Between shame and visibility: A network analysis of social anxiety and eating-disorder psychopathology

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.