Others' approval-based self-worth and eating disorder symptomatology

Abstract

Eating disorders cause a substantial amount of psychological, physical, and social impairment in the lives of sufferers. Cognitive-behavioural therapy (CBT), which targets the over-evaluation of weight and shape in the definition of self-worth, is considered to be the front-line treatment for adults with eating disorders at the current time. Yet recovery rates following this approach among those with bulimia nervosa or eating disorder not otherwise specified (EDNOS) are inadequate, and the efficacy of CBT for anorexia nervosa has not been established. There is thus a high need for an investigation into factors other than weight/shape over-evaluation that may underlie eating disorder pathology, which can be targeted in treatment. Emerging theoretical, empirical, and clinical research suggests that self-worth based on others' approval may play an important role in the triggering and maintenance of eating disorder pathology. In particular, it is hypothesised that the high co-morbidity found between social anxiety disorder and eating disorders may be due to a shared underlying vulnerability to heightened interpersonal sensitivity. The first study in the current research program examined the interpersonal evaluation concerns reported in an outpatient group discussion setting by five adolescent females diagnosed with anorexia nervosa. Perceived negative social evaluation across a wide range of settings (not just those specific to weight, shape or eating) were reported by participants to trigger, maintain and arise as a consequence of anorexia nervosa pathology. In addition, fears of negative evaluation or the experience of perceived negative evaluation appeared to act as a significant barrier to help-seeking among participants. The second study examined the relationship between self-worth based on others' approval, shape/weight based selfworth, and eating disorder and social anxiety disorder pathology. Participants were 82 women from a community sample (18-36 years), who completed an online survey. Results revealed a relationship between others' approval based self-worth and eating disorder pathology, which was fully mediated by self-worth based on body weight/shape. This suggests that self-worth based on others' approval may need to include a focus on the social evaluation of weight and shape in order to manifest as eating disorder pathology. Furthermore, a significant relationship was found between others' approval based selfworth and social anxiety disorder pathology, indicating that self-worth based on the evaluations of others may be a potential shared area of vulnerability between social anxiety and eating disorders. The final study investigated how self-worth based on weight/shape or the approval of others Influences eating disorder pathology, following the real-world experience of positive or negative social evaluation in an experimental setting. Participants were 98 female undergraduate students (18-35 years). Contrary to the findings of study two, results suggest that self-worth based highly on weight/shape or others' approval form two independent pathways to body dissatisfaction following the experience of negative evaluation. A low investment in shape/weight and others' approval based self-worth appeared to playa protective role against body dissatisfaction following the experience of negative social evaluation. Overall, results indicate that others' approval based self-worth should be considered in conjunction with self-worth based on weight/shape in theoretical approaches and treatment models of eating disorders. Clinical implications of findings and future research directions are discussed.