Abstract
BackgroundThe interpersonal Structural Analysis of Social Behavior (SASB) model of self-image has repeatedly proven valuable in relation to eating disorder (ED) symptoms and in predicting ED outcome.ObjectiveWe studied the association between initial self-image according to the SASB and 12-month outcome, in five diagnostic groups of female ED patients. Based on previous findings, we expected autonomy related variables (self-control/autonomy) would strongly predict outcome in anorexia nervosa (AN) groups, whereas variables related to affiliation (self-attack/love) would moderately predict outcome in bulimia nervosa (BN).MethodParticipants were adult female patients, of whom 457 had AN restrictive type, 228 AN binge/purge subtype, 861 BN, 505 other specified ED and 170 binge eating disorder. Data came from the Stepwise clinical database in Sweden. Outcomes were presence/absence of ED diagnosis and self-rated ED symptoms, and we controlled for baseline ED pathology, BMI, age and general psychiatric symptoms.ResultsRegression analyses showed that although the pattern differed somewhat between diagnostic groups, high initial self-love and low self-attack/self-blame predicted a more positive 12-month outcome. In some groups (AN/R in particular), these variables remained important even when baseline pathology and age were included in the analyses.DiscussionSelf-image aspects once again display substantial power in predicting outcome in EDs. In AN/R patients, self-love plays an almost as crucial a role as baseline ED pathology in relation to 12-month outcome.
Highlights
The interpersonal Structural Analysis of Social Behavior (SASB) model of self-image has repeatedly proven valuable in relation to eating disorder (ED) symptoms and in predicting ED outcome
We found strong associations between self-blame and inversely self-love/affirmation and ED symptoms, in several groups of female adolescent and adult ED patients, normal controls and non-treatment seeking but symptomatic women
Hypotheses Consistent with previous findings, we hypothesized that autonomy-related variables would strongly predict outcome in anorexia nervosa (AN), whereas variables related to affiliation would moderately predict outcome in bulimia nervosa (BN)
Summary
The interpersonal Structural Analysis of Social Behavior (SASB) model of self-image has repeatedly proven valuable in relation to eating disorder (ED) symptoms and in predicting ED outcome. The interpersonal Structural Analysis of Social Behavior (SASB) self-image or introject captures both the evaluative component of self-esteem and self-directed actions [8], i.e. how one treats oneself as a result of interpersonal learning. It has theoretical (and empirically supported) implications for interpersonal functioning: the self-image forms in early interactions with attachment figures and provides a template for subsequent interpersonal behavior as people tend to behave in ways to confirm their self-image, regardless of its quality [8,9,10]. The dimensional end points and their combinations form eight behavior “clusters” (see Fig. 1); e.g. self-love combined with autonomy-giving form behaviors such as being spontaneous and free to explore and accept one’s feelings, needs and wishes, whereas control combined with attack form excessive adherence to both internal and external rules, and harsh self-criticism
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