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Associations Between Fear of Negative Evaluation and Eating Pathology During Intervention and 12-Month Follow-up

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Abstract

Fear of negative evaluation (FNE), a core feature of social anxiety disorder, has been prospectively related to eating pathology over and above other established risk factors, suggesting that it may be an important cognitive risk factor for eating disorders. The present study examined reciprocal longitudinal relations among FNE and eating disorder risk factors using a female undergraduate sample (N = 82) enrolled in an eating disorder prevention program. Cross-lagged panel analysis revealed that FNE was a determinant of subsequent body dissatisfaction and eating disorder symptoms. Fear of negative evaluation also predicted subsequent thin-ideal internalization among participants with high body mass index (BMI), but not among those with low BMI. Fear of negative evaluation did not predict future dietary restraint or negative affect but was itself predicted by prior levels of thin ideal internalization, body dissatisfaction, dietary restraint, and negative affect. Findings suggest that FNE may be a useful target for reducing body image concerns and maladaptive eating behavior.

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References

  • Basow, S. A., Foran, K. A., & Bookwala, J. (2007). Body objectification, social pressure, and disordered eating behavior in college women: The role of sorority membership. Psychology of Women Quarterly, 31(4), 394–400.

    Article  Google Scholar 

  • Bäzner, E., Brömer, P., Hammelstein, P., & Meyer, T. D. (2006). Current and former depression and their relationship to the effects of social comparison processes: Results of an internet based study. Journal of Affective Disorders, 93, 97–103.

    Article  PubMed  Google Scholar 

  • Becker, C. B., Bull, S., Schaumberg, K., Cauble, A., & Franco, A. (2008). Effectiveness of peer-facilitated eating disorders prevention: A randomized replication trial. Journal of Consulting and Clinical Psychology, 76, 437–454.

    Google Scholar 

  • Becker, C. B., McDaniel, L., Bull, S., Powell, M., & McIntyre, K. (2012). Can we reduce eating disorder risk factors in female college athletes? A randomized exploratory investigation of two peer-led interventions. Body Image, 9, 31–42.

    Article  PubMed  Google Scholar 

  • Becker, C. B., Smith, L. M., & Ciao, A. C. (2005). Reducing eating disorder risk factors in sorority members: A randomized trial. Behavior Therapy, 36, 245–254.

    Article  Google Scholar 

  • Becker, C. B., Smith, L. M., & Ciao, A. C. (2006). Peer-facilitated eating disorder prevention: A randomized effectiveness trial of cognitive dissonance and media advocacy. Journal of Counseling Psychology, 53, 550–555.

    Article  Google Scholar 

  • Berscheid, E., Walster, E., & Bohrnstedt, G. (1973). The happy American body: A survey report. Psychology Today, 7, 119–131.

    Google Scholar 

  • Bouton, M. E. (2000). A learning theory perspective on lapse, relapse, and maintenance of behavior change. Health Psychology, 19, 57–63.

    Google Scholar 

  • Bouton, M. E. (2002). Context, ambiguity, and unlearning: Sources of relapse after behavioral extinction. Biological Psychiatry, 52, 976–986.

    Google Scholar 

  • Brewerton, T. D., Lydiard, R. B., Herzog, D. B., & Brotman, A. W. (1995). Comorbidity of Axis I psychiatric disorders in bulimia nervosa. Journal of Clinical Psychiatry, 56, 77–80.

    PubMed  CAS  Google Scholar 

  • Bulik, C. M., Sullivan, P. F., Fear, J. L., & Joyce, P. R. (1997). Eating disorders and antecedent anxiety disorders: A controlled study. Acta Psychiatrica Scandinavica, 96, 101–107.

    Article  PubMed  CAS  Google Scholar 

  • Carleton, R. N., Collimore, K. C., McCabe, R. E., & Antony, M. M. (2011). Addressing revisions to the Brief Fear of Negative Evaluation scale: Measuring fear of negative evaluation across anxiety and mood disorders. Journal of Anxiety Disorders, 25, 822–828.

    Article  PubMed  Google Scholar 

  • Carleton, R. N., McCreary, D. R., Norton, P. J., & Asmundson, G. J. G. (2006). Brief Fear of Negative Evaluation scale—revised. Depression & Anxiety, 23, 1091–4269.

    Google Scholar 

  • Cashel, M. L., Cunningham, D., Landeros, C., Cokley, K. O., & Muhammad, G. (2003). Sociocultural attitudes and symptoms of bulimia: Evaluating the SATAQ with diverse college groups. Journal of Counseling Psychology, 50, 287–296.

    Article  Google Scholar 

  • Crandall, C. S. (1988). Social contagion of binge eating. Journal of Personality and Social Psychology, 55, 588–598.

    Article  PubMed  CAS  Google Scholar 

  • Curran, P. J., & Bauer, D. J. (2011). The disaggregation of within-person and between-person effects in longitudinal models of change. Annual Review of Psychology, 62, 583–619.

    Google Scholar 

  • Curran, P. J., Lee, T. H., Howard, A. H., Lane, S. T., & MacCallum, R. C. (2012). Disaggregating within-person and between-person effects in multilevel and structural equation growth models. In G. Hancock (Ed.), Advances in longitudinal methods in the social and behavioral sciences (pp. 217–253). Charlotte, NC: Information Age.

  • Duemm, I., Adams, G. R., & Keating, L. (2003). The addition of sociotropy to the dual pathway model of bulimia. Canadian Journal of Behavioural Science/Revue canadienne des sciences du comportement, 35, 281–291.

    Article  Google Scholar 

  • Fairburn, C. G., & Beglin, S. J. (1990). Studies of the epidemiology of bulimia nervosa. American Journal of Psychiatry, 147, 401–408.

    PubMed  CAS  Google Scholar 

  • Fairburn, C. G., Cooper, Z., Sharfran, R., & Wilson, G. T. (2008). Eating disorders: A transdiagnostic protocol. Clinical handbook of psychological disorders: A step-by-step treatment manual (4th ed.). New York: Guilford Press.

    Google Scholar 

  • Fairburn, C. G., & Harrison, P. J. (2003). Eating disorders. Lancet, 361, 407–416.

    Article  PubMed  Google Scholar 

  • Fang, A., & Hofmann, S. G. (2010). Relationship between social anxiety disorder and body dysmorphic disorder. Clinical Psychology Review, 30, 1040–1048.

    Article  PubMed  Google Scholar 

  • Fitzsimmons-Craft, E. E. (2011). Social psychological theories of disordered eating in college women: Review and integration. Clinical Psychology Review, 31, 1224–1237.

    Article  PubMed  Google Scholar 

  • Gawronski, B. (2012). Back to the future of dissonance theory: Cognitive consistency as a core motive. Social Cognition, 30, 652–668.

    Article  Google Scholar 

  • Gilbert, N., & Meyer, C. (2003). Social anxiety and social comparison: Differential links with restrictive and bulimic attitudes among nonclinical women. Eating Behaviors, 4, 257–264.

    Article  PubMed  Google Scholar 

  • Hamer, R. M., & Simpson, P. M. (2009). Last observation carried forward versus mixed models in the analysis of longitudinal psychiatric clinical trials. American Journal of Psychiatry, 166, 639–641.

    Article  PubMed  Google Scholar 

  • Heatherton, T. F., Nichols, P., Mahmedi, F., & Keel, P. (1995). Body weight, dieting, and eating disorder symptoms among college students, 1982 to 1992. The American Journal of Psychiatry, 152, 1623–1629.

    PubMed  CAS  Google Scholar 

  • Heimberg, R. C., Brozovich, F. A., & Rapee, R. M. (2010). A cognitive behavioral model of social anxiety disorder: Update and extension. In S. G. Hofmann, P. M. DiBartolo (Eds.), Social anxiety: Clinical, developmental, and social perspectives (2nd ed.) (pp. 395–422). San Diego, CA US: Elsevier Academic Press. doi: 10.1016/B978-0-12-375096-9.00015-8.

  • Hudson, J. I., Hiripi, E., Pope, H. G., & Kessler, R. C. (2007). The prevalence and correlates of eating disorders in the national comorbidity survey replication. Biological Psychiatry, 61, 348–358.

    Article  PubMed  Google Scholar 

  • Keel, P. K., Heatherton, T. F., Dorer, D. J., Joiner, T. E., & Zalta, A. K. (2006). Point prevalence of bulimia nervosa in 1982, 1992, and 2002. Psychological Medicine, 36, 119–127.

    Article  PubMed  Google Scholar 

  • Kessler, R. C., & Greenberg, D. F. (1981). Linear panel analysis: Models of quantitative change. New York: Academic Press.

    Google Scholar 

  • Kilpela, L. S., DeBoer, L. B., West, J., Alley, M. C., Presnell, K., E. & Becker, C. B. (in preparation). Distributed and condensed versions of an eating disorder prevention program: Effects on eating disorder symptoms and risk factors.

  • Laessle, R. G., Tuschl, R. J., Kotthaus, B. C., & Pirke, K. M. (1989). Behavioral and biological correlates of dietary restraint in normal life. Appetite, 12, 83–94.

    Article  PubMed  CAS  Google Scholar 

  • Lapinkski, M. K., & Boster, F. J. (2001). Modeling the ego-defensive function of attitudes. Communication Monographs, 68, 314–324.

    Article  Google Scholar 

  • Larimer, M. E., Turner, A. P., Mallet, K. A., & Geisner, I. M. (2004). Predicting drinking behavior and alcohol-related problems among fraternity and sorority members: Examining the role of descriptive and injunctive norms. Psychology of Addictive Behaviors, 18, 203–214.

    Article  PubMed  Google Scholar 

  • Leary, M. R. (1983). A brief version of the Fear of Negative Evaluation Scale. Personality and Social Psychology Bulletin, 9, 371–375.

    Article  Google Scholar 

  • Levinson, C. A., & Rodebaugh, T. L. (2011). Validation of the Social Appearance Anxiety Scale: Factor, convergent, and divergent validity. Assessment, 18, 350–356.

    Article  PubMed  Google Scholar 

  • Levinson, C. A., & Rodebaugh, T. L. (2012). Social anxiety and eating disorder comorbidity: The role of negative social evaluation fears. Eating Behaviors, 13, 27–35.

    Article  PubMed  Google Scholar 

  • Lewinsohn, P. M., Streigel-Moore, R. H., & Seeley, J. R. (2000). Epidemiology and natural course of eating disorders in young women from adolescence to young adulthood. Journal of the American Academy of Child and Adolescent Psychiatry, 39, 1284–1292.

    Article  PubMed  CAS  Google Scholar 

  • McMillan, W., Stice, E., & Rohde, P. (2011). High- and low-level dissonance-based eating disorder prevention programs with young women with body image concerns: An experimental trial. Journal of Consulting and Clinical Psychology, 79, 129–134.

    Article  PubMed  Google Scholar 

  • Menard, S. (1991). Longitudinal research. Thousand Oaks, CA: Sage Publications, Inc.

    Google Scholar 

  • Neighbors, C., Lee, C. M., Lewis, M. A., Fossos, N., & Larimer, M. E. (2007). Are social norms the best predictor of outcomes among heavy-drinking college students? Journal of Studies on Alcohol and Drugs, 68, 556–565.

    PubMed  Google Scholar 

  • Olatunji, B. O., Rosenfield, D., Tart, C. D., Cottraux, J., Powers, M. B., & Smits, J. A. (2013). Behavioral versus cognitive treatment of obsessive-compulsive disorder: An examination of outcome and mediators of change. Journal of Consulting & Clinical Psychology (epub ahead of print).

  • Patrick, H., Neighbors, C., & Knee, C. R. (2004). Appearance-related social comparisons: The role of contingent self-esteem and self-perceptions of attractiveness. Personality and Social Psychology Bulletin, 30, 501–514.

    Article  PubMed  Google Scholar 

  • Petry, N. M., Barry, D., Pietrzak, R. H., & Wagner, J. A. (2008). Overweight and obesity are associated with psychiatric disorders: Results from the National Epidemiological Survey on alcohol and related conditions. Psychosomatic Medicine, 70, 288–297.

    Article  PubMed  Google Scholar 

  • Rapee, R. M., & Heimberg, R. G. (1997). A cognitive-behavioral model of anxiety in social phobia. Behaviour Research and Therapy, 35, 741–756.

    Article  PubMed  CAS  Google Scholar 

  • Ross, S. E., Neibling, B. C., & Heckert, T. M. (1999). Sources of stress among college students. College Student Journal, 33, 312–317.

    Google Scholar 

  • Schneider, F. R., Blanco, C., Antia, S. X., & Liebowitz, M. R. (2002). The social anxiety spectrum. Psychiatric Clinics of North America, 25, 757–774.

    Article  Google Scholar 

  • Scott-Sheldon, L. A. J., Carey, K. B., & Carey, M. P. (2008). Health behavior and college students: Does Greek affiliation matter? Journal of Behavioral Medicine, 31, 61–70.

    Article  PubMed  Google Scholar 

  • Shepherd, H., & Ricciardelli, L. A. (1998). Test of Stice’s dual pathway model: Dietary restraint and negative affect as mediators of bulimic behavior. Behaviour Research and Therapy, 36, 345–352.

    Article  PubMed  CAS  Google Scholar 

  • Smits, J. A. J., Julian, K., Rosenfield, D., & Powers, M. B. (2012). Threat reappraisal as a mediator of symptom change in cognitive-behavioral treatment of anxiety disorders: A systematic review. Journal of Consulting and Clinical Psychology, 80, 624–635.

    Article  PubMed  Google Scholar 

  • Smits, J. A. J., Rosenfield, D., McDonald, R., & Telch, M. J. (2006). Cognitive mechanisms of social anxiety reduction: An examination of specificity and temporality. Journal of Consulting and Clinical Psychology, 74, 1203–1212.

    Article  PubMed  Google Scholar 

  • Stice, E. (2001). A prospective test of the dual pathway model of bulimic pathology: Mediating effects of dieting and negative affect. Journal of Abnormal Psychology, 110, 124–135.

    Article  PubMed  CAS  Google Scholar 

  • Stice, E., & Agras, W. S. (1998). Predicting onset and cessation of bulimic behaviors during adolescence: A longitudinal grouping analysis. Behavior Therapy, 29, 257–276.

    Article  Google Scholar 

  • Stice, E., Chase, A., Stormer, S., & Appel, A. (2001). A randomized trial of a dissonance-based eating disorder prevention program. International Journal of Eating Disorders, 29, 247–262.

    Article  PubMed  CAS  Google Scholar 

  • Stice, E., Fisher, M., & Martinex, E. (2004). Eating Disorder Diagnostic Scale: Additional evidence of reliability and validity. Psychological Assessment, 16, 60–71.

    Article  PubMed  Google Scholar 

  • Stice, E., Marti, C. N., Spoor, S., Presnell, K., & Shaw, H. (2008). Dissonance and healthy weight eating disorder prevention programs: Long-term effects from a randomized efficacy trial. Journal of Consulting and Clinical Psychology, 76, 329–340.

    Article  PubMed  Google Scholar 

  • Stice, E., Mazotti, L., Weibel, D., & Agras, W. S. (2000a). Dissonance prevention program deceases thin-ideal internalization, body dissatisfaction, dieting, negative affect, and bulimic symptoms: A preliminary experiment. International Journal of Eating Disorders, 27, 206–217.

    Article  PubMed  CAS  Google Scholar 

  • Stice, E., Presnell, K., Gau, J., & Shaw, H. (2007a). Testing mediators of intervention effects in randomized controlled trials: An evaluation of two eating disorder prevention programs. Journal of Consulting and Clinical Psychology, 75, 20–32.

    Article  PubMed  Google Scholar 

  • Stice, E., Shaw, H., Burton, E., & Wade, E. (2006). Dissonance and healthy weight eating disorder prevention programs: A randomized efficacy trial. Journal of Consulting and Clinical Psychology, 74, 263–275.

    Article  PubMed  Google Scholar 

  • Stice, E., Shaw, H., & Marti, C. N. (2007b). A meta-analytic review of eating disorder prevention programs: Encouraging findings. Annual Review of Clinical Psychology, 3, 207–231.

    Article  PubMed  Google Scholar 

  • Stice, E., Shaw, H., & Nemeroff, C. (1998). Dual pathway model of bulimia nervosa: Longitudinal support for dietary restraint and affect-regulation mechanisms. Journal of Social and Clinical Psychology, 17, 129–149.

    Article  Google Scholar 

  • Stice, E., South, K., & Shaw, H. (2012). Future directions in etiologic, prevention, and treatment research for eating disorders. Journal of Clinical Child and Adolescent Psychology, 41, 845–855.

    Article  PubMed  Google Scholar 

  • Stice, E., Telch, C. F., & Rizvi, S. L. (2000b). Development and validation of the Eating Disorder Diagnostic Scale: A brief self-report measure for anorexia, bulimia, and binge eating disorder. Psychological Assessment, 12, 123–131.

    Article  PubMed  CAS  Google Scholar 

  • Stice, E., Trost, A., & Chase, A. (2003). Healthy weight control and dissonance-based eating disorder prevention programs: Results form a controlled trial. International Journal of Eating Disorders, 33, 10–21.

    Article  PubMed  Google Scholar 

  • Stice, E., Ziemba, C., Margolis, J., & Flick, P. (1996). The dual pathway model differentiates bulimics, subclinical bulimics, and controls: Testing the continuity hypothesis. Behavior Therapy, 27, 531–549.

    Article  Google Scholar 

  • Stopa, L., & Clark, D. M. (1993). Cognitive processes in social phobia. Behaviour Research and Therapy, 31, 255–267.

    Article  PubMed  CAS  Google Scholar 

  • Striegel-Moore, R. H., Silberstein, L. R., Grunberg, N. E., & Rodin, J. (1990). Competing on all fronts: Achievement orientation and disordered eating. Sex Roles, 23(11–12), 697–702.

    Article  Google Scholar 

  • Sullivan, P. F. (1995). Mortality in anorexia nervosa. The American Journal of Psychiatry, 152, 1073–1074.

    PubMed  CAS  Google Scholar 

  • Swinbourne, J., Hunt, C., Abbott, M., Russell, J., St Clare, T., & Touyz, S. (2012). The comorbidity between eating disorders and anxiety disorders: Prevalence in an eating disorder sample and anxiety disorder sample. Australian and New Zealand Journal of Psychiatry, 46, 118–131.

    Article  PubMed  Google Scholar 

  • Treasure, J., & Szmukler, G. I. (1995). Medical complications of chronic anorexia nervosa. In G. I. Szmukler, C. Dare, & J. Treasure (Eds.), Handbook of eating disorders: Theory, treatment and research (pp. 197–220). Oxford, England: Wiley.

    Google Scholar 

  • Tschacher, W., & Ramseyer, F. (2009). Modeling psychotherapy process by time-series panel analysis (TSPA). Psychotherapy Research Methods, 19, 469–481.

    Article  Google Scholar 

  • Utschig, A. C., Presnell, K., Madeley, M. C., & Smits, J. A. J. (2010). An investigation of the relationship between fear of negative evaluation and bulimic psychopathology. Eating Behaviors, 11, 231–238.

    Article  PubMed  Google Scholar 

  • van Strien, T., Frijters, J. E. R., Bergers, G. P. A., & Defares, P. B. (1986a). The Dutch Eating Behavior Questionnaire (DEBQ) for assessment of restrained, emotional, and external eating behavior. International Journal of Eating Disorders, 5, 295–315.

    Article  Google Scholar 

  • van Strien, T., Frijters, J. E., Van Staveren, W. A., Defares, P. B., & Deurenberg, P. (1986b). The predictive validity of the Dutch Restrained Eating Scale. International Journal of Eating Disorders, 5, 747–755.

    Article  Google Scholar 

  • Vassilopoulos, S. (2006). Interpretation and judgment biases in socially anxious and nonanxious individuals. Behavioural and Cognitive Psychotherapy, 34, 243–254.

    Article  Google Scholar 

  • Wardle, J. (1987). Eating style: A validation study of the Dutch eating behavioral questionnaire in normal subjects and women with eating disorders. Journal of Psychosomatic Research, 31, 161–169.

    Article  PubMed  CAS  Google Scholar 

  • Wardle, J., & Beales, S. (1987). Restraint and food intake: An experimental study of eating patterns in the laboratory and in normal life. Behavior Research and Therapy, 25, 179–185.

    Article  CAS  Google Scholar 

  • Watson, D., & Clark, L. A. (1992). Affects separable and inseparable: On the hierarchical arrangement of the negative affects. Journal of Personality and Social Psychology, 62, 489–505.

    Article  Google Scholar 

  • Watson, D., & Clark, L. A. (1999). The PANAS-X. Manual for the positive and negative affect scheduleexpanded form. Retrieved from University of Iowa, Department of Psychology Web site: www.psychology.uiowa.edu/faculty/Clark/PANAS-X.pdf.

  • Weeks, J. W., & Howell, A. N. (2012). The bivalent fear of evaluation model of social anxiety: Further integrating finding on fears of positive and negative evaluation. Cognitive Behaviour Therapy, 41, 83–95.

    Article  PubMed  Google Scholar 

  • Westerberg-Jacobson, J., Edlund, B., & Ghaderi, A. (2010). Risk and protective factors for disturbed eating: A 7-year longitudinal study of eating attitudes and psychological factors in adolescent girls and their parents. Eating and Weight Disorders, 15, 208–218.

    PubMed  CAS  Google Scholar 

  • Wilson, G. T., Becker, C. B., & Heffernan, K. (2003). Eating disorders. In E. J. Mash & R. A. Barkley (Eds.), Child psychopathology (2nd ed., pp. 687–715). New York: Guilford Press.

    Google Scholar 

  • Wonderlich-Tierney, A. L., & Vander Wal, J. S. (2010). The effects of social support and coping on the relationship between social anxiety and eating disorders. Eating Behaviors, 11, 85–91.

    Article  PubMed  Google Scholar 

  • Zivin, K., Eisenberg, D., Gollust, S. E., & Golberstein, E. (2009). Persistence of mental health problems and needs in a college student population. Journal of Affective Disorders, 117, 180–185.

    Article  PubMed  Google Scholar 

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DeBoer, L.B., Medina, J.L., Davis, M.L. et al. Associations Between Fear of Negative Evaluation and Eating Pathology During Intervention and 12-Month Follow-up. Cogn Ther Res 37, 941–952 (2013). https://doi.org/10.1007/s10608-013-9547-y

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