Social anxiety and phobia in anorexia nervosa: a case-control study

Social anxiety and isolation are often observed among anorexic patients. However, their relationship with this pathology has rarely been investigated. Forty patients suffering from anorexia nervosa (DSM-IV) were compared with thirty-two student controls in social anxiety and phobia (Social Avoidance and Distress Scale), depression (Beck Depression Inventory) and eating symptomatology (Eating Attitudes Test and Eating Disorder Inventory). Furthermore, anorexic patients were divided post-hoc into high socially anxious (HSA) and low socially anxious (LSA). Psychological traits of both subgroups were also compared. Anorexic patients showed significantly more social phobia and anxiety than control subjects (53% vs. 9% of the cases). In addition, HSA and LSA subgroups within anorexic patients were best differentiated by Ineffectiveness, Interpersonal Distrust, Interoceptive Awareness and Drive for thinness subscales on the Eating Disorders Inventory (EDI) (p< 0.001), and by depression (p< 0.001). Moreover, social anxiety and phobia correlated positively with depression (r= 0.62, p< 0.001). Our results suggest that patients with Anorexia nervosa, and especially those with HSA, present not only a higher severity in the disorder, but also lower self-esteem and greater depressive symptomatology.