Social appearance anxiety moderates the relationship between thin-ideal internalization and eating disorder symptoms cross-sectionally and prospectively in adolescent girls

Social appearance anxiety among the dark tetrad and self-concealment

This study analyzed the effects of the Dark Tetrad (narcissism, Machiavellianism, psychopathy, sadism) and self-concealment on social appearance anxiety. Empirical investigations on which personality traits influence social appearance anxiety are yet missing. In this study, a sample of N = 1186 Chinese students performed a questionnaire-based survey assessing different personality facets and social appearance anxiety tendencies. Measures included the Narcissistic Personality Inventory, the Levenson Self-Report Psychopathy Scale, the Machiavellian Personality Scale, the Short Sadistic Impulse Scale, the Self-concealment Scale, and the Social Appearance Anxiety Scale. The results of the multiple regression analysis showed that psychopathy, Machiavellianism, sadism, and self-concealment positively predicted social appearance anxiety and narcissism negatively predicted social appearance anxiety. Machiavellianism, psychopathy, sadism, and self-concealment were positive predictors of social appearance anxiety, whereas narcissism was a negative predictor. These findings provide insight into the complex nature of the Dark Tetrad and their influence on social appearance anxiety.

Motivational processes contributing to disturbances in women's body image and eating

Reinforcement Sensitivity Theory (RST) provides a neurobiological personality framework for understanding approach and avoidance behavioural patterns. Recent research suggests an association between RST personality traits (reward interest and behavioural inhibition system [BIS]) and women's body image and eating behaviours. The current study aimed to extend this research by testing for indirect relationships between reward interest and BIS and eating disorder symptoms, as mediated through thin ideal internalisation. Adult female participants (N = 354, M = 22.06 years of age, SD = 6.78) completed self-report measures of reward interest, BIS, thin ideal internalisation, and eating disorder symptoms (i.e., restraint, eating concerns, weight and shape concerns). Indirect relationships were tested using bootstrapped mediation analyses. Results showed thin ideal internalisation mediated the pathways between the BIS and restraint, eating concern, and weight and shape concerns. Reward interest was not associated with thin ideal internalisation, or with eating disorder symptoms. Although the application of RST to women's body image is an emerging research area, these novel findings suggest BIS trait sensitivity may increase women's risk of body image concerns and restricted eating, via increased levels of thin ideal internalisation. Overall, these findings provide preliminary support for inclusion of individual differences in BIS sensitivity in risk factor models of body image and eating disturbances. Future research should aim to replicate these findings in more diverse samples, using longitudinal designs.

Thin Ideal Internalization Assessment (THIINA): Development and Psychometric Validation of a New Measure of Female Body Image

Thin ideal internalization is widely implicated in women's body image and eating disturbances. A recently proposed multidimensional operationalization of internalization suggests the brevity and construct validity of existing questionnaires may limit the assessment of thin ideal internalization. Therefore, this research aimed to develop a new questionnaire (i.e., Thin Ideal Internalization Assessment; THIINA) to comprehensively assess thin ideal internalization. In Study 1, 301 female participants were administered the THIINA. Exploratory factor analyses revealed the 17-item THIINA had a stable 3-factor structure reflecting thin idealization, thin overvaluation, and thin behavioral drive. In Study 2, 337 female participants were administered the THIINA and validation measures. Confirmatory factor analysis confirmed stability of the 3-factor structure and findings supported convergent, discriminant, and incremental validity of the THIINA. Support for temporal stability was found within a sub-sample of participants (n = 132). The THIINA demonstrated strong psychometric properties, a stable three-factor structure representing theoretically-driven domains, and support for the creation of a composite score representing overall thin ideal internalization. These findings suggest the multidimensional operationalization and measurement of thin ideal internalization could improve theoretical and clinical understanding of the impact of thin ideal internalization on women's body image and eating.

Translation and psychometric properties of the Chinese version of the Sociocultural Attitudes Towards Appearance Questionnaire-4 (SATAQ-4) in college students

The current study aimed to translate the Sociocultural Attitudes Towards Appearance Questionnaire-4 (SATAQ-4) into Mandarin Chinese and to examine its psychometric properties. In Study 1 (N = 842, 427 women, 415 men), exploratory factor analysis supported a 4-factor solution for the Mandarin Chinese SATAQ-4, namely Internalization: Thin/Low body fat, Internalization: Muscular/Athletic, Pressures: Family/Peers, and Pressures: Media. Evidence also supported the high internal consistency and convergent validity of the male-subject and female-subject versions of Mandarin Chinese SATAQ-4. In Study 2 (N = 497, 290 women), confirmatory factor analyses supported the previously found 4-factor model, after allowing correlation between residuals of three pairs of items. In Study 3 (N = 294, 129 women), we examined the 3-month test-retest reliability across gender, and the results showed satisfactory ICC for both women (ICC =0.53-0.79) and men (ICC =0.56-0.66). Taken together, the male-subject and female-subject versions of the Mandarin Chinese SATAQ-4 are reliable and valid in evaluating sociocultural attitudes towards appearance.

Social physical anxiety and eating disorders: A systematic review and meta-analysis

The present study's aim was to summarize existing quantitative evidence linking social physique anxiety (SPA) and eating disorders (ED). Eligible studies were searched for up to June 2, 2022 in six databases: MEDLINE, Current Contents Connect, PsycINFO, Web of Science, SciELO, and Dissertations & Theses Global. Studies were considered eligible if they included information derived from self-report instruments that allowed for computing the relationship between SPA and ED. Pooled effect sizes (r) were computed using three-level meta-analytic models. Potential sources of heterogeneity were examined using univariable and multivariable meta-regressions. Influence analyses and a three-parameter selection model (3PSM) were used for the purpose of examining the robustness of the results and publication bias, respectively. Results summarizing 170 effect sizes from 69 studies (N = 41,257) showed two main groups of findings. Firstly, that SPA and ED were very largely related (i.e., r = .51). Secondly, that this relationship was stronger (i) among individuals from Western countries, and (ii) when ED scores concerned the diagnostic feature of bulimia/anorexia nervosa involving body image disturbances. The present study adds to the current understanding of ED by suggesting that SPA is a maladaptive emotion with a potential role in the onset and maintenance of these group of pathologies.

Eating disorders among middle school students in a Chinese population: Prevalence and associated clinical correlates

INTRODUCTION

Eating disorders are regarded to be associated with many psychological and behavioral problems. Moreover, adolescence has been reported to be the key period for developing eating habits, and eating disorders typically emerge in adolescence and early adulthood. This study aimed to investigate the prevalence of eating disorders and explore the associated factors among adolescents in Hunan province, China METHODS: A total of 1610 middle school students from Hunan province, China, were enrolled in this study. The participants were aged from 11 to 16 years old. The following data were collected: demographic variables, Body Mass Index (BMI), suicidal behaviors, non-suicidal self-injury, depression, anxiety, stress (depression - anxiety - stress scale, DASS-21), childhood trauma (Childhood Trauma Questionnaire, CTQ), symptoms of social anxiety (Social Anxiety Scale-Adolescents, SAS-A), and eating problems (Eating Attitudes Test, EAT-26).

RESULTS

The estimated prevalence of eating disorders was 8.9%. Compared with participants without eating disorders, participants with eating disorders were more likely to be at a younger age, obese and overweight, and have a history of non-suicidal self-injury, suicidal ideation, suicidal plans, suicide attempts, emotional abuse, physical abuse, emotional neglect, and physical neglect; more likely to experience stress, anxiety or depression as well as have high scores of social avoidance and distress related to general social contexts. Anxiety, emotional neglect, physical neglect, obesity, and overweight were still significant in the binary logistic regression model after controlling for confounding factors. Additionally, younger age, emotional abuse, physical abuse, stress, anxiety, depression, social avoidance, and distress related to general social contexts were significantly correlated with the EAT-26 scores in correlation analysis CONCLUSIONS: Eating disorders are quite common among middle school students. Moreover, eating disorders are associated with younger age, non-suicidal self-injury, suicidal ideation, suicide attempts, stress, anxiety, depression, emotional abuse, physical abuse, emotional neglect, physical neglect, social avoidance, and distress related to general social contents and BMI. This study provides a reference for school counselors and clinicians in the prevention and treatment of eating disorders.

Media Internalized Pressure and Restrained Eating Behavior in College Students: The Multiple Mediating Effects of Body Esteem and Social Physique Anxiety

Background

Restrained eating behavior has become the norm in college students' lives, and considering the harm it causes to college students, it is necessary to explore the factors associated with it. The aim of this study was to explore the association between media internalized pressure, body esteem, social physique anxiety, and restrained eating behavior.

Methods

The participants in this study were 1,032 Chinese college students (439 males and 593 females) and had a mean age of 20.22 years (SD = 1.277). They completed the Sociocultural Attitudes Toward Appearance Questionnaire-3, Body Esteem Scale (BES), Social Physique Anxiety Scale (SPAS), and Dutch Eating Behavior Questionnaire (DEBQ).

Results

The results showed that media internalized pressure was significantly and positively associated with college students' restrained eating behavior, that body esteem and social physique anxiety played a mediating role between media internalized pressure and restrained eating behavior, respectively, and that body esteem and social physique anxiety can also play a chained mediating role.

Conclusion

This study reveals the relationship between media internalized pressure and restrained eating behavior, and the important role played by body esteem and social physique anxiety. Future interventions targeting restrained eating should focus on the aspects of body esteem and social physique anxiety.

Eating disorder and social anxiety symptoms in Iranian preadolescents: a network analysis

PURPOSE

Network studies of eating disorder (ED) symptoms have identified central and bridge symptoms in Western samples, yet few network models of ED symptoms have been tested in non-Western samples, especially among preadolescents. The current study tested a network model of ED symptoms in Iranian preadolescents (ages 9 to 13), as well as a model of co-occurring social anxiety disorder (SAD) and ED symptoms.

METHOD

Preadolescent boys (n = 405) and girls (n = 325) completed the Children Eating Attitudes Test-20 and Social Anxiety Scale for Children. We estimated two network models (ED and ED/SAD networks) and identified central and bridge symptoms, as well as tested if these models differed by sex.

RESULTS

We found that discomfort eating sweets were the most central symptoms in ED networks. Concern over being judged was central in networks including both ED and SAD symptoms. Additionally, concern over being judged was the strongest bridge symptoms. Networks did not differ by sex.

CONCLUSION

Future research is needed to test if interventions focused on bridge symptoms (i.e., concern over being judged) as primary intervention points target comorbid ED-SAD pathology in preadolescents at risk for ED and SAD.

LEVEL OF EVIDENCE

Level III; Evidence obtained from well-designed observational study, including case-control design for relevant aspects of the study.

Prevention of eating disorders: 2021 in review

This review of 19 prevention-related publications in Eating Disorders during 2021 is framed by four models: (1) Mental Health Intervention Spectrum: health promotion → types of prevention → case identification/referral → treatment; (2) the prevention cycle: rationale and theory, shaped by critical reviews → clarifying risk and protective factors → program innovation and feasibility studies → efficacy and effectiveness research → program dissemination; (3) links between disordered eating (DE) and eating disorders (EDs); and (4) Kraemer and Jacobi's criteria for variable, causal risk factors (RFs). Twelve articles demonstrated the strengths and limitations of cross-sectional investigations of RFs for DE and EDs: five explored the role of trauma in activating genetic and psychological RFs (e.g., anxiety and experiential avoidance), while five suggest other variables meriting further evaluation: ergogenic supplement use, "feeling fat," internalized weight bias, food insecurity, and compulsive exercising. One article presents a pilot program that reduced risk factors in a high-risk group: professional ballerinas. Implications of the absence of efficacy, effectiveness, dissemination, and advocacy studies, along with the need to develop tailored programs for various high-risk groups, are discussed.

A population-based study of macronutrient intake according to mental health status with a focus on pure and comorbid anxiety and eating disorders

PURPOSE

Eating disorders (ED) and anxiety impact food choices. In addition, comorbid anxiety seems to increase ED symptoms and severity. However, the association between such comorbidity and dietary intake is unknown. This population-based, cross-sectional study aimed to assess macronutrient intake according to mental health status (i.e., no disorder, pure and comorbid anxiety and ED).

METHODS

The study included N = 24,771 participants (74% female, mean age = 53.2 ± 13.7 years) in the NutriNet-Santé cohort, who completed once the trait subscale of the State-Trait Anxiety Inventory (STAI-T; high anxiety: ≥ 40 points) between 2013 and 2016 and the SCOFF questionnaire screening for ED in 2014. The Expali algorithm was applied to categorize ED (no ED; restrictive: RS; bulimic: BL; hyperphagic: HP; other ED). Participants were divided into ten groups by crossing their anxiety status (two groups: low or high) and their ED status (five groups). Macronutrient intakes were evaluated from ≥ 3 24-h dietary records. Analyses of covariance (ANCOVA) and Dunnett-Hsu tests (reference = no disorder) were performed.

RESULTS

Significant differences in macronutrient intake were seen between the pure and comorbid forms, especially for RS and HP. Compared to the "no disorder" group, a significantly higher percentage of energy from carbohydrates, higher intakes of total carbohydrates, simple sugars, and plant-based protein, lower intakes of total fat, saturated and monounsaturated fatty acids, and cholesterol were observed in the comorbid anxiety + RS group, but not in the pure RS group. In contrast, significantly lower intakes of added sugar and plant-based protein, and a higher intake of cholesterol were observed in the pure HP group, but not in the comorbid anxiety + HP group. For BL and other ED, similar results were observed between the pure and comorbid forms.

CONCLUSION

This large epidemiological study provided some support for differences in macronutrient intake between individuals with pure or comorbid anxiety and ED. Differences in intake were largely dependent on ED type. Future prospective studies and studies using clinically defined anxiety and ED are needed to elucidate causality as well as potential effect modification of the observed associations.