Psychology Journals

The Diagnostic and Statistical Manual of Mental Disorders (DSM) states that individuals with a dependent personality are at increased risk for anxiety disorders. Meta-analysis of 53 studies examining the comorbidity of dependent personality disorder (DPD) and one or more anxiety disorders (ADs) revealed that the overall DPD-AD relationship is modest in magnitude (mean r = .11) and holds for some ADs but not others. Follow-up analyses indicated that the DPD-AD link was not moderated by diagnostic system, assessment method, or comparison group (other personality-disordered patients versus non-personality-disordered controls). Given these findings, future versions of the DSM may need a more tentative and qualified description of DPD-AD comorbidity.

Ng and Bornstein (this issue) examined the comorbidity between dependent personality disorder (DPD) and anxiety disorders (ADs) via meta-analytic techniques. Although meta-analysis can be useful in quantifying such comorbid relationships, several conceptual and methodological concerns may undermine one's confidence in Ng and Bornstein's conclusions. Specifically, the bulk of the papers reviewed by Ng and Bornstein examined to what extent DPDs occurred in individuals with ADs, even though the authors' primary research question was the extent to which individuals with a diagnosis of DPD also have a diagnosis of AD. We argue that the inclusionary criteria used in their review may have underestimated the rate of comorbidity between DPDs and ADs. Future analyses may be improved by being theory-driven and by differentiating between clinical diagnoses versus subclinical symptomatology.

Ng and Bornstein (this issue) conclude from their meta-analysis that the DSM assertion that dependent personality disorder (DPD) shows significant comorbidity with anxiety disorders (ADs) appears to be overstated. In this comment it is argued that the DSM assertion may be not overstated. It is reasoned that an increase of 10% ADs associated with the observed average r is not so small, given a number of reasons, including imperfect reliability and validity of assessments, multiple causation of ADs, and incomplete coverage of ADs and DPD by DSM criteria. A plea is made to extend the DSM concept of psychopathological dependency, which is mostly based on functional dependency, with emotional dependency. Based on theoretical, etiological, and empirical arguments it is argued that these forms of dependency should be differentiated from each other. Emotional dependency might constitute a separate risk factor for ADs.

The relationship between dependent personality disorder (DPD) and several of the anxiety disorders is explored. Recent meta-analytic findings (this issue) suggest that DPD is comorbid with social phobia, obsessive-compulsive disorder, and panic disorder but not with the other anxiety disorders. Examination of comorbidity rates clarifies the relationship between DPD and specific anxiety disorders, but this method does not address many of the important questions concerning this relationship. It remains unclear whether DPD is associated with an increased risk for developing an anxiety disorder or whether anxiety disorders increase the risk of developing DPD. Additionally, if DPD does serve as a risk factor for the development of anxiety disorders, it is unclear whether this risk is clinically meaningful. Finally, causal mechanisms leading from DPD to anxiety disorder have not been examined and warrant future investigation. Examination of comorbidity rates between DPD and the anxiety disorders does not address many clinically relevant issues surrounding the DPD-anxiety relationship, but it does highlight important directions for future research.

Various factors have been implicated in the development of body image dissatisfaction. Especially important are three constructs: awareness of a thin ideal, internalization of a thin ideal, and perceived pressures to be thin. Using meta-analysis, we calculated the strength of the relationships between each of these constructs and body image, and we evaluated the differences in magnitude across the average effect sizes. We also tested the moderating effects of age and ethnicity, and we compared the average effect sizes with those from meta-analyses of prospective and experimental studies in order to determine whether the effect sizes differed by study design. The results indicated the following: all three sociocultural factors had statistically significant relationships with body image; internalization and perceived pressures have a significantly stronger relationship to body image than does awareness; the effect sizes from cross-sectional studies were significantly larger than those of both longitudinal and experimental studies; and neither age nor ethnicity was a statistically significant moderator of the relationship between awareness and body image or that between internalization and body image. In this article, we discuss the limitations and implications of the findings on future research, theory, and clinical application.

Cafri, Yamamiya, Brannick, and Thompson (this issue) reported results from a meta-analysis of relations between three sociocultural factors and body image dissatisfaction. Comparison of the effect sizes reveals that internalization of a thin ideal and perceived pressures have significantly stronger relations to body image dissatisfaction than does awareness of a thin ideal. The authors tested for and found no evidence of a moderating relationship involving age or ethnicity. The findings raise implications for advancing the study of body image dissatisfaction and eating disorders. In this commentary, I consider some of the challenges of studying sociocultural factors within the contexts of clinical research and practice. Specifically, I consider how cultural influences may arise and describe the utility of ecological frameworks for conceptualizing and assessing the impact of sociocultural factors within a treatment context.

Body image is a multidimensional construct that has received increasing scientific study over the past few decades. Considerable research has examined the determinants of body image development and functioning and their implications for other aspects of psychosocial well-being, especially eating pathology among girls and young women. Cafri, Yamamiya, Brannick, and Thompson (this issue) reported the results of a meta-analysis of how selected, self-reported sociocultural influence variables correlate with the basic dimension of body image evaluation. Their work raises and reinforces important questions about the definition and measurement of sociocultural influence constructs.

The meta-analysis by Cafri, Yamamiya, Brannick, and Thompson (this issue) established that body image disturbances in females are associated with awareness of the thin ideal, internalization of the thin ideal, and perceived pressure to be thin. This commentary discusses several theoretical implications of these findings and suggests directions for future research. For example, the evidence that the cross-sectional relations between these three sociocultural factors and body dissatisfaction are larger than the relations observed in prospective studies suggests that these factors may be reciprocally related to body dissatisfaction; preliminary analyses of prospective data provided support for this assertion. In addition to following up these findings with prospective studies that test for reciprocal effects, it would be particularly useful if future studies provided experimental tests of these relations and more rigorous tests of the validity scales that assess sociocultural factors.