Social anxiety disorder (SAD) and eating disorders (EDs) are common and debilitating disorders that are highly comorbid[7-14]. Conceptualizations of comorbidity suggest that there may be underlying genetic and environmental vulnerabilities that create risk for multiple disorders[1-4]. Research on the shared vulnerabilities of SAD and EDs suggest that fear of negative evaluation may be a common underlying risk factor[29-31]. However, relatively little is known about the development of fear of negative evaluation into SAD and EDs and the underlying genetic vulnerabilities common to both disorders. Thus, the aims of this proposal are to examine the shared environmental and genetic vulnerabilities of these disorders and to develop a new model in which fear of negative evaluation and fear of negative evaluation of one?s appearance, or social appearance anxiety, contribute to both SAD and EDs. The current project proposes three studies to address these aims. In Study 1 we will test for shared genetic risk between SAD and EDs using an archival data set of twin pairs. In Study 2 the contribution of fear of negative evaluation and social appearance anxiety on social anxiety and disordered eating will be tested longitudinally over six months using measures of social anxiety and disordered eating with strong psychometric properties. In Study 3 fear of negative evaluation and social appearance anxiety will be experimentally primed using a modified speech task. Eating behaviors, state social anxiety, and galvanic skin response will be measured as dependent outcomes. This experiment will test whether an environmental trigger of fear of negative evaluation and social appearance anxiety cause eating and social anxiety outcomes. The integration of these studies will provide the skills for future research that tests a model of vulnerability spanning from genes to self-report of traits and behavior. Results from these studies and from future potential research may lead to the creation of treatments that address genetic and environmental vulnerabilities of both SAD and EDs in the same treatment protocol.

Public Health Relevance

Social anxiety disorder (SAD) and eating disorders (EDs) are severe public health problems that frequently co-occur within individuals: However, there has been little research examining the shared risk factors for both disorders. This project will examine fears of negative social evaluation as a link between SAD and EDs and will also test for shared genetic risk. This research may lead to novel treatment development that targets multiple disorders in one treatment protocol.

National Institute of Health (NIH)
National Institute of Mental Health (NIMH)
Predoctoral Individual National Research Service Award (F31)
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Special Emphasis Panel (ZRG1-F11-L (20))
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Rubio, Mercedes
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Washington University
Schools of Arts and Sciences
Saint Louis
United States
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Levinson, Cheri A; Rodebaugh, Thomas L; Shumaker, Erik A et al. (2015) Perception matters for clinical perfectionism and social anxiety. J Anxiety Disord 29:61-71
Levinson, Cheri A; Rapp, John; Riley, Elizabeth N (2014) Addressing the fear of fat: extending imaginal exposure therapy for anxiety disorders to anorexia nervosa. Eat Weight Disord 19:521-4
Levinson, Cheri A; Langer, Julia K; Rodebaugh, Thomas L (2013) Reactivity to exclusion prospectively predicts social anxiety symptoms in young adults. Behav Ther 44:470-8
Rodebaugh, Thomas L; Shumaker, Erik A; Levinson, Cheri A et al. (2013) Interpersonal constraint conferred by generalized social anxiety disorder is evident on a behavioral economics task. J Abnorm Psychol 122:39-44
Rodebaugh, Thomas L; Levinson, Cheri A; Lenze, Eric J (2013) A high-throughput clinical assay for testing drug facilitation of exposure therapy. Depress Anxiety 30:631-7
Levinson, Cheri A; Rodebaugh, Thomas L; Menatti, Andrew R et al. (2013) Validation of the Social Exercise and Anxiety Measure (SEAM): Assessing fears, avoidance, and importance of social exercise. J Psychopathol Behav Assess 35:
Levinson, Cheri A; Rodebaugh, Thomas L; White, Emily K et al. (2013) Social appearance anxiety, perfectionism, and fear of negative evaluation: distinct or shared risk factors for social anxiety and eating disorders? Appetite 67:125-33
Levinson, Cheri A; Rodebaugh, Thomas L (2012) Social anxiety and eating disorder comorbidity: the role of negative social evaluation fears. Eat Behav 13:27-35