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)
Project #
Application #
Study Section
Special Emphasis Panel (ZRG1-F11-L (20))
Program Officer
Rubio, Mercedes
Project Start
Project End
Budget Start
Budget End
Support Year
Fiscal Year
Total Cost
Indirect Cost
Washington University
Schools of Arts and Sciences
Saint Louis
United States
Zip Code
Levinson, Cheri A; Rodebaugh, Thomas L (2016) Clarifying the prospective relationships between social anxiety and eating disorder symptoms and underlying vulnerabilities. Appetite 107:38-46
Sala, Margarita; Levinson, Cheri A (2016) The longitudinal relationship between worry and disordered eating: Is worry a precursor or consequence of disordered eating? Eat Behav 23:28-32
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; Byrne, Meghan (2015) The fear of food measure: a novel measure for use in exposure therapy for eating disorders. Int J Eat Disord 48:271-83
Levinson, Cheri A; Rodebaugh, Thomas L; Fewell, Laura et al. (2015) D-Cycloserine facilitation of exposure therapy improves weight regain in patients with anorexia nervosa: a pilot randomized controlled trial. J Clin Psychiatry 76:e787-93
Levinson, Cheri A; Rodebaugh, Thomas L (2015) Negative Social Evaluative Fears Produce Social Anxiety, Food Intake, and Body Dissatisfaction: Evidence of Similar Mechanisms through Different Pathways. Clin Psychol Sci 3:744-757
Harpole, Jared K; Levinson, Cheri A; Woods, Carol M et al. (2015) Assessing the Straightforwardly-Worded Brief Fear of Negative Evaluation Scale for Differential Item Functioning Across Gender and Ethnicity. J Psychopathol Behav Assess 37:306-317
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
Menatti, Andrew R; Weeks, Justin W; Levinson, Cheri A et al. (2013) Exploring the Relationship Between Social Anxiety and Bulimic Symptoms: Mediational Effects of Perfectionism Among Females. Cognit Ther Res 37:914-922
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

Showing the most recent 10 out of 16 publications