Abstract
PurposeEating disorders (ED) and social anxiety disorder are highly comorbid with potentially shared symptoms like social appearance anxiety (SAA) referring to a fear of being negatively evaluated by others’ because of overall appearance. SAA constitutes a risk factor for eating psychopathology and bridges between EDs and social anxiety disorder.MethodsThe present studies examined internal consistency, factor structure, test–retest reliability, gender and age invariance, convergent validity and differences between individuals with and without an ED of a German version of the social appearance anxiety scale (SAAS) in four independent samples (n1 = 473; n2 = 712; n3 = 79; n4 = 33) including adolescents and patients with EDs.ResultsConsistently, the SAAS showed excellent internal consistency (ωs ≥ 0.947) and a one-factorial structure. Convergent validity was shown via high correlations of the SAAS with social anxiety (e.g., social interaction anxiety r = 0.642; fear of negative evaluation rs ≥ 0.694), body image disturbance measures (e.g., shape concerns rs ≥ 0.654; weight concerns rs ≥ 0.607; body avoidance rs ≥ 0.612; body checking rs ≥ 0.651) and self-esteem (r = −0.557) as well as moderate correlations with general eating psychopathology (e.g., restrained rs ≥ 0.372; emotional r = 0.439; external eating r = 0.149). Additionally, the SAAS showed gender and age invariance and test–retest reliability after 4 weeks with r = 0.905 in Study 2 and was able to discriminate between individuals with and without an ED in Study 4.ConclusionHence, the German version of the SAAS can reliably and validly assess SAA in female and male adolescents or adults with or without an ED. Additionally, the SAAS might be used in a therapeutic context to especially target patient groups suffering from EDs with comorbid social anxiety.Level of evidenceLevel III: Evidence obtained from cohort or case-control analytic studies.
Highlights
Eating disorders (ED) such as anorexia nervosa, bulimia nervosa and binge eating disorder are highly prevalent in the general population [1] and are associated with physiologicalJulia Reichenberger and Anne Kathrin Radix contributed .1 3 Vol.:(0123456789)Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity that constructs closely related to social evaluative anxieties trigger eating-related concerns, which in turn strengthen ED psychopathology
The initial model revealed mixed results with a poor fit according to root mean square error of approximation (RMSEA) = 0.111, acceptable fit to comparative fit index (CFI) = 0.924 and good fit to SRMR = 0.035
The social appearance anxiety scale (SAAS) was positively correlated with measures of social anxiety, i.e. higher fear of negative evaluation (FNE), and body image disturbances, i.e., higher eating, weight and shape concern, body checking and body avoidance
Summary
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity that constructs closely related to social evaluative anxieties trigger eating-related concerns, which in turn strengthen ED psychopathology Constructs such as fear of negative evaluation (FNE) or social appearance anxiety (SAA) may be relevant when trying to understand this overlap. In a longitudinal study DeBoer et al [12] showed that the individual degree of FNE predicted the experienced level of future body dissatisfaction This suggests that the extent of experienced FNE impacts one component of body image disturbance, which forms one of the core symptoms in EDs. The link between anxiety and body image disturbance has been strengthened by the demonstration that body size overestimations no longer significantly discriminated between patients with anorexia nervosa compared to controls after controlling for experienced anxiety during the experiment [13].
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