Abstract
Background and Aims: Social Rank theory is an evolutionary theory based on the idea that achieving enhanced social rank is an essential biosocial goal for all individuals. This theory has been applied to understand the aetiology and psychopathology of Eating Disorders (EDs), with the suggestion that individuals with EDs could be more likely than controls to focus excessively on social rank and how they stand in relation to others based on physical appearance. The aim of the current systematic review was to identify, evaluate and synthesise existing literature exploring social rank and related constructs (e.g., submissiveness, inferiority) in eating disorders, to shed light on how individuals with EDs perceive their social rank compared to others and the relationship between perceived social rank and ED psychopathology.Method: Five databases (Embase, Medline, PsychINFO, Web of Science, PubMed) were systematically searched in April 2021 for relevant studies. Studies were included if they involved a clinical sample of people with an ED, used a validated measure to assess social rank or related constructs, were cross-sectional or longitudinal studies, were quantitative in approach, published in peer reviewed journals, and available in English.
Results: Sixteen studies (n= 16), involving a total of 3,581 participants, with a diagnosis of AN, BN, or BED were included in the current review. Most of the studies employed a cross-sectional design (n= 12) and a minority used a prospective cohort study design (n= 3), with only one study employing an ecological momentary assessment (n= 1). A control group of healthy participants was included in most of the studies (n= 11). The quality of retrieved manuscripts was assessed using the National Institutes of Health (NIH) Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies.
Discussion: Overall, findings from the studies showed that individuals with EDs perceive their social rank as lower compared to healthy controls and present characteristic features of low social rank such as high levels of submissiveness, non-assertiveness, exploitability, rejection sensitivity, and feelings of shame and inferiority. Importantly, the perception of being of low social rank was significantly associated with more severe ED psychopathology, potentially suggesting that ED symptoms have the function of restoring or maintaining social rank. These findings were mainly drawn from cross-sectional studies, and the mechanistic role of social rank in the aetiology and maintenance of the ED, remains unclear. The current review highlighted the need for more longitudinal research to shed light on the role of social rank in the onset and maintenance of EDs, and the importance of accounting for interpersonal processes and difficulties, such as social rank issues, in the treatment of EDs.
| Date of Award | 1 Oct 2022 |
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| Original language | English |
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| Supervisor | Valentina Cardi (Supervisor) & Thomas Ward (Supervisor) |