رابطه نارضایتی از بدن و اختلال خوردن: نقش میانجی عزت نفس و افسردگی

The purpose of this study was to investigate the hypothesis that the effect of body dissatisfaction on disordered eating behavior is mediated through self-esteem and depression. If the effect of body dissatisfaction on disordered eating can be explained by self-esteem and depression, treatment may benefit from focusing more on self-esteem and depression than body dissatisfaction. We also hypothesized body image importance to be associated with lower self-esteem, stronger symptoms of depression, and more disordered eating. The results showed that the effect of body dissatisfaction on disorder eating was completely mediated, whereas the effect of body image importance was partly mediated. Both self-esteem and depression were significant mediators. Body image importance and self-esteem had a direct effect on restrained eating and compensatory behavior. Depression had a direct effect on binge eating. This effect was significantly stronger among women. Depression also had a direct effect on restrained eating. This effect was positive among women, but negative among men. The results support emotion regulation and cognitive behavioral theories of eating disorders, indicating that self-esteem and depression are the most proximal factors, whereas the effect of body dissatisfaction is indirect. The results point out the importance of distinguishing between different symptoms of bulimia. Depression may cause binge eating, but compensatory behavior depends on self-esteem and body image importance. The results suggest that women may turn to both binge eating and restrained eating to escape awareness of negative emotions, whereas men focus on eating to a lesser extent than women. Existing treatment focuses on eating behavior first and mechanisms such as self-esteem and depression second. The results from this study suggest that an earlier focus on self-esteem and depression may be warranted in the treatment of disordered eating.

Body dissatisfaction predicts development of disordered eating (e.g., Wertheim, Koerner, & Paxton, 2001), but why body dissatisfaction may lead to disordered eating remains an unanswered question. Self-esteem and negative emotions (e.g., depression) have been proposed as mediators in the relationship between body dissatisfaction and disordered eating (Fairburn et al., 1999 and Vitousek and Hollon, 1990), but with mixed results (e.g., Heywood and McCabe, 2006 and Van den Berg et al., 2002). Clinically, this proposition means that body dissatisfaction has an indirect impact on disordered eating, and that self-esteem and negative emotions are the intermediate agents or mechanisms through which the effect on disordered eating is transferred. We believe the mixed results may be explained by different aspects of body dissatisfaction (i.e., body dissatisfaction vs. body image importance) having different relations to different types of disordered eating (i.e., restrained eating, binge eating, and compensatory behavior). Studies including men (Heywood and McCabe, 2006 and Ricciardelli and McCabe, 2001) have been less successful in identifying the proposed mediation, than studies exclusively made up of women, thus the mixed results may also be due to gender differences.