1. 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: – 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 < 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 < Only significant paths are shown.