Anxiety sensitivity (AS), an individual difference characteristic involving the fear of anxiety-related bodily sensations due to beliefs that these sensations will have harmful physical, cognitive, or social consequences (Reiss, 1991), has received increasing attention as a potential transdiagnostic risk factor. Although originally conceptualized as a risk factor for anxiety-related pathology (particularly panic disorder; Cox, Borger, & Enns, 1999), recent research suggests that AS may underlie numerous forms of psychopathology, including substance use (Lejuez, Paulson, Daughters, Bornovalova, & Zvolensky, 2006), depression (Tull, Gratz, & Lacroce, 2006), and borderline personality disorder (Gratz, Tull, & Gunderson, 2008). Studies have also begun to examine the association between AS and disordered eating, finding elevated AS among undergraduates and outpatients with (vs. without) bulimic symptoms and highlighting the mediating role of maladaptive responses to internal experiences (including distress intolerance and a lack of interoceptive awareness) in the association between AS and bulimic symptoms (Anestis et al., 2008 and Anestis et al., 2007).
Another maladaptive response to internal experiences that may explain the association between AS and disordered eating is experiential avoidance (EA), defined as the unwillingness to remain in contact with unwanted internal experiences (e.g., thoughts, emotions, physical sensations; Hayes, Wilson, Gifford, Follette, & Strosahl, 1996). Specifically, individuals high in AS may be unwilling to remain in contact with anxiety-related bodily sensations and thus, may be motivated to engage in strategies that function to escape or lessen these sensations and their associated distress. Consistent with this suggestion, research indicates an association between AS and both EA (Stewart et al., 2002, Tull and Gratz, 2008 and Zvolensky and Forsyth, 2002) and several experientially-avoidant behaviors (e.g., substance use; DeHaas et al., 2001 and Stewart et al., 2002). Further, EA has been found to mediate the association between AS and other forms of psychopathology, such as borderline personality disorder (Gratz et al., 2008) and depression (Tull & Gratz, 2008). Given evidence that disordered eating may also serve an experientially-avoidant function (e.g., Heatherton and Baumeister, 1991 and Polivy and Herman, 1993), and consistent with research demonstrating an association between bulimic symptoms and EA (Hayaki, 2009 and Lavender et al., 2009), EA may likewise underlie the association between AS and disordered eating.
The current study sought to examine associations between AS, EA, and disordered eating. Given the focus within past research on the association between global AS and bulimic symptoms only, we examined associations between specific AS dimensions and disordered eating in general. We hypothesized that: (a) AS dimensions would be uniquely associated with disordered eating after controlling for relevant covariates, (b) EA would be uniquely associated with disordered eating after controlling for AS and covariates, and (c) EA would fully mediate the associations between the AS dimensions and disordered eating.
