The fragility of perceived social rank following exercise in anorexia nervosa: an ecological momentary assessment study
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ORIGINAL ARTICLE
The fragility of perceived social rank following exercise in anorexia nervosa: an ecological momentary assessment study of shame and pride Ruofan Ma1 · Allison C. Kelly1 Received: 24 June 2019 / Accepted: 3 October 2019 © Springer Nature Switzerland AG 2019
Abstract Purpose Pride and shame are self-conscious emotions closely associated with perceived social rank. Goss and Gilbert (In: Gilbert and Miles (eds) Body shame: conceptualization, research & treatment. Brunner-Routledge, Hove, 2002) proposed that weight-control behaviours in anorexia nervosa (AN) provide a temporary sense of increased rank that dissipates afterwards, thereby perpetuating further symptoms. This pilot study tested their theory by examining whether shame increases and pride decreases as time passes post-exercise in individuals with AN. Pre-exercise patterns were also explored. Methods Over 2 weeks, 23 females with AN provided ecological momentary assessment data via six semi-random daily signals and after each exercise episode. The State Shame and Guilt Scale assessed pride and shame. Items modified from the Experience of Shame Scale and the Other as Shame Scale assessed general shame and body/eating shame. Multilevel models analyzed patterns of shame and pride prior to and following exercise episodes. Results In the hours after exercise, pride decreased, body/eating shame increased, and general shame increased on one measure. Pride was, therefore, higher and shame lower immediately after exercise as compared to later in the day. In the hours before exercise, pride increased, but shame levels did not change significantly. Conclusion The anticipation and immediate aftermath of exercise may be associated with higher perceived social rank in people with AN, but their feelings about self may worsen as time passes after exercise. Fluctuations in shame and pride may contribute to the maintenance of exercise in people with AN. Level of evidence IV, multiple time series analysis. Keywords Anorexia nervosa · Exercise · Ecological momentary assessment · Shame · Pride · Social rank
Introduction Although a portion of individuals with anorexia nervosa (AN) achieve remission during treatment, as many as 70% do not [1]. Social rank theory [2] may help to improve our conceptualizations of the illness and strengthen treatments. The social rank system is a motivational system that evolved to help organisms navigate social hierarchies so as to maximize their access to resources necessary for survival and reproductive success (e.g., food, mates) while minimizing the risk of harm and death [3]. The system promotes social * Allison C. Kelly [email protected] 1
Department of Psychology, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L 3G1, Canada
comparisons as a way of appraising one’s relative rank and triggers appropriate feelings and behaviours (e.g., submissive vs. dominant displays) in response [4]. In humans, social rank hinges primarily on existing positively in the minds of others [2, 4]. Early ex
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