The role of anxiety sensitivity in eating pathology

By: Christian Nickole Klepper

A review of:
Anestis, M. D., Holm-Denoma, J. M., Gordon, K. H., Schmidt, N. B., & Joiner, T. E. (2008). The role of anxiety sensitivity in eating pathology. Cognitive Therapy and Research, 32(3), 370-385.

Anxiety sensitivity (AS) is an individual difference variable that represents one’s fear of anxiety. It encompasses responsiveness to somatic, cognitive and social consequences of anxiety. High AS can predispose people to anxiety (specifically panic attacks), depressive disorders, substance use disorders and borderline personality disorder (Bilgiç, Türkoğlu, Ozcan, Tufan, Yılmaz & Yüksel, 2013; Fulton, Lavender, Tull, Klein, Muehlenkamp & Gratz, 2012). The relationship between AS and eating disorders is less clear. Eating disorders often co-occur with anxiety, depression and alcohol and substance use and abuse (NEDA, 2012). Among those with a diagnosed eating disorder, up to 75% will have an anxiety disorder at some point in their lives (Becker, DeViva & Zayfert, 2004).

Anestis, Holm-Denoma, Gordon, Schmidt & Joiner (2008) examined the relationship between anxiety sensitivity and disordered eating, specifically symptoms of bulimia nervosa (BN). They believed a relationship between fear of somatic symptoms would lead to eating as a method of reducing this tension and subsequent purging. They hypothesized that interoceptive awareness (IA), or the ability to discern and accept emotional and visceral experiences, would mediate the predicted relationship between AS and eating pathology.

They conducted two studies: one with 88 undergraduates and the other with 96 clients at an outpatient mental health clinic. They used the Anxiety Sensitivity Index (ASI) to assess anxiety sensitivity, their predictor variable, and three subscales from the Eating Disorders Inventory (EDI; Drive for Thinness, Bulimia and Body Dissatisfaction) to assess eating pathology, their dependent variables. They controlled for anxiety, depression and impulsivity, which were measured with the Beck Anxiety Inventory (BAI) and Beck Depression Inventory – Second Edition (BDI) in both studies and Urgency subscale of the Urgency, (lack of) Premeditation, (lack of) Perseverance, Sensation Seeking Impulsive Behavior Scale (UPPS) in the undergraduate sample and the Impulsive Behavior Scale (IBS) in the clinical sample. Their proposed mediator variable, IA, was measured with the Interoceptive Awareness subscale on the EDI.

Anestis, Holm-Denoma, Gordon, Schmidt & Joiner (2008) conducted regression analyses for each dependent variable: EDI-Bulimia, EDI-Drive for Thinness and EDI-Body Dissatisfaction. They ran the analyses by entering the control variables first followed by the ASI score. This process was repeated for the clinical sample the same as the undergraduate sample. In the undergraduate sample, they found that, when controlling for BAI, BDI and UPPS scores, AS significantly predicted EDI-B scores but not EDI-BD or EDI-DT. Baron and Kenny (1986) proposed meeting four criteria to determine a meditational relationship: the predictor variable (ASI) must predict the mediator (EDI-Interoceptive Awareness), the mediator variable must predict the dependent variable (EDI-B), the predictor variable must predict the dependent variable and the relationship between the predictor variable and the dependent variable must be non-significant when the mediator is added to the model. In the undergraduate sample, the relationship between AS and EDI-B was in fact mediated by EDI-IA. In the clinical sample, when controlling for BAI, BDI and IBS scores, ASI scores significantly predicted EDI-B and EDI-DT scores but not EDI-BD scores. Baron and Kenny’s (1986) criteria were met for both of these significant relationships, indicating that IA mediated the relationships between ASI and EDI-B and ASI and EDI-DT.

These results indicated that increased fears of somatic experiences of anxiety may increase the risk of developing problem eating behaviors and beliefs. The significant relationship between AS and EDI-B means there may be a distinct symptom pattern among individuals with disordered eating to be investigated. This is especially important given how broad the diagnosis of eating disorder not otherwise specified (EDNOS), now other specified feeding or eating disorder (OSFED) and unspecified feeding or eating disorder (UFED), is (Fairburn & Bohn, 2005). They interpreted the significant relationship between AS and EDI-DT to mean that AS may play a role in the development and maintenance of disordered eating. The meditation of these relationships by IA may indicate that disordered eating may be due to a general diminished ability to understand somatic and emotional indicators rather than a specific reaction to physical cues.

These studies were cross-sectional and had small sample sizes, which are limitations. Similarly, within the clinical sample, only five participants had diagnosed eating disorders, which made it difficult to determine the relationship between AS and clinical eating pathology. Future research should use different methods of measuring AS and IA, to provide more evidence that this relationship does in fact exist, and should assess this relationship in a larger population with diagnosed eating disorders.

Baron, R. M., & Kenny, D. A. (1986). The moderator–mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51(6), 1173–1182.

Becker, C. B., DeViva, J. C., & Zayfert, C. (2004). Eating disorder symptoms among female anxiety disorder patients in clinical practice: The importance of anxiety comorbidity assessment. Journal of Anxiety Disorders, 18(3), 255-274.

Bilgiç, A., Türkoğlu, S., Ozcan, O., Tufan, A. E., Yılmaz, S., & Yüksel, T. (2013). Relationship between anxiety, anxiety sensitivity and conduct disorder symptoms in children and adolescents with attention-deficit/hyperactivity disorder (ADHD). European Child & Adolescent Psychiatry, 22(9), 523-32. Retrieved from

Fairburn, C. G., & Bohn, K. (2005). Eating disorder NOS (EDNOS): An example of the troublesome “not otherwise specified” (NOS) category in DSM-IV. Behaviour Research and Therapy, 43(6), 691-701.

Fulton, J. J., Lavender, J. M., Tull, M. T., Klein, A. S., Muehlenkamp, J. J., & Gratz, K. L. (2012). The relationship between anxiety sensitivity and disordered eating: The mediating role of experiential avoidance. Eating Behaviors, 13(2), 166-169.

National Eating Disorders Association [NEDA]. (2012). What Are Eating Disorders? Retrieved from

To cite this review, please use this reference:
Klepper, C.N. (2015). The role of anxiety sensitivity in eating pathology. Psychology Alert (1).