Download Rank, depression and eating disorder symptoms

Social rank and eating pathology 1
Pre-publication version
The specificity of social rank in eating disorder versus
depressive symptoms
Nicholas A. Troop1 & Anna H. Baker2
1
School of Psychology, University of Hertfordshire, Hertfordshire, UK
2
Department of Psychology, London Metropolitan University, London, UK
Address for correspondence:
Dr Nicholas A. Troop, School of Psychology, University of Hertfordshire,
Hatfield, Hertfordshire, AL10 9AB, United Kingdom
[email. [email protected]]
Acknowledgement:
We would like to thank Jackie Bretton for her assistance with data collection.
Keywords:
Social rank, eating disorders, evolution, depression
Social rank and eating pathology 2
The specificity of social rank in eating disorder versus
depressive symptoms
Abstract
It has been proposed that an evolutionary approach to understanding rank
and social status may contribute to our understanding of eating disorder
symptoms. The present study sought to explore the degree to which rank
might be related to eating pathology independently of its known association
with depression. A non-clinical sample of 74 women completed rank-relevant
measures of social defeat, entrapment, submissive behavior and social
comparison as well as measures of depressive and eating disorder
symptoms. Independently of other symptoms, submissive behavior and an
unfavorable social comparison predicted eating pathology while social defeat
and internal entrapment predicted depressive symptoms. There appears to be
a specific role for social rank in relation to eating pathology. However, further
research is required to determine precisely what this role is and the degree to
which it relates to risk or recovery.
Social rank and eating pathology 3
Introduction
Socio-cultural theories have played a central role in trying to understand the
etiology and phenomenology of eating disorders in recent years, for example
in terms of comparison with others and the acceptance of an externally
imposed ideal body shape (e.g. Stice, 1994; Rodin, Striegel-Moore &
Silberstein, 1992) or women’s diminished position in society (Nasser &
Katzman, 2003; Nasser, Katzman & Gordon, 2001). More recently, however,
such constructs have begun to be considered in terms of a theory of social
rank (Troop & Connan, 2003), thus placing the development of eating
disorders in an evolutionary framework. Such a conceptualisation also seeks
to explain why we make social comparisons in the first place, not simply to
document what effect such comparisons have on our behavior.
Humans have evolved as a social species as a solution to threats and
challenges to our survival and reproduction, for example to facilitate goals
such as access to limited resources, attracting mates and the formation of
alliances (Gilbert, 1992, 1995). The co-ordination of such group living is
proposed to be achieved through social ranking where the goals of low rank
group members are subordinate to those of high rank group members in order
to achieve self-preservation (by avoiding conflict and attack) and group
cohesion (Gilbert, 1997). The downside to ranking, however, is that in some
contexts they can become maladaptive and may be at the root of
psychopathology (Stevens & Price, 2000). For example, low social rank can
become the source of depression or shame for those individuals whose
perceived subordination is both involuntary and inescapable (Gilbert, 2006).
Social rank and eating pathology 4
Thus, low social rank can be conceived as a range of interconnected
perceptions, feelings, behaviors and situations including the perception that
one is of low social rank (unfavorable social comparison), that one has been
put down by a dominant other (social defeat), that one is unable to escape an
uncontrollable set of circumstances (entrapment) and the giving up of
competing with others, including the signalling of one’s intention to avoid
conflict (submissive behavior) (Allan & Gilbert, 1995, 1997; Gilbert & Allan,
1998).
Traditionally viewed as the outcome following an experience of a severe loss
event, Brown, Harris and Hepworth (1995) have shown that, apart from losses
involving bereavement, only those loss events that include an element of
humiliation or entrapment are associated with the onset of depressive illness.
Gilbert & Allan (1998) have also shown that variables associated with social
rank are more strongly related to symptoms of depression than are variables
based on other theories of depression such as hopelessness. Since then,
research has extended this application of social rank into social anxiety
(Gilbert, 2000), auditory hallucinations in schizophrenia (Birchwood, Meaden,
Trower, Gilbert & Plaistow, 2000) and, more recently, eating disorders.
Troop, Allan, Treasure and Katzman (2003) showed that eating disorder
patients had a more unfavorable social comparison and reported more
submissive behaviors than age-matched student controls. Furthermore, in the
patient sample, the relationship between scores of the Eating Disorders
Inventory (Garner, Olmsted & Polivy, 1983) and levels of submissive behavior
Social rank and eating pathology 5
and unfavorable social comparison were independent of levels of depression.
More recently, Connan, Troop, Landau, Campbell and Treasure (2007)
replicated these results in patients with anorexia nervosa, finding that women
who were currently ill and those who had recovered reported more submissive
behaviors and a more unfavorable social comparison relative to non-eating
disordered women. Interestingly, low social rank also perfectly mediated the
association between childhood interpersonal adversity and a history of
anorexia nervosa.
Studies exploring social rank and eating pathology in female student samples
also report significant associations. For example, Bellew, Gilbert, Mills,
McEwan and Gale (2006) found that unfavorable social comparison and an
insecure striving to avoid inferiority were related to eating attitudes. The above
studies have explored the link between social rank and inferiority and eating
pathology in a broad sense. Another study by Faer, Hendriks, Abed and
Figueredo (2005), however, tested Abed’s (1998) sexual competition
hypothesis and found that competing with other females for mates was related
to both anorexic and bulimic symptoms (mediated by body dissatisfaction and
drive for thinness) while competing with other females for status was related
to anorexic symptoms (mediated by perfectionism).
Troop and Connan (2003) summarise a range of other findings that are also
associated with (and therefore consistent with) a ranking approach to
understanding eating disorders such as low self-esteem, helplessness,
teasing and rank-relevant emotions such as shame and jealousy.
Social rank and eating pathology 6
While there is some consistency emerging in the relationship between some
ranking variables and eating pathology, there is an issue concerning the
breadth of rank-related constructs that have been measured which, to date,
have been somewhat limited in eating disorder research. Since the
development of measures of submissive behavior (Allan & Gilbert, 1997) and
unfavorable social comparison (Allan & Gilbert, 1995), these authors have
further explored this broad construct of social rank and describe the
development of measures of entrapment (both internally and externally
imposed) and social defeat (Gilbert & Allan, 1998). With the development of
all of these measures, these authors’ perspective is primarily one of
identifying the links between social rank and depression. Nevertheless, given
the observed links between social rank and eating behavior in humans and
animals (Troop & Connan, 2003), further exploration of this construct in
relation to eating disorder symptoms is warranted.
The present study, therefore, aims to explore the broader range of rankrelated constructs in relation to eating pathology to identify more precisely the
nature of this link. Secondly, this study will also determine whether any such
relationship with eating pathology exists independently of a shared
association with symptoms of depression.
Social rank and eating pathology 7
Method
Participants
Participants were 74 women (response rate 74%) drawn from white-collar
office personnel working in a large company in London, U.K. The sample had
a mean age of 24.6 (s.d. 7.6) and a mean body mass index (BMI) of
22.3kg/m2 (s.d. 3.9).
Measures
The Social Comparison Rating Scale (SCRS: Allan & Gilbert, 1995) is an
11-item scale in which respondents rate their perceptions of self in relation to
others on 10-point scales, anchored at either end by descriptors such as
unattractive-attractive, weak-strong etc. Scores of around 60 would indicate
that the respondent perceived herself as no better or worse than anyone else.
The Submissive Behaviour Scale (SBS: Allan & Gilbert, 1997) is a 16-item
questionnaire in which respondents rate a series of statements referring to
behaviors such as avoiding eye contact with others or walking out of a shop,
knowing one had been short-changed but without challenging the
shopkeeper.
The Social Defeat Scale (SDS: Gilbert & Allan, 1998) measures the sense of
failed struggle and losing rank. Sample items include “I feel that I have not
made it in life” and “I feel that there is no fight left in me”.
Social rank and eating pathology 8
The Internal-External Entrapment Scale (IEE: Gilbert & Allan, 1998)
measures the perception of things in the outside world (external entrapment:
IEE-EXT) or internal feelings and thoughts (internal entrapment: IEE-INT) that
induce escape motivation but where such escape is blocked. Sample items
include “I am in a situation I feel trapped in” (external entrapment) and “I feel
powerless to escape myself” (internal entrapment).
The Beck Depression Inventory-II (BDI-II: Beck, Steer & Brown, 1996) is a
modification of the original BDI-IA (Beck & Steer, 1987) with changes to some
items that bring it more into line with the DSM-IV (APA, 1994).
The Eating Disorders Examination-Questionnaire (EDE-Q: Fairburn &
Beglin, 1994) is the questionnaire version of a semi-structured interview
designed to diagnose eating disorders according to DSM-IV (APA, 1994). The
questionnaire includes sub-scales for restraint, eating concern, weight
concern and shape concern as well as a number of diagnostic items. For the
purposes of the present report only the total EDE-Q score (the sum of the four
sub-scales) will be used.
For the SBS, SDS, IEE, BDI-II and EDE-Q, higher scores indicate more of the
construct. For the SCRS, a bi-directional measure, scores above 60 indicate a
favorable social comparison while those below 60 indicate an unfavorable
social comparison. Internal reliability of all measures was high (see Table 1).
Social rank and eating pathology 9
Procedure
Questionnaires were distributed through a senior manager at a large business
in London. Female office staff were invited to participate in a study on social
influences on mood and eating. They were assured that their completed
questionnaires would be passed directly to the researcher, that the research
was not related to their work and that senior management would not see their
questionnaires or receive individual feedback on them.
Results
Sample characteristics
Sample characteristics are presented in Table 1. The mean scores on ranking
variables are broadly similar to those in other non-clinical samples. EDE-Q
scores are also in the expected non-clinical range although scores on the
BDI-II are slightly higher than expected with the mean falling slightly above
the cut-off for non-depressed and into mildly depressed.
Table 1. about here
Rank, depression and eating disorder symptoms
All five ranking variables are significantly correlated with both the BDI-II and
the EDE-Q scores (Table 2). However, BDI-II and EDE-Q scores are
themselves significantly correlated (r = .62, p < .001) and so partial
correlations were carried out (Table 2). These show that all five ranking
variables are still significantly correlated with BDI-II scores but that only
scores on the SCRS, SBS and IEE-EXT are significantly correlated with the
EDE-Q once BDI-II scores have been partialled out.
Social rank and eating pathology 10
Table 2. about here
In order to determine the independent contribution of these variables to BDI-II
and EDE-Q scores, regression analyses were carried out. However, given the
high inter-correlations between variables, multi-collinearity was a potential
problem and collinearity diagnostics indicated factors with Eigen-values
approaching zero and condition indices exceeding 15. This was resolved by
entering standardised variables into the equation (yielding condition indices
below 5 for both sets of regression analysis) and the results are presented in
Table 3.
Table 3. about here
Even after controlling for EDE-Q scores in Step 2, the variables SDS and IEEINT made a significant and independent contribution to BDI-II scores with the
ranking variables accounting for approximately 71% of the variance.
Conversely, even after controlling for BDI-II scores in Step 2, the variables
SCRS, SBS and IEE-EXT (at p = .057) made a significant and independent
contribution to EDE-Q scores with these variables accounting for
approximately 44% of the variance.
Discussion
The present study aimed to determine the degree to which rank-related
variables were associated with eating pathology independently of depressive
symptoms.
Social rank and eating pathology 11
Not only were rank-related variables predictive of eating pathology
independently of depression, there emerged a degree of specificity in the way
that rank was related to depressive versus eating disorder symptoms. Social
defeat and perceived internal entrapment predicted depressive symptoms
while submissive behavior and unfavorable social comparison predicted
eating disorder symptoms. It may be that these differences reflect different
aspects of social rank, a loss of control over the social environment (defeat
and entrapment) versus a sense of inferiority (submissiveness and social
comparison) with the former being more closely linked to depression and the
latter to eating pathology. It may also be that these different aspects of social
rank have different causes and consequences. Clearly this is a matter for
further research.
The present study was cross-sectional and included a non-clinical sample of
adult women. Thus these results cannot claim to have identified a causal
relationship between social rank and eating disorders. Indeed, most of the
research on rank in eating pathology to date has been cross-sectional and so
no causal association can be proven (although this is also true of most of the
research on rank in depression and other pathological states). However,
Troop and Bifulco (2002) report on a retrospective interview study in which
there was some evidence that subjectively felt inferiority predated onset of an
eating disorder, at least in patients who went on to develop anorexia nervosa
of the binge-purge subtype. Nevertheless, there is clearly a need for further
longitudinal work to determine whether social rank plays a causal role in
eating pathology.
Social rank and eating pathology 12
On the other hand, a broad range of rank-related constructs was included
here and the results replicate, albeit in a non-clinical sample, those of Troop
et al. (2003) who found that submissive behavior and unfavorable social
comparison were related to eating pathology in a clinical one. While Troop et
al. (2003) justified their initial study by citing circumstantial evidence linking
rank and eating disorders the current study adds weight to this line of enquiry
and justifies further research into exactly how social rank is involved. For
example, subordinate status may be directly related to symptoms of anorexia
nervosa such as low weight through its effect on serotonin, the HPA axis and
appetite (see Troop & Connan, 2003). Alternatively there may be an indirect
relationship such as via personality features associated with eating disorders.
For example, subordinate status is related to higher levels of perfectionism,
particularly socially prescribed perfectionism in which attitudes are attributed
to others regarding the expectation of high standards in oneself (Wyatt &
Gilbert, 1998) and high levels of perfectionism and obsessional traits are
known to be associated with eating disorders both concurrently and as
childhood risk factors (Anderluh, Tchanturia, Rabe-Hesketh & Treasure,
2003). It is also possible that social rank plays a role in the life events and
difficulties known to trigger the onset of the majority of eating disorder cases
(e.g. Schmidt, Tiller, Andrews, Blanchard & Treasure).
Clearly there is further work to do to establish the possible role that social
rank may have in the etiology of eating pathology. Of clinical interest is also
whether there is a role for social rank in recovery from eating disorder
Social rank and eating pathology 13
symptoms and the degree to which it is necessary to address social status
explicitly in therapy. Nevertheless, the current study adds weight to this
literature by (a) replicating the results of earlier work, (b) identifying possible
specificity in which may be the key aspects of social rank in eating pathology
and (c) demonstrating a link between social rank and eating pathology that is
independent of any shared association with depression.
Social rank and eating pathology 14
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Social rank and eating pathology 18
Table 1. Demographic and sample characteristics
Mean
s.d.
N
Cronbach’s α
Age
24.6
7.6
74
-
BMI
22.3
3.9
71
-
BDI-II
11.1
10.3
74
.94
EDE-Q
2.0
1.4
74
.96
SCRS
68.0
14.9
74
.91
SBS
23.3
10.9
74
.90
IEE-INT
5.4
6.1
74
.92
IEE-EXT
7.2
8.0
74
.90
SDS
15.9
12.2
74
.96
BDI-II = Beck Depression Inventory, 2nd edition; BMI = body mass index;
EDE-Q = Eating Disorder Examination, Questionnaire version; SCRS = Social
Comparison Rating Scale; SBS = Submissive Behaviour Scale; IEE-INT =
Internal Entrapment; IEE-EXT = External Entrapment; SDS = Social Defeat
Scale.
Social rank and eating pathology 19
Table 2. Bivariate and partial correlations between depressive and eating
disorder symptoms and measures of social rank
Bivariate correlations
Partial correlations
BDI-II
EDE-Q
BDI-II1
EDE-Q2
Age
-.17
-.17
-.08
-.08
BMI
-.03
.20
-.19
.27*
SCRS
-.55***
-.50***
-.35**
-.24*
SBS
.58***
.52***
.39**
.24*
IEE-INT
.76***
.51***
.66***
.08
IEE-EXT
.64***
.56***
.44***
.27*
SDS
.81***
.54***
.71***
.09
BDI-II = Beck Depression Inventory, 2nd edition; EDE-Q = Eating Disorder
Examination, Questionnaire version; BMI = body mass index; SCRS = Social
Comparison Rating Scale; SBS = Submissive Behaviour Scale; IEE-INT =
Internal Entrapment; IEE-EXT = External Entrapment; SDS = Social Defeat
Scale.
* p < .05, ** p < .01, *** p < .001
1
2
Controlling for EDE-Q scores
Controlling for BDI-II scores
Social rank and eating pathology 20
Table 3. Regressing depressive and eating disorder symptoms onto social
rank variables
BDI-II
EDI-Q
Step 1
Step 2
Step 1
Step 2
SCRS
-.07
-.01
SCRS
-.28*
-.25*
SBS
.10
.04
SBS
.28*
.23*
IEE-INT
.31*
.34**
IEE-INT
-.13
-.26
IEE-EXT
-.04
-.09
IEE-EXT
.26
.28+
SDS
.49***
.46***
SDS
.14
.08
.23**
BDI-II
EDE-Q
.44**
ΔF-value
32.86***
7.45**
ΔF-value
10.54***
7.45**
Df
5, 68
1, 67
Df
5, 68
1, 67
ΔR2
.707
.029
ΔR2
.437
.056
R2
.707
.737
R2
.437
.493
BDI-II = Beck Depression Inventory, 2nd edition; EDE-Q = Eating Disorder
Examination, Questionnaire version; BMI = body mass index; SCRS = Social
Comparison Rating Scale; SBS = Submissive Behaviour Scale; IEE-INT =
Internal Entrapment; IEE-EXT = External Entrapment; SDS = Social Defeat
Scale.
* p < .05, ** p < .01, *** p < .001, + p < .06