IMPLICIT SELF-ESTEEM IN EATING DISORDERS

Several studies have assessed implicit and explicit self-esteem in clinical ED populations. Cockerham, Stopa, Bell and Gregg (2009) asked female participants in a mixed BN/binge eating disorder sample and healthy female controls to complete explicit measures of self-esteem as well as a self-esteem IAT. Participants in the clinical group scored significantly lower than healthy controls on the explicit self-esteem measure, even after controlling for depression. However, the clinical group scored significantly higher on the self-esteem IAT (M=.87), indicating stronger positive associations with the self compared to controls (M=.59).

Vanderlinden et al. (2009) found a pattern of results similar to Cockerham et al. (2009). The authors used an EAST paradigm (see p.60) to assess implicit self-esteem in a mixed AN/BN sample compared to healthy controls. Again, the clinical group reported significantly lower explicit self-esteem than the controls. Although a marginal group x stimulus valence interaction was found, further analyses within each group found no significant effect of valence in either. This suggests that there were no significant differences in implicit self-esteem between the groups. It is worth noting that the study also assessed implicit self-esteem change following feedback. Participants were given mock results (either positive or negative) on an intelligence test with self-esteem assessed before and after. Analyses of both the implicit and explicit measures found a main effect of feedback in the ED group only: both implicit and explicit self- esteem was found to increase in response to positive feedback and decrease in response to negative feedback. Such an effect was absent in the control group. It is unclear whether these findings indicate that implicit self-esteem was more responsive to feedback in the clinical group, or whether implicit self-esteem instability could have contributed to the development of ED pathology.

Self-esteem discrepancy has also been found in non-clinical participant samples. Hoffmeister, Teige-Mocigemba, Blechert, Klauer and Tuschen-Caffier (2010) assessed self- esteem in restrained and unrestrained eaters using an IAT paradigm, and found that, like ED patients, REs scored lower on explicit self-esteem than unRE, whilst the two groups did not

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differ in implicit self-esteem. The study also assessed changes in self-esteem following a body salience task (in which participants were asked to examine their own bodies in a mirror). Implicit self-esteem was found to increase following the task, but only in the unRE group. This contrasts with Vanderlinden et al.’s findings (2009), but the tasks used (intelligence test

feedback vs. body salience) are quite different. It could be argued that both could be associated with feelings of insecurity, anxiety and ego threat, but these were not assessed in participants in either study. However, both studies suggest that while implicit self-esteem does not differ between clinical/RE groups and healthy/unRE controls, there do appear to be individual differences in how it changes in response to external threat.

Implicit attitude measures have also been used to assess the possibility of implicit SAWBS. Blechert, Ansorge, Beckmann and Tuschen-Caffier (2010) carried out an affective priming study using shape and weight sentences as primes and adjectives related to self-esteem as target stimuli. Participants diagnosed with an ED (and in particular those with BN) had significantly stronger associations between shape and weight concerns and congruent

interpersonal adjectives (e.g., “When I lose weight I feel...” + “Liked”, or “When I stop dieting I feel...” + “Incompetent”). A significant effect was also found for REs, but it was less pronounced than in the two ED groups. These findings suggest that the associations between self-worth and body and shape are internalised to the extent of forming automatic associations in people with EDs, and, to some extent, in REs. In the context of implicit attitude theories which espouse spreading activation (such as the REC model), ED pathology could strengthen associations between self-worth and body image (and vice versa). These associations may weaken after undergoing treatment in favour of enhancing connections between self-worth and other attributes (e.g., social relationships). While these hypotheses are consistent with their theoretical context, longitudinal research would be necessary to test potential change in implicit associations over the course of the illness and treatment.

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3.5. THEORETICAL ACCOUNTS

There are currently several hypothesis which have been proposed to explain the apparent self-esteem discrepancy in clinical or sub-clinical ED pathology. Cockerham et al. (2009) suggest that discrepant self-esteem (where explicit self-esteem is low but implicit self- esteem is high) is fragile, which could be indicative of “psychological distress” (p.271) and may be a risk factor for developing ED pathology. This is consistent with Rydell, McConnell and Mackie (2008), who found that greater discrepancy between implicit and explicit attitudes also lead to greater dissonance-based discomfort. More relevant to disordered eating, discrepant self-esteem has been found in people with depression (De Raedt, Schacht, Dranck, & De Houwer, 2006; Schröder-Abé, Rudolph, & Schütz, 2007) and in those with elevated

perfectionism (Zeigler-Hill & Terry, 2007). Both are frequently co-morbid with ED symptoms, both at clinical and sub-clinical levels (Halmi, Casper, Eckert, Goldberg, & Davis, 1979; Joiner Jr, Heatherton, Rudd, & Schmidt, 1997).

Alternatively, Zeigler-Hill and Terry (2007) suggest that people who report a pattern of low explicit but high implicit self-esteem can be characterised as possessing a “glimmer of hope” (p.140). The authors propose that the discrepancy creates an ambivalence in the person’s feelings of self-worth; the automatic positive attitude can potentially affect cognition and behaviour despite the negative explicit self-evaluation. This hypothesis has been supported in a study by Spencer, Jordan, Logel and Zanna (2005), who found that perseverance on a task was correlated with implicit, but not explicit self-esteem. The research evidence appears to converge; self-esteem discrepancy may be associated with a range of pathologies co-morbid with ED symptoms. However, no study has yet addressed these together with ED symptoms. The next steps should therefore be aimed at modeling the relationship, if any, between perfectionism, perseverance/persistence, depression, ED pathology and implicit and explicit self-esteem.

It must be noted that the findings have not been unequivocal. Fronza, Galimberti, Fadda, Fanini and Bellodi (2011) assessed implicit and explicit self-esteem using the IAT in a mixed

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AN/BN/BED sample and in healthy controls. In contrast to previous findings, the authors found that those in the clinical sample had significantly lower implicit self-esteem compared to healthy controls. However, the study was never published as a full article (only as a conference abstract), therefore it is unclear how methodology or analysis could have affected the outcome. Additionally, a study by Svaldi, Zimmermann and Naumann (2012) found that participants who reported low body dissatisfaction also reported lower implicit self-esteem than those with high body dissatisfaction. However, while body dissatisfaction can be consistent with disordered eating behaviour, it is can also exist without it. This study is therefore not necessarily inconsistent with previously discussed studies.

It is also worth noting that studies in ED pathology and implicit self-esteem typically do not report the IAT-D value. The calculation of the IAT-D reflects the relative association strength: e.g., an IAT-D value above zero indicates stronger associations between self-positive than self-negative (and vice versa for values below zero). However, many studies (Cockerham, Stopa, Bell, & Gregg, 2009; Hoffmeister, Teige-Mocigemba, Blechert, Klauer, & Tuschen-Caffier, 2010) report only analyses pertaining to group differences. While this is helpful when

contrasting high- and low-pathology participants, there is a difference between implicit self- esteem which is lower in one group than another, and implicit self-esteem which is low – that is, where an IAT-D is significantly different from zero in a direction which suggests stronger negative associations with the self.

The research picture which emerges is therefore as follows: people with elevated ED pathology tend to report lower explicit self-esteem than healthy controls, but report high

implicit self esteem; it is unclear what role this discrepancy plays in the development or

maintenance of ED pathology, or how it is related to other traits associated with ED pathology (such as perfectionism). The present study was designed as a first step towards resolving these questions.

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