Shared Vulnerabilities for Social Anxiety, Binge Eating, and Obesity Irina Vanzhula, B.A. & Cheri Levinson, Ph.D. University of Louisville, Department of Psychological and Brain Sciences Introduction High comorbidity between social anxiety, binge eating, and obesity (Darlymple et al., 2015) Binge eating and social anxiety have shared vulnerabilities: Maladaptive perfectionism (MP) Social appearance anxiety (SAA) Fear of negative evaluation (FNE) (Levinson & Rodebaugh, 2016) Binge eating and obesity may have shared vulnerabilities: Negative affect (NA) Dietary restraint (Mason et al., 2016) Lack of research on vulnerabilities shared between BMI, social anxiety, and binge eating The current study tested MP, SAA, FNE, NA, and dietary restraint in a combined model of social anxiety, binge eating, and obesity (using BMI) Participants Three hundred undergraduate females Mean age = 18.71, SD = 1.05 Mean BMI = 21.76, SD = 3.08, Range: 16.04 – 34.43 European Americans 61%, Asian Americans 27%, African Americans 4%, Hispanic 3% Procedure Participants filled out self-report questionnaires at two time points Baseline (Time 1) Six months later (Time 2) BMI was calculated from height and weight measurements that were taken using a scale and a height chart in a laboratory BMI was used as proxy for obesity Measures Measure Examples Psychometric properties The Eating Disorder Inventory 2 (Garner, Olmstead, & Polivy, 1983) Binge eating subscale I have gone on eating binges where I have felt I could not stop Good internal consistency and discriminant validity The Eating Disorder Examination Questionnaire IV (Fairburn & Beglin, 1994) Dietary restraint subscale Have you been consciously trying to restrict the amount of food you eat to influence your shape or weight? Good reliability and validity (Cooper & Fairburn, 1993) The Social Appearance Anxiety Scale (Hart et al., 2008) I get nervous when talking to people because of the way I look Good internal consistency and high test-retest reliability The Brief Fear of Negative Evaluation Scale (Leary, 1983) When I am talking to someone, I worry about what they may be thinking about me Excellent psychometric properties The Frost Multidimensional Perfectionism Scale (Frost et al., 1990) MP = composite of parental criticism, parental expectations, doubts about actions, and concern over mistakes 1. If I fail partly, it is as bad as being a complete failure 2. Even when I do something very carefully, I often feel that it is not quite done right. Best factor structure has been found for 2 factors: high standards and maladaptive perfectionism The Positive and Negative Affect Scale (Clark & Tellegen, 1988) Negative affect subscale Indicate to what extent you generally feel distressed Good internal consistency, convergent, and discriminant validity The Social Interaction Anxiety Scale (SIAS) and The Social Phobia Scale (SPS; Mattick & Clarke, 1989) Calculated composite Social Anxiety by adding SPS and straight SIAS SIAS: I find myself worrying that I won't know what to say in social situations SPS: I worry others may think my behavior is odd SIAS has excellent reliability and good construct validity (Heimberg & Turk, 2002); SPS has good internal consistency and test–retest reliability Data Analyses We used cross-lagged path analyses to test five potential vulnerabilities (FNE, SAA, restraint, NA, and MP) as predictors of three outcomes: Social anxiety Binge eating BMI We tested two models: cross-sectional prospective 6-month Model fit was evaluated using Comparative fit index (CFI; Bentler, 1990) Tucker-Lewis incremental fit index (TLI; Tucker & Lewis, 1973) .95 and greater considered excellent Root mean square error of approximation (RMSEA; Steiger & Lind, 1980) Standardized root mean square residual (SRMR, Benter, 1990) .05 and less considered excellent Results Cross-sectional model (Fig. 1) All five predictors (FNE, SAA, restraint, NA, and MP) were significantly associated with social anxiety SAA, restraint, and NA, were significantly associated with binge eating Restraint and NA were significantly associated with BMI (all ps<.05) Prospective model (Fig. 2) MP predicted social anxiety (p=0.008) SAA predicted binge eating over time (p=0.003) There were no prospective predictors of BMI Discussion Cross-sectional model Restraint and NA were associated with all three outcomes May help maintain but not predict social anxiety, binge eating, and BMI over time Prospective model We replicated previous findings: MP predicted later social anxiety, but not binge eating SAA, but not NA or restraint, was a predictor of binge eating (Brosof & Levinson, 2016; Levinson & Rodebaugh, 2016) We found no evidence of shared prospective vulnerabilities across social anxiety, binge eating, and BMI No vulnerability predicted BMI across time More research is needed to identify what vulnerabilities are shared between BMI, social anxiety, and binge eating across time It is possible that traits not assessed here may be shared across disorders such as: Self-esteem Weight stigma Implications Understanding mechanisms of overlap may improve prevention and treatment efforts Focus interventions on shared vulnerabilities and thereby treat multiple problems simultaneously Figure 1. Cross-Sectional Model of Shared Vulnerabilities of Binge Eating, Social Anxiety, and Obesity Figure 2. Prospective 6-month Model of Shared Vulnerabilities of Binge Eating, Social Anxiety, and Obesity Social Appearance Anxiety Restraint Negative Affect Maladaptive Perfectionism Binge Eating Social Anxiety BMI .16** .21** Fear of Negative Evaluation Time 2 Time 1 Fear of Negative Evaluation Social Appearance Anxiety Restraint Negative Affect Maladaptive Perfectionism Binge Eating Social Anxiety BMI Note: * p < .05; ** p < .001. Only significant paths are shown. .20** -.15** .15* .32** -.11* .19** .23** .17** CFI=1.00, TLI=1.00 RMSEA<0.001, SRMR=.01 CFI=1.00, TLI=1.00 RMSEA<0.001, SRMR=.03 Note: * p < .05; ** p < .001. Only significant paths are shown.