Social appearance anxiety, perfectionism, and fear of negative evaluation. Distinct or shared risk factors for social anxiety and eating disorders?

Abstract

Social anxiety and eating disorders are highly comorbid. Social appearance anxiety (i.e., fear of negative evaluation of one's appearance), general fear of negative evaluation, and perfectionism have each been proposed as risk factors for both social anxiety disorder and the eating disorders. However, no research to date has examined all three factors simultaneously. Using structural equation modeling in two diverse samples (N = 236; N = 136) we tested a model in which each of these risk factors were uniquely associated with social anxiety and eating disorder symptoms. We found support for social appearance anxiety as a shared risk factor between social anxiety and eating disorder symptoms, whereas fear of negative evaluation was a risk factor only for social anxiety symptoms. Despite significant zero-order relationships, two facets of perfectionism (high standards and maladaptive perfectionism) did not emerge as a risk factor for either disorder when all constructs were considered. These results were maintained when gender, body mass index, trait negative affect, and depression were included in the model. It is possible that treating negative appearance evaluation fears may reduce both eating disorder and social anxiety symptoms.

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

“…These results are in accordance with current conceptualizations of EDs [23] and vulnerability models for both EDs and SAD [9]. Stress from negative social evaluation regarding one's appearance may actually play a pivotal role as a cause of EDs such that social appearance anxiety (SAA) may explain the high occurrence of EDs and SAD [9,23].…”

“…In line with the last explanation, recent experimental manipulations of social appearance anxiety (i.e., the fear that one will be negatively evaluated because of one's appearance [21]) revealed its unique effects on social anxiety, negative body image, and (over-and under-controlled) food intake [22]. These results are in accordance with current conceptualizations of EDs [23] and vulnerability models for both EDs and SAD [9]. Stress from negative social evaluation regarding one's appearance may actually play a pivotal role as a cause of EDs such that social appearance anxiety (SAA) may explain the high occurrence of EDs and SAD [9,23].…”

“…Following Allison's [66] guideline, regressions performed in SAS 9.3 [67] were stratified by ED diagnosis, and controlled for depression, gender, BMI, and age [7,9,21]. Variables entered simultaneously 9 into logistic regression models were standardized by the use of Proc Standard to make interpretations of odds ratios for independent variables more comparable; odds ratios whose confidence limits exclude 1 are statistically significant [66]. To further assess the impact of variables, effect sizes (Cohen's d; see Study 1) were calculated [66].…”

“…Additionally, despite the fact that the sample comprised only women, the association between the SAAS, depression (known to be associated with both SAD and EDs [7]), and other types of social fear (i.e., fear of scrutiny, of negative evaluation, and of social interactions, which represent well-known situational domains of social anxiety [24] and often occur concurrently [6,21,24]) were not examined so far. Furthermore, information about the co-occurrence with SAD was not obtained, which might be important for evaluating and understanding whether SAA distinguish ED patients with and without comorbid SAD [9].…”

“…A great deal of research [6][7][8][9][10][11][12][13][14] documented associations between negative body image (i.e., dissatisfaction, concern, and distress related to one's appearance [14,15]), abnormal eating behaviours, social anxiety symptoms, or fear that one's social self will be judged negatively (recognised as a cognitive vulnerability for, or core feature of, social anxiety [6,16]) in female and male samples with or at risk for EDs. There is also compelling evidence that: (a) Social Anxiety Disorder (SAD) has the highest occurrence of all anxiety disorders in EDs, and is significantly more common in ED patients than in controls [8,[17][18][19]; (b) individuals with SAD are more likely to report abnormal eating behaviours than controls, and 20 % of them meet criteria for an ED [17,20]; (c) 20-42 % of individuals with an ED also meet current criteria for SAD diagnosis [18,20]; and (d) the life time prevalence of SAD is significantly more common in ED patients (i.e., 23-71.5 %) than in the general population (12.1 %) [12,17,18].…”