An examination of the prospective impact of bulimic symptoms and dietary restraint on life hassles and social support

Highlights

• We tested the stress generation hypothesis in relation to eating disorder symptoms.

• Bulimic symptoms predicted greater life hassles but not lower social support.

• Dietary restraint did not predict life hassles or social support.

Abstract

Background

The stress generation hypothesis posits that individuals with psychopathology engage in maladaptive behaviors that create stress. Although extensively researched in the depression literature, few studies have investigated whether the stress generation hypothesis applies to eating disorders. This study examined whether bulimic symptoms and dietary restraint predict future life hassles and low social support among undergraduate students.

Methods

Three hundred seventy-four undergraduate students participated in this two-part prospective study through a secure online system. They completed questionnaires assessing depressive symptoms, bulimic symptoms, dietary restraint, life hassles, and social support.

Results

Regression analyses revealed that baseline bulimic symptoms predicted greater life hassles but not lower social support one month later, after statistically controlling for baseline measures. Baseline dietary restraint did not predict future life hassles or social support.

Limitations

Limitations include use of self-report measures, suboptimal response rates at the follow-up assessment, and use of a non-clinical sample with primarily White participants.

Conclusions

These results provide preliminary support for the stress generation hypothesis in relation to bulimic symptoms. Individuals with bulimic symptoms may generate stressors similar to those experiencing depressive symptoms. Our findings suggest that emphasizing stress management in the treatment of individuals with bulimic symptoms could potentially improve treatment outcomes.

Introduction

The majority of empirical findings suggest that stress both precedes the development of (Welch et al., 1997) and maintains eating disorders (, ). However, few studies have examined the role of eating disorders in predicting subsequent stress. Given the debilitating effects (, ) and high relapse rates of eating disorders (Wilson et al., 1997), it is particularly important to understand whether eating disorders also lead to prospective stress. If this is the case, it may be possible to minimize the negative consequences and to lower the relapse rates of eating disorders. The purpose of this prospective study was to examine the predictive power of eating disorder symptoms with regards to future life hassles and social support.

According to the stress generation hypothesis, individuals actively create stress in their lives as a result of psychopathology. Stress generation is posited to maintain or increase symptoms of psychopathology. , suggested that interpersonal functioning plays a particularly important role in the generation of stress. For example, as a result of depression, affected women have a tendency to withdraw from social situations, make critical remarks of their children, and engage in interpersonal conflicts, all of which contribute to the maintenance or worsening of depressive symptoms (Hammen, 2003). Though under-researched in eating disorders, the stress generation hypothesis may be particularly relevant due to the impaired interpersonal functioning found among individuals with eating disorders (Arcelus et al., 2013). Existing literature suggests that individuals with eating disorders engage in negative feedback seeking (Joiner, 1999), exhibit impaired social skills (Grisset and Norvell, 1992), and demonstrate elevated rejection sensitivity (Selby et al., 2010). These behaviors may repel others and may also lead to stressful events, thus presenting a compelling reason to believe that the stress generation hypothesis may be applicable to eating disorders.

Bodell et al. (2012) were among the first to examine the stress generation hypothesis in relation to eating disorder symptoms in a sample of undergraduate women. In this study, eating disorder symptoms (i.e., bulimic symptoms, drive for thinness, and body dissatisfaction) did not predict negative life events beyond depressive symptoms over a two-month period, suggesting that negative life events in this population were likely attributable to depressive symptoms. Dodd et al. (2014) extended the study of Bodell et al. (2012) by including more eating disorder symptoms (e.g., dietary restraint and weight concern). Findings revealed that only dietary restraint predicted an increase in negative life events over a one-month period. These two studies suggest that the stress generation hypothesis may be applicable to some specific symptoms of eating disorders, such as dietary restraint.

Research has shown that individuals with eating disorders show deficits in various aspects of social support, including lower perceived social support (Grisset and Norvell, 1992) and smaller support networks (Rorty et al., 1999). Social support is often viewed as having a stress-buffering effect (Cohen and Wills, 1985). Although social support and stress may not necessarily be correlated, social support is an important variable to consider in light of the crucial role of interpersonal functioning in stress generation (Hammen, 2003). The present study aimed to replicate previous studies by examining the stress generation hypothesis in eating disorders. Moreover, the present study intended to extend previous studies by including a second dependent variable that is pertinent to eating disorders and the stress generation hypothesis: social support.

Based on the findings of Dodd et al. (2014) and the interpersonal impairments in eating disorders, we hypothesized that baseline dietary restraint would predict greater life hassles and lower social support. Although bulimic symptoms did not predict stress generation in the two previous studies (, ), evidence suggests bulimic symptoms are strongly associated with impaired psychosocial functioning (Spoor et al., 2007), which may contribute to further stress. For example, both bulimia nervosa patients and undergraduate students with bulimic symptoms have been found to engage in excessive reassurance seeking (Anestis et al., 2009) and negative feedback seeking (Joiner, 1999). These behaviors may frustrate and irritate the people around and subsequently, lead to social rejection (Joiner et al., 1999). Therefore, we hypothesized that baseline bulimic symptoms would also predict greater life hassles and lower social support.