Sociotropy and Bulimic Symptoms in Clinical and Nonclinical Samples Jumi Hayaki, 1 Michael A. Friedman, 1 * Mark A. Whisman, 2 Sherrie S. Delinsky, 1 and Kelly D. Brownell 3 1 Department of Psychology, Rutgers, The State University of New Jersey, Piscataway, New Jersey 2 Department of Psychology, University of Colorado at Boulder, Boulder, Colorado 3 Department of Psychology, Yale University, New Haven, Connecticut Accepted 15 January 2003 Abstract: Objective: The purpose of this study is to examine the relation between sociotropy and bulimic symptoms. Studies of interpersonal functioning among individuals with bulimia nervosa consistently reveal issues of social dependency, need for approval, and fear of rejection. These themes are conceptually related to sociotropy, a cognitive-personality factor that has been implicated in the development and maintenance of depression. Individuals high in sociotropy are keenly invested in attaining others approval and avoiding social rejection. Methods: The relationship between sociotropy and bulimic symptoms was examined in two samples of women: undergraduate women and community women seeking treatment at a private eating disorder facility. Results: In both samples, sociotropy was significantly associated with bulimic symptoms beyond the shared relation with depressed mood. Discussion: Findings are discussed in terms of the maintenance and treatment of bulimia nervosa. # 2003 by Wiley Periodicals, Inc. Int J Eat Disord 34: 172 176, 2003. Key words: sociotropy; bulimic symptoms; depressed mood INTRODUCTION Empirical investigations of bulimia nervosa (BN) consistently reveal deficits in interpersonal functioning. Interpersonal conflict has also been identified as an antecedent of binge-eating episodes (Steiger, Gauvin, Jabalpurwala, Seguin, & Stotland, 1999), and interpersonal dysfunction may trigger the development and maintenance of BN (Keel, Mitchell, Miller, Davis, & Crow, 2000). Furthermore, social maladjustment may persist in bulimics (Keel et al., 2000) and can predict residual posttreatment bulimic symptoms (Steiger, Leung, & Thibaudeau, 1993). *Correspondence to: Michael A. Friedman, Ph.D., Assistant Professor of Psychology, Department of Psychology, Rutgers, The State University of New Jersey, 152 Frelinghuysen Road, Piscataway, NJ 08854-8020. E-mail: mikefri@rci.rutgers.edu Published online in Wiley InterScience (www.interscience.wiley.com). DOI: 10.1002/eat.10172 # 2003 by Wiley Periodicals, Inc.
Sociotropy and Bulimic Symptoms 173 Despite abundant evidence of social maladjustment in bulimic individuals, less is known about the cognitive processes that may perpetuate interpersonal difficulties. Problems with self-other perceptions constitute an important cognitive factor underlying interpersonal deficits (Blatt & Zuroff, 1992) and have been explored in other areas of psychopathology, most notably depression. Sociotropy is a cognitive-personality style characterized by social dependency and need for approval (Beck, 1983). Sociotropy is thought to constitute one key feature of depression (for a review, see Coyne & Whiffen, 1995). The interpersonal style of bulimic individuals may be conceptually related to sociotropy. Bulimics are known to exhibit low self-esteem and a strong desire to please others (Jacobson & Robins, 1989; Thelen, Farmer, Mann, & Pruitt, 1990). Intensely invested in their social persona, bulimics are keenly sensitive to rejection, with heightened public self-consciousness and preoccupation with perceived social fraudulence (Evans & Wertheim, 1998; Striegel-Moore, Silberstein, & Rodin, 1993). Preliminary evidence indicates that sociotropy is related to symptoms of BN. Friedman and Whisman (1998) found a significant relationship between sociotropy and bulimic symptoms in a sample of 105 undergraduate women, even when controlling for depressed mood. This study helps identify a cognitive-personality factor that is specifically related to bulimic pathology. The purpose of this investigation was to replicate this finding and test the link between sociotropy and bulimic symptoms in a clinical sample. We examined the specificity of the relationship between sociotropy and bulimic symptoms in a sample of female undergraduates and a sample of women with clinical symptoms seeking treatment. On the basis of previous research (Friedman & Whisman, 1998), it was expected that sociotropy would be a predictor of bulimic symptoms in both samples and that this relation would remain significant when controlling for depressed mood. METHODS Participants Participants were 141 undergraduate women enrolled in introductory psychology classes (participating for course credit) and 74 women seeking treatment at a private eating and weight disorders facility. The mean age of the nonclinical sample was 18.63 years (SD ¼ 1.03), and the racial composition was 55% Caucasian, 7% Latina, 9% African- American, 22% Asian, 1% Native American, and 7% other. The mean age of the clinical sample was 28.65 years (SD ¼ 12.86), and the racial composition was 95% Caucasian, 3% Native American, and 2% other. Participants missing data on any measure were omitted. The final sample included 139 individuals in the nonclinical sample and 62 individuals in the clinical sample. Measures Bulimia Test (BULIT; Smith & Thelen, 1984) This 36-item instrument assesses behavioral and emotional aspects of bulimic symptoms. This scale has demonstrated acceptable construct validity and reliability (Smith & Thelen, 1984).
174 Hayaki et al. Beck Depression Inventory (BDI; Beck, Rush, Shaw, & Emery, 1979) This 21-item instrument is a widely used measure of depressed mood, with higher scores indicating greater severity. To minimize potential construct overlap with other measures, one item assessing self-evaluation of physical appearance was omitted. The modified scale exhibited favorable internal consistency (with a Cronbach s alpha of 0.82 in the nonclinical sample and 0.92 in the clinical sample). Sociotropy and Autonomy Scale (SAS; Beck, Epstein, Harrison, & Emery, 1983) The SAS is a 60-item self-report measure designed to assess cognitive-personality styles conceptually related to major depression, including sociotropy. The Sociotropy subscale of this measure was used. This scale demonstrated favorable internal consistency (with a Cronbach s alpha of 0.87 in the nonclinical sample and 0.91 in the clinical sample). RESULTS The means and standard deviations of scores on the BULIT, revised BDI, SAS Sociotropy scale, and age for both samples are shown in Table 1. Pearson product-moment correlations were calculated to determine the relationship between bulimic symptoms and sociotropy. As illustrated in Table 1, bulimic symptoms were significantly and positively associated with sociotropy in both samples. To examine the specificity of the relationship between sociotropy and bulimic symptoms, a hierarchical regression analysis was performed for each sample. Because age was not significantly correlated with bulimic symptoms in either sample, this variable was omitted. Depressed mood and sociotropy were entered separately in each step of the regression model and accounted for unique variance in bulimic symptoms in both samples. In the nonclinical sample, depressed mood contributed 0.16 of the variance, F(1, 136) ¼ 5.25, p < 0.0001. This variable continued to contribute significant variance in the final step, F(1, 136) ¼ 4.73, p < 0.0001, but sociotropy also accounted for a unique 0.02 of the variance, F(1, 137) ¼ 3.31, p < 0.05. The final model accounted for 0.18 of the variance in bulimic symptoms. In the clinical sample, depressed mood contributed 0.24 of the variance in bulimic symptoms, F(1, 60) ¼ 4.48, p < 0.0001. In the final step, depressed mood remained a significant predictor, F(1, 60) ¼ 2.71, p < 0.01, but sociotropy Table 1. Means, standard deviations, and intercorrelations among constructs Variable M SD 2 3 4 Nonclinical sample (n ¼ 139) 1. Bulimic symptoms 53.68 19.74 0.41*** 0.25** 0.06 2. Depressed mood 7.19 5.38 0.22** 0.12 3. Sociotropy 96.18 15.32 0.11 4. Age 18.63 1.03 Clinical sample (n ¼ 62) 1. Bulimic symptoms 91.67 28.70 0.50*** 0.49*** 0.06 2. Depressed mood 18.27 11.36 0.51*** 0.18 3. Sociotropy 97.95 18.73 0.09 4. Age 28.65 12.86 *p < 0.05. **p < 0.01. ***p < 0.0001.
Sociotropy and Bulimic Symptoms 175 contributed a unique 0.07 of the variance, F(1, 60) ¼ 5.56, p < 0.05. The final model accounted for 0.30 of the variance in bulimic symptoms. DISCUSSION These results indicate that sociotropy is associated with bulimic symptoms, both among undergraduate women exhibiting a nonclinical to clinical range of bulimia nervosa, as well as among community women with greater severity of bulimic symptoms seeking treatment at an eating disorder facility. The observed relation between sociotropy and bulimic symptoms was independent of the shared relation with depression. These results replicate the previous findings by Friedman and Whisman (1998) and also extend these findings to a clinical sample. Future work should clarify the nature of this relationship. It is possible that individuals high in sociotropy may be more vulnerable to pleasing others and may therefore engage in the unhealthy dieting behaviors that can trigger bulimic episodes (Striegel-Moore, Silberstein, & Rodin, 1986). Alternatively, it is possible that in the face of stressful interpersonal events, individuals high in sociotropy are more likely to experience negative mood and engage in binging and purging behavior in part for mood regulation (Heatherton & Baumeister, 1992). This investigation has several limitations. The sample sizes are relatively small. In addition, although the clinical sample included only women seeking treatment for eating problems, these problems were not necessarily exclusive to BN. Replication is therefore necessary in a sample of individuals diagnosed with BN. Finally, this study used as its measure of bulimic symptoms a scale whose items represent heterogeneous clinical features of BN. Despite these limitations, this study provides an extension of previous work suggesting that sociotropy is a specific cognitive-personality style associated with bulimia nervosa. REFERENCES Beck, A.T. (1983). Cognitive therapy of depression: New perspectives. In P.J. Clayton & J.E. Barrett (Eds.), Treatment of depression: Old controversies and new approaches (pp. 265 290), New York: Raven Press. Beck, A.T., Epstein, N., Harrison, R.P., & Emery, G. (1983). Development of the Sociotropy-Autonomy Scale: A measure of personality factors in psychopathology. Unpublished manuscript, University of Pennsylvania, Philadelphia. Beck, A.T., Rush, A.J., Shaw, B.F., & Emery, G. (1979). Cognitive therapy of depression. New York: Guilford Press. Blatt, S.J. & Zuroff, D.C. (1992). Interpersonal relatedness and self-definition: Two prototypes for depression. Clinical Psychology Review, 12, 527 562. Coyne, J.C., & Whiffen, V.E. (1995). Issues in personality as diathesis for depression: The case of sociotropy/ dependency and autonomy/self-criticism. Psychological Bulletin, 118, 358 378. Evans, L., & Wertheim, E.H. (1998). Intimacy patterns and relationship satisfaction of women with eating problems and the mediating effects of depression, trait anxiety, and social anxiety. Journal of Psychosomatic Research, 44, 355 365. Friedman, M.A., & Whisman, M.A. (1998). Sociotropy, autonomy, and bulimic symptomatology. International Journal of Eating Disorders, 23, 439 442. Heatherton, T.F., & Baumeister, R.F. (1991). Binge eating as escape from self-awareness. Psychological Bulletin, 110, 86 108. Jacobson, R. & Robins, C.J. (1989). Social dependency and social support in bulimic and nonbulimic women. International Journal of Eating Disorders, 8, 665 670. Keel, P.K., Mitchell, J.E., Miller, K.B., Davis, T.L., & Crow, S.J. (2000). Social adjustment over 10 years following diagnosis with bulimia nervosa. International Journal of Eating Disorders, 27, 21 28.
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