Generalized anxiety disorder (GAD) is one of the most common comorbid disorders found in individuals with eating disorders. Despite this, little is known of shared vulnerability factors between the two disorders. The aim of the present study was to examine the four main components of a cognitive model for GAD in the eating disorders. One hundred and sixty-two females took part. Three groups were formed comprising of 19 participants with an eating disorder and GAD, 70 with an eating disorder without GAD and 73 healthy controls. All completed self-report questionnaires that measured eating attitudes, levels of GAD, intolerance of uncertainty, positive beliefs about worry, negative problem orientation, and cognitive avoidance. Participants with an eating disorder and GAD scored the highest on all four components when compared to healthy individuals and on most components when compared to those with an eating disorder. Participants with an eating disorder without GAD scored higher on all components compared to healthy controls. Findings extend our understanding of shared vulnerability factors between the eating disorders and GAD.
Anxiety often co-occurs with the eating disorders, and research suggests that up to two thirds of individuals with eating disorders also meet diagnostic criteria for an anxiety disorder (Jordan et al., 2008 and Kaye et al., 2004). Comorbid anxiety is likely to negatively affect the course of the eating disorder and its treatment (Berkman et al., 2007 and Pallister and Waller, 2008). Furthermore, it has been suggested that targeting non-eating disordered behaviors, such as comorbid anxiety, may increase treatment effectiveness for eating disorders (Fletcher, Kupshik, Uprichard, Shah, & Nash, 2008).
One of the most common anxiety disorders found in individuals with eating disorders is generalized anxiety disorder (GAD; Kaye et al., 2004 and Pallister and Waller, 2008). The main feature of GAD is worry, which has been found elevated in patients with eating disorders when compared to a healthy control group (Kerkof et al., 2000 and Sassaroli et al., 2005). To date, research examining the link between the eating disorders and anxiety has mainly focused on levels of comorbidity between the two. However, Pallister and Waller (2008) suggest that there is a strong need to explore further shared vulnerability factors between the two disorders.
Dugas, Gagnon, Ladouceur, and Freeston (1998) have proposed a model of GAD that suggests that worry, the main feature of GAD, is maintained by four components: Intolerance of uncertainty, positive beliefs about worry, poor problem orientation and cognitive avoidance. Intolerance of uncertainty refers to an individual's tendency to experience uncertainty as distressing due to a set of negative beliefs about uncertainty and its implications (Dugas and Robichaud, 2007 and Heimberg et al., 2004). Positive beliefs about worry refer to a set of beliefs that promote worry as a useful strategy. These include the belief that worry aids problem solving, motivates the individual to do things, prevents negative outcomes, protects one from negative emotions in the event of a negative outcome and that worry is a positive personality trait (Freeston, Rheaume, Letarte, Dugas, & Ladouceur, 1994). Negative problem orientation refers to a set of beliefs about one's cognitive approach towards solving problems, such as, doubting one's problem-solving abilities, finding problems threatening and having a pessimistic view about the outcome of a problem (Davey, 1994 and Dugas et al., 1995). Finally, cognitive avoidance consists of an individual's tendency to use avoidance strategies to manage worry, such as suppressing threatening intrusive thoughts or unpleasant emotions (Dugas & Robichaud, 2007).
