Several risk factors have been proposed to contribute to both SAD and eating disorders, and those that have received the most attention to date are perfectionism, fear of negative evaluation, and social appearance anxiety. Given strong but incomplete comorbidity between these disorders (i.e., not every individual with an eating disorder has social anxiety disorder), it seems plausible that there are both specific risk factors (i.e., risk factors that contribute to only one disorder) and shared risk factors between the disorders. To prevent mental disorders and treat individuals with comorbid SAD and eating disorders, it is important to identify the risk factors contributing to these disorders. Research suggests that all mental disorders represent clusters of illness with overlapping genetic and non-genetic risk factors and that these overlapping risk factors may contribute to the high comorbidity rates between disorders (e.g., Fyer & Brown, 2009 Hyman, 2003).
Risk Factors for SAD and eating disorders Understanding the nature of this comorbidity may therefore improve treatment success for eating disorders. This risk is concerning because within individuals with EDs, SAD is a barrier for help-seeking, a negative prognostic factor for treatment outcomes, and decreases treatment engagement ( Buckner, Eggleston, & Schmidt, 2006 Goodwin & Fitzgibbon, 2002). The lifetime prevalence of SAD has been reported to be between 23 and 71.4% among individuals with anorexia nervosa (AN)( Godart et al., 2000 Halmi et al., 1991 Hinrichsen, Waller, & van Gerko, 2004) and between 23 and 67.8% among individuals with bulimia nervosa (BN) ( Brewerton et al., 1995 Hinrichsen et al., 2004 Laessle & Schulz, 2009) whereas the lifetime prevalence rate of SAD in the general public is significantly lower at approximately 12% ( Ruscio et al., 2008).Ĭlearly, the comorbidity between SAD and eating disorders goes above and beyond SAD being a common mental disorder, suggesting that there may be shared vulnerabilities that confer risk for both SAD and eating disorders. Further, individuals with SAD are more likely to report disordered eating than controls, and, in individuals with SAD, it has been reported that 20% meet criteria for an eating disorder ( Becker, DeViva, & Zayfert, 2004 Godart et al., 2003). Social anxiety disorder (SAD) has the highest occurrence of all anxiety disorders in individuals with eating disorders and is significantly more common among individuals with eating disorders than in control groups ( Godart et al., 2003 Godart et al., 2000). Social Anxiety and Eating Disorder ComorbidityĮating and anxiety disorders are highly comorbid, with some studies finding up to 83 percent of individuals with an eating disorder also meeting criteria for an anxiety disorder ( Godart, Flament, Lecrubier, & Jeammet, 2000 Pallister & Waller, 2008). It is possible that treating negative appearance evaluation fears may reduce both eating disorder and social anxiety symptoms. These results were maintained when gender, body mass index, trait negative affect, and depression were included in the model. Despite significant zero-order relationships, two facets of perfectionism (high standards and maladaptive perfectionism) did not emerge as a risk factor for either disorder when all constructs were considered. We found support for social appearance anxiety as a shared risk factor between social anxiety and eating disorder symptoms, whereas fear of negative evaluation was a risk factor only for social anxiety symptoms.
Using structural equation modeling in two diverse samples ( N = 236 N = 136) we tested a model in which each of these risk factors were uniquely associated with social anxiety and eating disorder symptoms.
However, no research to date has examined all three factors simultaneously. Social appearance anxiety (i.e., fear of negative evaluation of one's appearance), general fear of negative evaluation, and perfectionism have each been proposed as risk factors for both social anxiety disorder and the eating disorders. Social anxiety and eating disorders are highly comorbid.
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