Elsevier

Eating Behaviors

Volume 12, Issue 1, January 2011, Pages 44-48
Eating Behaviors

The impact of perceived social support and negative life events on bulimic symptoms

https://doi.org/10.1016/j.eatbeh.2010.11.002Get rights and content

Abstract

Objective

The purpose of the current study was to evaluate the relationship between social support, negative life events, and disordered eating using a longitudinal design. More specifically, we examined whether the interaction between perceived social support and occurrence of negative life events would predict symptoms of eating disorders.

Method

Two hundred seventy female undergraduate students completed self-report questionnaires at two time points to assess perceived social support, negative life events experienced, and current psychopathology.

Results

Low social support and a greater number of negative life events interacted to predict increased bulimic symptoms, but not restrictive eating tendencies or symptoms of depression or anxiety.

Discussion

Low perceived social support in the face of negative events may exacerbate bulimic symptoms. Management of interpersonal problems and the enhancement of social skills may be important targets in the treatment of eating disorders.

Research Highlights

► Low social support and negative life events interacted to predict bulimic symptoms. ► Low social support and negative life events did not predict restrictive eating. ► Low social support and negative life events did not predict anxiety symptoms. ► Low social support and negative life events did not predict depressive symptoms.

Introduction

Bulimia nervosa (BN) affects approximately one to three percent of women and symptoms tend to persist over time (American Psychiatric Association, 2000, Joiner et al., 1997). Several risk factors for both the onset and maintenance of the disorder have been identified including body dissatisfaction, negative affect, and maladaptive coping skills (Stice, 2002). Although several studies have indicated that women with eating disorders frequently report interpersonal problems and dissatisfaction with social support (Grissett and Norvell, 1992, Rorty et al., 1999, Tiller et al., 1997), interpersonal risk factors for eating disorders have been given less attention. According to the escape theory of binge eating (Heatherton & Baumeister, 1991), individuals binge eat to “escape” from or reduce negative self-awareness. In turn, individuals may be particularly susceptible to binge eating when they lack other coping skills or means of support (e.g. seeking support from a friend), especially when faced with stressful life events. The current study aimed to investigate whether low social support in the face of negative life events would predict the occurrence of bulimic symptoms.

Researchers have consistently found an association between poor social functioning and disordered eating behaviors. For example, women with BN have been found to have less social competence (Grissett & Norvell, 1992), smaller social networks (Tiller et al., 1997, Rorty et al., 1999), less social support (Tiller et al., 1997), and higher levels of interpersonal distress (Hartmann, Zeeck, & Barrett, 2009) than the comparison samples. In a study examining the relationship between BN recovery status and social support, Rorty et al. (1999) found that individuals with current or past BN reported significantly greater dissatisfaction with emotional support from relatives compared to the control group, suggesting that some interpersonal problems may persist after recovery from BN or that social support dissatisfaction may be present in those susceptible to BN regardless of whether they are currently ill. Steiger, Gauvin, Jabalpurwala, Seguin, and Stotland (1999) found that individuals with current BN rated negative social interactions as significantly worse in the time period prior to binge episodes than on days when binge eating was absent, further highlighting that social factors may influence the occurrence of future binge episodes. Overall, interpretations of these studies' results are limited given the cross-sectional designs.

Longitudinal studies also have found a relationship between interpersonal functioning and eating disorder symptoms over time. Low perceived social support has been associated with worse eating attitudes in a female college sample (Jackson, Weiss, Lunquist, & Soderlind, 2005) as well as onset of binge eating in adolescent girls (Stice, Presnell, & Spangler, 2002). However, interpretations of the latter study are limited, because they did not control for a lifetime history of binge eating. In another study, Keel, Mitchell, Miller, Davis, and Crow (2000) found that poor social adjustment persisted even after recovery from BN, suggesting that interpersonal impairment may represent an underlying vulnerability from which disordered eating developed. Similarly, interpersonal problems prior to treatment have been associated with greater binge severity at the end of treatment, further suggesting that interpersonal problems may play a role in the maintenance of bulimic symptoms and treatment response (Hartmann et al., 2009). In support of these interpretations, poor social adjustment (Agras et al., 2000) and dissatisfaction with social support (Bell, 2002) have been associated with poorer response to treatment in patients with BN.

Interpersonal support may be particularly crucial to an individual's mental health when negative life events occur. To our knowledge, no studies have examined how social support and negative life events may interact to predict bulimic symptoms, though some studies have examined the impact of negative life events on the development of BN symptoms. In a retrospective study examining life events in the six months preceding the onset of BN, Raffi, Rondini, Grandi, and Fava (2000) found that compared to control participants, individuals with BN reported significantly more stressful life events and rated more events as having a moderate or severe impact on them. In a community-based case-controlled retrospective study, Welch, Doll, and Fairburn (1997) found that frequent house moves and separation from parents occurred at a higher frequency among women with BN compared to healthy control participants; however, neither factor differentiated women with BN from general psychiatric controls, suggesting that these factors may represent general risk for psychopathology rather than specific risk factors for BN.

The aim of the current study was to evaluate the relationship between social support, negative life events, and disordered eating using a longitudinal design. Specifically, we examined our prediction that low social support and many negative life events would predict greater bulimic symptoms; we further assessed whether the same interaction would also predict symptoms of restricted eating, anxiety or depression.

Section snippets

Participants

Two hundred ninety two female undergraduate students who were enrolled in an introductory psychology course at a large, southeastern state university participated in this study. The study took place during three semesters (two fall and one spring semester). Two hundred students initially participated during the fall semesters and 92 participated during the spring semester. The majority of participants were in their first year of college (88%), 8% were in their second year, and 4% were in their

Sample characteristics

There were small but significant decreases in bulimic symptoms from T1 to T2 (T1 mean = 12.88; and T2 mean = 12.15, t = 3.50, p < .001) and in anxiety symptoms from T1 to T2 (T1 mean = 27.39; and T2 mean = 25.79, t = 5.19, p < .001). These decreases are likely the result of regression toward the mean. Additionally, there were some significant differences in the mean scores on variables of interest by ethnicity (see Table 1).

Social support × negative life events predicting Time 2 bulimic symptoms

Two regression analyses were conducted to examine the potential two-way interaction

Discussion

The present study investigated the role of social support and negative life events on eating behaviors. Additionally, the study examined the specificity of the relationship between social support and negative life events in the prediction of increased bulimic symptoms. We found that the combination of low social support and multiple negative life events predicted bulimic symptoms but not restrictive eating or anxiety or mood symptoms. Specifically, after controlling for baseline bulimic,

Role of funding source

This study was funded, in part, by the National Institute of Mental Health grant F31MH083382 to A. R. Smith (under the sponsorship of T. E. Joiner). The content of this paper is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Mental Health or the National Institutes of Health.

Contributors

Kathryn Gordon and Jill Holm-Denoma designed the study and wrote the protocol. Kathryn Gordon and Lindsay Bodell conducted literature searches and provided summaries of previous research studies. April Smith conducted the statistical analysis and drafted the results section. Jill Holm-Denoma drafted the methods section, and Lindsay Bodell drafted the introduction and discussion sections. Thomas Joiner provided consultation for the various statistical analyses conducted; additionally, he

Conflict of interest

All authors declare that they have no conflicts of interest.

References (28)

  • W.S. Agras et al.

    Outcome predictors for the cognitive behavior treatment of bulimia nervosa: Data from a multisite study

    The American Journal of Psychiatry

    (2000)
  • American Psychiatric Association

    Diagnostic and statistical manual of mental disorders

    (2000)
  • C.S. Aneshensel et al.

    Stress, support, and depression: A longitudinal causal model

    Journal of Community Psychology

    (1982)
  • C.S. Aneshensel et al.

    Stress and depression: A test of the buffering model of social support

    Archives of General Psychiatry

    (1982)
  • A. Beck et al.

    Psychometric properties of the beck depression inventory: Twenty-five years of evaluation

    Clinical Psychology Review

    (1998)
  • A.T. Beck et al.

    An inventory for measuring clinical anxiety: psychometric properties

    Journal of Consulting and Clinical Psychology

    (1988)
  • L. Bell

    Does concurrent psychopathology at presentation influence response to treatment for bulimia nervosa?

    Eating and Weight Disorders

    (2002)
  • D. Brock et al.

    Simultaneous assessment of perceived global and relationship-specific support

    Journal of Social and Personal Relationships

    (1996)
  • O.S. Dalgard et al.

    Social support, negative life events and mental health

    The British Journal of Psychiatry

    (1995)
  • C.G. Fairburn et al.

    A prospective study of outcome in bulimia nervosa and the long-term effects of three psychological treatments

    Archives of General Psychiatry

    (1995)
  • D. Garner et al.

    Development and validation of a mulitdimensional eating disorder inventory for anorexia and bulimia

    The International Journal of Eating Disorders

    (1983)
  • N.I. Grissett et al.

    Perceived social support, social skills, and quality of relationships in bulimic women

    Journal of Consulting and Clinical Psychology

    (1992)
  • HartmannA. et al.

    Interpersonal problems in eating disorders

    The International Journal of Eating Disorders

    (2009)
  • T.F. Heatherton et al.

    Binge eating as escape from self-awareness

    Psychological Bulletin

    (1991)
  • Cited by (30)

    • Social support across eating disorder diagnostic groups: Results from the National Epidemiologic Survey on Alcohol and Related Conditions-III (NESARC-III)

      2023, Eating Behaviors
      Citation Excerpt :

      According to the interpersonal theory of EDs, social support and problems with social interactions may be critical in the etiology of EDs but also in the maintenance and recovery from EDs (Ansell et al., 2011; Rieger et al., 2010). For instance, studies have found evidence for the association between social support and EDs and found that lack of social support is related to the higher prevalence and poor management of EDs (Bodell et al., 2011; Ghaderi & Scott, 2001). It is widely believed that family and close friends can influence disordered eating behaviors and thoughts.

    • Association between exposure to interpersonal violence and social isolation, and the adoption of unhealthy weight control practices

      2019, Appetite
      Citation Excerpt :

      This may be explained by the development of anxiety and depression by the victims, who use unhealthy weight control practices (use of laxatives, self-induced vomiting and use of medication for weight loss or gain) as a way to control and regulate these feelings (Brady, 2008; Farrow & Fox, 2011). Further, greater social isolation was associated with increased risk of eating disorders (Bodell, Smith, Holm-Denoma, Gordon, & Joiner, 2011; Sarmento, Schoen-Ferreira, Medeiros, & Cintra, 2010). Socially isolated adolescents may present bad mood, depression and low self-esteem, with consequent development of body dissatisfaction and eating disorders (Sharpe, Schober, Treasure, & Schmidt, 2014).

    • The effects of social support and stress perception on bulimic behaviors and unhealthy food consumption

      2016, Eating Behaviors
      Citation Excerpt :

      For example, Bodell, Smith, Holm-Denoma, Gordon, and Joiner (2011) found that undergraduate students with lower social support experienced greater bulimic symptoms when faced with negative life events. Moreover, the predictive role of social support was specific to bulimic symptoms and not restrictive eating, depression, or anxiety symptoms (Bodell et al., 2011), which again, suggests the relevance of social support to bulimic symptoms as compared to other psychiatric symptoms. While the majority of research findings suggest that decreased social support is associated with increased bulimic symptomatology, a major limitation is that the specific mechanism by which social support influences bulimic symptoms has not been examined.

    View all citing articles on Scopus
    View full text