Social rejection sensitivity and its role in anorexia nervosa: a systematic review of experimental literature

Objective: Social rejection sensitivity (SRS) is characterised by anxious expectations of rejection, and the increased tendency to readily perceive and react intensely to rejection-based cues. It has been suggested SRS may play a role in anorexia nervosa (AN). Our review investigates whether SRS is exhibited in AN, and the cognitive mechanisms that underly this disposition. Method: We included experimental studies if they used social threat or rejection-based stimuli, reported on measures related to either cognitive, emotional, and/or behavioural responses, and compared patients with a diagnosis of AN and/or those who have recovered from the illness with healthy controls. Results: This article identified 47 eligible studies, with risk of bias assessment indicating the research was of good quality. Main findings showed patients with AN exhibit attentional bias towards social rejection cues, negative interpretation bias during ambiguous social scenarios, and heightened negative affect during and following rejection-based experiences. Physiological blunting during and following rejection-based experiences was observed in AN with some evidence to suggest this remediates during the process of weight-restoration. demonstrating an incongruence between affective and somatic experience in active illness. Discussion: Our results suggest females with AN display a cognitive profile that could lead to a tendency to expect rejection, readily perceive rejection and react with more intense negative affect to rejection-based cues, with limited evidence to suggest this cognitive profile persists in recovery. Our results can be interpreted through theoretical models that postulate drive for thinness may partially function to cope with anticipated or experienced rejection.