Social Difficulties As Risk and Maintaining Factors in Anorexia Nervosa: A Mixed-Method Investigation

Abstract

Anorexia nervosa (AN) is a serious psychiatric disorder characterized by severe restriction of energy intake and dangerously low body weight. Other domains of functioning are affected, including social functioning. Although difficulties within this domain have started to be acknowledged by the literature, some important gaps remain to be filled. Do social difficulties predate the onset of the illness? What difficulties in particular are relevant for the development and maintenance of the illness? The aim of this study is to combine the use of quantitative and qualitative methods to answer these questions. Ninety participants with lifetime AN (88 women and 2 men) completed an online survey assessing memories of involuntary submissiveness within the family, fear of negative evaluation from others, perceived lack of social competence, feelings of social belonging, eating disorder symptoms, and work and social adjustment. Participants also answered three open questions regarding their experience of social relationships before and after the illness onset. The findings provided support for the hypothesized relationships between the study variables. Involuntary submissiveness and fear of negative evaluation predicted eating disorder symptoms and these associations were partially mediated by perceived lack of social competence. Two-thirds of the sample recalled early social difficulties before illness onset and recognized that these had played a role in the development of the illness. A larger proportion of participants stated that the eating disorder had affected their social relationships in a negative way. This study sheds some light on patients’ perspective on the predisposing and maintaining role that social difficulties play in AN and identifies key psychological variables that could be targeted in treatment.

Re‐conceptualization of anorexia nervosa psychopathology: A network analysis study in adolescents with short duration of the illness

“…Adolescence is the period when psychopathology commonly emerges (Paus, Keshavan, & Giedd, ), thus making childhood/adolescence ideal to study direct associations between EDs and general psychiatric symptoms. According to the AN staging model (Treasure, Stein, & Maguire, ), this appears to be particularly important in AN given that interpersonal difficulties and comorbid psychiatric symptoms gradually worsen as the illness progresses (Cardi et al, ; Cardi, Tchanturia, & Treasure, ; Hudson, Hiripi, Pope Jr, & Kessler, ). Hence, an assessment of the relationships between general psychopathology and ED symptoms in adolescence may clarify whether general psychopathological symptoms are as central in young people with a short illness duration as in adults (Solmi et al, , ).…”

Emotion Recognition Abilities in Adults with Anorexia Nervosa are Associated with Autistic Traits

“…Difficulties in social functioning have been identified as key factors in the development and maintenance of AN [2]. For example, before illness onset, individuals with AN report more social difficulties, fewer childhood friends, and engage in more solitary activities than healthy controls (HCs) [3][4][5][6]. During the illness, a variety of difficulties are seen, including high social anxiety, poorer social skills and social problem-solving abilities, loss of interest in social activities, and reduced social networks [7][8][9][10][11][12][13][14].…”

Training Rejection Interpretation in Eating disordeRs (TRIER): Preliminary Findings of a Feasibility Study in Adolescents with Anorexia Nervosa

“…50% of females and 25% of males reporting dieting in the previous year; Neumark-Sztainer et al 2011). Adverse interpersonal experiences predate the onset of the anorexia nervosa at least in a subgroup of individuals (Cardi et al 2018a). Negative social experiences include episodes of bullying, criticism from others (especially in relation to weight and shape), exposure to the sudden death of a close relative and poor care and communication in the family, amongst others (Cardi et al 2018b).…”