Hostname: page-component-78c5997874-fbnjt Total loading time: 0 Render date: 2024-11-10T05:18:35.767Z Has data issue: false hasContentIssue false
  • English
  • Français

Social anxiety in the eating disorders: a systematic review and meta-analysis

Published online by Cambridge University Press:  10 April 2018

Jess Kerr-Gaffney Open the ORCID record for Jess Kerr-Gaffney [Opens in a new window] ,
Amy Harrison  and
Kate Tchanturia
Jess Kerr-Gaffney*
Affiliation:
King's College London, Institute of Psychiatry, Psychology and Neuroscience, Psychological Medicine, London, UK
Amy Harrison
Affiliation:
Department of Psychology and Human Development, University College London, London, UK
Kate Tchanturia
Affiliation:
King's College London, Institute of Psychiatry, Psychology and Neuroscience, Psychological Medicine, London, UK South London and Maudsley NHS Trust, National Eating Disorders Service, Psychological Medicine Clinical Academic Group, London, UK Ilia State University, Tbilisi, Georgia
*
Author for correspondence: Jess Kerr-Gaffney, E-mail: jess.kerr-gaffney@kcl.ac.uk
Get access Rights & Permissions [Opens in a new window]

Abstract

Social anxiety disorder is one of the most common comorbid conditions in eating disorders (EDs). The aim of the current review and meta-analysis is to provide a qualitative summary of what is known about social anxiety (SA) in EDs, as well as to compare levels of SA in those with EDs and healthy controls. Electronic databases were systematically searched for studies using self-report measures of SA in ED populations. In total, 38 studies were identified, 12 of which were included in the meta-analyses. For both anorexia nervosa (AN) and bulimia nervosa, there were significant differences between ED groups and HCs, with medium to large effect sizes. Findings from the qualitative review indicate that levels of SA are similar across the ED diagnoses, and SA improves with treatment in AN. In addition, high levels of SA are associated with more severe ED psychopathology, but not body mass index. These findings add to the wider literature on socio-emotional functioning in EDs, and may have implications for treatment strategies.

Keywords

Anorexia nervosabulimia nervosaeating disorderssocial anxiety disorder
Type
Review Article
Information
Psychological Medicine , Volume 48 , Issue 15 , November 2018 , pp. 2477 - 2491
Copyright
Copyright © Cambridge University Press 2018 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Abbate-Daga, G et al. (2015) Day hospital treatment for anorexia nervosa: a 12-month follow-up study. European Eating Disorders Review 23, 390–398.Google Scholar
Adambegan, M et al. (2012) Internalizing and externalizing behaviour problems in childhood contribute to the development of anorexia and bulimia nervosa – A study comparing sister pairs. European Eating Disorders Review 20, 116–120.Google Scholar
Allen, HN and Craighead, LW (1999) Appetite monitoring in the treatment of binge eating disorder. Behavior Therapy 30, 253–272.Google Scholar
Allen, KL et al. (2013) DSM–IV–TR and DSM-5 eating disorders in adolescents: prevalence, stability, and psychosocial correlates in a population-based sample of male and female adolescents. Journal of Abnormal Psychology 122, 720–732.Google Scholar
Antony, MM et al. (1998) Dimensions of perfectionism across the anxiety disorders. Behaviour Research and Therapy 36, 1143–1154.Google Scholar
Begg, CB and Mazumdar, M (1994) Operating characteristics of a rank correlation test for publication bias. Biometrics 50, 1088–1101.Google Scholar
Berkman, ND, Lohr, KN and Bulik, CM (2007) Outcomes of eating disorders: a systematic review of the literature. International Journal of Eating Disorders 40, 293–309.Google Scholar
Blinder, BJ, Cumella, EJ and Sanathara, VA (2006) Psychiatric comorbidities of female inpatients with eating disorders. Psychosomatic Medicine 68, 454–462.Google Scholar
Bora, E and Kose, S (2016) Meta-analysis of theory of mind in anorexia nervosa and bulimia nervosa: a specific impairment of cognitive perspective taking in anorexia nervosa? International Journal of Eating Disorders 49, 739–740.Google Scholar
Buchholz, A et al. (2007) Self-silencing in a clinical sample of female adolescents with eating disorders. Journal of the Canadian Academy of Child and Adolescent Psychiatry 16, 158–163.Google Scholar
Buckner, JD, Silgado, J and Lewinsohn, PM (2010) Delineation of differential temporal relations between specific eating and anxiety disorders. Journal of Psychiatric Research 44, 781–787.Google Scholar
Bulik, CM et al. (1991) An analysis of social anxiety in anorexic, bulimic, social phobic, and control women. Journal of Psychopathology and Behavioral Assessment 13, 199–211.Google Scholar
Bulik, CM et al. (1997) Eating disorders and antecedent anxiety disorders: a controlled study. Acta Psychiatrica Scandinavica 96, 101–107.Google Scholar
Caglar-Nazali, HP et al. (2014) A systematic review and meta-analysis of ‘systems for social processes’ in eating disorders. Neuroscience and Biobehavioral Reviews 42, 55–92.Google Scholar
Cederlof, M et al. (2015) Etiological overlap between obsessive-compulsive disorder and anorexia nervosa: a longitudinal cohort, multigenerational family and twin study. World Psychiatry 14, 333–338.Google Scholar
Ciarma, JL and Mathew, JM (2017) Social anxiety and disordered eating: the influence of stress reactivity and self-esteem. Eating Behaviors 26, 177–181.Google Scholar
Cohen, J (1988) Statistical Power Analysis for the Behavioral Sciences, 2nd edn., London: Laurence Erlbaum Associates.Google Scholar
Courty, A et al. (2015) Alexithymia, a compounding factor for eating and social avoidance symptoms in anorexia nervosa. Comprehensive Psychiatry 56, 217–228.Google Scholar
Dakanalis, A et al. (2016) The social appearance anxiety scale in Italian adolescent populations: construct validation and group discrimination in community and clinical eating disorders samples. Child Psychiatry and Human Development 47, 133–150.Google Scholar
Davies, H et al. (2016) Facial expression to emotional stimuli in non-psychotic disorders: a systematic review and meta-analysis. Neuroscience and Biobehavioral Reviews 64, 252–271.Google Scholar
Dias, P et al. (2011) Autonomic correlates of attachment insecurity in a sample of women with eating disorders. Attachment & Human Development 13, 155–167.Google Scholar
Duclos, J et al. (2014) Expressed emotion in anorexia nervosa: what is inside the “black box”? Comprehensive Psychiatry 55, 71–79.Google Scholar
Fairburn, CG et al. (1999) Risk factors for anorexia nervosa: three integrated case-control comparisons. Archives of General Psychiatry 56, 468–476.Google Scholar
Fairweather-Schmidt, AK and Wade, TD (2014) DSM-5 eating disorders and other specified eating and feeding disorders: is there a meaningful differentiation? International Journal of Eating Disorders 47, 524–533.Google Scholar
Flament, MF et al. (2001) Predictive factors of social disability in patients with eating disorders. Eating and Weight Disorders 6, 99–106.Google Scholar
Gadalla, T and Piran, N (2008) Psychiatric comorbidity in women with disordered eating behavior: a national study. Women & Health 48, 467–484.Google Scholar
Gander, M, Seveck, K and Buchheim, A (2015) Eating disorders in adolescence: attachment issues from a developmental perspective. Frontiers in Psychology 6, 1136.Google Scholar
Gilbert, N and Meyer, C (2003) Social anxiety and social comparison: differential links with restrictive and bulimic attitudes among nonclinical women. Eating Behaviors 4, 257–264.Google Scholar
Gilboa-Schechtman, E et al. (2006) Emotional processing in eating disorders: specific impairment or general distress related deficiency? Depression and Anxiety 23, 331–339.Google Scholar
Godart, NT et al. (2000) Anxiety disorders in anorexia nervosa and bulimia nervosa: co-morbidity and chronology of appearance. European Psychiatry 15, 38–45.Google Scholar
Goddard, E and Treasure, J (2013) Anxiety and social-emotional processing in eating disorders: examination of family trios. Cognitive Therapy and Research 37, 890–904.Google Scholar
Grabhorn, M et al. (2006) Social anxiety in anorexia and bulimia nervosa: the mediating role of shame. Clinical Psychology and Psychotherapy 13, 12–19.Google Scholar
Gross, J and Rosen, JC (1988) Bulimia in adolescents: prevalence and psychosocial correlates. International Journal of Eating Disorders 7, 51–61.Google Scholar
Harrison, A, Mountford, VA and Tchanturia, K (2014) Social anhedonia and work and social functioning in the acute and recovered phases of eating disorders. Psychiatry Research 218, 187–194.Google Scholar
Hinrichsen, H, Sheffield, A and Waller, G (2007 a) The role of parenting experiences in the development of social anxiety and agoraphobia in the eating disorders. Eating Behaviours 8, 285–290.Google Scholar
Hinrichsen, H, Waller, G and Dhokia, R (2007 b) Core beliefs and social anxiety in the eating disorders. Eating and Weight Disorders 12, e14–e18.Google Scholar
Hinrichsen, H, Waller, G and Emanuelli, F (2004 a) Social anxiety and agoraphobia in the eating disorders: associations with core beliefs. The Journal of Nervous and Mental Disease 192, 784–787.Google Scholar
Hinrichsen, H, Waller, G and van Gerko, K (2004 b) Social anxiety and agoraphobia in the eating disorders: associations with eating attitudes and behaviours. Eating Behaviours 5, 285–290.Google Scholar
Hinrichsen, H et al. (2003) Social anxiety and coping strategies in the eating disorders. Eating Behaviors 4, 117–126.Google Scholar
Jiménez-Murcia, S et al. (2015) Differences and similarities between bulimia nervosa, compulsive buying and gambling disorder. European Eating Disorders Review 23, 126–132.Google Scholar
Kaye, WH et al. (2004) Comorbidity of anxiety disorders with anorexia and bulimia nervosa. American Journal of Psychiatry 161, 2215–2221.Google Scholar
Kessler, RC et al. (2005) Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the national comorbidity survey replication. Archives of General Psychiatry 62, 593–602.Google Scholar
Krug, I et al. (2013) Low social interactions in eating disorder patients in childhood and adulthood: a multi-centre European case control study. Journal of Health Psychology 18, 26–37.Google Scholar
Kuusikko, S et al. (2008) Social anxiety in high-functioning children and adolescents with autism and Asperger syndrome. Journal of Autism and Developmental Disorders 38, 1697–1709.Google Scholar
Lázaro, L et al. (2011) Effectiveness of self-esteem and social skills group therapy in adolescent eating disorder patients attending a day hospital treatment programme. European Eating Disorders Review 19, 398–406.Google Scholar
Levinson, CA and Rodebaugh, TL (2016) Clarifying the prospective relationships between social anxiety and eating disorder symptoms and underlying vulnerabilities. Appetite 107, 38–46.Google Scholar
Liberati, A et al. (2009) The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. PLoS Medicine 6, e1000100.Google Scholar
Liebowitz, MR (1987) Social phobia. Modern Problems of Pharmacopsychiatry 22, 141–173.Google Scholar
Lloyd, S et al. (2014) Perfectionism in anorexia nervosa: novel performance based evidence. PLoS ONE 9, e111697.Google Scholar
MacDonald, DE, McFarlane, TL and Olmsted, MP (2014) “Diagnostic shift” from eating disorder not otherwise specified to bulimia nervosa using DSM-5 criteria: a clinical comparison with DSM-IV bulimia. Eating Behaviors 15, 60–62.Google Scholar
Mattar, L, Huas, C and Godart, N (2012 a) Relationship between affective symptoms and malnutrition severity in severe anorexia nervosa. PLoS ONE 7, e49380.Google Scholar
Mattar, L et al. (2012 b) Depression, anxiety and obsessive-compulsive symptoms in relation to nutritional status and outcome in severe anorexia nervosa. Psychiatry Research 200, 513–517.Google Scholar
McFarlane, T et al. (2015) The effectiveness of an individualized form of day hospital treatment. Eating Disorders 23, 191–205.Google Scholar
Melfsen, S, Walitza, S and Warnke, A (2006) The extent of social anxiety in combination with mental disorders. European Child and Adolescent Psychiatry 15, 111–117.Google Scholar
Obeid, N et al. (2013) Self-esteem and social anxiety in an adolescent female eating disorder population: age and diagnostic effects. Eating Disorders 21, 140–153.Google Scholar
Ohmann, S et al. (2013) Emotional aspects of anorexia nervosa: results of prospective naturalistic cognitive behavioral group therapy. Neuropsychiatrie 27, 119–128.Google Scholar
Ostrovsky, NW et al. (2013) Social anxiety and disordered overeating: an association among overweight and obese individuals. Eating Behaviors 14, 145–148.Google Scholar
Pollatos, O et al. (2008) Reduced perception of bodily signals in anorexia nervosa. Eating Behaviours 9, 381–388.Google Scholar
Ranta, K et al. (2017) Social phobia, depression and eating disorders during middle adolescence: longitudinal associations and treatment seeking. Nordic Journal of Psychiatry 71, 605–613.Google Scholar
Rosenthal, R (1979) The “file drawer problem” and tolerance for null results. Psychological Bulletin 86, 638–641.Google Scholar
Core Team (2017) R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria. Available at https://www.R-project.org/Google Scholar
Russell, J et al. (2018) Intranasal oxytocin in the treatment of anorexia nervosa: randomized controlled trial during re-feeding. Psychoneuroendocrinology 87, 83–92.Google Scholar
Sawaoka, T et al. (2012) Social anxiety and self-consciousness in binge eating disorder: associations with eating disorder psychopathology. Comprehensive Psychiatry 53, 740–745.Google Scholar
Schmelkin, C et al. (2017) Low oxytocin levels are related to alexithymia in anorexia nervosa. International Journal of Eating Disorders 50, 1332–1338.Google Scholar
Schneier, FR et al. (2016) Attention bias in adults with anorexia nervosa, obsessive-compulsive disorder, and social anxiety disorder. Journal of Psychiatric Research 79, 61–69.Google Scholar
Schulze, UME et al. (2009) Trait anxiety in children and adolescents with anorexia nervosa. Eating and Weight Disorders 14, e163–e168.Google Scholar
Schwalberg, MD et al. (1992) Comparison of bulimics, obese binge eaters, social phobics, and individuals with panic disorder on comorbidity across DSM-III—R anxiety disorders. Journal of Abnormal Psychology 101, 675–681.Google Scholar
Silgado, J et al. (2010) Social anxiety and bulimic behaviors: the moderating role of perfectionism. Cognitive Therapy and Research 34, 487–492.Google Scholar
Slade, P (1982) Towards a functional analysis of anorexia nervosa and bulimia nervosa. British Journal of Clinical Psychology 21, 167–179.Google Scholar
Solano, R et al. (2005) Self-injurious behaviour in people with eating disorders. European Eating Disorders Review 10, 3–10.Google Scholar
Steinglass, JE et al. (2017) Temporal discounting across three psychiatric disorders: Anorexia nervosa, obsessive compulsive disorder, and social anxiety disorder. Depression and Anxiety 34, 463–470.Google Scholar
Steinman, SA et al. (2016) Prepulse inhibition deficits only in females with obsessive-compulsive disorder. Depression and Anxiety 33, 238–246.Google Scholar
Striegel-Moore, RH, Silberstein, LR and Rodin, J (1993) The social self in bulimia nervosa: public self-consciousness, social anxiety, and perceived fraudulence. Journal of Abnormal Psychology 102, 297–303.Google Scholar
Strober, M et al. (2007) The association of anxiety disorders and obsessive compulsive personality disorder with anorexia nervosa: evidence from a family study with discussion of nosological and neurodevelopmental implications. International Journal of Eating Disorders 41, 174–179.Google Scholar
Swinbourne, J et al. (2012) The comorbidity between eating disorders and anxiety disorders: prevalence in an eating disorder sample and anxiety disorder sample. Australian & New Zealand Journal of Psychiatry 46, 118–131.Google Scholar
Swinbourne, J and Touyz, S (2007) The co-morbidity of eating disorders and anxiety disorders: a review. European Eating Disorders Review 15, 215–221.Google Scholar
Tchanturia, K et al. (2015) Cognitive remediation and emotion skills training (CREST) for anorexia nervosa in individual format: self-reported outcomes. BMC Psychiatry 15, 53.Google Scholar
Treasure, J and Schmidt, U (2013) The cognitive-interpersonal maintenance model of anorexia nervosa revisited: a summary of the evidence for cognitive, socio-emotional and interpersonal predisposing and perpetuating factors. Journal of Eating Disorders 1, 13.Google Scholar
Utschig, AC et al. (2010) An investigation of the relationship between fear of negative evaluation and bulimic psychopathology. Eating Behaviors 11, 231–238.Google Scholar
Vall, E and Wade, TD (2015) Predictors of treatment outcome in individuals with eating disorders: a systematic review and meta-analysis. International Journal of Eating Disorders 48, 946–971.Google Scholar
Viechtbauer, W (2010) Conducting meta-analyses in R with the metafor package. Journal of Statistical Software 36, 3.Google Scholar
Westwood, H et al. (2017 a) Alexithymia in eating disorders: systematic review and meta-analyses of studies using the Toronto alexithymia scale. Journal of Psychosomatic Research 99, 66–81.Google Scholar
Westwood, H et al. (2016) Exploration of friendship experiences, before and after illness onset in females with anorexia nervosa: a qualitative study. PLoS ONE 11, e0163528.Google Scholar
Westwood, H, Mandy, W and Tchanturia, K (2017 b) Clinical evaluation of autistic symptoms in women with anorexia nervosa. Molecular Autism 8, 12.Google Scholar
Wildes, JE, Ringham, RM and Marcus, MD (2010) Emotion avoidance in patients with anorexia nervosa: initial test of a functional model. International Journal of Eating Disorders 43, 398–404.Google Scholar
Zonnevylle-Bender, MJS et al. (2005) Adolescent anorexia nervosa patients have a discrepancy between neurophysiological responses and self-reported emotional arousal to psychosocial stress. Psychiatry Research 135, 45–52.Google Scholar
Zonnevylle-Bender, MJS et al. (2004) Emotional functioning in anorexia nervosa patients: adolescents compared to adults. Depression and Anxiety 19, 35–42.Google Scholar