Abstract
Anorexia nervosa (AN) is a serious psychiatric disorder characterized by severe restriction of energy intake and dangerously low body weight. Other domains of functioning are affected, including social functioning. Although difficulties within this domain have started to be acknowledged by the literature, some important gaps remain to be filled. Do social difficulties predate the onset of the illness? What difficulties in particular are relevant for the development and maintenance of the illness? The aim of this study is to combine the use of quantitative and qualitative methods to answer these questions. Ninety participants with lifetime AN (88 women and 2 men) completed an online survey assessing memories of involuntary submissiveness within the family, fear of negative evaluation from others, perceived lack of social competence, feelings of social belonging, eating disorder symptoms, and work and social adjustment. Participants also answered three open questions regarding their experience of social relationships before and after the illness onset. The findings provided support for the hypothesized relationships between the study variables. Involuntary submissiveness and fear of negative evaluation predicted eating disorder symptoms and these associations were partially mediated by perceived lack of social competence. Two-thirds of the sample recalled early social difficulties before illness onset and recognized that these had played a role in the development of the illness. A larger proportion of participants stated that the eating disorder had affected their social relationships in a negative way. This study sheds some light on patients’ perspective on the predisposing and maintaining role that social difficulties play in AN and identifies key psychological variables that could be targeted in treatment.
Highlights
Anorexia nervosa (AN) is diagnostically defined by abnormal eating behavior and distorted attitudes toward body weight and shape [DSM-5 [1]]
How do you experience the interaction with others now? How does your eating disorder affect your relationships at the moment?” and (iii) “Do you feel that the quality of your social relationships as a child/adolescent might have played a role in the development of your eating disorder? If so, in what way(s)?.”
The aim of this paper was to test the hypotheses that: (i) fear of negative evaluation and early experiences of involuntary submissiveness would predict eating disorder symptoms and poor work and social adjustment, (ii) that this relationships would be partially mediated by feelings of perceived burdensomeness (PB) and (iii) that patients’ narratives would highlight that early social difficulties predate the onset of the illness and are causally linked to the development of the eating disorder; and that they would indicate that the eating disorder had had a negative impact on social functioning
Summary
Anorexia nervosa (AN) is diagnostically defined by abnormal eating behavior (i.e., restriction of energy intake followed by dangerously low body weight) and distorted attitudes toward body weight and shape (e.g., body dissatisfaction and exaggerated influence of physical appearance on selfevaluation) [DSM-5 [1]]. In the acute phase of the illness, patients often report isolation and loneliness [2, 3]. They recall a preference to pursue solitary activities in childhood [4] and difficulties interacting with peers [5, 6]. Parental reports confirm the extent of these difficulties [7] and corroborate the evidence that impairments in interpersonal functioning are not merely a consequence of the illness. Adverse early interpersonal experiences, such as exposure to sudden death of a relative [11], poor communication and care within the family [12, 13], and critical comments about the self { regarding weight, shape and eating [e.g., Ref. Adverse early interpersonal experiences, such as exposure to sudden death of a relative [11], poor communication and care within the family [12, 13], and critical comments about the self { regarding weight, shape and eating [e.g., Ref. [14,15,16]]}, have been found to increase the risk for the development of eating disorder symptoms in longitudinal studies
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