Current Psychiatry Reports

, 20:71 | Cite as

Threats to Belonging, Immune Function, and Eating Behavior: an Examination of Sex and Gender Differences

  • Lisa M. Jaremka
  • Olga Lebed
  • Naoyuki Sunami
Sex and Gender Issues in Behavioral Health (CN Epperson and L Hantsoo, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Sex and Gender Issues in Behavioral Health


Purpose of Review

The first goal of this review is to discuss the evidence linking belonging threats to immune function and food intake. The second goal is to evaluate whether the links among belonging threats, immune function, and eating behavior differ based on gender.

Recent Findings

Threats to belonging are linked to elevated herpesvirus antibody titers, dysregulated appetite-relevant hormones, and increased food consumption. Furthermore, these relationships are largely consistent for both men and women. Threats to belonging are also linked to elevated inflammation. However, some studies showed that these effects were stronger among women, others demonstrated that they were stronger among men, and others determined that the links were consistent for men and women.


Understanding why belonging threats are inconsistently linked to inflammation across men and women is an important next step. We conclude the review with four concrete recommendations for researchers studying belonging threats, immune function, and eating behavior.


Need to belong Loneliness Close relationships Immune function Eating Ghrelin 


Compliance With Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: •• Of major importance

  1. 1.
    •• Baumeister RF, Leary MR. The need to belong: desire for interpersonal attachments as a fundamental human motivation. Psychol Bull. 1995;117:497–529. This paper provides a conceptual framework for understanding the need to belong, and the importance of this need for mental and physical health. CrossRefPubMedGoogle Scholar
  2. 2.
    Bowlby J. Attachment and loss. New York, NY: Basic Books; 1969.Google Scholar
  3. 3.
    Maslow AH (1968) Toward a psychology of being. 2nd ed. D. Van Nostrand, Oxford England.Google Scholar
  4. 4.
    Tooby J, Cosmides L (1996) Friendship and the banker’s paradox: other pathways to the evolution of adaptations for altruism. In: Runciman WG (Ed), Smith JM, Dunbar RIM (eds) Evol. Soc. Behav. Patterns Primates Man. Oxford University Press, New York, NY, pp 119–143.Google Scholar
  5. 5.
    •• Robles TF, Slatcher RB, Trombello JM, McGinn MM. Marital quality and health: a meta-analytic review. Psychol Bull. 2014;140:140–87. This is the most recent meta-analysis summarizing links between marital quality and health, and it provides a comprehensive and up-to-date review of the literature. This meta-analysis concluded there were no gender differences in the health outcomes they examined. CrossRefPubMedGoogle Scholar
  6. 6.
    Uchino BN. Understanding the links between social support and physical health: a life-span perspective with emphasis on the separability of perceived and received support. Perspect Psychol Sci. 2009;4:236–55.CrossRefPubMedGoogle Scholar
  7. 7.
    Cacioppo JT, Hawkley LC, Crawford LE, Ernst JM, Burleson MH, Kowalewski RB, et al. Loneliness and health: potential mechanisms. Psychosom Med. 2002;64:407–17.CrossRefPubMedGoogle Scholar
  8. 8.
    Whisman MA. Loneliness and the metabolic syndrome in a population-based sample of middle-aged and older adults. Health Psychol. 2010;29:550–4.CrossRefPubMedGoogle Scholar
  9. 9.
    Whisman MA, Uebelacker LA, Settles TD. Marital distress and the metabolic syndrome: linking social functioning with physical health. J Fam Psychol. 2010;24:367–70.CrossRefPubMedGoogle Scholar
  10. 10.
    Holt-Lunstad J, Smith TB, Layton JB. Social relationships and mortality risk: a meta-analytic review. PLoS Med. 2010;7:e1000316. Scholar
  11. 11.
    Hansson GK. Inflammation, atherosclerosis, and coronary artery disease. N Engl J Med. 2005;352:1685–95.CrossRefPubMedGoogle Scholar
  12. 12.
    Harris TB, Ferrucci L, Tracy RP, Corti MC, Wacholder S, Ettinger WH Jr, et al. Associations of elevated interleukin-6 and C-reactive protein levels with mortality in the elderly. Am J Med. 1999;106:506–12.CrossRefPubMedGoogle Scholar
  13. 13.
    Hotamisligil GS. Inflammation and metabolic disorders. Nature. 2006;444:860–7.CrossRefPubMedGoogle Scholar
  14. 14.
    Geleijnse JM, Kok FJ, Grobbee DE. Blood pressure response to changes in sodium and potassium intake: a metaregression analysis of randomised trials. J Hum Hypertens. 2003;17:471–80.CrossRefPubMedGoogle Scholar
  15. 15.
    He FJ, MacGregor GA. Effect of modest salt reduction on blood pressure: a meta-analysis of randomized trials. Implications for public health. J Hum Hypertens. 2002;16:761–70.CrossRefPubMedGoogle Scholar
  16. 16.
    He FJ, Li J, Macgregor GA. Effect of longer term modest salt reduction on blood pressure: Cochrane systematic review and meta-analysis of randomised trials. Br Med J. 2013;346:f1325.CrossRefGoogle Scholar
  17. 17.
    Mensink RP, Zock PL, Kester AD, Katan MB. Effects of dietary fatty acids and carbohydrates on the ratio of serum total to HDL cholesterol and on serum lipids and apolipoproteins: a meta-analysis of 60 controlled trials. Am J Clin Nutr. 2003;77:1146–55.CrossRefPubMedGoogle Scholar
  18. 18.
    Morenga LAT, Howatson AJ, Jones RM, Mann J. Dietary sugars and cardiometabolic risk: systematic review and meta-analyses of randomized controlled trials of the effects on blood pressure and lipids. Am J Clin Nutr. 2014;100:65–79.CrossRefGoogle Scholar
  19. 19.
    Mozaffarian D, Katan MB, Ascherio A, Stampfer MJ, Willett WC. Trans fatty acids and cardiovascular disease. N Engl J Med. 2006;354:1601–13.CrossRefPubMedGoogle Scholar
  20. 20.
    Maslow AH. A theory of human motivation. Psychol Rev. 1943;50:370–96.CrossRefGoogle Scholar
  21. 21.
    Cross SE, Madson L. Models of the self: self-construals and gender. Psychol Bull. 1997;122:5–37.CrossRefPubMedGoogle Scholar
  22. 22.
    •• Kiecolt-Glaser JK, Newton TL. Marriage and health: his and hers. Psychol Bull. 2001;127:472–503. This is an older meta-analysis summarizing links between marital quality and health. This meta-analysis concluded there were gender differences in the health outcomes they examined. CrossRefPubMedGoogle Scholar
  23. 23.
    Crissman HP, Berger MB, Graham LF, Dalton VK. Transgender demographics: a household probability sample of US adults, 2014. Am J Public Health. 2017;107:213–5.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Ershler WB, Keller ET. Age-associated increased interleukin-6 gene expression, late-life diseases, and frailty. Annu Rev Med. 2000;51:245–70.CrossRefPubMedGoogle Scholar
  25. 25.
    Nabipour I, Vahdat K, Jafari SM, Pazoki R, Sanjdideh Z. The association of metabolic syndrome and Chlamydia pneumoniae, Helicobacter pylori, cytomegalovirus, and herpes simplex virus type 1: the Persian Gulf Healthy Heart Study. Cardiovasc Diabetol. 2006;5:25. Scholar
  26. 26.
    Parkin DM. The global health burden of infection-associated cancers in the year 2002. Int J Cancer. 2006;118:3030–44.CrossRefPubMedGoogle Scholar
  27. 27.
    Glaser R, Jones J. Human herpesvirus infections. New York, NY: Dekker; 1994.Google Scholar
  28. 28.
    Kiecolt-Glaser JK, Fisher L, Ogrocki P, Stout J, Speicher C, Glaser R. Marital quality, marital disruption, and immune function. Psychosom Med. 1987;49:13–34.CrossRefPubMedGoogle Scholar
  29. 29.
    Kiecolt-Glaser JK, Kennedy S, Malkoff S, Fisher L, Speicher CE, Glaser R. Marital discord and immunity in males. Psychosom Med. 1988;50:213–29.CrossRefPubMedGoogle Scholar
  30. 30.
    Glaser R, Kiecolt-Glaser JK, Speicher CE, Holliday JE. Stress, loneliness, and changes in herpesvirus latency. J Behav Med. 1985;8:249–60.CrossRefPubMedGoogle Scholar
  31. 31.
    Kiecolt-Glaser JK, Dura JR, Speicher CE, Trask OJ, Glaser R. Spousal caregivers of dementia victims: longitudinal changes in immunity and health. Psychosom Med. 1991;53:345–62.CrossRefPubMedGoogle Scholar
  32. 32.
    Dixon D, Cruess S, Kilbourn K, Klimas N, Fletcher MA, Ironson G, et al. Social support mediates loneliness and human herpesvirus type 6 (HHV-6) antibody titers. J Appl Soc Psychol. 2006;31:1111–32.CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Jaremka LM, Fagundes CP, Glaser R, Bennett JM, Malarkey WB, Kiecolt-Glaser JK. Loneliness predicts pain, depression, and fatigue: understanding the role of immune dysregulation. Psychoneuroendocrinology. 2013;38:1310–7.CrossRefPubMedGoogle Scholar
  34. 34.
    Sompayrac LM (2015) How the immune system works. John Wiley & Sons.Google Scholar
  35. 35.
    Cole SW, Hawkley LC, Arevalo JM, Sung CY, Rose RM, Cacioppo JT. Social regulation of gene expression in human leukocytes. Genome Biol. 2007;8:R189.CrossRefPubMedPubMedCentralGoogle Scholar
  36. 36.
    •• Kiecolt-Glaser JK, Loving TJ, Stowell JR, Malarkey WB, Lemeshow S, Dickinson SL, et al. Hostile marital interactions, proinflammatory cytokine production, and wound healing. Arch Gen Psychiatry. 2005;62:1377. This was a seminal paper examining the relationship between marital interactions and immune function. CrossRefPubMedGoogle Scholar
  37. 37.
    Jaremka LM, Fagundes CP, Peng J, Bennett JM, Glaser R, Malarkey WB, et al. Loneliness promotes inflammation during acute stress. Psychol Sci. 2013;24:1089–97.CrossRefPubMedGoogle Scholar
  38. 38.
    Brooks KP, Gruenewald T, Karlamangla A, Hu P, Koretz B, Seeman TE Social relationships and allostatic load in the MIDUS study. Health Psychol doi:, 2014.
  39. 39.
    Hasselmo K, Mehl MR, Tackman AM, Carey AL, Wertheimer AM, Stowe RP, Sbarra DA (2017) Objectively measured social integration is associated with an immune risk phenotype following marital separation. Ann Behav Med.Google Scholar
  40. 40.
    Marsland AL, Gianaros PJ, Prather AA, Jennings JR, Neumann SA, Manuck SB. Stimulated production of proinflammatory cytokines covaries inversely with heart rate variability. Psychosom Med. 2007;69:709–16.CrossRefPubMedGoogle Scholar
  41. 41.
    Steptoe A, Owen N, Kunz-Ebrecht SR, Brydon L. Loneliness and neuroendocrine, cardiovascular, and inflammatory stress responses in middle-aged men and women. Psychoneuroendocrinology. 2004;29:593–611.CrossRefPubMedGoogle Scholar
  42. 42.
    Whisman MA, Sbarra DA. Marital adjustment and interleukin-6 (IL-6). J Fam Psychol. 2012;26:290–5.CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Hackett RA, Hamer M, Endrighi R, Brydon L, Steptoe A. Loneliness and stress-related inflammatory and neuroendocrine responses in older men and women. Psychoneuroendocrinology. 2012;37:1801–9.CrossRefPubMedGoogle Scholar
  44. 44.
    Sbarra DA. Marriage protects men from clinically meaningful elevations in C-reactive protein: results from the National Social Life, Health, and Aging Project (NSHAP). Psychosom Med. 2009;71:828–35.CrossRefPubMedPubMedCentralGoogle Scholar
  45. 45.
    Friedman EM. Sleep quality, social well-being, gender, and inflammation: an integrative analysis in a national sample. Ann N Y Acad Sci. 2011;1231:23–34.CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    Hughes S, Jaremka LM, Alfano CM, Glaser R, Povoski SP, Lipari AM, et al. Social support predicts inflammation, pain, and depression: longitudinal relationships among breast cancer survivors. Psychoneuroendocrinology. 2014;42:38–44.CrossRefPubMedPubMedCentralGoogle Scholar
  47. 47.
    Engström G, Hedblad B, Rosvall M, Janzon L, Lindgärde F. Occupation, marital status, and low-grade inflammation: mutual confounding or independent cardiovascular risk factors? Arterioscler Thromb Vasc Biol. 2006;26:643–8.CrossRefPubMedGoogle Scholar
  48. 48.
    Costanzo ES, Lutgendorf SK, Sood AK, Anderson B, Sorosky J, Lubaroff DM. Psychosocial factors and interleukin-6 among women with advanced ovarian cancer. Cancer. 2005;104:305–13.CrossRefPubMedGoogle Scholar
  49. 49.
    Friedman EM, Hayney MS, Love GD, Urry HL, Rosenkranz MA, Davidson RJ, et al. Social relationships, sleep quality, and interleukin-6 in aging women. Proc Natl Acad Sci USA. 2005;102:18757–62.CrossRefPubMedGoogle Scholar
  50. 50.
    Shephard RJ. Cytokine responses to physical activity, with particular reference to IL-6: sources, actions, and clinical implications. Crit Rev Immunol. 2002;22:165–82.PubMedGoogle Scholar
  51. 51.
    Steptoe A (2012) Socioeconomic status, inflammation, and immune function. Oxf. Handb. Psychoneuroimmunology.Google Scholar
  52. 52.
    Lyon CJ, Law RE, Hsueh WA. Minireview: adiposity, inflammation, and atherogenesis. Endocrinology. 2003;144:2195–200.CrossRefPubMedGoogle Scholar
  53. 53.
    Law MR, Frost CD, Wald NJ. By how much does dietary salt reduction lower blood pressure? III-analysis of data from trials of salt reduction. BMJ. 1991;302:819–24.CrossRefPubMedPubMedCentralGoogle Scholar
  54. 54.
    Klok MD, Jakobsdottir S, Drent ML. The role of leptin and ghrelin in the regulation of food intake and body weight in humans: a review. Obes Rev. 2007;8:21–34.CrossRefPubMedGoogle Scholar
  55. 55.
    Cummings DE, Purnell JQ, Frayo RS, Schmidova K, Wisse BE, Weigle DS. A preprandial rise in plasma ghrelin levels suggests a role in meal initiation in humans. Diabetes. 2001;50:1714–9.CrossRefPubMedGoogle Scholar
  56. 56.
    Cummings DE, Frayo RS, Marmonier C, Aubert R, Chapelot D. Plasma ghrelin levels and hunger scores in humans initiating meals voluntarily without time- and food-related cues. Am J Physiol - Endocrinol Metab. 2004;287:E297–304.CrossRefPubMedGoogle Scholar
  57. 57.
    Wren AM, Seal LJ, Cohen MA, Brynes AE, Frost GS, Murphy KG, et al. Ghrelin enhances appetite and increases food intake in humans. J Clin Endocrinol Metab. 2001;86:5992.CrossRefPubMedGoogle Scholar
  58. 58.
    Licinio J, Caglayan S, Ozata M, Yildiz BO, de Miranda PB, O'Kirwan F, et al. Phenotypic effects of leptin replacement on morbid obesity, diabetes mellitus, hypogonadism, and behavior in leptin-deficient adults. Proc Natl Acad Sci U S A. 2004;101:4531–6.CrossRefPubMedPubMedCentralGoogle Scholar
  59. 59.
    Tomiyama AJ, Schamarek I, Lustig RH, Kirschbaum C, Puterman E, Havel PJ, et al. Leptin concentrations in response to acute stress predict subsequent intake of comfort foods. Physiol Behav. 2012;107:34–9.CrossRefPubMedPubMedCentralGoogle Scholar
  60. 60.
    Skibicka KP, Hansson C, Egecioglu E, Dickson SL. Role of ghrelin in food reward: impact of ghrelin on sucrose self-administration and mesolimbic dopamine and acetylcholine receptor gene expression. Addict Biol. 2012;17:95–107.CrossRefPubMedPubMedCentralGoogle Scholar
  61. 61.
    Buss J, Havel PJ, Epel E, Lin J, Blackburn E, Daubenmier J. Associations of ghrelin with eating behaviors, stress, metabolic factors, and telomere length among overweight and obese women: preliminary evidence of attenuated ghrelin effects in obesity? Appetite. 2014;76:84–94.CrossRefPubMedPubMedCentralGoogle Scholar
  62. 62.
    Torres SJ, Nowson CA. Relationship between stress, eating behavior, and obesity. Nutrition. 2007;23:887–94.CrossRefPubMedGoogle Scholar
  63. 63.
    Epel E, Jimenez S, Brownell K, Stroud L, Stoney C, Niaura R. Are stress eaters at risk for the metabolic syndrome? Ann N Y Acad Sci. 2004;1032:208–10.CrossRefPubMedGoogle Scholar
  64. 64.
    Greeno CG, Wing RR. Stress-induced eating. Psychol Bull. 1994;115:444–64.CrossRefPubMedGoogle Scholar
  65. 65.
    Wardle J, Steptoe A, Oliver G, Lipsey Z. Stress, dietary restraint and food intake. J Psychosom Res. 2000;48:195–202.CrossRefPubMedGoogle Scholar
  66. 66.
    Kandiah J, Yake M, Willett H. Effects of stress on eating practices among adults. Fam Consum Sci Res J. 2008;37:27–38.CrossRefGoogle Scholar
  67. 67.
    Mouchacca J, Abbott GR, Ball K. Associations between psychological stress, eating, physical activity, sedentary behaviours and body weight among women: a longitudinal study. BMC Public Health. 2013;13:828.CrossRefPubMedPubMedCentralGoogle Scholar
  68. 68.
    O’Connor DB, Jones F, Conner M, McMillan B, Ferguson E. Effects of daily hassles and eating style on eating behavior. Health Psychol. 2008;27:S20–31.CrossRefPubMedGoogle Scholar
  69. 69.
    •• Jaremka LM, Belury MA, Andridge RR, Malarkey WB, Glaser R, Christian L, et al. Interpersonal stressors predict ghrelin and leptin levels in women. Psychoneuroendocrinology. 2014;48:178–88. This was the first paper to examine threats to belonging and ghrelin levels among humans. CrossRefPubMedGoogle Scholar
  70. 70.
    Jaremka LM, Fagundes CP, Peng J, Belury MA, Andridge RR, Malarkey WB, et al. Loneliness predicts postprandial ghrelin and hunger in women. Horm Behav. 2015;70:57–63.CrossRefPubMedPubMedCentralGoogle Scholar
  71. 71.
    Wen LK, Shepherd MD, Parchman ML. Family support, diet, and exercise among older Mexican Americans with type 2 diabetes. Diabetes Educ. 2004;30:980–93.CrossRefPubMedGoogle Scholar
  72. 72.
    Henriksen RE, Torsheim T, Thuen F. Loneliness, social integration and consumption of sugar-containing beverages: testing the social baseline theory. PLoS One. 2014;9:e104421.CrossRefPubMedPubMedCentralGoogle Scholar
  73. 73.
    Jaremka LM, Belury MA, Andridge RR, Lindgren ME, Habash D, Malarkey WB, et al. Novel links between troubled marriages and appetite regulation: marital distress, ghrelin, and diet quality. Clin Psychol Sci. 2016;4:363–75.CrossRefPubMedGoogle Scholar
  74. 74.
    Troisi JD, Gabriel S, Derrick JL, Geisler A. Threatened belonging and preference for comfort food among the securely attached. Appetite. 2015;90:58–64.CrossRefPubMedGoogle Scholar

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Authors and Affiliations

  1. 1.Department of Psychological and Brain SciencesUniversity of DelawareNewarkUSA

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