Social anxiety and self-consciousness in binge eating disorder: associations with 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
References (36)
- et al.
The prevalence and correlates of eating disorders in the National Comorbidity Survey replication
Biol Psychiatry
(2007) - et al.
Overvaluation of shape and weight in binge eating disorder, bulimia nervosa, and sub-threshold bulimia nervosa
Behav Res Ther
(2009) - et al.
The effects of caloric deprivation and negative affect on binge-eating in obese binge-eating disordered women
Behav Ther
(1998) - et al.
Psychometric properties of the Beck Depression Inventory: twenty-five years of evaluation
Clin Psychol Rev
(1988) - et al.
Binge eating disorder: a need for additional diagnostic criteria
Compr Psychiatry
(2000) - et al.
Comorbidity of anxiety disorders with anorexia and bulimia nervosa
Am J Psychiatry
(2004) - et al.
DSM-IV psychiatric disorder comorbidity and its correlates in binge eating disorder
Int J Eat Disord
(2008) - et al.
Comparison of bulimics, obese binge eaters, social phobics, and individuals with panic disorder on comorbidity across DSM-III-R anxiety disorders
J Abnorm Psychol
(1992) - et al.
Social phobia: review of a neglected anxiety disorder
Arch Gen Psychiatry
(1985) The obese binge eater: diagnosis, etiology, and clinical issues
Exposure plus response prevention treatment of bulimia
The social self in bulimia nervosa: public self-consciousness, social anxiety, and perceived fraudulence
J Abnorm Psychol
The relationship between perceived evaluation of weight and treatment outcome among individuals with binge eating disorder
Int J Eat Disord
Body checking and avoidance in overweight patients with binge eating disorder
Int J Eat Disord
Overvaluation of shape and weight in binge eating disorder and overweight controls: refinement of a diagnostic construct
J Abnorm Psychol
Depression and self-focused attention
Motiv Emot
Subtyping binge eating disorder
J Consult Clin Psychol
Differences in body image and depression among obese women with and without binge eating disorder
Obes Res
Cited by (29)
Clustered Patterns of Behavioral and Health-Related Variables Among Young Lesbian Women
2019, Behavior TherapyCitation Excerpt :Further, research shows those women with bulimia nervosa who engage in multiple impulsive behaviors report more affective disturbance than women with bulimia nervosa who do not (Myers et al., 2006). Consistent with research demonstrating an association between disordered eating and social anxiety (McLean, Miller, & Hope, 2007; Sawaoka, Barnes, Blomquist, Masheb, & Grilo, 2012), the three risk groups all showed elevated social anxiety in comparison to the healthy groups. Social support from friends was particularly lower among the disordered eating, hazardous alcohol use group compared to the healthy groups.
Association between binge eating disorder and psychiatric comorbidity profiles in patients with obesity seeking bariatric surgery
2018, Comprehensive PsychiatryCitation Excerpt :The care of persons with obesity and of those with psychiatric disorders is a major public health issue for the coming years [1–3]. These two types of disorders are very costly for society as they result in excessive healthcare consumption, disabilities, and working days lost [4–6]. Among psychiatric disorders in general and more specifically among eating disorder, binge-eating disorder (BED) is most strongly associated with morbid obesity [7,8].
Mirror exposure therapy for body image disturbances and eating disorders: A review
2018, Clinical Psychology ReviewCitation Excerpt :The biases of body dissatisfied for processing of own-body are characterized by an increase in general self-focused attention with a specific focus on their self-defined least attractive body parts. Increased self-focused attention has been observed in many psychiatric disorders (Ingram, 1990), including BDD, BED and weight-restored individuals with history of AN (Sawaoka, Barnes, Blomquist, Masheb, & Grilo, 2012; Windheim et al., 2011; Zucker et al., 2015). Interestingly, underweight individuals with AN report less self-focused attention than healthy controls (Zucker et al., 2015).
Piracetam attenuates binge eating disorder related symptoms in rats
2018, Pharmacology Biochemistry and BehaviorCitation Excerpt :Further, there was increase in corticosterone and leptin along with reduced ghrelin levels. Similar to our findings, a clinical study reported that BED is associated with social isolation anxiety (Sawaoka et al., 2012). In some studies, binge eating was developed though social isolation stress without palatable diet (Razzoli et al., 2015) or with 2 h footshock stress and caloric restriction (Boggiano et al., 2005).
Modification of the medical exclusion criterion in DSM-5 social anxiety disorder: Comorbid obesity as an example
2017, Journal of Affective DisordersSocial appearance anxiety and dietary restraint as mediators between perfectionism and binge eating: A six month three wave longitudinal study
2017, AppetiteCitation Excerpt :Furthermore, obese individuals with Binge Eating Disorder (BED) have higher rates of social anxiety than the general population or obese individuals without BED (Ostrovsky et al., 2013). Social anxiety has also been found to predict binge eating frequency, independent of body mass index (BMI) (Ostrovsky et al., 2013; Sawaoka et al., 2012). One specific form of social anxiety that might relate to binge eating, and that has not yet been explored, is social appearance anxiety.
This research was supported, in part, by NIH grants (R01 DK49587 and K24 DK070052).