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