The specificity of reassurance-seeking to different psychological disorders

Eating disorders have the highest mortality rate of any mental health diagnosis in the United Kingdom. They are also highly co-morbid with anxiety and depression. It is possible that some of the maintaining factors of anxiety and depression are also present in eating disorders - particularly safety behaviours. One safety behaviour that has received little attention in eating disorders is reassurance-seeking. To enhance understanding of this safety behaviour, specifically in eating disorders, this research set out to: 1. understand the relationship between reassurance-seeking and clinical anxiety and depression; and 2. develop and validate a reassurance-seeking measure specific to eating disorders. A systematic review identified 19 papers that examined the relationship between reassurance-seeking and clinical depression or anxiety. The findings of this review suggest that the more a person seeks reassurance, the worse their symptoms of anxiety and depression are. Moreover, the pattern of reassurance-seeking across the two diagnoses had several differences (e.g., those with depression seek reassurance about social threats, while those with anxiety seek reassurance about general threats). However, the findings were based on a limited number of papers and thus should be treated cautiously. Limitations and implications for clinical practice are also discussed. Recommendations for future research include the need to investigate reassurance-seeking in other disorders (e.g., eating disorders). Subsequently, the development and validation of a reassurance-seeking measure specific to eating disorders was undertaken. One hundred and sixty-seven participants completed the Reassurance-Seeking in Eating Disorders Questionnaire (RSED-Q), which was developed for this research. Additional measures completed by participants addressed anxiety, depression, eating pathology, social anxiety, and general reassurance-seeking. Factor analysis was undertaken on the responses of the RSED-Q. Six factors emerged, which were meaningful both statistically and psychologically. The six factors showed strong internal consistency, good test-retest reliability, acceptable concurrent validity, and strong clinical validation. The RSED-Q predicted eating pathology more strongly than did the more generic measure of reassurance-seeking. Thus, the RSED-Q was more useful in explaining eating pathology than existing measures of reassurance-seeking. Limitations are discussed, and recommendations are made for addressing reassurance-seeking in clinical practice in eating disorders. Recommendations for future research include using a specific rather than generic measure of reassurance-seeking, and to extend this work into experimental designs to determine causality.