Andrew R. Menatti

Social appearance anxiety, perfectionism, and fear of negative evaluation: distinct or shared risk factors for social anxiety and eating disorders?

Social anxiety and eating disorders are highly comorbid. Social appearance anxiety (i.e., fear of negative evaluation of ones appearance), general fear of negative evaluation, and perfectionism have each been proposed as risk factors for both social anxiety disorder and the eating disorders. However, no research to date has examined all three factors simultaneously. 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. 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. 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. These results were maintained when gender, body mass index, trait negative affect, and depression were included in the model. It is possible that treating negative appearance evaluation fears may reduce both eating disorder and social anxiety symptoms.

Social anxiety and associations with eating psychopathology: Mediating effects of fears of evaluation.

Recent work suggests unique relations among features of social anxiety disorder and eating disorder pathology. Thus, it may be important to determine specific facets of social anxiety that account for the relation between it and eating disorders. Given the similarities in social-evaluative concerns in both sets of symptoms, we hypothesized that fears of both positive and negative evaluation would each independently account for the relationship between social anxiety symptoms and eating pathology among college females (N=167). Results were partially supportive of hypotheses. Fear of negative evaluation independently accounted for a significant portion of the relationship between social anxiety and each domain of eating pathology that was tested, which included Drive for Thinness, Body Dissatisfaction, and Bulimic Symptoms. Body mass index appeared to play a moderating role on the relationship between fear of negative evaluation and body dissatisfaction, but not drive for thinness or bulimia symptoms. Clinical implications including diagnostic and treatment considerations will be discussed.

Exploring the Relationship Between Social Anxiety and Bulimic Symptoms: Mediational Effects of Perfectionism Among Females.

Previous findings indicate that social anxiety and bulimia co-occur at high rates; one mechanism that has been proposed to link these symptom clusters is perfectionism (Silgado et al. in Cogn Ther Res 34(5):487–492, 2010). We tested meditational models among 167 female undergraduates in which maladaptive evaluative perfectionism concerns (MEPC; i.e., critical self-evaluative perfectionism) mediated the relationship between social anxiety and bulimic symptoms. Results from a first model indicated that MEPC mediated the relationship between fear of public scrutiny and bulimia symptoms. This indirect effect was significant above and beyond the indirect effects of maladaptive body-image cognitions and perfectionism specific to pure personal standards. A second model was tested with MEPC mediating the relationship between social interaction anxiety and bulimia symptoms. Similar results were obtained; however, in this model, a significant direct effect remained after partialing out the indirect effect of the mediators. Theoretical implications are discussed.

Social anxiety and the Big Five personality traits: the interactive relationship of trust and openness.

It is well established that social anxiety (SA) has a positive relationship with neuroticism and a negative relationship with extraversion. However, findings on the relationships between SA and agreeableness, conscientiousness, and openness to experience are mixed. In regard to facet-level personality traits, SA is negatively correlated with trust (a facet of agreeableness) and self-efficacy (a facet of conscientiousness). No research has examined interactions among the Big Five personality traits (e.g., extraversion) and facet levels of personality in relation to SA. In two studies using undergraduate samples (N = 502; N = 698), we examined the relationships between trust, self-efficacy, the Big Five, and SA. SA correlated positively with neuroticism, negatively with extraversion, and had weaker relationships with agreeableness, openness, and trust. In linear regression predicting SA, there was a significant interaction between trust and openness over and above gender. In addition to supporting previous research on SA and the Big Five, we found that openness is related to SA for individuals low in trust. Our results suggest that high openness may protect against the higher SA levels associated with low trust.

Validation of the Social Exercise and Anxiety Measure (SEAM): Assessing fears, avoidance, and importance of social exercise.

In two studies (N = 416; N = 118) examining responses from undergraduates, we developed the Social Exercise and Anxiety Measure (SEAM) and tested its factorial, convergent, and divergent validity. Our results demonstrate that the SEAM exhibits an excellent three factor structure consisting of the following subscales: Social Exercise Self-efficacy, Gym Avoidance, and Exercise Importance. In both studies, Social Exercise Self-efficacy correlated negatively, and Gym Avoidance correlated positively with social interaction anxiety, fear of scrutiny, and fear of negative evaluation. Exercise Importance correlated positively with frequency of exercise and frequency of public exercise. Implications for the mental and physical health of individuals with high levels of social anxiety are discussed.

Psychometric evaluation of the Concerns of Social Reprisal Scale: Further explicating the roots of fear of positive evaluation

Fear of positive evaluation (FPE) has been proposed to be an important feature of social anxiety disorder (SAD) and to be rooted, at least partly, in concerns of social reprisal due to positive impressions. In order to formally test this hypothesis, the Concerns of Social Reprisal Scale (CSRS) was developed. The purpose of the present series of studies was to examine the psychometric profile of the CSRS across several independent samples including: a large (n=981) undergraduate sample; a clinical sample of individuals diagnosed with social anxiety disorder (n=27), and a demographically-matched subsample of healthy control participants (n=24). The factorial validity, internal consistency, and construct validity of the CSRS were examined. Results across both studies provided support for the psychometric profile of the CSRS. The implications of concerns of social reprisal for the assessment of social anxiety symptoms, theoretical models of fear of evaluation and SAD, and their potential clinical utility with regard to treating SAD are discussed.

Psychometric properties of the gaze anxiety rating scale: convergent, discriminant, and factorial validity.

Fear and avoidance of gaze are two features thought to be associated with problematic social anxiety. Avoidance of eye contact has been linked with such undesirable traits as deceptiveness, insincerity, and lower self-esteem. The Gaze Anxiety Rating Scale (GARS) is a self-report measure designed to assess gaze anxiety and avoidance, but its psychometric properties have only been assessed in one preliminary study. We further investigated psychometric properties of the GARS by assessing convergent and factorial validity. We obtained a two-factor solution: gaze anxiety and avoidance across situations (1) in general (GARS-General) and (2) related to dominance communication (GARS-Dominance). The GARS-General factor related more strongly to social anxiety than the GARS-Dominance, and convergent validity of the factors was supported by expected relationships with personality and social anxiety variables. Our results indicate that the GARS subscales are psychometrically valid measures of gaze aversion, supporting their use in future study of the relationship between social anxiety and eye contact behavior.

The vulnerability of self-reported disability measures to malingering: a simulated ADHD study

Abstract Objective: Making diagnostic and accommodation decisions for potential Attention-Deficit/Hyperactivity Disorder (ADHD) in adults is difficult, as the assessor often relies more on self-reported symptoms and functional disability than in childhood evaluations. Malingering of ADHD occurs frequently in the educational setting and for a variety of reasons, including the potential benefits of access to stimulant medications and academic accommodations. Method: The present study utilized a simulation design to examine the potential for malingering of self-reported functional disability on the World Health Organization Disability Schedule 2.0 (WHODAS). Participants were 167 students from two Midwestern universities. Thirty-six self-reported a previous diagnosis of ADHD, and the remaining 131 students were randomly assigned to one of three conditions: best effort, malingering for the purpose of receiving stimulant medication, or malingering for the purpose of receiving extra time accommodations. Results: Individuals in both malingering groups reported higher levels of disability on all domains of the WHODAS compared to healthy controls and individuals with ADHD. There were no significant differences between malingering groups. Conclusions: Results suggest the WHODAS is susceptible to non-credible responses and should not be relied upon solely as a measure of disability in the context of ADHD evaluations.

The structure of vulnerabilities for social anxiety disorder

Social anxiety disorder symptoms are generally proposed to be related to broad temperamental vulnerabilities (e.g., a low level of approach and high level of avoidance temperament), specific psychological vulnerabilities (e.g., fears of negative and positive evaluation), and additional disorders (e.g., major depressive disorder). However, existing tests of such a model have either not considered depressive symptoms or relied on samples of undergraduates. We examined these and related questions via a latent variable model in a large dataset (N=2253) that combined participants across a variety of studies. The model had adequate fit in the whole sample, and good fit in a subsample in which more participants completed the depression measure. The model indicated that low level of approach and high level of avoidance temperament contributed to fears of evaluation and social anxiety symptoms, and that fears of evaluation additionally contributed independently to social anxiety symptoms. The relationship between social anxiety and depressive symptoms was entirely accounted for by these vulnerabilities: Depressive symptoms were only predicted by avoidance temperament.

Malingered Attention Deficit/Hyperactivity Disorder on the Conners’ Adult ADHD Rating Scales: Do Reasons for Malingering Matter?:

Malingering is a significant assessment concern in adults undergoing evaluations for attention deficit/hyperactivity disorder (ADHD) and may occur for a number of reasons, including access to medication and/or accommodations. Therefore, it is important to investigate ways to determine accuracy of self-reported ADHD symptoms. The present study used a simulation design to examine the impact of reasons for malingering on the Conners’ Adult ADHD Rating Scales (CAARS) Symptom subscales and the CAARS infrequency index (CII). Participants (N = 157) were randomly assigned to one of three conditions: best effort, malingering for stimulant medication, or malingering for extra time accommodations. The three groups were compared with 34 individuals reporting previous diagnosis of ADHD. Results showed that individuals in both malingering groups scored higher than controls on all CAARS subscales and CII. Individuals in the medication malingering group, but not the extra time malingering group, scored higher than the ADHD group on CII and several CAARS subscales whose content overtly reflects ADHD symptomatology. Findings emphasize the influence of malingering on self-reported ADHD symptoms and the need to assess for malingering in ADHD evaluation. Results also suggest that reason for malingering might differentially affect self-report of ADHD symptoms.