Social appearance anxiety and bulimia nervosa

Abstract

Social appearance anxiety is an unexplored concept in eating disorders (ED). It refers to social anxiety surrounding overall appearance, including body shape, and fear of negative evaluation by others. It is potentially relevant to those with bulimia nervosa (BN) as both social anxiety and body image disturbance are commonly experienced by patients. Thirty women with BN and forty healthy controls (HC) completed the Social Appearance Anxiety Scale (SAAS), a 16-item self-report questionnaire. ED cognitions and behaviours were assessed with the Eating Disorders Examination-Questionnaire. Women with BN have significantly higher SAAS scores than HC (z=-6.79, p<0.001). In BN, SAAS scores show significant positive correlation with global ED subscales and dietary restraint. In HC, SAAS scores are correlated with shape, weight, eating concern, and global eating disturbance subscales. Preliminary findings suggest the SAAS is potentially useful in future research concerning overall risk factors for eating disturbance and treatment outcome in BN.

The Social Appearance Anxiety Scale in Italian Adolescent Populations: Construct Validation and Group Discrimination in Community and Clinical Eating Disorders Samples

“…As in the current study, when the raw scores on the SAAS of the participants are compared, other studies have found [29,30] that ED patients obtained a higher score than control community groups. Although, to our knowledge, no research has analysed the role of gender and age in the specific fear of judgment based on appearance (SAA) in adult or adolescent samples, the gender and age differences across adolescents found in this research converged with a large body of research indicating that in general terms body and overall appearance concerns, social fears and particularly negative evaluation fears, and social anxiety are more salient from mid-adolescence onwards and across female participants [26,27,32,34,37,47,62,69].…”

“…Employing a female adult sample of 60 outpatients with EDs, Claes et al [10] supported the one-factor model of the SAAS and found that its score was significantly positive in relation to mistrust of others, social detachment, emotional lability and desire to become thinner. Evidence that ED patients obtained higher SAAS scores than matched healthy controls exists as well [29,30].…”

“…In light of these concerns, and because of society's emphasis on the importance of overall appearance and attractiveness in societal judgments [21,27], the developers of the SPAS constructed the Social Appearance Anxiety Scale (SAAS) to assess perceived anxiety (e.g., nervous, tension) in situations where one's overall appearance (including, but not limited to, body weight, shape or specific body proportions) may be negatively evaluated by others, in both adolescent and adults [24]. The SAAS items [24] were rationally derived from current social anxiety measures and core diagnostic features of both SAD and EDs as presented in DSM-IV [28], making it particularly relevant for a clinical setting [29].…”

“…Finally, prior studies have examined the differences in SAAS observed scores between EDs and healthy controls [29,30] without establishing and testing the measurement equivalence/invariance (ME/I) of the SAAS. This approach is problematic [41] because if one does not verify that the items of an instrument hold the same meaning and the underlying constructs are perceived similarly in all populations of interest prior to making comparisons across groups, one can never be sure that the reported differences are indicative of true group differences [45].…”

Behavioral and neurodevelopmental precursors to binge-type eating disorders: support for the role of negative valence systems

“…Neural mechanisms underlying the known association between social-appearance anxiety, a potential NVS construct, and BN symptoms (Koskina et al 2011, Levinson et al 2013) are examined when women imagine that someone is comparing their own bodies to other women’s (Spangler and Allen 2012). Women with BN demonstrate greater activity in the rostral-ventral anterior cingulate cortex than healthy controls upon exposure to obese (vs. thin) bodies (Spangler and Allen 2012).…”