Running Head: TERROR MANAGEMENT AND ANOREXIA 1. Terror Management and Anorexia Nervosa: Does Mortality Salience

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1 Running Head: TERROR MANAGEMENT AND ANOREXIA 1 Terror Management and Anorexia Nervosa: Does Mortality Salience Increase Negative Perceptions of Women With Anorexia Nervosa? M. Katherine Kubota Marietta College

2 Running Head: TERROR MANAGEMENT AND ANOREXIA 2 Abstract Research on terror management theory suggests that mortality salience (MS) leads people to reject out-group members. The present study investigated the influence of MS on perceptions of a target labeled with anorexia in contrast to a target labeled with diabetes using a 2 (mortality salience: high vs. control) x2 (diagnostic label: anorexia vs. diabetic) random block design. I expected to find a significant MS by diagnostic label interaction, hypothesizing that participants would give significantly lower opinion ratings to the anorexic target under the high MS condition than those in other conditions. Results showed no significant interaction. There was a significant main effect between diagnostic label and several opinion ratings. This finding supports previous research on the stigma of mental disorders.

3 Running Head: TERROR MANAGEMENT AND ANOREXIA 3 Terror Management and Anorexia Nervosa: Does Mortality Salience Increase Negative Perceptions of Women With Anorexia Nervosa? As primates, humans share many traits and behavioral characteristics with animals (Goldenberg, et al., 2001). However, a unique characteristic of humans appears to be an awareness of the inevitability of their own death. Terror management theory (TMT) (Greenberg, Pyszczynski, & Solomon, 1986) proposes that human awareness of death is at the root of a variety of social and cognitive behaviors. TMT theory states that in order to combat adverse feelings of anxiety over the awareness of one s mortality (i.e. mortality salience) a cognitive process is actuated that reaffirms one s socio-cultural world views. For example TMT researchers have found that priming individuals mortality salience leads individuals to embrace in-group members, reject out-group members, conform to cultural standards, shift to more favorable attitudes about their religion and seek out family members for support (Harmon-Jones, 1997). The shift to reaffirm ones socio-cultural world views is an attempt to deal with the anxiety of mortality salience. In essence, people seek the structure provided by society and culture, thus increasing their self-esteem and decreasing the uncomfortable thoughts associated with death (Greenberg, Pyszczynski, & Solomon, 1986). After decades of research on TMT, one of the most consistent findings has been that increasing mortality salience results in increased liking of in-group members and rejection of different out-group members, (Goldenberg et al, 2001). For example, Solomon, Greenberg and Pyszczynski (2000) found that Christian participants whose mortality salience was primed rated Christian targets more positively than Jewish targets. The same was not found to be true of participants in a control condition whose mortality

4 Running Head: TERROR MANAGEMENT AND ANOREXIA 4 salience was not primed. In the control condition participants evaluated both groups equally. In a second series of studies American participants whose mortality salience was primed were asked to rate pro- and anti-america essays which were said to be written by foreign students. The researchers found that the authors of pro-american essays were rated as more positive by participants in the mortality salience condition than those in the control condition. The same was true for negative ratings in the anti-american condition (Solomon, Greenberg, & Pyszczyski, 2000). Yet another Solomon, Greenberg, and Pyszczynski (2000) study asked participants to read essays that either supported or attacked their political views after being primed for mortality salience or a control condition. They were then asked in an allegedly unrelated study how much Tabasco sauce should be used in preparing a food dish for the author of the essay. As predicted, the participants in the mortality salience condition estimated a larger amount of Tabasco for the authors of the essays that attacked their political views, thus making the food uncomfortably spicy. These findings provide evidence that priming mortality salience may cause people to harm out-group members. Solomon, Greenberg and Pyszczyski (2000) conducted a study in which American municipal court judges were primed to experience mortality salience and asked to set bail for an alleged prostitute. Because prostitution is both illegal and generally thought to contradict American morals, it was found that judges in the mortality salience condition set a significantly higher bond for prostitutes than those defendants accused of crimes not related to prostitution. The judges who were exposed to the mortality salience activating stimulus assigned the alleged prostitute an average bail of $455 while the control group assigned her an average bail of $50 (Solomon, Greenberg, & Pyszczynski,

5 Running Head: TERROR MANAGEMENT AND ANOREXIA ). The desire to cause other physical harm has huge societal implications. Similar examples of mortality salience affecting social institutions have been explored in previous research. There is a significant body of research supporting the effects of mortality salience, yet there is still a need for additional research on how TMT can influence perceptions of specific out-groups especially when these out-groups may violate cultural views of what constitutes normal behavior. For example, anorexia nervosa is an eating disorder that causes an intense fear of gaining weight or of becoming obese, even if the patient is underweight. The hallmark of this disease is extreme weight loss which is accompanied by a distorted body image and possibly amenorrhea (Barlow & Durand, 2009). Stewart, Schiavo, Herzog and Franko (2008) report that of all psychiatric disorders, anorexia nervosa has the highest mortality rate, and they note that existing research indicates a stigma towards people with this disorder. A common myth surrounding anorexia nervosa is the belief that it is a choice; a behavior that a person with anorexia nervosa can control (Stewart, Schiavo, Herzog & Franko, 2008). The false assumption that anorexia nervosa is due to a lack of will power is not surprising given that Feldman and Crandall (2007) state the misperception of controllability plays a role in stereotypes and stigma of many mental disorders. Crisp, Gelder, Rix, Meltzer, and Rowlands, (2000) asked participants to rate how they felt about several mental disorders. The mental disorders that were thought to be the most controllable (i.e. alcoholism and drug addiction) elicited the most negative reactions from participants (Crisp, Gelder, Rix, Meltzer, & Rowlands, 2000). In 2006, Stewart, Keel, and Schiavo, conducted similar research that compared participants opinions of four

6 Running Head: TERROR MANAGEMENT AND ANOREXIA 6 target disorders and found that subjects attributed more negative traits to the target labels of anorexic than to those labeled healthy, schizophrenic, or asthmatic. Participants in Stewart s study also rated the anorexic target as significantly more able to pull themselves together, assigned more blame for their behavior, and viewed the anorexic target as more likely to be seeking attention with their behavior than any of the other conditions. This assignment of blame for one condition but not another, is a common bias, but is contrary to the social justice theory suggested by Adams (1963) which at its base asserts that people desire fairness and justice in their lives. Although prior research has shown that labeling a person as having anorexia results in a negative social stigma toward that person, no research has demonstrated if MS can significantly increase negative reactions to persons labeled as having anorexia. In other words, does MS increase rejection and stigma towards persons with anorexia? This question is important because acceptance and social support from others is important as it has been found to have a positive impact on longevity and decreasing physical and psychological illness (see Barlow & Durand, 2009). If the family members and friends of patients with anorexia are experiencing mortality salience it may cause them to be less accepting, less supportive and perhaps even rejecting of the patient which could in turn, have a negative impact on their treatment and recovery. The present study will investigate the influence of mortality salience on social perceptions of a female target labeled with anorexia nervosa in contrast to a female target labeled as having a physical illness (i.e. diabetes). Participants will be randomly assigned to a 2 (mortality salience: high vs. control) x 2 (diagnostic label: anorexia vs. diabetic) random block design. I expected to find a significant mortality salience by diagnosis

7 Running Head: TERROR MANAGEMENT AND ANOREXIA 7 interaction. Specifically I hypothesized that comparisons would show that participants would have significantly lower opinion ratings (i.e. more rejecting) of the anorexic target under the high mortality salience condition as compared to the other three conditions, which would not be significantly different from one another. Method Participants Seventy-two subjects (21 male and 51 female) were recruited out of introductory psychology and economics classes at a small private college. Participants received either partial research participation credit toward psychology course requirements or a small gift (i.e. pens) for their participation. Materials and Procedure Students arrived individually to the psychology lab room and completed an informed consent form, followed by a demographic questionnaire which included questions regarding gender, college major, and opinions about health practices, spiritual/religious beliefs and political affiliation. Participants were then randomly assigned receive one of two induction instruments. Using a common TMT induction, those in the high MS condition were asked to think about what would happen to their body and the emotions they would experience at the time of their death. Participants in the no MS control condition were asked to think about their emotions as they watched television (Harmon-Jones, 1997). A word search puzzle was given as a time delay, because it has been shown that MS takes a few minutes to take effect (Goldenberg, et al, 2001). Next an MS induction manipulation check was given to all participants via a word stem completion task. This consisted of a list of word stems, or words with one or more

8 Running Head: TERROR MANAGEMENT AND ANOREXIA 8 letters missing. The participants were asked to fill in to make real words for example, sk l could become skill, skull, or several other variations (see Gailliot, Schmeichel, & Baumeister, 2006). If the mortality salience induction technique has had an effect, the participants in this condition should create more death-related words than people in the control condition. So in the example above, if the participant was in the activated mortality salience condition they would be more likely to write skull than someone who is not experiencing mortality salience (see DeWall & Baumeister 2007). The existing research indicates that when people are more aware of death (for example, after they have seen a picture that reminds them of death) they tend to score higher on implicit, but not on explicit measures of death anxiety (Gailliot, Schmeichel, & Baumeister, 2006). All participants then read a vignette (disguised as an advertisement for a hospital) and viewed a photo of a young woman that labeled her as having either anorexia or diabetes. Next, the primary dependent measure was given as a self-report (Likert scale) questionnaire designed to measure participants social perceptions and attitudes toward the woman described in the vignette. Each item was assessed on a 7 point scale with higher ratings indicating greater agreement with that statement about the person in the photo. Questions included measures of sympathy, liking, ratings of attractiveness, intelligence, self-worth, health etc. Results As part of a manipulation check to assess the effectiveness of the mortality salience induction, a comparison was done between MS, high vs. control, and the number of death related words on the word stem completion task. The t-test revealed no

9 Running Head: TERROR MANAGEMENT AND ANOREXIA 9 significant difference in the death related words between the high MS condition and the control condition t(70)=-.128, p<.898, M=1.75 SD=.874 and M=1.78 SD=.959 This suggests the MS induction may not have been effective. A mortality salience and diagnostic label analysis of variance (ANOVA) was performed on opinion ratings for perceived trust, health, personal responsibility, rejection by others, intelligence and attractiveness. None of the expected interactions on any of the opinion ratings were found to be significant. However, there were several significant main effects for diagnostic label indicating that participants had more negative opinion ratings of the woman in the photo when she was labeled as anorexic than when she was labeled with diabetes. Participants rated the target labeled diabetic as healthier than the same target labeled anorexic, F(1,68)=8.60, p<.005, M=4.55, SD=1.12, versus M=3.74, SD=1.16. They also believed the diabetic target to be more trustworthy than the anorexic target, F(1,68)=10.50, p<.002, M=4.15, SD=3.33 versus M=3.18 SD=1.19. On the personal responsibility scale, the anorexic target was rated as more responsible for their condition, F(1,68)=25.33, p<.000, M=4.15, SD=1.58, as compared to the diabetic target, M=2.42, SD=1.25. The target with anorexia also received a higher rating on the rejection by others scale, F(1,68)=36.95, p<.000, M=4.33. SD=1.56, than the target with diabetes, M=2.33, SD=1.16, indicating that participants believed the anorexic target was more likely to be rejected by others. There were no significant main effects found for diagnostic label for ratings of attractiveness of the target, F(1,68)=1.81, p<.183, M=4.79, SD=.978 for the anorexic target vs. M=5.12,SD=1.05 for the diabetic target, or perceived intelligence F(1,68)=.32, p<.573, M=4.85, SD=1.20 for the anorexic target versus M=5.00, SD=1.09 for the diabetic target.

10 Running Head: TERROR MANAGEMENT AND ANOREXIA 10 After initial analyses were completed, correlation tests revealed several interesting findings. For example, liberal political views were correlated with more positive ratings on the item how likeable do you think she (the target in the photo) is? r(70)=-.248, p<.037. There was also a negative correlation found between personal responsibility and trust, indicating that the more personal responsibility participants believed the target to have, the less they trusted her, r(70)=-.323, p<.006. Another positive correlation that was also found was between target likeability and target friendliness, r(70)=.687, p<..000, trust, r(70)=.469, p<.000, competence, r(70)=.582, p<.000, and intelligence, r(70)=.497, p<.000. There were also positive correlations between personal responsibility and her ability to be healthy again, r(70)=.340, p<.003. Discussion The results of this study did not support the original hypothesis. The analysis suggests that there was no effect of the mortality salience induction as indicated by the manipulation check. This signifies that the mortality salience induction did not have the desired effect on participants. This may also be why there was no significant interaction between MS induction and diagnostic label for any of the dependent variables, as was predicted in the original hypothesis. However, there were main effects between the diagnostic label and several of the dependent variables such as trust, health, and personal responsibility. These results support previous research asserting that people with mental disorders, like anorexia, tend to be stigmatized (see Crisp, 2000 and Stewart, Keel, & Schiavo, 2006). For example, in the current study, participants rated the target in the anorexic condition significantly more personally responsible for their condition than the

11 Running Head: TERROR MANAGEMENT AND ANOREXIA 11 same target in the diabetic condition. They also found the anorexic person to be less trustworthy, less healthy, and more likely to be rejected by others than the diabetic target. Several of the correlations are not surprising; for example, people that believed the target to be more personally responsible for having the disorder (in both the physical and mental conditions) also believed that she could be healthy again. The logical link between these two items is that both indicated the belief in free will rather than determinism. Another correlation that is not surprising is that participants who found the target to be likeable also found her to be more competent, intelligent, friendlier, and trusted her more. All of these items indicate a general liking of the target, so it makes sense that they would be positively correlated. One limitation of this research included weakness in MS induction. The weak MS induction is evident in the t-test that revealed no significant interaction between MS induction and the manipulation check, t(70)=-.128, p<.898. This may be due to the length of time given for the participants to complete the word search delay task. In this study, participants were given six minutes which may not have been long enough. Previous research has had success activating mortality salience with as long as ten minutes (Norenzayan, Dar-Nimrod, Hansen, & Proulx, 2009). In this study, six minutes may not have been enough time for the effects of MS to be observed. Another approach to fixing the issue of MS induction may be to ask people to think longer about their death. The task used in this study had no time requirement, and many people only wrote a few lines. It is possible that the induction was not effective because participants were not focusing on their own death, or not thinking about it in very much depth.

12 Running Head: TERROR MANAGEMENT AND ANOREXIA 12 A less common way of inducing mortality salience is in the form of a questionnaire, a technique which was successfully used by Goldenberg and Shackelford (2005) in their study. The questionnaire in the high mortality salience condition asked participants to answer a series of true or false questions about their own death, including questions about the fear they feel surrounding their death, how often they think about it, etc (Goldenberg & Shackelford, 2005). This may be an option for mortality salience induction in future replications of this study, or in similar lines of research. Yet another way mortality salience might be activated in future research is to use a sample with lower self esteem. Previous studies indicate that people with high self-esteem are less likely to experience anxiety when they feel threatened, a response which is at the root of terror management theory (Pyszczynski, Greenberg, Solomon, & Maxfield, 2006). If a sample is selected that has lower self-esteem to begin with mortality salience may be easier to prime, and the result may be the interaction that was expected in the current research. Another weakness of this study is the small sample size. More participants would have made this research stronger and the results more able to be generalized to larger populations. However, time restraints and a small subject pool made getting more data a difficult task. The seventy-two participants that did complete this study are enough to make the results viable, but more subjects could have made the results more valid. If mortality salience was activated in a replication of this study the findings may be that the social stigma of anorexia causes people experiencing mortality salience to be rejecting of those suffering from the disorder. The implications of a finding such as this could have an effect on the way anorexia is treated. Social support, for example has a

13 Running Head: TERROR MANAGEMENT AND ANOREXIA 13 significant impact on both development of, and recovery from mental disorders (Barlow & Durand, 2009). If people are experiencing mortality salience when dealing with family members, friend, or anyone who has anorexia it may cause them to feel more rejecting which could hinder their recovery progress. Although the hypothesis that mortality salience may increase negative perceptions and stigma toward persons labeled as having anorexia was not supported by the present study, it is an important question that certainly warrants future research.

14 Running Head: TERROR MANAGEMENT AND ANOREXIA 14 References Adams, J. S. (1963) Toward an Understanding of Inequity. Journal of Abnormal Social Psychology.67:422-36, Barlow, D., & Durand, V. (2009). Abnormal Psychology; an Integrative Approach (5 th ed.). Belmont, CA: Wadsworth Cengage Learning Crisp, A. H., Gelder, M. G., Rix, S., Meltzer, H. I., & Rowlands, O. J. (2000). Stigmatisation Of People With Mental Illness. British Journal of Psychiatry 177: DeWall, C., & Baumeister, R. (2007). From Terror to Joy: Automatic Tuning to Positive Affective Information Following Mortality Salience. Psychological Science, 18(11), doi: /j x Feldman, D., & Crandall, C. (2007, February). Dimensions Of Mental Illness Stigma: What About Mental Illness Causes Social Rejection?. Journal of Social & Clinical Psychology, 26(2), Retrieved September 30, 2009, from Academic Search Complete database. Gailliot, M., Schmeichel, B., & Baumeister, R. (2006). Self-Regulatory Processes Defend Against the Threat of Death: Effects of Self-Control Depletion and Trait Self- Control on Thoughts and Fears of Dying. Journal of Personality & Social Psychology, 91(1), doi: /

15 Running Head: TERROR MANAGEMENT AND ANOREXIA 15 Goldenberg, J., Pyszczynski, T., Greenberg, J., Solomon, S., Kluck, B., & Cornwell, R. (2001, September). I Am Not an Animal: Mortality Salience, Disgust, and the Denial of Human Creatureliness. Journal of Experimental Psychology / General, 130(3), 427. Retrieved September 22, 2009, from Academic Search Complete database. Goldenberg, J., & Shackelford, T. (2005). Is It Me or Is It Mine? Body-self Integration as a Function of Self-esteem, Body-esteem, and Mortality Salience. Self & Identity, 4(3), doi: / Greenberg, J., Pyszczynski, T., & Solomon, S. (1986). The Causes and consequences of the need for self-esteem: a terror management theory. In R. F. Baumeister (Ed.), Public self and private self (pp ). New York: Springer-Verlag. Harmon-Jones, E., Simon, L., Greenberg, J., Solomon, S., Pyszczynski, T., & McGregor, H. (1997). Terror Management Theory and Self-Esteem: Evidence That Increased Self-Esteem Reduces Mortality Salience Effects. Journal of Personality & Social Psychology, 72(1), Norenzayan, A., Dar-Nimrod, I., Hansen, I., & Proulx, T. (2009). Mortality salience and religion: divergent effects on the defense of cultural worldviews for the religious and the non-religious. European Journal of Social Psychology, 39(1), doi: /ejsp.482. Pyszczynski, T., Greenberg, J., Solomon, S., & Maxfield, M. (2006). Commentary: On the Unique Psychological Import of the Human Awareness of Mortality: Theme and Variations. Psychological Inquiry, 17(4), Retrieved September 22, 2009, doi: /

16 Running Head: TERROR MANAGEMENT AND ANOREXIA 16 Solomon, S., Greenberg, J., & Pyszczynski, T. (2000). Pride and Prejudice: Fear of Death and Social Behavior. Current Directions in Psychological Science, 9(6), Stewart, M., Keel, P., & Schiavo, R. (2006, May). Stigmatization of anorexia nervosa. International Journal of Eating Disorders, 39(4), Retrieved September 22, 2009, doi: /eat Stewart, M., Schiavo, R., Herzog, D., & Franko, D. (2008, July). Stereotypes, prejudice and discrimination of women with anorexia nervosa. European Eating Disorders Review, 16(4), Retrieved September 30, 2009, doi: /erv.849

17 Running Head: TERROR MANAGEMENT AND ANOREXIA 17 Table 1 Mean opinion ratings by Diagnostic Label Diagnostic Label Measure and Condition Anorexic Diabetic Health 3.74 a 4.55 a Trust 3.18 b 4.15 b Responsible for Condition 4.15 c 2.42 c Rejected by Others 4.33 d 2.33 d Intelligence 4.85 f 5.00 f Attractiveness 4.79 f 5.12 f Note. Means sharing a common superscript differ at p<.05. Measures of Health and Trust could range from 1 (not at all) to 7 (very much); measures of responsibility for condition could range from 1 (not at all responsible) to 7 (completely responsible); Rejection by others could range from 1 (no rejection) to 7 (total rejection).

18 Running Head: TERROR MANAGEMENT AND ANOREXIA 18 Figure 1