Body Image 14 (2015) 20–28 Contents lists available at ScienceDirect Body Image journa l h om epa ge: www.elsevier.com/locate/bodyimage Social anxiety and associations with eating psychopathology: Mediating effects of fears of evaluation Andrew R. Menatti a , Lindsey B. Hopkins DeBoer b , Justin W. Weeks a,∗ , Richard G. Heimberg c a Center for Evaluation and Treatment of Anxiety, Ohio University, Athens, OH, United States b San Francisco VA Medical Center, San Francisco, CA, United States c Temple University, Philadelphia, PA, United States a r t i c l e i n f o Article history: Received 12 June 2014 Received in revised form 18 February 2015 Accepted 19 February 2015 Keywords: Social anxiety Eating disorders Fear of negative evaluation Fear of positive evaluation Social-evaluative concerns Body image a b s t r a c t 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 inde- pendently account for the relationship between social anxiety symptoms and eating pathology among college females. Results were partially supportive of hypotheses. Fear of negative evaluation indepen- dently 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. © 2015 Elsevier Ltd. All rights reserved. Introduction The high correlation between social anxiety disorder (SAD) and various forms of eating pathology has been well documented (e.g., Hudson, Hiripi, Pope, & Kessler, 2007; Silgado, Timpano, Buckner, & Schmidt, 2010; Swinbourne & Touyz, 2007). Many studies examin- ing the comorbidity of SAD and eating disorders (EDs) have found that SAD tends to precede EDs in age of onset, leading researchers to suspect that SAD may serve as a risk factor for the later develop- ment of EDs (Brewerton et al., 1995; Bulik, Sullivan, Fear, & Joyce, 1997). Consistent with this notion, SAD tends to be highly overrep- resented in ED populations (Kaye et al., 2004). There is a need for an increased understanding of the overlap between social anxiety and eating pathology, particularly in clinical settings, as false negative detection rates for EDs may be as high as 80% in clinics specializing in treatment of anxiety disorders (Becker, DeViva, & Zayfert, 2004). A growing body of research has attempted to identify cog- nitive and behavioral explanatory mechanisms that account for this relationship (Hinrichsen, Wright, Waller, & Meyer, 2003). SAD ∗ Corresponding author at: 200 Porter Hall, Athens, OH, United States. Tel.: +1 740 597 3299. E-mail address: weeksj@ohio.edu (J.W. Weeks). may be a particularly relevant risk factor for EDs due to overlap in reported concerns, such as a desire to ‘fit in’ or to avoid the loss of social resources (i.e., mates, allies, etc.; P. Gilbert, 2001). Individuals with social anxiety, especially females, may be more likely to ascribe to social constructions such as the ‘thin ideal’ if they believe it will protect them from negative social outcomes (Utschig, Presnell, Madeley, & Smits, 2010). A number of studies have reported that fear of negative evaluation (FNE) may increase vulnerability to psychological symptoms beyond social anxiety, and FNE specific to body-image or eating concerns may, in part, account for the link between social anxiety and eating pathology (Bulik, Beidel, Duchmann, Weltzin, & Kaye, 1991; N. Gilbert & Meyer, 2003, 2005). Utschig et al. (2010) reported that FNE, a core component of SAD (Heimberg, Brozovich, & Rapee, 2014), was uniquely associ- ated with bulimic pathology over and above risk factors included in the widely-cited dual-pathway etiological model proposed by Stice and Agras (1998). The dual-pathway model posits that inter- nalization of the thin ideal and perceived societal pressures to be thin lead to body dissatisfaction which, in turn, leads to both nega- tive affect and problematic dieting behaviors, which together result in problematic eating behaviors. Utschig et al. (2010) reported that FNE was positively related to many elements in the dual-pathway model, including pressure to be thin, internalization of the thin ideal, and negative affect. This pattern suggests that there may be http://dx.doi.org/10.1016/j.bodyim.2015.02.003 1740-1445/© 2015 Elsevier Ltd. All rights reserved.