Analyzing the relation between self-esteem and eating disorders: differential effects of self-liking and self-competence

The moderating role of emotional intelligence in the link between self-esteem and symptoms of eating disorders

OBJECTIVE

This research aimed to explore the moderating role of emotional intelligence (EI) in the relationship between self-esteem and eating disorders (ED) symptomatology.

METHOD

A battery of online questionnaires was administered to a sample of 516 adults including university students and a community population. The sample, age range of 18-77 years (X = 38.90; SD = 14.76), was made up of 63% women and 32% men.

RESULTS

EI moderated the association between self-esteem and ED symptomatology for the total sample. However, a gender-specific analysis showed that the moderation effect was only significant for women. Specifically, when women reported a low level of self-esteem, those with high scores in EI reported lower scores in ED symptoms than those with low EI.

DISCUSSION

Our findings are discussed in terms of the need for future research to understand the different gender associations and to consider these differences in further intervention programs for reducing the risk of ED, in which training in emotional skills may be more beneficial for women than men.

Psychosocial profile related to disordered eating attitudes in Spanish adolescents

Different psychosocial variables are related to disordered eating attitudes in adolescents, especially in girls. But some studies show that the variables involved in eating disorders may be different in boys and girls. The aim of this study was to analyse the psychosocial profile related to disordered eating attitudes in adolescents of both sexes, separately. Method: a cross-sectional study was conducted in 1630 Spanish adolescents, 890 of whom were girls with an average age of 14 (SD = 1.34) selected from secondary schools in the province of Alicante through random sampling stratified by school year. Results: The cluster analysis showed two profiles in both sexes. One profile presents high disordered eating attitudes, where the highest scores were in body dissatisfaction, perfectionism, pressure to lose weight and social comparison, and the lowest scores were for self-esteem. This contrasts with the other profile that presents low disordered eating attitudes. The logistic regression model showed that girls were 3.8 times more likely to have disordered eating attitudes if they dieted, experienced body dissatisfaction and compared themselves socially with their peers. Disordered eating attitudes in boys was 3.3 times greater when they experienced body dissatisfaction and pressure to lose weight. Conclusion: These results showed that both sexes present similar profiles. Girls and boys present disordered eating attitudes when they have low self-esteem, body dissatisfaction, self-oriented and socially prescribed perfectionism, comparison with peers, pressure to lose weight, or are on a diet. In future studies, it will be necessary to develop further longitudinal studies which could help to shed light on the risks and protective factors of eating disorders.

From Deficits in Emotional Intelligence to Eating Disorder Symptoms: A Sequential Path Analysis Approach Through Self-Esteem and Anxiety

Past studies have reported emotional intelligence (EI) as a relevant factor in development and maintenance of eating disorders (ED), as well as in increasing self-esteem and reducing anxiety. Similarly, research has showed that anxiety and self-esteem are positively and negatively associated to ED criteria, respectively. However, no prior studies have yet tested the multiple intervening roles of both self-esteem and anxiety as potential mediators of the association between EI and ED symptomatology. The present study aims to bridge these gaps by testing a sequential path model. Specifically, we examine the potential sequential mediation effects of self-esteem-anxiety on the link between EI and ED. A sample composed of 516 Spanish undergraduate students and community adults completed measures of EI, self-esteem, anxiety, and ED symptomatology. The results show that high levels of EI were positively associated with self-esteem and negatively associated with anxiety and ED symptoms. Anxiety was positively associated to ED symptoms, while self-esteem levels were negatively linked to ED symptoms. Moreover, path analyses showed that self-esteem and anxiety fully mediated the relationship between EI and ED symptoms in sequence. These findings suggest that EI plays a key role in reducing symptomatology of ED through increased self-esteem and reduced anxiety symptoms, providing novel evidence regarding psychological mechanisms through which EI contributes to a reduction of ED symptomatology. Implications for assessing and improving these psychological resources in ED preventive programs are discussed.

Heterogeneity Matters: Predicting Self-Esteem in Online Interventions Based on Ecological Momentary Assessment Data

Self-esteem is a crucial factor for an individual's well-being and mental health. Low self-esteem is associated with depression and anxiety. Data about self-esteem is oftentimes collected in Internet-based interventions through Ecological Momentary Assessments and is usually provided on an ordinal scale. We applied models for ordinal outcomes in order to predict the self-esteem of 130 patients based on diary data of an online depression treatment and thereby illustrated a path of how to analyze EMA data in Internet-based interventions. Specifically, we analyzed the relationship between mood, worries, sleep, enjoyed activities, social contact, and the self-esteem of patients. We explored several ordinal models with varying degrees of heterogeneity and estimated them using Bayesian statistics. Thereby, we demonstrated how accounting for patient-heterogeneity influences the prediction performance of self-esteem. Our results show that models that allow for more heterogeneity performed better regarding various performance measures. We also found that higher mood levels and enjoyed activities are associated with higher self-esteem. Sleep, social contact, and worries were significant predictors for only some individuals. Patient-individual parameters enable us to better understand the relationships between the variables on a patient-individual level. The analysis of relationships between self-esteem and other psychological factors on an individual level can therefore lead to valuable information for therapists and practitioners.

Relevance of social and self-standards in eating disorders

OBJECTIVE

To compare the importance given to self/other standards by eating disorder (ED) patients and healthy controls.

METHODS

A total of 392 individuals (240 consecutively referred and 152 healthy controls) took part in this study. All subjects were diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision criteria and were female patients. Participants completed the Family Style, Self-Expectations and Emotional related subscales of the Cross-Cultural Questionnaire.

RESULTS

Three domains (namely, family standards, self-achievement and physical appearance) were associated with ED. Family standards scores discriminated for the presence of an ED (area under receiver operating characteristic curve equals 0.89), the main predictors being a higher level of importance of physical appearance (p < .001), family standards (p = .029) and conflicts with parents about physical appearance (p < .001). Higher self-standards, in physical appearance, were more relevant in bulimia nervosa and ED not otherwise specified, whereas higher family standards were more associated with anorexia nervosa.

CONCLUSIONS

High self-standards and social standards are common features in ED. The parallelism that ED may establish between reaching them and their life success may have a crucial role as a developing and maintaining factor in ED.

Low perception of control as a cognitive factor of eating disorders. Its independent effects on measures of eating disorders and its interactive effects with perfectionism and self-esteem

OBJECTIVE

There is a large body of research about perfectionism and low self-esteem in eating disorders (ED). However, little is known about the influence in ED of a distorted cognition in the domain of control: the perception of low control. The present study examined the main and interactive effects of concern over mistakes (an important dimension of perfectionism), self-esteem, and perception of control on drive for thinness, bulimia, and body dissatisfaction.

METHOD

Forty individuals with ED and 55 controls completed the Multidimensional Perfectionism Scale, the Anxiety Control Questionnaire, the Rosenberg self-esteem scale, and the three symptomatic scales of the Eating Disorder Inventory, which are drive for thinness, bulimia and body dissatisfaction. Multiple linear regression was used to test the hypothesis that perception of low control has a significant effect on the symptomatic scales of the EDI.

RESULTS

The ED group had significantly lower perception of control and self-esteem and higher concern over mistakes, drive for thinness, bulimia, and body dissatisfaction than the control group. Analysis of interactive effects suggested that a combination of a low perception of control and a low self-esteem seems to moderate the effects of concern over mistakes on drive for thinness, bulimia, and body dissatisfaction.

DISCUSSION

ED are associated with a tendency to worry about mistakes, a low sense of self-esteem, and a low perception of control over internal feelings and external events. Perception of control and self-esteem seems to moderate the predictive power of concern mistakes on symptoms of ED. The results suggest that a low perception of control is an important cognitive factor in ED.

A study of the relationship between parental bonding, self-concept and eating disturbances in Norwegian and American college populations

This study investigated the relationship between bonding patterns and self-concept, and the influence of these constructs on a measure of sub-clinical eating disturbances. Undergraduate students from the United States (N=166) and Norway (N=233) were given self-report questionnaires that included measures of parental bonding, locus of control, self-concept clarity, self-esteem, and disturbed cognitions associated with eating. A structural equation model showed the expected pattern, with bonding predicting self-concept and self-concept predicting eating disturbances. The model fit equally well for samples from both countries and for both genders. This model links the pattern of low care and overprotective parental bonding indicators mediated through a self-concept defined by a lack of self-understanding, low self-esteem, and external locus of control to increased risk of eating disturbances for college aged men and women.

Self-liking and self-competence: relationship to symptoms of anorexia nervosa

Self-esteem has been hypothesised to play a pivotal role in the development and treatment, and outcome of anorexia nervosa (AN). Though this relationship is typically investigated by considering self-esteem as a unitary construct, research suggests that this comprises of two related but distinct components of self-liking and self-competence. This study investigates the association between self-liking, self-competence, and symptomatology of AN through the course of a defined treatment episode in 77 women. Self-liking was significantly associated with laxative abuse. Self-competence was significantly associated with elevated ineffectiveness, perfectionism and interpersonal distrust. Although self-competence and eating disturbance severity significantly improved over the treatment episode, one in three participants reported a reduced self-like or self-competence. Changes in both self-competence and self-liking at the end of treatment was associated with changes in drive for thinness. Such findings have implications for treatment models concerned with improving self-esteem.

Relational competence and eating disorders

Eating Disorders are very widespread within the adolescent population. A possible interpretation and the comprehension of such forms of psychopathology may revolve around the failure to develop a well-defined personal identity, an incapacity to achieve a sense of differentiation with respect to others, an incapacity to measure oneself against others, dependence on others, the fear of rejection and a sense of inadequacy. This study explores the relational styles and behaviour of individuals suffering from eating disorders and their influence on the development of the personality, with reference being made in particular to self-valuation, dependence on others and levels of differentiation. A sample population of 90 women with eating disorders was studied. The subjects were subdivided into 3 groups (30 with restricting anorexia nervosa, 30 with binge-eating/purging anorexia nervosa and 30 with bulimia nervosa), overlapping in terms of age, duration of disorders and interrelation style, using the Relational Competence Test. The most significant results of this study concern the question of the definition of an autonomous personal identity. This process seems to be in progress in young women suffering from bulimia nervosa who appear to be driven towards a "definition of the self in opposition" with the consequent tendency towards relational experiences outside their own family. In women with binge-eating/purging AN moreover an awareness of the difference between the self and others and of their state of dependence would appear to be present, however behaviour aimed at the determination of an autonomous self is not evident. In women with restricting anorexia nervosa a definition of the identity is totally absent; these women develop an omnipotent self in their 'oneness' with others. These relational aspects lead to the identification of a continuum between restricting anorexia nervosa, binge-eating/purging anorexia nervosa and bulimia nervosa in an evolutionary perspective regarding the self-with-others.

Stress plays a role in the association between cognitive constructs and measures of eating disorders in male subjects

OBJECTIVE

Several theorists have hypothesized that stressful situations may trigger abnormal eating and even eating disorders in predisposed people. The purpose of this study was to assess whether a stressful situation would reveal an association between perfectionism and low self-esteem, and measures of eating disorder symptoms in male high school students.

METHOD

A sample of 61 male high school students completed the Eating Disorder Inventory, the Multidimensional Perfectionism Scale, and the Self Liking and Competence Scale three times: on an average school day, on the day of an exam and on the day the subjects received the results of that exam. Linear regression analysis was carried out to verify whether the dimensions of perfectionism were associated with the measures of eating disorders.

RESULTS

Interoceptive awareness was associated with 'Bulimia' only during the stressful situation and with 'Drive for thinness' both in stress and non stress situations. Other results were contradictory and difficult to interpret.

DISCUSSION

The results suggest that in nonclinical male individuals stress might bring out a previously absent association between some psychological predisposing factors for eating disorders and an actual desire or plan for ED related thoughts and behaviours. Such a finding suggests that stress may stimulate behaviours related to eating disorders in a predisposed personality. A central role may be played by interoceptive awareness in male subjects.

Self-Esteem and “At Risk” Women: Determinants and Relevance to Sexual and HIV-Related Risk Behaviors

In this study, we describe the relationship between self-esteem and HIV-related risk behaviors, and explore what factors predict self-esteem levels of "at risk" women. Interviews were conducted with 250 (predominantly African American) women living in the Atlanta, Georgia metropolitan area between August 1997 and August 2000. A community identification process was used to identify potential study participants, with further expansion of the sample via targeted and theoretical sampling and ethnographic mapping procedures. Self-esteem was related to the number of times having oral sex, the number of times having sex with paying partners, the frequency of sexual risk-taking (all during the 90 days prior to interview), the number of different HIV risk behaviors practiced during the previous year, and condom use attitudes and self-efficacy. Greater involvement HIV risk behaviors was associated with lower self-esteem. Multivariate analyses revealed five significant predictors of women's self-esteem levels: race, religiosity, childhood experiences with emotional neglect, the number of money-related problems experienced, and the number of drug-related problems experienced. The findings indicate that self-esteem is highly relevant to "at risk" women's HIV risk behavior practices, and this has important implications for HIV intervention programs.

The role of stress in the association between low self-esteem, perfectionism, and worry, and eating disorders

OBJECTIVE

Several theorists have hypothesized that stressful situations may trigger abnormal eating and even eating disorders in predisposed people. The purpose of the current study was to assess whether a stressful situation would reveal an association between perfectionism, low self-esteem, worry, and body mass index (BMI) and measures of eating disorder symptoms in female high school students.

METHOD

A sample of 145 female high school students completed the Eating Disorder Inventory, the Multidimensional Perfectionism Scale, the Penn State Worry Questionnaire, and the Self Liking and Competence Scale three times--on an average school day, on the day of an examination, and on the day the subjects received the results of that examination. Linear regression analysis was performed to verify whether the dimensions of perfectionism were associated with the measures of eating disorders.

RESULTS

Low self-esteem, worry, and parental criticism (a dimension of perfectionism) were associated with the measures of eating disorders only during the stressful situation, whereas concern over mistakes (another dimension of perfectionism) was associated in both stressful and nonstressful situations.

DISCUSSION

The results suggest that in nonclinical female individuals, stress might bring out a previously absent association between some psychological predisposing factors for eating disorders and an actual desire or plan to lose weight. Such a finding suggests that stress may stimulate behaviors related to eating disorders in a predisposed personality.

Causes and recovery in anorexia nervosa: the patient's perspective

OBJECTIVE

We explored anorexic patients' subjective accounts of the causes of their anorexia and of the factors that fostered recovery. Subjective accounts could assist in understanding this complicated and often intractable disorder.

METHOD

All female new referrals to an eating disorders service underwent extensive interviews including open-ended questions about their beliefs concerning the causes of their anorexia nervosa and factors that led to recovery. Responses were categorized by two independent raters.

RESULTS

The most commonly mentioned perceived causes were dysfunctional families, weight loss and dieting, and stressful experiences and perceived pressure. The three most commonly cited factors contributing to recovery were supportive nonfamilial relationships, therapy, and maturation.

DISCUSSION

Individuals with anorexia nervosa perceive both external (family environment) and personal factors (dieting and stress) as contributory to their disorders. The results underscore the importance of interpersonal factors in recovery from anorexia nervosa and suggest that attention to this area in treatment may be beneficial.

The effect of exercise, cognitive therapy, and nutritional counseling in treating bulimia nervosa

OBJECTIVE

The aim of this treatment study on bulimia nervosa was (i) to examine the effect of physical exercise as an experimental treatment condition against the well-documented effect of cognitive-behavioral therapy (CBT), and (ii) to compare the effect of CBT versus the effect of nutritional advice as one single treatment component of CBT.

METHOD

Normal weight female bulimic patients aged 18-29 yr were randomly assigned to a physical exercise program (N = 15), CBT (N = 16), nutritional advice (N = 17), or a waiting list control group (N = 16). Seventeen healthy female control subjects were also included. Treatment effects were determined by the frequency of binge eating and purging, scores on the Eating Disorder Inventory subscales "Drive for thinness," "Bulimia," and "Body dissatisfaction" and by a clinical interview to measure symptom severity. Assessments were made before and after treatment and at 6- and 18-month follow-up after the end of treatment.

RESULTS

Nutritional counseling did not prove more effective than CBT. Physical exercise appeared more effective than CBT in reducing pursuit of thinness; change in body composition; aerobic fitness; and frequency of bingeing, purging, and laxative abuse.

CONCLUSION

Physical exercise is important in the treatment of normal weight bulimic patients. Further studies should address possible additive effects of CBT and physical exercise.

Bulimia nervosa: an update and treatment recommendations

Bulimia nervosa is a common eating disorder in adolescent women. Biological, psychological, and social factors are implicated in onset and important in treatment. Diagnosis of the syndrome, but not its subtypes, can be made well using the DSM-IV system. Screening tools, laboratory findings, and physical findings can be helpful in making the diagnosis. Comorbid disorders include affective disorders, addictive disorders, anxiety disorders, personality disorders, and anorexia nervosa. The etiology of bulimia nervosa is complex, with biologic, psychological, social, and family factors, which likely differ somewhat from patient to patient. Treatment, accordingly, should be comprehensive, individualized, and multifaceted. Many patients respond well to the use of an antidepressant, and cognitive-behavioral therapy is a useful approach for many patients. Combining these two treatments seems to be a good strategy. Environmental and family issues also need to be addressed. Many patients are treated insufficiently. More research on bulimia nervosa specific to adolescence is needed.