Elsevier

Comprehensive Psychiatry

Volume 53, Issue 6, August 2012, Pages 740-745
Comprehensive Psychiatry

Social anxiety and self-consciousness in binge eating disorder: associations with eating disorder psychopathology

https://doi.org/10.1016/j.comppsych.2011.10.003Get rights and content

Abstract

Objective

Research has consistently shown that anxiety disorders are common among individuals with eating disorders. Although social phobia has been found to be highly associated with eating disorders, less is known about social anxiety in individuals with binge eating disorder (BED). The present study examined associations between social anxiety and self-consciousness with body mass index (BMI) and eating disorder psychopathology in BED.

Methods

Participants were 113 overweight or obese treatment-seeking men and women with BED. Participants were administered semistructural diagnostic clinical interviews and completed a battery of self-report measures.

Results

Social anxiety was positively and significantly correlated with shape and weight concerns and binge eating frequency. After accounting for depressive levels, social anxiety and self-consciousness accounted for significant variance in eating, shape, and weight concerns and overall eating disorder global severity scores (Eating Disorder Examination). Social anxiety also accounted for significant variance in binge eating frequency after covarying for depressive levels. Social anxiety and self-consciousness were not significantly associated with BMI or dietary restraint.

Discussion

Our findings suggest that greater social anxiety and heightened self-consciousness are associated with greater eating disorder psychopathology, most notably with greater shape and weight concerns and binge eating frequency in patients with BED. Social anxiety and self-consciousness do not appear to be merely functions of excess weight, and future research should examine whether they contribute to the maintenance of binge eating and associated eating disorder psychopathology.

Introduction

Research has consistently shown that anxiety disorders are common among individuals with eating disorders [1], [2], [3]. The prevalence of anxiety disorders is significantly higher in people with anorexia nervosa or bulimia nervosa (BN) than in nonclinical populations [1]. Although fewer research has examined anxiety disorders in people with binge eating disorder (BED), a disorder characterized by recurrent episodes of binge eating without the regular use of extreme weight control behaviors, available findings suggest similarly high incidence rates [2], [3]. Schwalberg et al [4] compared obese individuals who regularly binge eat, normal-weight persons with BN, and those with either social phobia or panic disorder on measures of anxiety and depression. They found similarities among the 4 groups with respect to levels of anxiety and depression, as well as incidence, prevalence, and clinical severity of anxiety disorders [4]. Of the anxiety disorders, social phobia is one of the most commonly diagnosed among obese individuals who binge eat [4]. Social phobia is marked by high levels of social anxiety [5], which is defined as a lack of confidence in social situations, difficulty interacting with other people, and fear of negative evaluations from others. Despite findings connecting social phobia to binge eating, little work has explored social anxiety in BED.

Clinically, social anxiety has long been thought to be common in people who binge eat [6], [7], although it has received relatively little empirical attention. Striegel-Moore et al [8] found that specific aspects of social anxiety and high public self-consciousness (ie, concerns about the opinions of others regarding the self) were significantly associated with body dissatisfaction in individuals with BN. Striegel-Moore et al [8] posited that individuals with BN are extremely sensitive to the evaluations others make of them and are particularly attuned to their physical appearance, thus making social anxiety and self-consciousness important influences on how they feel about their bodies. We hypothesize that associations similar to those found by Striegel-Moore et al [8] for BN may also be present among those with BED, given that individuals with BED also exhibit sensitivity to the evaluations of others [9] and heightened body image concerns as reflected in behavioral [10] and cognitive-evaluative [11], [12] manifestations. Social anxiety and self-consciousness, therefore, may be related to the shape and weight concerns of people with BED.

Social anxiety and self-consciousness are also associated with depression [13], which is important because depressive levels account for some of the variance in body dissatisfaction in individuals with BED [14], [15] as well as for variations in other features of eating disorder psychopathology in BED [14], [16], [17], [18], [19]. However, among the disordered eating behaviors associated with BED psychopathology, dietary restraint was not expected to be associated with social anxiety and self-consciousness due to low levels of incidence and variability of dietary restraint in BED patients [12]. Thus, the present study sought to specifically examine associations between social anxiety and heightened self-consciousness with broader aspects of eating disorder psychopathology in BED than previously considered for BN [8] and whether observed associations exist after controlling for depressive affect. We hypothesized that social anxiety and self-consciousness would be significantly associated with greater binge eating and eating disorder psychopathology (notably greater eating, weight, and shape concerns) but not with restraint (which tends to be low and not very variable [12]) in patients with BED.

Section snippets

Participants

Participants were 113 men and women with BED who responded to newspaper advertisements seeking overweight and obese men and women who binge eat for treatment studies at a medical school-based program in an urban setting. Study inclusion criteria required meeting full Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) research criteria for BED [20]. Exclusion criteria included pregnancy, current treatment for eating or weight problems, specific medical problems (eg,

Results

Table 1 summarizes the correlations between social anxiety and self-consciousness (ie, public and private self-consciousness) and depressive symptoms, BMI, EDE (global score, dietary restraint, eating concern, shape concern, weight concern), and binge eating frequency. Social anxiety was correlated with both public (r = .41, P < .001) and private (r = .25, P < .01) self-consciousness. Social anxiety was also significantly and positively correlated with depressive symptoms, global EDE score,

Discussion

This study examined correlates of social anxiety and self-consciousness in overweight and obese men and women with BED. Social anxiety was significantly associated with higher levels of overall eating disorder psychopathology, including shape and weight concerns and binge eating frequency. Social anxiety accounted for significant variance in shape concern and binge eating frequency after controlling for depressive symptoms. Private self-consciousness was significantly associated with higher

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    This research was supported, in part, by NIH grants (R01 DK49587 and K24 DK070052).

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