Perception of social rank and submissive behavior in eating disorders.

OBJECTIVE: The aim of this paper is to study the social behavior in patients with eating disorders, in particular the presence of low social ranking and high submissive behavior. We also considered the relationship between these factors and the presence of some personality traits and pathological eating behaviors. METHOD: We performed a case-control study on 249 young women (124 controls and 125 eating disorders subjects). Eating disorders were diagnosed as anorexia nervosa, bulimia nervosa and eating disorders non otherwise specified. The patients underwent a routine assessment by means of a diagnostic interview and some self-reported questionnaires. All the subjects (cases and controls) also completed two scales for the assessment of social ranking and submissive behaviors. The two questionnaires were translated from English with the back-translation method. RESULTS: The two scales were valid and reliable in their Italian version. We observed a significant difference between cases and controls: social ranking was lower in cases, and submissive behavior was lower in controls. Social ranking had an inverse relationship with submissive behavior both in cases and controls, and a significant correlation was found with other interpersonal aspects (ineffectiveness, interpersonal sensitivity) and with some pathological traits and behaviors, like self-injurious behavior. CONCLUSION: Our study shows that features of low social ranking and submissive behavior are common in eating disorders subjects. These features could represent a risk factor for the development of an eating disorder or, on the contrary, represent a consequence of an eating disorder. A useful therapeutic approach to these disorders could be focused on shifting from submissive to assertive behavior.