][92][93]. ...
Article
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Background Prior research indicates that deficits in emotional abilities are key predictors of the onset and maintenance of eating disorders (ED). As a relatively new emotion-related construct, emotional intelligence (EI) comprises a set of basic emotional abilities. Preliminary research suggests that deficits in EI are linked with disordered eating and other impulsive behaviours. Also, previous research reveals that emotional and socio-cognitive abilities, as well as ED symptomatology, varies across lifespan development. However, while the findings suggest promising results for the development of potential effective treatments for emotional deficits and disordered eating, it is difficult to summarise the relationship between EI and ED due to the diversity of theoretical approaches and variety of EI and ED measures.Objective Our study, therefore, aimed to systematically review the current evidence on EI and ED in both the general and clinical populations and across different developmental stages.Methods The databases examined were Medline, PsycInfo and Scopus, and 15 eligible articles were identified. Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines were used.ResultsAll the studies reviewed indicated negative associations between EI and the dimensions of ED. Additionally, several mechanisms involved, namely adaptability, stress tolerance and emotional regulation were highlighted.Conclusion The systematic review suggests promising but challenging preliminary evidence of the associations between EI and the dimensions of ED across diverse stages of development. In addition, future research, practical implications and limitations are discussed.Level of evidence ISystematic review.
... Auch für ESS konnten Zusammenhänge mit der ARS nachgewiesen werden (Schmidt und Martin 2017;Park 2007). Darüber hinaus mediierte in einer Studie von Linardon et al. (2017) die ARS den Zusammenhang zwischen sozialer Angst und gezügeltem Essverhalten, Essanfällen sowie zwanghaftem Sporttreiben, nicht aber selbst induziertem Erbrechen. Aufgrund der stärkeren Psychopathologie von KDS hinsichtlich sozialphobischer Symptome (Hrabosky et al. 2009;Kollei et al. 2012;Rosen und Ramirez 1998) (Pudel und Ellrott 2005). ...
Article
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Background Body dysmorphic disorder (BDD) and eating disorders (ED) share a variety of symptoms, which complicates a differential diagnosis. The psychopathology of both disorders points to appearance-based rejection sensitivity (ARS) as a possible discriminating feature.Objective The study aimed to provide evidence for an improvement of the differential diagnosis between BDD and ED. Therefore, the two disorders were compared with reference to the ARS scores. Based on previous empirical literature, people with BDD were expected to show a higher ARS score than people with an ED. Furthermore, BDD was tested to explain more variance on ARS than ED, even if confounding variables (social anxiety symptoms, body mass index, sex) are held constant.Material and methodsA community sample (n = 736) filled out an online survey including the appearance-based rejection sensitivity scale, the Liebowitz social anxiety scale, the eating disorder examination questionnaire and a DSM‑5 screening on BDD.ResultsParticipants with a comorbid positive BDD-ED screening reached the highest ARS scores but similar scores as participants with a positive ED screening. Both groups yielded significantly higher scores than participants with a positive BDD screening, which in turn had significantly higher scores than symptomfree participants. Regression analysis confirmed a greater explanation of variance on ARS by ED than by BDD when confounding variables were held constant.Conclusion The ARS could not be confirmed as a distinguishing feature between BDD and ED in the sense of the hypothesis. Nevertheless, high scores on ARS could be an indication for both ED and BDD symptoms and very high scores for comorbid BDD-ED symptoms. Thus, this should be considered in the diagnostic process and in therapy.
... Group differences on the more implicit level could be explained by high levels of avoidance and rejection sensitivity in samples with EDs, but when looking at the content, the SAD-and GAD-specific sentence-word pairs did not completely correspond to their specific appearance-based rejection sensitivity (Linardon, Braithwaite, Cousins, & Brennan, 2017). Consistent with our hypotheses, women with very high ED symptoms endorsed more negative SAD and GAD interpretations than did nonclinical controls, yet this negative IB was not reflected in their reaction times. ...
Article
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Objective: Cognitive biases, such as memory, attention, and interpretation bias, are thought to play a central role in the development and maintenance of eating disorders (EDs). The aim of the present study was to investigate whether the interpretation bias is ED-specific or can be generalized to comorbid disorder-related threats in women with high levels of ED symptoms. Method: In an online study, we measured interpretation bias using the modified Sentence Word Association Paradigm (SWAP), comparing women with (n = 39) and without (sub)threshold eating disorders (n = 56). We assessed endorsement and rejection rates as well as reaction times in response to a positive/neutral or a negative ED-specific, social anxiety-specific (SAD), or generalized anxiety-specific (GAD) interpretive word following an ambiguous sentence. Results: In ambiguous situations, women with high ED symptoms selected more negative (p < .001) and fewer positive/neutral ED-related interpretations (p < .001). Negative interpretations were endorsed significantly faster (p < .001), while positive interpretations were rejected faster in this group (p < .001). These women also manifested negative SAD-specific interpretation bias patterns in reaction time measures. Nevertheless, ED severity was best predicted by the endorsement of negative ED-specific stimuli, whereas ED and SAD reaction time measures seemed to have a negligible effect. Discussion: The results indicate that the interpretation bias might be ED-specific. The SWAP can be a useful tool for the further investigation of the etiological relevance of the interpretation bias as well as for the development of modification training interventions.
... This form of rejection sensitivity has been found to predict disordered eating in community samples (Park, 2007), increase interest in cosmetic surgery in college students (Park, Calogero, Harwin & DiRaddo, 2009) and was associated with more severe body dysmorphic disorder (BDD) and depressive symptoms in BDD patients (Kelly, Didie & Phillips, 2014). This form of rejection sensitivity was also found to be a mediator of the relationship between social anxiety symptoms and disordered eating cognitions and behaviour in a community sample of males and females (Linardon, Braithwaite, Cousins, & Brennan, 2017). Despite these findings, there are no known studies that have investigated appearance-based rejection sensitivity in those with BPD, or in eating disorder samples in general. ...
Article
Objective: To examine the relationship between disordered eating behaviour and Borderline Personality Disorder (BPD) in a clinical population of adolescent girls. We hypothesized that BPD and disordered eating would be strongly associated and that this association would be partially mediated by rejection sensitivity. Method: Participants were 73 female patients aged 11-18 presenting for mental health treatment at an outpatient psychiatry clinic in a large metropolitan hospital. Measures used in this study include the Diagnostic Interview for Borderline Personality Disorder-Revised, Borderline Personality Questionnaire and The Short Screen for Eating Disorders. Results: Youth with BPD had significantly more disordered eating behaviour compared to controls. Of the nine facets of BPD, eight were highly correlated with disordered eating, suggesting important shared variance between the constructs of BPD and disordered eating. This study also demonstrated that rejection sensitivity significantly mediated the relationship between BPD symptoms and disordered eating. Conclusions: This paper provides a novel association between a diagnosis of BPD in adolescents and disordered eating and the mediation effect of rejection sensitivity. These findings suggest that disordered eating should be screened in BPD samples and interventions targeting rejection sensitivity may be of clinical use.
... Responses to these items are given on a 7-point scale, ranging from zero (no days) to six (every day), with higher scores indicating greater severity of dietary restraint. Single items from the EDE-Q, including these restraint items, have been used extensively in previous research (Goldschmidt et al., 2010;Lethbridge, Watson, Egan, Street, & Nathan, 2011;Linardon & Mitchell, 2017;Linardon, Braithwaite, Cousins, & Brennan, 2017a;Mitchison et al., 2017;Ojserkis, Sysko, Goldfein, & Devlin, 2012;Watson, Raykos, Street, Fursland, & Nathan, 2011;Wilson et al., 2002). ...
Article
Although empirical evidence identifies dietary restraint as a transdiagnostic eating disorder maintaining mechanism, the distinctiveness and significance of the different behavioural and cognitive components of dietary restraint are poorly understood. The present study examined the relative associations of the purportedly distinct dietary restraint components (intention to restrict, delayed eating, food avoidance, and diet rules) with measures of psychological distress (depression, anxiety, and stress), disability, and core eating disorder symptoms (overvaluation and binge eating) in patients with anorexia nervosa (AN) and bulimia nervosa (BN). Data were analysed from a treatment-seeking sample of individuals with AN (n = 124) and BN (n = 54). Intention to restrict, food avoidance, and diet rules were strongly related to each other (all r's > 0.78), but only weakly-moderately related to delayed eating behaviours (all r's < 0.47). In subsequent moderated ridge regression analyses, delayed eating was the only restraint component to independently predict variance in measures of psychological distress. Patient diagnosis did not moderate these associations. Overall, findings indicate that delayed eating behaviours may be a distinct component from other indices of dietary restraint (e.g., intention to restrict, food avoidance, diet rules). This study highlights the potential importance of ensuring that delayed eating behaviours are screened, assessed, and targeted early in treatment for patients with AN and BN.
... Responses to these items are given on a 7-point scale, ranging from zero (no days) to six (every day), with higher scores indicating greater severity of dietary restraint. Single items from the EDE-Q, including these restraint items, have been used extensively in previous research (Goldschmidt et al., 2010;Lethbridge, Watson, Egan, Street, & Nathan, 2011;Linardon & Mitchell, 2017;Linardon, Braithwaite, Cousins, & Brennan, 2017a;Mitchison et al., 2017;Ojserkis, Sysko, Goldfein, & Devlin, 2012;Watson, Raykos, Street, Fursland, & Nathan, 2011;Wilson et al., 2002). ...
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Aim: University students are one of the groups who are at risk for eating disorders. This study was conducted to investigate the relationship between social physique anxiety and depression with the risk of eating disorders in university students. Subjects and Method: Eating Attitude Test (EAT-26) and REZZY (SCOFF) Eating Disorders Scale were used to assess the risk of eating behaviour disorder in a total of 318 students with a mean age of 20.6±1.7 years. Beck Depression Scale (BDS) was used to determine the presence of depression, and Social Physique Anxiety Scale was used to measure the level of discomfort that individuals feel when their physical appearance is evaluated by others. Results: According to EAT-26 and REZZY scales, 20.1% and 28.6% of students were at risk of eating disorders, respectively. The risk of eating disorders was significantly associated with social physique anxiety (r=0.345, p=0.000) and depression (r=0.247, p=0.000). There was also a significant positive association between risk of eating disorders and body mass index (r=0.248, p=0. 000. Additionally, social physique anxiety levels were higher in overweight and obese girls (p<0.05). Conclusion: Social-physical anxiety and depression may lead to eating disorder in university students. Further studies on risk of eating disorders and underlying factors are needed to confirm these findings on large samples. The development of depression and subsequent risk of eating disorders can be prevented by assessment of disordered eating behaviors in ‘at risk’ groups (e.g. females, overweight and/or obese subjects, presence of depression, etc.) by using short screening tools (e.g. REZZY) and monitoring body weight.
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Social anxiety disorder (SAD) is a common, distressing and persistent mental illness. Recent studies have identified a number of psychological factors that could explain the maintenance of the disorder. These factors are presented here as part of a comprehensive psychological maintenance model of SAD. This model assumes that social apprehension is associated with unrealistic social standards and a deficiency in selecting attainable social goals. When confronted with challenging social situations, individuals with SAD shift their attention toward their anxiety, view themselves negatively as a social object, overestimate the negative consequences of a social encounter, believe that they have little control over their emotional response, and view their social skills as inadequate to effectively cope with the social situation. In order to avoid social mishaps, individuals with SAD revert to maladaptive coping strategies, including avoidance and safety behaviors, followed by post-event rumination, which leads to further social apprehension in the future. Possible disorder-specific intervention strategies are discussed.
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This study aimed to replicate and extend from Tylka, Calogero, and Daníelsdóttir (2015) findings by examining the relationship between rigid control, flexible control, and intuitive eating on various indices of disordered eating (i.e., binge eating, disinhibition) and body image concerns (i.e., shape and weight over-evaluation, body checking, and weight-related exercise motivations). This study also examined whether the relationship between intuitive eating and outcomes was mediated by dichotomous thinking and body appreciation. Analysing data from a sample of 372 men and women recruited through the community, this study found that, in contrast to rigid dietary control, intuitive eating uniquely and consistently predicted lower levels of disordered eating and body image concerns. This intuitive eating-disordered eating relationship was mediated by low levels of dichotomous thinking and the intuitive eating-body image relationship was mediated by high levels of body appreciation. Flexible control predicted higher levels of body image concerns and lower levels of disordered eating only when rigid control was accounted for. Findings suggest that until the adaptive properties of flexible control are further elucidated, it may be beneficial to promote intuitive eating within public health approaches to eating disorder prevention. In addition to this, particular emphasis should also be made toward promoting body acceptance and eradicating a dichotomous thinking style around food and eating.
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This meta-analysis assessed the strength of the association between correlates of shape and weight over-evaluation across binge eating disorder and mixed eating disorder samples. Across 32 studies, over-evaluation correlates were divided into demographic, eating pathology, or psychosocial. Shape and weight over-evaluation was associated with higher eating pathology and psychosocial impairment. The method of assessment (interview versus self-report questionnaire) moderated some of the relationships. Over-evaluation was unrelated to demographics and treatment outcome. These findings highlight the importance of addressing shape and weight over-evaluation during treatment, and supports the idea of using shape and weight over-evaluation as a severity specifier for binge eating disorder.
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Social anxiety and eating disorders are highly comorbid, which suggests there are shared vulnerabilities that underlie the development of these disorders. Two proposed vulnerabilities are fear of negative evaluation and social appearance anxiety (i.e., fear of negative evaluation regarding one’s appearance). In the current experimental study (N = 160 women), we measured these fears (a) through a manipulation comparing fear conditions, (b) with trait fears, and (c) with state fears. Results indicated that participants assigned to the fear of negative evaluation condition increased food consumption, whereas those assigned to the social appearance anxiety condition and high in trait social appearance anxiety experienced the highest amounts of body dissatisfaction. Participants in the fear of negative evaluation and social appearance anxiety conditions experienced elevated social anxiety. These results support the idea that negative-evaluation fears are shared vulnerabilities for eating and social anxiety disorders, but that the way these variables exert their effects may lead to disorder-specific behaviors.
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Although sociocultural pressures are thought to contribute to bulimia nervosa, little research has examined the mechanisms by which these factors might actually produce eating pathology. The present study tested an integrative model of bulimia that centers around dietary restraint and affect regulation pathways. It also incorporates perceived sociocultural pressure, body-mass, ideal-body internalization, and body dissatisfaction. Using data from 257 female undergraduates, structural equation modeling revealed that the model accounted for 71% of the variance in bulimic symptomatology. The relation between perceived sociocultural pressure and bulimic symptoms was mediated by ideal-body internalization, body dissatisfaction, dietary restraint, and negative affect. The results support the dual pathway model of bulimia and suggest variables that might be targeted in prevention efforts.
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Objective The Eating Disorder Examination-Questionnaire (EDE-Q) is widely used in research studies across clinical and nonclinical groups. Relatively little is known about psychometric properties of this measure and the available literature has not supported the proposed scale structure. This study evaluated the factor structure and construct validity of the EDE-Q in a nonclinical study group of young adults.Method Participants were 801 young adults (573 females and 228 males) enrolled at a large public university in the Midwestern United States who completed the EDE-Q and a battery of behavioral and psychological measures.ResultsConfirmatory factor analysis (CFA) revealed an inadequate fit for the original EDE-Q structure but revealed a good fit for an alternative structure suggested by recent research with predominately overweight/obese samples. CFA supported a modified seven-item, three-factor structure; the three factors were interpreted as dietary restraint, shape/weight overvaluation, and body dissatisfaction. Factor loadings and item intercepts were invariant across sex and overweight status. The three factors had less redundancy than the original EDE-Q scales and demonstrated improved convergent and discriminant validity in relation to relevant other measures.DiscussionThese factor-analytic findings, which replicate findings from studies with diverse predominately overweight/obese samples, supported a modified seven-item, three-factor structure for the EDE-Q with improved psychometric characteristics. The findings provide further empirical support for the distinction between body dissatisfaction and overvaluation and have implications for assessment and research. These findings need to be replicated in samples of persons with eating-disorder psychopathology including those with anorexia nervosa, bulimia nervosa, and allied states. © 2014 Wiley Periodicals, Inc. (Int J Eat Disord 2014)
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Body dysmorphic disorder (BDD) is characterized by extreme preoccupation with perceived deficits in physical appearance, and sufferers experience severe impairment in functioning. Previous research has indicated that individuals with BDD are high in social anxiety, and often report being the victims of appearance-based teasing. However, there is little research into the possible mechanisms that might explain these relationships. The current study examined appearance-based rejection sensitivity as a mediator between perceived appearance-based victimization, social anxiety, and body dysmorphic symptoms in a sample of 237 Australian undergraduate psychology students. Appearance-based rejection sensitivity fully mediated the relationship between appearance-based victimization and body dysmorphic symptoms, and partially mediated the relationship between social anxiety and body dysmorphic symptoms. Findings suggest that individuals high in social anxiety or those who have a history of more appearance-based victimization may have a bias towards interpreting further appearance-based rejection, which may contribute to extreme appearance concerns such as BDD.
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Previous findings indicate that social anxiety and bulimia co-occur at high rates; one mechanism that has been proposed to link these symptom clusters is perfectionism (Silgado et al. in Cogn Ther Res 34(5):487–492, 2010). We tested meditational models among 167 female undergraduates in which maladaptive evaluative perfectionism concerns (MEPC; i.e., critical self-evaluative perfectionism) mediated the relationship between social anxiety and bulimic symptoms. Results from a first model indicated that MEPC mediated the relationship between fear of public scrutiny and bulimia symptoms. This indirect effect was significant above and beyond the indirect effects of maladaptive body-image cognitions and perfectionism specific to pure personal standards. A second model was tested with MEPC mediating the relationship between social interaction anxiety and bulimia symptoms. Similar results were obtained; however, in this model, a significant direct effect remained after partialing out the indirect effect of the mediators. Theoretical implications are discussed.
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Objective: The close relationship between social anxiety and eating disorders has attracted considerable scholarly attention in recent years. Shame has been identified as the key emotional symptom in the link between social anxiety and social phobia. While shame is commonly recognized as a meaningful construct for understanding eating disorders, empirical research into this issue has been lacking. Thus, the objective of this study was to determine the strength of influence shame and social anxiety have in the psychopathology of anorexia nervosa and bulimia nervosa compared with other clinical groups. Furthermore, the issue of whether shame can account for clinical group differences in the experienced levels of social anxiety was examined.
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Objective: This study examined whether the self-report version of the Liebowitz Social Anxiety Scale (LSAS-SR) could accurately identify individuals with social anxiety disorder and individuals with the generalized subtype of social anxiety disorder. Furthermore, the study sought to determine the optimal cutoffs for the LSAS-SR for identifying patients with social anxiety disorder and its generalized subtype. Methods: Two hundred and ninety-one patients with clinician-assessed social anxiety disorder (240 with generalized social anxiety disorder) and 53 control participants who were free from current Axis-1 disorders completed the LSAS-SR. Results: Receiver Operating Characteristic analyses revealed that the LSAS-SR performed well in identifying participants with social anxiety disorder and generalized social anxiety disorder. Consistent with Mennin et al.'s [2002: J Anxiety Disord 16:661-673] research on the clinician-administered version of the LSAS, cutoffs of 30 and 60 on the LSAS-SR provided the best balance of sensitivity and specificity for classifying participants with social anxiety and generalized social anxiety disorder, respectively. Conclusions: The LSAS-SR may be an accurate and cost-effective way to identify and subtype patients with social anxiety disorder, which could help increase the percentage of people who receive appropriate treatment for this debilitating disorder.
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This study investigates the underlying psychopathology of disordered eating and social phobia behaviours by examining the interrelationships between variables thought to be common to both. The participants were 252 female tertiary students. Each completed measures of eating behaviours, social phobia, body esteem, fear of negative evaluation, social support, self-acceptance, and general psychopathology. Structural equation modelling was used to determine if fear of negative evaluation and social support had a direct or indirect effect on the behaviours of disordered eating, social phobia, and body esteem. Findings indicated that fear of negative evaluation had a direct and indirect effect on the behaviours associated with eating disorders and social phobia, and only an indirect effect on body esteem. Social support indirectly affected eating disorders, social phobia, and body esteem. Implications from this study are that social support, fears of being criticised or rejected by others, and low self-acceptance are important variables in the assessment of eating disorders and social phobia.
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Social anxiety and eating disorders are highly comorbid. However, it is unknown how specific domains of social anxiety relate to disordered eating. We provide data on these relationships and investigate social appearance anxiety and fear of negative evaluation as potential vulnerabilities linking social anxiety with disordered eating. Specifically, we examined five domains of social anxiety: Social interaction anxiety, fear of scrutiny, fear of positive evaluation, fear of negative evaluation, and social appearance anxiety. Results indicated that social appearance anxiety predicted body dissatisfaction, bulimic symptoms, shape concern, weight concern, and eating concern over and above fear of scrutiny, social interaction anxiety, and fear of positive evaluation. Fear of negative evaluation uniquely predicted drive for thinness and restraint. Structural equation modeling supported a model in which social appearance anxiety and fear of negative evaluation are vulnerabilities for both social anxiety and eating disorder symptoms. Interventions that target these negative social evaluation fears may help prevent development of eating disorders.
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Three cognitive constructs are risk factors for eating disorders: undue influence of weight and shape, concern about weight and shape, and body dissatisfaction (BD). Undue influence, a diagnostic criterion for eating disorders, is postulated to be closely associated with self-esteem whereas BD is postulated to be closely associated with body mass index (BMI). We understand less about the relationships with concern about weight and shape. The aim of the current investigation was examine the degree of overlap across these five phenotypes in terms of latent genetic and environmental risk factors in order to draw some conclusions about the similarities and differences across the three cognitive variables. A sample of female Australian twins (n=1056, including 348 complete pairs), mean age 35 years (S.D.=2.11, range 28-40), completed a semi-structured interview about eating pathology and self-report questionnaires. An independent pathways model was used to investigate the overlap of genetic and environmental risk factors for the five phenotypes. In terms of variance that was not shared with other phenotypes, self-esteem emerged as being separate, with 100% of its variance unshared with the other phenotypes, followed by undue influence (51%) and then concern (34%), BD (28%) and BMI (32%). In terms of shared genetic risk, undue influence and concern were more closely related than BD, whereas BMI and BD were found to share common sources of risk. With respect to environmental risk factors, concern, BMI and BD were more closely related to each other than to undue influence.
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The current study examined the hypotheses that social support and coping moderate and or mediate the relationship between a broad and a narrow form of social anxiety and eating disorder symptoms. One hundred sixty-nine female undergraduates at a private Midwestern university, completed measures of social support, coping, social anxiety, fear of negative evaluation, and disordered eating attitudes and behaviors. Results of hierarchical multiple regression analyses indicated that higher levels of social support are associated with a weaker association between social anxiety and eating disorder symptomatology. Low use of task- and avoidant-oriented (distraction) coping and increased use of emotion-oriented coping are associated with a stronger association between social anxiety and eating disorder symptomatology. Implications for research and clinical intervention are discussed.
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This study examined the temporal sequencing of eating and anxiety disorders to delineate which anxiety disorders increase eating disorder risk and whether individuals with eating disorders are at greater risk for particular anxiety disorders. The sample was drawn from the Oregon Adolescent Depression Project. Temporal relations between specific eating and anxiety disorders were examined after controlling for relevant variables (e.g., mood disorders, other anxiety disorders) over 14 years. After excluding those with anorexia nervosa (AN) in adolescence (T1), OCD was the only T1 anxiety disorder to predict AN by age 30 (T4). No T1 anxiety disorder was associated with T4 bulimia nervosa (BN). Although T1 AN did not increase risk of any T4 anxiety disorder, T1 BN appeared to increase risk for social anxiety and panic disorders. Evidence that eating disorders may have differential relations to particular anxiety disorders could inform prevention and treatment efforts.
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Despite the widespread use of the Eating Disorder Examination (EDE) as a primary assessment instrument in studies of eating and weight disorders, little is known about the psychometric aspects of this interview measure. The primary purpose of this study was to evaluate the factor structure of the EDE interview in a large series of patients with binge-eating disorder (BED). Participants were 688 treatment-seeking patients with BED who were reliably administered the EDE interview by trained research clinicians at three research centers. Exploratory factor analysis (EFA) performed on EDE interview data from a random split-half of the study group suggested a brief 7-item 3-factor structure. Confirmatory factor analysis (CFA) performed on the second randomly selected half of the study group supported this brief 3-factor structure of the EDE interview. The three factors were interpreted as Dietary Restraint, Shape/Weight Overvaluation, and Body Dissatisfaction. In this series of patients with BED, factor analysis of the EDE interview did not replicate the original subscales but revealed an alternative factor structure. Future research must further evaluate the psychometric properties, including the factor structure, of the EDE interview in this and other eating-disordered groups. The implications of these factor analytic findings for understanding and assessing the specific psychopathology of patients with BED are discussed.
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This article proposes that binge eating is motivated by a desire to escape from self-awareness. Binge eaters suffer from high standards and expectations, especially an acute sensitivity to the difficult (perceived) demands of others. When they fall short of these standards, they develop an aversive pattern of high self-awareness, characterized by unflattering views of self and concern over how they are perceived by others. These aversive self-perceptions are accompanied by emotional distress, which often includes anxiety and depression. To escape from this unpleasant state, binge eaters attempt the cognitive response of narrowing attention to the immediate stimulus environment and avoiding broadly meaningful thought. This narrowing of attention disengages normal inhibitions against eating and fosters an uncritical acceptance of irrational beliefs and thoughts. The escape model is capable of integrating much of the available evidence about binge eating.
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Bulimic women appear preoccupied not only with their physical presentation but also with their "social self"--how others perceive them in general. This study examined the relationship of the social self to body esteem and to bulimia nervosa. In Phase 1, in which 222 nonclinical women (aged 16 to 50) participated, the social-self measures of Perceived Fraudulence, Social Anxiety, and Public Self-Consciousness were negatively associated with body esteem. In Phase 2, 34 bulimic women were compared with 33 Ss scoring high on the Eating Attitudes Test (EAT) and 67 matched control. Bulimic Ss, high-EAT Ss, and control Ss all differed on Perceived Fraudulence, and bulimic Ss and high-EAT Ss scored higher than control Ss on Public Self-Consciousness and Social Anxiety. The findings strongly support the hypothesized link of social-self concerns to body dissatisfaction and bulimia nervosa.
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We compared the prevalence and age of onset of adult and childhood anxiety disorders relative to the primary diagnosis in 68 women with anorexia nervosa (AN), 116 women with bulimia nervosa (BN), 56 women with major depression with no eating disorder (MD) and 98 randomly selected controls (RC) in order to determine whether antecedent anxiety disorders are plausible risk factors for AN and BN. Comorbid anxiety disorders were common in all three clinical groups (AN, 60%; BN, 57%; MD, 48%). In 90% of AN women, 94% of BN women and 71% of MD women, anxiety disorders preceded the current primary condition (P = 0.01), although panic disorder tended to develop after the onset of AN, BN or MD. In multivariate logistic regressions, the odds ratios (ORs) for overanxious disorder (OR = 13.4) and obsessive-compulsive disorder (OR = 11.8) were significantly elevated for AN. The ORs for overanxious disorder and social phobia were significantly elevated for BN (OROAD = 4.9; ORSP = 15.5) and MD (OROAD = 6.1; ORSP = 6.4). These data suggest that certain anxiety disorders are non-specific risk factors for later affective and eating disorders, and others may represent more specific antecedent risk factors.
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The Liebowitz social anxiety scale (LSAS) is a commonly used clinician-administered instrument. The present study reports on the properties of a self-report version of the LSAS (LSAS-SR). About 175 participants diagnosed with social phobia participated in the study. The LSAS-SR showed overall good psychometric properties as indicated by the results of test-retest reliability, internal consistency, and convergent and discriminant validity. Furthermore, the scale was sensitive to treatment change. The construct validity of the LSAS-SR, however, remains to be further explored. These findings support the utility of the LSAS-SR, which has the advantage of saving valuable clinician time compared to the clinician-administered version.
Article
The goal of this pilot investigation is to determine the relationship between social anxiety and treatment-seeking behavior for eating disorders in an outpatient psychiatric clinic. Twenty-eight patients seeking treatment for anorexia or bulimia at an outpatient eating disorders clinic completed a battery of self-report measures on eating pathology, attachment style and functioning, and social anxiety at initial intake appointment. Levels of eating pathology and social anxiety at consult were compared with service utilization records on entry into treatment. Individuals who did not engage in treatment had significantly higher levels of social anxiety (F = 8.29, df = 1, p < .05) compared with those who did engage in treatment. There were no differences in demographic characteristics, diagnoses, or level of eating pathology at intake. Social anxiety may act as a barrier to effective help-seeking and utilization of mental health treatment among individuals with eating disorders. Replication of these findings in a larger sample and more in-depth study of the mechanism of the observed association between use of services and social anxiety may be useful in planning more effective outreach in the community to underserved populations in need of treatment for eating disorders.
Article
This paper is concerned with the psychopathological processes that account for the persistence of severe eating disorders. Two separate but interrelated lines of argument are developed. One is that the leading evidence-based theory of the maintenance of eating disorders, the cognitive behavioural theory of bulimia nervosa, should be extended in its focus to embrace four additional maintaining mechanisms. Specifically, we propose that in certain patients one or more of four additional maintaining processes interact with the core eating disorder maintaining mechanisms and that when this occurs it is an obstacle to change. The additional maintaining processes concern the influence of clinical perfectionism, core low self-esteem, mood intolerance and interpersonal difficulties. The second line of argument is that in the case of eating disorders shared, but distinctive, clinical features tend to be maintained by similar psychopathological processes. Accordingly, we suggest that common mechanisms are involved in the persistence of bulimia nervosa, anorexia nervosa and the atypical eating disorders. Together, these two lines of argument lead us to propose a new transdiagnostic theory of the maintenance of the full range of eating disorders, a theory which embraces a broader range of maintaining mechanisms than the current theory concerning bulimia nervosa. In the final sections of the paper we describe a transdiagnostic treatment derived from the new theory, and we consider in principle the broader relevance of transdiagnostic theories of maintenance.
Article
The eating disorders have a high comorbidity with anxiety disorders, but it is not clear what cognitions underpin those anxiety symptoms. The present study investigated whether social anxiety and agoraphobia in eating-disordered individuals are associated with different types of unconditional core beliefs. The participants were 70 women meeting DSM-IV criteria for an eating disorder. The short version of Young's Schema Questionnaire (YSQ-S) was used as a measure of core beliefs, while the Social Phobia and Anxiety Inventory was used as a measure of levels of social anxiety and agoraphobia. Eating-disordered individuals reporting high levels of comorbid social anxiety had higher abandoment and emotional inhibition core beliefs. In contrast, patients with high levels of agoraphobia had higher vulnerability to harm beliefs. The findings highlight the importance of identifying and addressing core beliefs in subgroups of eating-disordered individuals presenting with comorbid anxiety. Implications for future research are discussed, including the need for longitudinal studies to elaborate on the specificity of the cognition-anxiety link in the eating disorders.
Article
Social anxiety and disordered eating frequently overlap, and evidence suggests that emotional suppression may be an important mediating factor. The present study examines the relationships among social anxiety, emotional suppression, and disordered eating in a non-clinical sample of 160 undergraduate women. Participants completed self-report measures for social anxiety, disordered eating, expressive suppression, depression, and negative affect. Results from mediation analyses indicate that the relationship between social anxiety and disordered eating is fully mediated by expressive suppression. Findings are consistent with a displacement theory in which unexpressed negative affect is shifted towards the body, thereby promoting symptoms of disordered eating.
Article
The excessive influence of shape or weight on self-evaluation--referred to as overvaluation--is considered by some a central feature across eating disorders but is not a diagnostic requirement for binge eating disorder (BED). This study examined shape/weight overvaluation in 399 consecutive patients with BED. Participants completed semistructured interviews, including the Eating Disorder Examination (EDE; C. G. Fairburn & Z. Cooper, 1993) and several self-report measures. Shape/weight overvaluation was unrelated to body mass index (BMI) but was strongly associated with measures of eating-related psychopathology and psychological status (i.e., higher depression and lower self-esteem). Participants were categorized via EDE guidelines into 1 of 2 groups: clinical overvaluation (58%) or subclinical overvaluation (42%). The 2 groups did not differ significantly in BMI or binge eating frequency, but the clinical overvaluation group had significantly greater eating-related psychopathology and poorer psychological status than the subclinical overvaluation group. Findings suggest that overvaluation does not simply reflect concern commensurate with being overweight but is strongly associated with eating-related psychopathology and psychological functioning and warrants consideration as a diagnostic feature for BED.
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