Silence is Golden?

Silence is Golden?

                                               

By Ken J. Rotenberg1 and Pamela Qualter2

By the age of 20, 15% of women have an eating disorder including anorexia nervosa (.08%), bulimia nervosa (2.6%), and binge eating disorder (3.0%) (Stice, Marti, & Rohde, 2013). The prevalence of eating disorders in men is considerably less (about 50% less).

Anorexia nervosa involves the successful pursuit of weight loss to achieve a body mass index less than 85% of the median expected for age and gender. Individuals with this disorder engage in a severe and selective restriction of food intake and they refuse to eat what they view as fattening foods. Anorexia nervosa is associated with depression, irritability, impaired concentration, loss of sexual appetite and obsessive behavior (Fairburn & Harrison, 2003).

Bulimia nervosa entails attempts to restrict food intake, but this is punctuated by repeated binges. Binges are episodes in which individuals experience a loss of control and consume a large among of food. During these binges individuals experience intense distress, including shame. Some individuals with bulimia nervosa purge themselves from their overconsumption of food by vomiting and using laxatives (Fairburn & Harrison, 2003). Research shows that, compared to the public at large, these people with those eating disorders show greater social impairment (e.g., poor family relationships, poor work performance), psychological problems (e.g., depression, loneliness), suicidal tendencies, and mental health problems/ treatment (see Spoor et al., 2007).

It is disheartening to report, though, that there is evidence that people with eating disorders suffer in silence. Researchers have found that people with eating disorders (1) hold low trust beliefs in others (Rotenberg, Bharathi, Davies, & Finch, 2013), (2) show an unwillingness to disclose personal information to others notably about eating (e.g., Basile, 2004), and (3) show elevated loneliness (e.g., Coric & Murstein, 1993). These patterns are presumably part of the shame people with eating disorders experience regarding their eating behavior (see Swan, & Andrews, 2003). We refer to this as the social withdrawal syndrome and we believe that it places those with eating disorders at risk for social, mental, and physical health problems.

We have found that bulimia nervosa (as indexed by bulimia symptoms) is linked to the social withdrawal syndrome, and notably to low trust beliefs. In one study, we (Rotenberg et al., 2013) tested 137 young adults and found that bulimic symptoms were associated with low trust beliefs in close others (mother, father, and friends), an unwillingness to disclose personal information to them, and high loneliness. Furthermore, we fund there were close links between these variables. This supports the conclusion that low trust beliefs in close others are associated with an unwillingness to disclose personal information to close others, which promotes loneliness and bulimic symptoms. In a follow-up study we (Rotenberg & Sangha, 2014) tested a group of 101 early adolescents (11 to 12 years of age) across a 5-month period. We found that the adolescents’ low trust beliefs in close others (mother, father, and friend) predicted an increase in their bulimic symptoms over time and that the relation was due, in part, to the relation between low trust beliefs in close others and loneliness. The findings support the hypothesis that having bulimia nervosa is attributable, in part, to a person holding low trust beliefs and a resulting unwillingness to disclose to others and experiences of loneliness.

Are there health problems of being lonely? Human beings are social animals and experience pain and distress when they are separated from others (Baumeister & Leary, 1995). They have an inherent need to belong to social groups and therefore need human contact and close relationships. When those needs are not met --- and people experience loneliness --- they show mental health difficulties and physical health problems including increased mortality (see Hawkley, & Cacioppo, 2010; Qualter et al., 2013). Because those with eating disorders experience loneliness, as part of the social withdrawal syndrome, they are disposed to those problems. Our research directly shows that loneliness contributes to eating problems (Rotenberg & Flood, 1999). In our study, we increased the extent to which participants felt loneliness by asking them to imagine being in situations that lead to that mood. Some participants were not exposed to that mood inducing instruction. Afterwards, the participants had the opportunity to consume food (cookies) as part of a taste test. We found that dieters consumed more food when they had experienced loneliness as compared to dieters who had not. The findings show that experiencing loneliness caused a form of binge eating in persons who normally restrain their food consumption (i.e., dieters). We have proposed that loneliness contributes to bulimia nervosa in particular because it causes individuals to experience a loss of control over their eating behavior (Rotenberg et al., 2005) and that this intensifies the food binges which are part of the disorder (Rotenberg & Flood, 1999).

Does the social withdrawal syndrome pose a problem for those with eating disorders? As noted, the loneliness experienced by those with eating disorders predisposes them to a wide range of social and health problems. We have proposed that the social withdrawal syndrome, specifically the unwillingness to disclose personal information to others, results in the tendency for them not to seek out psychological and medical treatment. Accordingly, those with eating disorders are unlikely to tell other people such as close others and doctors about their eating problems – as well as the accompanying social and health problems -- and therefore do not receive the treatment they require (Rotenberg et al., 2013). If you do have an eating problem then we strongly encourage you to overcome the social withdrawal syndrome and seek out help. Please do not suffer in silence.

Affiliations and Acknowledgment

1 Professor Ken J. Rotenberg, School of Psychology, Keele University, Keele, Newcastle -Under-Lyme, Staffordshire, UK, ST5 5BH, e-mail: k.j.rotenberg@keele.ac.uk

2 Dr. Pamela Qualter, Reader in Developmental Psychology, School of Psychology, University of Central Lancashire, Preston, UK, PR1 2HE, email: PQualter@uclan.ac.uk

The authors thank Professor James Hartley (Keele University) for his assistance in writing this blog.

References

Basile, B. (2004). Self-disclosure in eating disorders. Eating and Weight Disorders, 9, 217-232.

Baumeister, R. F. & Leary, M. R. (1995). The need to belong: Desire for interpersonal attachments as a fundamental human motivation. Psychological Bulletin, 117, 497-529.

Evans, L. & Wertheim, E. H. (2002). An examination of willingness to self-disclose in women with bulimic symptoms considering the context of disclosure and negative affect levels. International Journal of Eating Disorders, 31, 344-8.

Fairburn, C. G & Harrison, P. J. (2003). Eating disorders. Lancet, 361, 407-417.

Hawkley, L. C. & Cacioppo, J. T. (2010). Loneliness matters: A theoretical and empirical review of consequences and mechanisms, Annals of Behavioral Medicine, 40, 218-227.

Qualter, P., Brown, S. L., Rotenberg, K. J. Vanhalst, J., Harris, R. A., Goossens, L., Bangee, M., &

Munn, P. (2013). Trajectories of loneliness during childhood and adolescence: Predictors and health outcomes. Journal of Adolescence, 36, 1283-1293

Rotenberg, K. J., Bharathi, C., Davies, H., & Finch, T. (2013). Bulimic symptoms and the social withdrawal syndrome. Eating Behaviors, 14, 281-284.

Rotenberg, K. J., & Flood, D. (1999). Loneliness, dysphoria, dietary restraint and eating behavior. International Journal of Eating Disorders, 25, 55-64.

Rotenberg, K. J., Lancaster, C., Marsden, J., Pryce, S., Williams, J., & Lattimore, P. (2005). The effects of priming control cognitions on anxiety and food intake. Appetite, 44, 235-241.

Rotenberg, K. J. & Sangha, R (2014, paper in preparation). Bulimic symptoms and social withdrawalduring early adolescence.

Stice, E., Marti, N., & Rohde, P. (2013). Prevalence, incidence, impairment, and course of the proposed DSM-5 eating disorder diagnoses in an 8-year prospective community study of young women. Journal of Abnormal Psychology, 122, 445-457.

Swan, S., & Andrews, B. (2003). The relationship between shame, eating disorders and disclosure in treatment. British Journal of Clinical Psychology, 42, 367-378.

Spoor, S. T. P. Stice, E., Burton, E., Bohon, C. (2007). Relations of bulimic symptom frequency and intensity to psychosocial impairment and health care utilization: Results from a community-recruited sample. International Journal of Eating Disorders, 40, 505-514.

About the Authors

Ken Rotenberg, Ph.D.

Ken Rotenberg, Ph.D., is a professor of psychology at Keele University in the UK. He researches trust, loneliness, and other areas.

Pamela Qualter, Ph.D.

Pamela Qualter, Ph.D., is a Reader in Developmental Psychology, School of Psychology, at the University of Central Lancashire in the UK.

Lucy Betts, Ph.D.

Lucy Betts, Ph.D., is a Senior Lecturer in the Division of Psychology, Nottingham Trent University in the UK.

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