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March 24, 2026Psychiatry Research0 citationsOpen Access

Between Shame and Visibility: A Network Analysis of Social Anxiety and Eating-Disorder Psychopathology

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PMPaolo MeneguzzoAMAlberto De MicoMZMarta Zago

Key Points

  • This study aims to understand how social anxiety is related to eating disorder symptoms and evaluative fears in different populations.
  • Analyzed data from 223 adults, including 103 eating disorder patients and 120 community controls.
  • Utilized questionnaires to measure eating disorder symptoms and social anxiety.
  • Estimated regularized partial correlation networks for clinical and non-clinical samples.
  • Evaluated network stability through bootstrap procedures.
  • ED patients showed a denser network of symptoms centered around body image compared to controls.
  • Shape and weight concerns were identified as central nodes in the eating disorder network.
  • Social anxiety was more integrated with appearance-related issues in ED patients.
  • In the general population, evaluative fears were more closely linked to social anxiety.

Abstract

• Social anxiety is embedded within body-image–centered symptom networks in eating disorders. • Clinical networks show greater density and stronger clustering around shape and weight concerns. • Shape and weight concerns emerge as central nodes in the eating-disorder network. • Evaluative fears are more tightly linked to social anxiety in non-clinical samples. • Findings support transdiagnostic models emphasizing shared socio-evaluative processes across eating-disorder presentations. Social anxiety is highly prevalent in eating disorders (EDs), yet its relationship with eating psychopathology and distinct social-evaluative fears remains incompletely understood. This study examined how general social anxiety, fear of negative evaluation (FNE), fear of positive evaluation (FPE), and eating-disorder symptom domains are interconnected in clinical and non-clinical samples using a network-based approach. Participants were 223 adults (103 ED patients, 120 community controls) who completed the Eating Disorder Examination Questionnaire, the Social Interaction Anxiety Scale, the Brief Fear of Negative Evaluation Scale, and the Fear of Positive Evaluation Scale. Regularized partial correlation networks were estimated separately for ED and general population groups to compare symptom architecture and node centrality. Network stability was evaluated using bootstrap procedures. Networks revealed a denser and more body-centered symptom structure in ED patients compared with controls. Shape and weight concerns emerged as the most central nodes in the clinical network, with social anxiety showing greater integration with appearance-related domains. In contrast, evaluative fears were more tightly anchored to social anxiety in the general population network. Overall, findings suggest increased coupling between interpersonal anxiety and body-image processes in EDs. Social anxiety appears embedded within a broader internalizing symptom architecture organized around body-related evaluation in eating disorders. These results support transdiagnostic models emphasizing shared socio-evaluative processes across ED presentations and highlight the clinical relevance of addressing both social anxiety and appearance-focused cognitions to promote more flexible social engagement.

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Cite This Study

Meneguzzo et al. (2026) studied this question.

synapsesocial.com/papers/69c2294caeb5a845df0d38a5https://doi.org/10.1016/j.psychres.2026.117114
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