URC

Women with Eating Disorders and Perceived Social Support

Claire E. Cusack & Jennifer L. Hughes*

Agnes Scott College

Abstract

Body image issues and eating disorders are becoming a growing concern for women. Social support has been found to serve as a buffer for mental health even when the person is experiencing psychological distress (Kawachi & Berkman, 2001). The aim of the current study was to determine whether social support is related to eating disorder attitudes and body image concerns by examining the effects of social support for women with and without eating disorders while attending to other variables, such as eating disorder type, level of care received, and sexual orientation. Our sample was composed of 202 participants who voluntarily completed an online survey. There were positive correlations between body image and perceived social support from family and friends for women with and without eating disorders. ANOVAs showed no significant effect of perceived social support from friends or family or level of care on eating disorder symptoms or body image. Lastly, in regard to sexual orientation, there were no significant differences between heterosexual women and sexual minority women in eating disordered symptoms, number of women with eating disorders, or body image concern. The results indicate that women with eating disorders perceive less social support than women without eating disorders from friends, and family. Additionally, social support from family and friends is related to a more positive body image for both women with and without eating disorder history. Women experience similar frequency of eating disordered symptoms and body image concerns regardless of type of social support or level of care. Lastly, our findings show that women of varying sexual orientations experience eating disorder symptoms and body image concerns at similar rates. The results of this research have implications to influence eating disorder prevention and treatment programs by acknowledging the impact of social support on eating disorder symptoms and body image for women.

Introduction

Eating disorders are becoming increasingly prevalent in our society. In a study investigating eating disorders in college women Mintz and Betz (1988) found that although only 3 percent of the sample was found to be bulimic, 82 percent engaged in at least one dieting behavior daily, 33 percent reported serious forms of managing weight, such as laxatives and self-induced vomiting, and 38 percent reported a problem with binge eating. In fact, the results suggested that unhealthy eating habits are the norm for college students. As eating disorders are becoming progressively more common, it is essential to examine potential correlates with eating disorders. Social ties have been known to influence mental health and help maintain psychological wellbeing (Kawachi & Berkman, 2001). However, they argued that social support could have two effects: one promoting self-efficacy and esteem and one disabling by emphasizing dependence. The aim of the current study was to determine the effects of social support for women with and without eating disorders while examining other variables, such as type of eating disorder, level of care received, and sexual orientation. This research was important because it furthered our understanding of eating disorders to advance both prevention and treatment programs.

Social Support

Perceived social support includes the functional features of social relationships, and this perceived support has been found to buffer stress, promote psychological wellbeing, and alleviate indicators of psychological distress, such as depressive and anxious symptoms (Kawachi & Berkman, 2001). Perceived social support is generally derived from structural aspects of social relationships, for example social networks and social integration. Integration within a social network may result in positive psychological states, which can increase motivation for self-care.

Limbert (2010) studied perceived social support and characteristics of eating disorders. Limbert's results yielded no significant relationship between eating disorder symptoms and social support from family members and individuals with anorexia nervosa (AN), and individuals with bulimia nervosa (BN) did not differ in the amount of social support received from family; however, there was a correlation between satisfaction with amount of social support and eating disorder symptoms. Individuals who scored high on bulimia characteristics reported significantly low levels of satisfaction with social support. In looking at perceptions of relationships of women with eating disorders, Jackson, Weiss, Lunquit, and Soderlind (2005) found that social support and perceptions of interpersonal difficulties for college women predicted greater eating disorder symptoms over time. Less social support and greater conflict within social networks may correspond with greater eating disturbances. Prevention and treatment implications involve identifying more vulnerable individuals and mechanisms that may initiate the onset and/or maintenance of eating pathology.

Another study found several general psychopathology predictors of AN, and social support was predictive of most of these subscales, including obsessive-compulsive disorder, interpersonal sensitivity, depression, hostility, and global severity index (GSI) (Karatzias, Chouliara, Power, Collin, Yellowlees, & Grierson, 2010). For these subscales, greater levels of psychopathology with AN patients were associated with lower levels of social support. These results suggest that targeting interpersonal challenges could be useful in treating general pathology in patients with AN. In a study examining adolescent friendships and body image, one of Gerner and Wilson's (2005) findings was perception of social support from friends significantly contributed to the variance for body image concern. Prouty, Protinsky, and Canady (2002) examined help-seeking preferences of college women. The data showed that women, regardless of whether they were diagnosed with an eating disorder or not, would speak with a friend first for help if they were concerned about their weight or eating habits. Additionally, the women would want a close friend as their first choice and a significant other or parent as their second choice for someone to support them and their work in therapy. This is important because it is necessary for mental health professionals to know what women with eating disorders find helpful so that support is more accessible. However, similar to Kawachi and Berkman (2001), Prouty et al. (2002) also touch on the potential negative effects of social support in relation to eating disorder symptoms. The authors asserted that if an individual's friend is struggling with similar issues of disordered eating, the social support may actually be more toxic than helpful.

Individuals with eating disorders often depend on family members' support (Dimitropoulus, Carter, Schachter, & Woodside, 2008). They found that the most common form of support provided by carers of individuals with AN was emotional support. Social support most strongly correlated with general functioning, with lower levels of social support predicting higher levels of family dysfunction, which was correlated with greater burdens, family conflict, and stigma. Another study found that there are differences between carers of individuals with AN and individuals with BN (Graap, Bleich, Herbst, Trostmann, Wancata, & de Zwann, 2008). Carers of AN patients reported greater psychological distress than carers of BN patients. Furthermore, carers reported a great amount of moderate and serious problems by providing care of individuals with AN or BN. Some of the most frequent problems reported included disappointment caused by chronic course of illness, concern about the patient's future, communication and conflict difficulties, and lack of information about relapse and prevention. Although these were issues reported in high numbers by carers of both AN and BN patients, carers of AN patients had more of these concerns and increased problems caused by relapse, depression, anxiety, and burn-out. With common concerns, such as these, for carers of individuals with eating disorders, Whitney and Eisler's (2005) work involving family life and structure was not surprising. They argued that it was critical to understand family dynamics because the impact on the family and the way a family attempts to help the individual with an eating disorder might assist in either alleviating or maintaining eating disorder symptoms. The authors found that just as the life of the individual with an eating disorder revolves around food, the family life begins to do so as well. Sometimes in the efforts to help with individual with an eating disorder, they may be unhelpful and reinforce eating disordered behaviors. Brown and Geller (2006) investigated the difference between supporters' intentions and reality with supporting an individual with an eating disorder. The results showed that collaborative support was more helpful than controlling support, but most of the participants providing support anticipated that they would say something controlling; such high rates of unhelpful methods could account for the discontentment with social support reported by individuals with eating disorders.

In investigating eating disorders, social support has implications for the individual struggling with an eating disorder and people offering support to those struggling. Thus there are either positive or negative effects experienced by all parties that ultimately influence the course of the eating disorder. It is imperative to be cognizant of the demands and experience of those providing support to the individual with an eating disorder so that both their mental health is maintained and the individual suffering with an eating disorder receives optimal support. By understanding the needs of the individual with an eating disorder and the person caring for that person, there is a better opportunity to provide more information and practical support.

Eating Disorders

Eating disorders and disordered eating are pervasive on college campuses. As previously mentioned, Mintz and Betz (1988) found staggering rates of dieting, compensatory behaviors, and binge eating in their sample. Although their study found high prevalence rates of several unhealthy eating behaviors, this paper will now shift into discussing individuals with diagnoses.

AN poses numerous physical and mental health threats to an individual struggling with this disorder. Ninety-seven percent of women with eating disorders also had a comorbid diagnoses (Blinder, Cumella, & Sanathara, 2006). Karatzias et al. (2010) found that higher levels of general psychopathology were associated with earlier age of onset of AN, greater anorexic psychopathology, lower self-esteem, and less social support. It is particularly of interest that the individual may experience reduced social support caused by both the eating disorder and cormorbid diagnoses. In treatment, focus on interpersonal skills may help in reducing distress from not only eating disordered symptoms but symptoms from general psychopathology as well. Graap et al. (2008) found that general functioning of carers for AN was less than that of the general functioning of carers for BN, which could be because of visibly severe physical damage of individuals with AN as compared to those with BN, indicating that the illnesses, while sharing similarities, present unique experiences and challenges.

Devoting more attention to those similarities and differences between AN and BN, one study found that patients with AN and BN reported significantly less social support than the control group (Tiller, Sloane, Schmidt, Troop, Power, & Treasure, 1997). Although individuals with AN and BN had comparable levels of social support, patients with AN were less likely to have a spouse or partner for social support. Although patients with AN and BN did not differ in amount of perceived social support, individuals with BN were significantly less satisfied with the social support received from parents than AN. In part, this could be explained by the finding that patients with AN had lower ideals for perceived social support than patients with BN. Whereas Tiller et al. found no correlation between amount of perceived social support and duration of the eating disorder, another study presented contradictory results (Bloks, Van Furth, Callewaert, & Hoek, 2004). This research team studied coping skills and recovery of individuals with eating disorders and found that patients who recovered or were in partial remission at the 2.5-year follow-up reported seeking social support significantly more so than those who were experiencing an active eating disorder. Patients who had recovered at the 2.5-year follow-up reported less avoidant coping strategies after treatment than patients who were in partial remission or active eating disordered. As seeking social support emerged as a coping strategy for recovered individuals, this contributed to the prediction of less AN and BN symptomatology and better global function. Although these results were true for recovered individuals of AN and BN, seeking social support had more predictive power for patients with BN than AN. These results suggested that seeking social support may make patients less susceptible to relapse.

Although BN may not be as visibly and imminently threatening on physical condition as AN, it is a serious eating disorder that is just as necessary to research, especially as BN is more prevalent than AN (Mintz & Betz, 1988). Striegel-Moore, Silberstein, and Rodin (1993) studied aspects of the social self in BN. This study found that social-self concerns, such as public self-consciousness, social anxiety, and perceived fraudulence, were associated with body dissatisfaction and an eating disorder. The preoccupation with self-presentation and an impaired social self may lead an individual with an eating disorder to further isolate from her social spheres, thus, reducing social support. One study found that individuals with BN are significantly more socially impaired than control participants in all areas of social functioning, including work, social/leisure, extended family, role as a spouse, role as a parent, membership in a family unit, and overall adjustment (Herzog, Killer, Lavori, & Ott, 1987). Sixty-eight percent of participants with BN experienced social impairment in comparison to only 13 percent of participants in the control group.

Contradictory to these results, Spoor, Stice, Burton, and Bohon (2007) found no significant results indicating BN behaviors were associated with greater psychosocial impairment in peer functioning. However, they did find modest correlations that more binge eating and compensatory and psychosocial impairment and duration of symptoms were not significantly related to functioning. Threshold and subthreshold binge eating and compensatory behaviors were associated with greater psychosocial impairment than controls, with no differences between the subthreshold and threshold individuals. The results from this study implied that BN attitudes were related to functional impairment, and the threshold for diagnosis may have been too high.

Cattanach and Rodin (1988) examined the stress process in BN and the mediators of stress. One of the mediators attended to was social support. Social support could provide protection from stressors having a full impact and could facilitate coping; however, many individuals with BN reported social difficulties and increased isolation, which limited the number of social supports. Results suggested that inadequate social supports in an individual with BN's environment could be involved in perpetuating the BN cycle. Grisset and Norvell (1992) found deficits in individuals with BN's environment. Results revealed that individuals with BN perceived less social support, greater negative interactions, and poor quality of relationships. Overall negative interactions were strongly related to BN symptoms. Individuals often rely on their friends for help support and emotional support (Rorty, Yager, Buckwalter, & Rossotto, 1999). Recovered individuals from BN reported greater support from friends than those with active BN, but there was no difference of levels of support received from family between those recovered from BN and those with active BN. Individuals with active BN were significantly socially impaired, and while those who recovered from BN had less social impairment than those with active BN, they still reported greater social impairment than the control group. Even if an individual recovers from BN, there still might be residual effects that influence their social functioning and adjustment.

Binge Eating Disorder

Because binge eating disorder (BED) is becoming increasingly recognized, it is important to examine the social support for those who struggle with this disorder. In a study on obesity and social support, Wiczinski, Doring, John, and von Lengerke (2007) found no significant correlation between body mass index (BMI) and social support. BMI was negatively correlated with physical health quality of life but not related to mental healthy quality of life. Obesity and perceived available social support were not correlated; however, social support was related with both physical and mental healthy quality of life. In a study pertaining to BED treatment, Goodrick, Pendleton, Kimball, Peston, Reeves, and Foreyt (1999) found that at 6 months after treatment, less binge eating was associated with greater self-esteem and self-efficacy but was not related to social support. At 18 months post treatment, individuals who reported less binge eating reported greater self-esteem, self-efficacy, and increased social support. These results revealed some of the long-term treatment benefits, one of which includes improvements in social supports; thus, treatment should address both behavioral changes and psychological factors. Further research examining the amount and role of social support for individuals with BED is necessary when considering recovery and advancements in treatment options. 

Sexual Orientation

Because the current study investigates women with eating disorders and perceived social support, it is crucial to examine the prevalence of eating disorders of diverse women and how they experience social support. Although on one side close social communities can lead to better mental health, sometimes close and small communities can lead to ill consequences on mental health (Kawachi & Berkman, 2001). For example, individuals who have varying sexual orientations other than heterosexual or who are feminist may operate in a close social sphere, but they may be oppressed from not conforming to societal standards. Striegel-Moore, Tucker, Hsu (1990) found that for lesbian participants weight concern and physical condition were significantly related to self-esteem, but sexual attractiveness was not a predictor for self-esteem for lesbian women. Lesbian and heterosexual women did not differ on body esteem. Similarly, Beren, Hayden, Wilfley, and Grilo's (1996) study found no significant differences between lesbian women and heterosexual women in body dissatisfaction. These results were noteworthy because although the lesbian subculture generally rejects societal standards of beauty, this ideology might not be impervious to the greater culture's overwhelming physical ideals. In a study examining the prevalence of eating disorders in sexual minorities, Feldman and Meyer (2007) discovered that eating disorders occurred in comparable rates in lesbian and bisexual women as they occurred in heterosexual women. Although lesbian culture may have more flexible gender roles and views of beauty, lesbian women are at the same risk for eating disorders as their heterosexual counterparts (Beren et al., 1996; Feldman & Meyer, 2007; Striegel-Moore et al., 1990).

Hypotheses

The current study is important to expand the research on the role of social support for women with eating disorders with implications for improving recovery rates. Based on the preexisting literature, we derived the following hypotheses:

(a) Women with eating disorders will report less perceived social support than women without eating disorders.

(b) For women with eating disorders, there will be a negative relationship between perceived social support and symptoms.

(c) Greater perceived social support will be related to better body image for both women with and without eating disorders.

(d) Amount of perceived social support and level of care received will affect eating disorder symptoms and body image for women with eating disorders.

(e) There will be no significant difference between type of social support (i.e., friends or family) on amount of symptoms or body image for women with eating disorders.

(f) There will be no significant difference in amount of symptoms, number of women with eating disorders, or body image between lesbian women and heterosexual women.

Method

Participants

Our sample was composed of 202 participants, with 197 identifying as female and 5 as gender-queer. Seventy eight percent of participants were between the ages of 18 - 22, 13.4 percent between the ages of 23 - 26, 5.5 percent between the ages of 27 - 30, and 3.5 percent chose not to report their age. The participants reported their racial identities as White (70.0%), Black (12.5%), Hispanic (4.0%), Asian (4.0%), Indian (0.5%), and multi-racial (9.0%). The highest level of education obtained by our participants was 6.9 percent with a high school degree, 61.9 percent with some college, 28.2 percent with a Bachelor's degree, and 3 percent with a Masters or PhD. Of our participants, 26.9 percent had been diagnosed with an eating disorder and 73.1 percent had no history of eating disorder diagnosis. One hundred and thirty participants (65.3%) identified their sexual orientation as heterosexual and 69 (34.7%) participants identified their sexual orientation as bisexual, queer, or lesbian.

Measures

Anorexia Nervosa. To measure symptoms of AN, the Eating Attitudes Test (EAT), established by David M. Garner and Paul E. Garfinkel (1979), was used. This is a 40-item scale that measures behaviors and attitudes commonly observed in this disorder. Participants indicate what degree the statement applies using a Likert-type scale, ranging from 1 always to 6 never. The cutoff score is 30; scores above 30 indicate anorectic eating concerns. An example question is "avoid eating when I am hungry." A 23-item prototype of this measure was tested for known-groups validity, and scores differed significantly from a sample of individuals with AN and controls (Garner & Garkfinkel, 1979). The authors reported reliability and respectable internal consistency with an alpha reliability coefficient of .94 for a sample of both individuals with AN and controls, and a coefficient of .79 for the sample with AN. An alpha reliability coefficient of .94 was found for the current study.

Body Shape. The Body Shape Questionnaire (BSQ), designed by Cooper, Taylor, Cooper, and Fairburn (1987), measures concern about body shape. The BSQ is based on the concept that distorted body image is a central characteristic of both AN and BN. What is unique about the BSQ, as compared to other instruments measuring body image, is it focus on concerns about body shape and the phenomena of feeling fat that many individuals with AN experience. The BSQ is a 34-item scale, and an example item includes "have you worried about your thighs spreading out when sitting down?" Participants responded using a 6-point scale, ranging from 0 Never to 6 Always. Lower scores signify lower concerns about body shape. The BSQ has good concurrent and known-groups validity (Cooper et al., 1987). Significant correlations between the BSQ and EAT and the Body Dissatisfaction subscale of the EDI established concurrent validity. For the current study, an alpha coefficient of .98 was found.

Bulimia Nervosa. The Eating Questionnaire-Revised (EQ-R) was used to measure BN (Williamson, Davis, Goreczny, McKenzie, & Watkins, 1989). The 15-item scale was designed to assess symptoms of BN, documenting eating and purging habits. Participants responded by selecting the answer that best described their eating behaviors. An example item is "do you ever vomit after a binge?" Concurrent validity has been established for the EQ-R, correlating with the Eating Attitudes test and the Bulimia Test-Revised (BULIT-R), and the EQ-R has good known-groups validity, differentiating bulimic, obese, and nonclinical samples (Williamson et al., 1989). They reported a coefficient alpha of .87. For the present study, an alpha coefficient of .67 was found.

Perceived Social Support. To measure the fulfillment of social support from friends and family, we used the Perceived Social Support-Friend Scale (PSS-Fr) and the Perceived Social Support-Family Scale (PSS-Fa) (Procidano & Heller, 1983). These measures are 20-item scales to assess the degree one perceives his /her needs for support are met by friends and family. An example item for the PSS-Fr is "I rely on my friends for emotional support," and an example item for the PSS-Fa is "my family gives me the moral support I need." Participants responded either yes, no, or don't know to each item. Both the PSS-Fr and PSS-Fa have reputable concurrent validity. The scores are correlated with psychological distress and social competence, as well as associated with psychological symptoms (Procidano & Heller, 1983). Authors reported alphas for the PSS-Fr ranging from .84 to .90 and for the PSS-Fa ranging from .88 to .91. Alpha reliability coefficients of .88 and .93 were found for PSS-Fr and PSS-Fa, respectively, in the current study.

Procedure

Participants for this study were recruited through convenience sampling. Authors used email and social media to gather participants. Participants were asked to complete an online survey using Survey Monkey. Eligibility for participation required that participants be 18 years of age or older and living in the United States. Prior to beginning the survey, the participants gave informed consent electronically. Upon giving consent, the survey was administered. It included questions regarding demographic information, eating attitudes, eating disorder symptoms, body image, and social support. Participants were automatically entered into a random drawing to win a $25 Amazon gift card.

Results

We predicted women with eating disorders would report less perceived social support than women without eating disorders. We used independent samples t tests to evaluate the first hypothesis to determine if there was a difference in how women with and without eating disorders perceive social support. For women with eating disorders, the mean PSS-Fr score was 11.84 with a standard deviation of 4.80, and the mean PSS-Fa score was 10.44 with a standard deviation of 6.02. For women without eating disorders, the mean PSS-Fr score was 14.19 with a standard deviation of 4.50, and the mean PSS-Fa score was 13.99 with a standard deviation of 5.82. Women with eating disorders reported significantly lower levels of perceived social support from friends, t(189) = -3.14, p = .002, d = 0.51, and family, t(191) = -3.67, p < .001, d = 0.60. Our first hypothesis was confirmed.

We hypothesized, for women with eating disorders, there would be a negative relationship between perceived social support and eating disordered symptoms. To determine this hypothesis we used Pearson Correlations. Perceived social support from friends was negatively correlated with EAT scores, r = -.37, p = .01, but there was no relationship between perceived social support from friends and the EQR. Perceived social support from family was not significantly correlated with EAT or EQR scores. Our second hypothesis was partially confirmed.

We also hypothesized that greater perceived social support would be correlated with better body image for women with and without eating disorders. For women with eating disorders, the BSQ was significantly correlated with the PSS-Fr, r = -.34, p = .03, and the PSS-Fa, r = -.30, p = .05. For women without eating disorders, the BSQ was significantly correlated with the PSS-Fr, r = -.18, p = .05, and the PSS-Fa, r = .20, p = .03. Our third hypothesis was supported.

Additionally, we hypothesized the amount of perceived social support and level of care received would affect eating disorder symptoms and body image for women with eating disorders. Furthermore, we hypothesized that there would be no difference in type of social support, friends or family, on eating disorder symptoms and body image. We conducted two one-way analysis of variances (ANOVA) to compare the effect of perceived social support from friends and family on AN symptoms, BN symptoms, and body image. For women with eating disorders, there was no significant effect of PSS-Fr or PSS-Fa on the EAT, EQR, or BSQ scores. We conducted another one-way ANOVA to compare the effect of level of care on the three variables (see Table 1). Level of care had no significant effect on AN symptoms, BN eating symptoms, or body image. Our fourth hypothesis was not confirmed.

Table 1
Perceived Social Support, Level of Care, and Eating Disorder Symptoms

 

EAT

EQR

BSQ

PSS-Fa

F(2, 45) = 0.62, p = .86

F(2, 28) = 1.54, p = .21

F(2, 41) = 1.12, p = .39

PSS-Fr

F(2, 46) = 1.93, p = .06

F(2, 28) = 0.47, p = .91

F(2, 40) = 1.78, p = .09

Level of Care

F(1, 45) = 0.13, p = .72

F(1, 27) = 3.27, p = .08

F(1, 39) = 0.02, p = .90

Note. PSS-Fa = Perceived Social Support-Family; PSS-Fr = Perceived Social Support-Friends; EAT = Eating Attitudes Test (AN symptoms); EQR = Eating Questionnaire-Revised (BN symptoms); BSQ = Body Shape Questionnaire.

We did not find a significant difference in type of social support on eating disordered symptoms or body image. Therefore, our fifth hypothesis was confirmed.

Lastly, we predicted no significant difference in amount of symptoms, number of women with eating disorders, or body image between lesbian women and heterosexual women. To evaluate this hypothesis, we ran three independent samples t tests. There were no significant differences between heterosexual women and sexual minority women (bisexual, lesbian, and queer) in eating disordered symptoms, both anorectic, t(179) = 1.43, p = .15, and bulimic, t(56) = 0.79, p = .43, number of women with eating disorders, t(196) = -0.97, p = .33, or body image concern, t(174) = 1.03, p = .31. Our sixth hypothesis was supported.

Discussion

In this research, we wanted to determine relationships and effects of perceived social support on eating disorder symptoms. First, we hypothesized women with eating disorders would report lower levels of perceived social support than women without eating disorders, and it was confirmed. This is in support of previous research. Pre-existing literature has found that less social support is related to more eating disorder symptoms (Jackson et al., 2005) and is one of the strongest predictors of AN psychopathology (Karatzias et al., 2010). This could be explained by Kawachi and Berkman's research (2001) that states social support can buffer the effects of psychological stress. Another possible explanation that could work in conjunction with this one is that women with eating disorders have less social support because of the secretive nature of the disease (Long, Smith, Midgley, & Cassidy, 1993; Smart & Wegner, 1999).

We took our first hypothesis one step further and also hypothesized that for women with eating disorders, there would be a negative relationship between eating disordered symptoms and perceived social support. Our second hypothesis was partially confirmed. Greater amounts of perceived social support from friends was associated with lower AN symptoms, but there was no relationship in perceived social support from friends with symptoms of BN. Additionally, perceived social support from family had no significant relationship on AN or BN eating disordered symptoms. These results were surprising, as Bloks et al. (2004) reported that the more often social support was used as a coping strategy by individuals with eating disorders there was less eating disorder symptoms. These results could be partially explained by the fact that the first preference of women with eating disorders often is to seek help from friends (Prouty et al., 2002). Perhaps, perceived social support from friends is only significant for AN eating pathology and not BN eating pathology because of the shame associated with bingeing and purging (Hepworth & Paxton, 2007).

Furthermore, we hypothesized that greater perceived social support will be related to better body image for both women with and without eating disorders. This hypothesis was supported. Perceived social support from friends and family were associated with better body image regardless of whether the individual had a history of an eating disorder. This finding was expected because Striegel-Moore et al. (1993) found that social support was an important factor for body satisfaction in a sample of individuals with BN. Also, in a study evaluating a support group for adolescent girls, members of the support group reported better body image and increased social support after attending the program (Steese, Dollette, Phillips, Hossfeld, Matthews, & Taormina, 2006). Ata, Ludden, and Lally (2007) found that girls who reported low parental support were more at risk for disordered eating and lower body image. The current study and previous literature indicate that social support from friends and family is important for achieving and maintaining a positive body image.

We hypothesized that amount of perceived social support and level of care received will affect eating disorder symptoms and body image for women with eating disorders. This hypothesis was not supported. This was particularly surprising because of the literature from previous studies and the relationships we had found in the current study between social support and eating disorder symptoms. Moreover, Brewerton and Costin (2011) found that residential treatment was highly effective in reducing amount of symptoms for individuals with AN and BN. However, Cockell, Zaitsoff, and Geller (2004) found that once discharged from a residential treatment facility, individuals with eating disorders reported loss of structure, a sense of disconnection, daily hassles, environmental changes, and moving home to be triggers for relapse. This could explain why level of care had an insignificant effect on eating disorder symptoms.

Our fifth hypothesis was there would be no significant difference between type of social support on amount of symptoms or body image for women with eating disorders. This hypothesis was confirmed. Although the literature indicated that persons with AN were less likely to rely on spouse or partner for social support than BN (Tiller et al., 1997), we believed that (because of Bloks et al., 2004 study) the overarching theme of social support was more important in mediating symptoms than the actual type of social support.

Lastly, we hypothesized that there would not be a significant difference in amount of symptoms, number of women with eating disorders, or body image between lesbian women and heterosexual women. Our sixth hypothesis was supported. These results indicate that lesbian women and heterosexual women suffer from eating disorders at the same frequency and have similar levels of body image. These findings are in support of previous literature that stated lesbian and heterosexual women did not differ on body image (Striegel-Moore et al., 1990). The reason could be because lesbian women still live in a heterosexual society that places great importance on thinness (Beren et al., 1996). Feldman and Meyer (2007) found eating disorders occur in lesbian and heterosexual women at similar rates. Although the lesbian subculture may have initially been thought to protect individuals within the community from eating disorders (Kawachi & Berkamn, 2001), this may not be the case because of the pervasive drive for thinness in Western society.

The results of this study are important because they confirm the role of social support in the maintenance of eating disordered symptoms. The current study furthers research on eating disorders. Previous studies show that less than half of individuals with eating disorders who receive treatment will recover (Clausen, 2008; Helverskov, Clausen, Mors, Frydenberg, Thomsen, & Rokkedal, 2010). With low recovery rates and high relapse rate, it is imperative that research continues so that recovery is more attainable. Social support is one avenue that could be better integrated in treatment with the purpose to reduce the risk of relapse. Possible treatment implications could include implementing family therapy or interpersonal therapy so that individuals with eating disorders and/or family members can learn how to communicate with each other effectively, ask for the support they need, and provide support to the individual recovering. Additionally, this information can be used to further develop eating disorder awareness and prevention programs so that friends can be knowledgeable of their impact and what is and is not supportive.

This research pertains to a pervasive and pertinent disorder that has grown in frequency over the past decade. With disordered eating being the norm for college students (Mintz & Betz, 1988), this study is of particular importance so that society may alleviate and prevent disordered eating through offering social support to prevent it from developing into a full-blown eating disorder. Additionally, this study investigated a sample with an age demographic known to have the highest prevalence of eating disorders (Hilbert, de Zwaan, & Braehler, 2012). However, one of the weaknesses of this study is the reliability found for EQ-R and the OI. The lower reliability of the EQR could be because 4.9 percent of the sample had a history of BN, thus only 10 participants took this measure based on logic sequence in the online survey. In regard to the OI, the lower reliability coefficient found in the current study could be a result of our sample demographic. Sixty-three percent of the sample was heterosexual, whereas 12.7 percent reported bisexual, 12.3 percent reported lesbian, and 8.8 percent reported queer. Perhaps, there are differences in how out an individual is based on how they identify (i.e., bisexual, lesbian, queer).

Although this research advances the field and its understanding of eating disorders, future research is necessary. It would be interesting to supplement these results with a caregiver, family, or close friend's rating of the individual with an eating disorder and their relationship with that individual to investigate the relationship between how the individual with an eating disorder perceives social support and how the caregiver, family member, or close friend perceives social support given. Furthermore, it would be worthwhile to examine the role of attachment style on perceived social support of women with eating disorders. Previous research indicates that individuals with eating disorders are more likely to have an insecure attachment style (Hochdorf, Latzer, Canetti, & Bacher, 2005; Ringer & Crittenden, 2007). Moreover, insecure attachment style has been linked to lower levels of perceived social support (Martin, Paetzold, & Rholes, 2010); thus, future research examining this potential relationship may provide significant results with profound implications for treatment of individuals recovering from eating disorders.

References

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