Emotion regulation moderates relationships between body image concerns and psychological symptomatology

Emotion regulation as a transdiagnostic construct across the spectrum of disordered eating in adolescents: A systematic review

OBJECTIVE

This systematic review aimed to understand the role of emotion regulation (ER) across the spectrum of disordered eating behaviors and attitudes in adolescents.

METHOD

A literature search was conducted using the PubMed, Scopus, and Web of Science databases, and 8381 articles were extracted. After removing duplicates and screening, data from 50 articles involving 31,591 participants from 18 countries were included.

RESULTS

Consistent associations between difficulties in ER/maladaptive ER and overeating (but not restrictive) behaviors/attitudes were found among adolescents without an eating disorder diagnosis. In contrast, in adolescents with eating disorders, ER difficulties were associated with restrictive-, compensatory- and overeating-type eating disorders. More difficulties in ER were found among adolescents with eating disorder diagnoses (i.e., anorexia nervosa, bulimia nervosa, or binge eating disorder) than among their healthy/normal-weight peers. Nonetheless, difficulties in ER abilities and in the implementation of ER strategies were greater in adolescents with anorexia nervosa or bulimia nervosa than in adolescents with binge eating disorder. Finally, concerning the role of adaptive ER, although fewer adaptive ER strategies were consistently found in adolescents with a diagnosis of anorexia nervosa than in healthy controls, the results in community samples were less consistent.

DISCUSSION

Overall, ER was associated with disordered eating behaviors/attitudes and eating disorder diagnoses, supporting the transdiagnostic role of ER in the spectrum of eating psychopathology. Fewer consistent findings were found across the weight spectrum, specifically at the higher end (overweight/obesity). These results highlighted the role of different ER abilities and strategies and the relevance of maladaptive (vs. adaptive) ER in understanding disordered eating. The findings also set the context for developing specific ER-based interventions across the spectrum of disordered eating behaviors and attitudes.

Peer sexual harassment, appearance esteem, and emotional problems: Testing a mediation model across early adolescence

This study used a longitudinal sample of early adolescent boys and girls (ages 10-12; N = 1113) to test a theoretically and empirically informed model suggesting that exposure to peer sexual harassment (age 10) predicts more emotional problems (age 12), and that lower appearance esteem (age 11) mediates this relation. On the within-person level, which is the level on which the processes theoretically should play out, we found no support for the proposed mediation model for boys or for girls. Unexpectedly, we found that following times of more exposure to peer sexual harassment than usual, early adolescents instead experienced higher appearance esteem and fewer emotional problems than usual. More research is needed to replicate and understand these unexpected findings.

Emotional Distress and Body Dissatisfaction: The Mediating Role of Social Media and Emotional Regulation

BACKGROUND

Body dissatisfaction is defined as a negative attitude towards one's body, characterized by emotional disorders. Currently, problematic use of social media seems to be associated with an increase in body dissatisfaction and emotional distress. Therefore, the present study examined the relationship between emotional distress (i.e., depression, anxiety, and stress) and body dissatisfaction, as well as the mediating role of emotional regulation and problematic social media use in this relationship. In addition, the study aims to identify sex differences in the four research variables.

METHODS

Measures of the four variables mentioned above were administered to 2520 participants over 18 (M = 48.35; SD = 16.56, 51% females).

RESULTS

The results reveal that women reported higher levels of emotional regulation, emotional distress, body dissatisfaction, and problematic use of social media. Emotional distress correlated with problematic use of social media, emotion regulation strategies (i.e., rumination and catastrophizing), and body dissatisfaction. The relationship between emotional distress and body dissatisfaction was mediated by the problematic use of social media and emotional regulation.

CONCLUSIONS

These findings underscore the relevance of educating social media users on strategies for emotional regulation. The results highlight the clinical importance of including the emotion regulation approach to a comprehensive understanding of body dissatisfaction.

Relationship between quality of life, emotional symptomology and perceived emotional intelligence in a sample of burn victims

The main objective of this study is to analyse the association between Quality of Life (QOL), Emotional Symptomology and perceived Emotional Intelligence (EI) in burn patients. Additionally, it is intended determine the predictor models of QOL, and confirm the mediating effect of emotional symptomology between QOL and perceived EI. This is a transversal study developed in the Hospital da Prelada, Porto, Portugal, with a sample of 92 patients that were hospitalized in the Burn Unit and the Reconstructive Plastic Surgery Service. The assessment protocol consisted of a sociodemographic and clinical data sheet. To assess the perception of QOL of the burn patient it was used the Burn Specific Health Scale - Revised (BSHS-R), the emotional symptomology was measured by the Brief Symptom Inventory (BSI) and Trait Met-Mood Scale-24 (TMMS) was used to assess Emotional Intelligence (EI). The cross-sectional and correctional data were analysed through descriptive statistics, correlations, regressions and simple mediations. The results obtained suggest significant associations between QOL, perceived EI and Emotional Symptomology in burn patients. The results of the predictor models of the QOL domains encompass the Positive Symptom Distress Index (PSDI of Emotional Symptomology), where the total variance is explained mainly by the models of QOL Affect and Body Image 46% and Treatment 31%. The mediating effect of the PSDI in the relationship between QOL in the Affect and Body Image dimension and the Mood Repairs (MR) was also tested, having proved to have a total mediation (the Mood Repairs loses its contribution in the QOL model when the PSDI variable is introduced). This study underscores the importance of perceived Emotional Intelligence and its association with the burn impact in the different dimensions of QOL of the patients. The intention of this study is to alert health professionals for patient support in the search for strategies that aim for positive adaptation which promotes QOL and emotional adjustment of burn patients to their new condition.

Positive Body Image and Psychological Wellbeing among Women and Men: The Mediating Role of Body Image Coping Strategies

This study aimed to examine the mediating role of body image coping strategies in the relationship between positive body image and wellbeing. Three hundred and seventy-two women and three hundred and seventy-seven men completed a questionnaire assessing body appreciation, body appreciation functionality, body compassion, body image coping strategies (appearance fixing, avoidance, positive rational acceptance), self-acceptance and overall psychological wellbeing. Path analysis showed that avoidance significantly mediated the relationship between body appreciation and overall psychological wellbeing among both women and men; its mediating role was confirmed for men's but not for women's self-acceptance. Positive rational acceptance was a significant mediator of the relationship between body compassion and both psychological wellbeing and self-acceptance among men but not among women. These findings show that higher body appreciation is associated with a lower tendency to avoid appearance-related cognitions or thoughts that are interpreted as threatening, with an indirect effect on women's and men's psychological wellbeing. Analogously, but only for men, body compassion is associated with mental activities and self-care behaviors that foster rational self-talk and the acceptance of one's experiences, which, in turn, are linked to higher wellbeing. These findings can help to plan programs aimed at fostering individuals' wellbeing by focusing on their positive body image considering gender differences.

Cognitive reappraisal moderates the protective effect of body satisfaction on mental health and wellbeing in adults: A prospective study during COVID-19 lockdown

BACKGROUND

Body satisfaction is associated with mental health and well-being in adults. However, prospective studies are needed to better understand its protective effects, and in whom these are most beneficial. This study investigated body satisfaction as a predictor of depressive symptoms, generalised anxiety, and well-being in a representative Australian sample collected during the initial COVID-19 lockdown. Two emotion regulation strategies - cognitive reappraisal and expressive suppression - were also tested as moderating variables.

METHODS

The sample comprised 684 adults aged 19 to 87 years who completed three primary waves of data spanning two months [Wave 3 (W3), W4 and W7] from the Australian National COVID-19 Mental Health, Behaviour and Risk Communication Survey.

RESULTS

Hierarchical multiple regression models controlling for demographic and COVID-19 risk factors, as well as W3 for each outcome variable, indicated that W3 body satisfaction predicted greater W7 well-being, and fewer W7 depressive symptoms and greater W7 well-being in participants reporting low levels of W4 cognitive reappraisal. No moderation for W4 expressive suppression was observed, nor predictive relationships between W3 body satisfaction and W7 anxiety.

LIMITATIONS

The two-month follow-up period precludes conclusions relating to the longer-term protective effects of body satisfaction within and beyond the pandemic context. Examination of focal relationships in clinical samples, and inclusion of broader indices of body image, emotion regulation and mental health, is needed in future studies.

CONCLUSIONS

Findings suggest body satisfaction warrants attention in community well-being promotion in adults, and may be particularly beneficial for those lack adaptive emotion regulation strategies.

The relations of psychotic-like experiences (PLEs) and depressive symptoms and the bias of depressive symptoms during the clustering among Chinese adolescents: Findings from the network perspective

BACKGROUND

There are rare studies about the network structure of psychotic-like experiences (PLEs) and depressive symptoms among adolescents. Studies have widely acknowledged that PLEs in adolescents confer a higher risk of depressive symptoms, but the complex interactions remain inadequately understood. Our study aimed to examine the hierarchy and inter-associations of PLEs and depressive symptoms in a large adolescent sample from the network analysis perspective.

METHODS

A total of 5008 Chinese adolescents were enrolled in our sample. Community Assessment of Psychic Experiences-42 (CAPE-42) was applied to build the network. Centrality indexes were calculated to represent the significance of nodes in the network. Community detection was conducted to figure out the specific clustering of nodes. Demographic information was collected for the sub-network comparisons. Accuracy and stability of the network were also tested.

RESULTS

"Failure", "External control", and "Lack of activity" were the most central nodes. The main bridge nodes linking PLEs and depressive symptoms were "Failure", "Guilty", and "No future". Positive PLE "Odd looks" and negative PLE "Unable to terminate" are the two PLEs that were most relevant to depressive nodes. Community detection further demonstrated the bias of depressive nodes in the data-driven clustering. Comparative sub-network analysis suggested that age was the only demographic factor related to the current network.

CONCLUSION

In this study of a large adolescent sample, we first demonstrated the network structure and specific clustering preference of PLEs and depressive symptoms. Our findings may enhance the understanding of the relationship between PLE and depressive symptoms.

Psychological correlates of body dissatisfaction in Swiss youth over a one-year study-period

Introduction

It is well known that young individuals often report pronounced negative perceptions and attitudes towards their own body or intense fear of being not muscular enough. There is much less data available, however, on the role of psychological mechanisms on these perceptions and attitudes, such as emotion regulation difficulties, correlates of alexithymia, and appearance-related rejection sensitivity.

Methods

We therefore set out to assess associations between these psychological mechanisms, and body image as well as muscle dysmorphic symptoms. Our sample was recruited as part of a larger-scale study aiming at assessing correlates of mental health (with a focus on eating disorder symptoms) in German speaking Switzerland. The first wave (T1), starting in April 2021, included 605 participants (80% female, 19.6 ± 2.5 years) who completed the online-questionnaire and were reassessed in a second wave (T2), one year later.

Results

Results indicated that at both waves, emotion regulation difficulties [DERS-SF] and appearance-based rejection sensitivity [ARS-D] were both positively cross-sectionally associated with body dissatisfaction [BSQ-8C] and muscle dysmorphic symptoms [MDDI] at the first assessment time-point and one year later at follow-up assessment. Moreover, alexithymia [TAS-20] was positively cross-sectionally associated with muscle dysmorphic symptoms at both waves. We further observed high absolute and relative level stabilities for all variables involved across the one-year study period.

Discussion/Conclusion

Even though the effects for some associations were rather small, our findings underline the relevance of such mechanisms in the development of body dissatisfaction and to a lesser extent of muscle dysmorphia symptoms over the period of one year. Additional research is necessary to replicate these findings in other youth samples.

A randomized controlled trial of mindfulness-based cognitive therapy for body dysmorphic disorder: Impact on core symptoms, emotion dysregulation, and executive functioning

BACKGROUND AND OBJECTIVES

Mindfulness-based cognitive therapy (MBCT) is garnering increasing empirical interest as an intervention for Body Dysmorphic Disorder (BDD), although no studies of mindfulness as a standalone treatment have included a sample composed entirely of patients with BDD or a comparison group. The aim of this study was to investigate the improvement of MBCT intervention on the core symptoms, emotional dysfunction, and executive function of BDD patients, as well as the feasibility and acceptability of MBCT training.

METHOD

Patients with BDD were randomized into an 8-week MBCT group (n = 58) or treatment-as-usual (TAU) control group (n = 58) and were assessed at pre-treatment, post-treatment, and 3-month follow-up.

RESULTS

Participants who received MBCT showed greater improvement on self-reported and clinician ratings of BDD symptoms, self-reported emotion dysregulation symptoms and executive function compared with TAU participants. Improvement for executive function tasks was partially supported. In addition, feasibility and acceptability of MBCT training were positive.

LIMITATIONS

There is no systematic assessment of the severity of key potential outcome variables associated with BDD.

CONCLUSION

MBCT may be a useful intervention for patients with BDD, improving patients' BDD symptoms, emotion dysregulation, and executive functioning.

A prospective study on body image disturbances during pregnancy and postpartum: the role of cognitive reappraisal

Background

During pregnancy, body size rapidly modifies over a relatively short period. Literature emphasizes the need to identify the factors that influence body image during peripartum as the extent of women's adaptation to these changes has significant repercussions on both mother's and newborn's health. Emotion regulation strategies (i.e., expressive suppression and cognitive reappraisal) were linked to body image in the general and clinical population, but no studies were conducted in the peripartum. The present study aims to investigate the longitudinal impact of prepartum body image disturbances on postpartum body image disturbances and to evaluate the mediational role of emotional regulation strategies.

Methods

A total of 133 pregnant women completed a three-phase longitudinal study. Women answered online questionnaires during the second (T1) and the third (T2) trimesters of pregnancy, and at about 6 months postpartum (T3).

Results

Findings indicated that body image disturbances at T1 were a significant predictor of body image disturbances in the postpartum (1 year after the first assessment). Moreover, cognitive reappraisal measured at T2 partially mediated this relationship: body image disturbances in the second trimester of pregnancy were linked to less use of cognitive reappraisal in the third trimester of pregnancy, and this, in turn, was associated with worse body image disturbances at 6 months after birth.

Conclusion

Findings of this longitudinal study highlight the importance of assessing body image disturbances during pregnancy to early identify women at risk, and suggest cognitive reappraisal as a possible target intervention.

Relationship between emotional divorce and alexithymia among married women in Saudi Arabia

BACKGROUND

Emotional divorce occurs when a couple continues to live together due to necessity and coercion but they do not have a positive or constructive relationship, which negatively affects the stability of married life. Due to the low social acceptance of a formal divorce in the Saudi society, emotional divorce is common in several families. The rigidity of feelings and emotions within the family and the inability to express them may indicate the presence of alexithymia, which could result in the collapse of the family system and place the people involved at risk of mental health problems such as depression. Therefore, it is important to determine the prevalence of emotional divorce among married women in Saudi Arabia and to examine the relationship between emotional divorce and alexithymia.

METHODS

Data were collected from 305 married women in Saudi Arabia (Mage = 33.24 years; SDage = 4.87 years), using the Emotional Divorce Scale and the Alexithymia Scale.

RESULTS

Results revealed that 78.36% of the participants experienced moderate to severe levels of emotional divorce. Working women, those who had been married for more than ten years, and those with five or more children exhibited a higher incidence of emotional divorce as compared to their counterparts. A linear regression analysis indicated that alexithymia was significantly associated with emotional divorce in this sample.

CONCLUSION

These results suggest the need for examining the negative consequences of emotional divorce on the family and society. Additionally, it is important to educate young individuals of marriageable age about the nature of married life, and ways to deal with problems that occur. Finally, couples should be encouraged to express their positive and negative emotions with their spouse to build the marital relationship, and achieve compatibility and marital satisfaction.

The Relationship between Body Image, Disability and Mental Health in Patients with Multiple Sclerosis

BACKGROUND

Multiple sclerosis is a progressive degenerative disorder that frequently involves the development of physical and emotional changes, including loss of limb function or sensitivity, sexual dysfunction, and cognitive and mood alterations. It is likely that these alterations lead to changes in body aspects. However, knowledge about body image perception in multiple sclerosis is lacking.

PURPOSE

The present study investigated the relationship between body image perception and its correlation with a disability, neuropsychiatric symptoms, and self-esteem.

METHODS

A total of 100 outpatients with relapsing-remitting multiple sclerosis underwent neurological assessment using the Expanded Disability Status Scale. Participants also completed the Body Image Scale (BIS), Rosenberg Self-Esteem Scale (RSES), and Symptom Checklist-90-Revised (SCL-90-R).

RESULTS

We found a significant positive correlation between body image and disability (r = 0.21; p = 0.03), body image and self-esteem (r = -0.52; p < 0.001), body image and somatization (r = 0.44; p < 0.001), body image and depression (r = 0.57; p < 0.001), and body image and anxiety (r = 0.5; p < 0.001).

CONCLUSIONS

The body is considered one of the main parts of a person's identity. Dissatisfaction with one's own body changes the general evaluation of the "self". The body image construct has important health outcomes and should be studied more in patients with multiple sclerosis.

Effect of body image perception and skin-lightening practices on mental health of Filipino emerging adults: a mixed-methods approach protocol

INTRODUCTION

The rampant distribution of idealised images on the internet may lead the general public to improve their body appearance in a way that is sometimes excessive, compulsive or detrimental to other aspects of their lives. There is a decreasing appreciation of body image among emerging adults and an increasing trend on skin-lightening practices linked with psychological distress. This protocol describes the mixed-method approach to assess the relationships among body image perception, skin-lightening practices and mental well-being of Filipino emerging adults and determine the factors that influence them.

METHODS AND ANALYSIS

An explanatory sequential mixed-method approach will be used. A cross-sectional study design will involve an online self-administered questionnaire of 1258 participants, while a case study design will involve in-depth interviews with 25 participants. Data analysis will use generalised linear models and structural equation modelling with a Bayesian network for the quantitative data. Moreover, the qualitative data will use an inductive approach in thematic analysis. A contiguous narrative approach will integrate the quantitative and qualitative data.

ETHICS AND DISSEMINATION

The University of the Philippines Manila Review Ethics Board has approved this protocol (UPMREB 2022-0407-01). The study results will be disseminated through peer-reviewed articles and conference presentations.

Feeling difficult to identify: Alexithymia is inversely associated with positive body image in adults from the United Kingdom

BACKGROUND

Research has increasingly examined the ways in which internal bodily experiences influence body image, including the relationship between alexithymia - the reduced ability to identify and describe one's own emotional feelings and bodily sensations - and negative body image. However, relationships between facets of alexithymia and positive body image remain unexplored.

METHODS

To bridge this gap in the literature, we assessed relationships between facets of alexithymia and multiple, core indices of positive body image in an online sample of adults from the United Kingdom. A total of 395 participants (226 women, 169 men) aged 18 to 84 years completed measures of alexithymia, body appreciation, functionality appreciation, body image flexibility, body acceptance by others, and positive rational acceptance.

RESULTS

Once the effects of age had been accounted for, alexithymia was significantly and negatively associated with all five body image constructs in hierarchical multiple regressions. In the final models, the alexithymia facet of Difficulties Identifying Feeling emerged as a significant and negative predictor of all indices of positive body image.

LIMITATIONS

The use of cross-sectional data limits the causal conclusions that can be drawn.

CONCLUSIONS

These findings extend previous work by demonstrating the unique relationship between alexithymia and positive body image, providing important implications for body image research and practice.

Negative comments and social media: How cognitive biases relate to body image concerns

Body image concern (BIC) is a prevalent issue thought to be exacerbated by social media. In addition to sociocultural factors, cognitive biases may also contribute to BIC. We explore whether cognitive biases in memory for body image-related words, presented in a mock social-media context, are associated with BIC in young adult women. A sample of 150 University students was presented with a series of body image-related comments aimed at either themselves, a close friend, or a celebrity in a recognisable social media context. Afterwards, a surprise memory task was completed that assessed the participant's memory for body image-related words (item memory), their insight (metamemory), and to whom a specific word was directed (source memory). Self-referential biases were identified for both item memory and source memory. Individuals with greater BIC displayed a greater self-referential bias for correctly and incorrectly sourcing negative words to themselves compared with both friend and celebrity. A greater self-referential effect in metacognitive sensitivity was also associated with higher BIC. We provide novel evidence for a cognitive bias in sourcing negative body image-related information to the self in individuals with higher BIC. The results should inform cognitive remediation programmes aimed at treating individuals with body and eating-related disorders.

Adapting integrative cognitive-affective therapy for adolescents with full and subthreshold bulimia nervosa: A feasibility study

BACKGROUND

Integrative Cognitive Affective Therapy (ICAT) is an empirically supported treatment for bulimia nervosa (BN) in adults. However, it is unclear whether a modified version, Integrative Cognitive Affective Therapy-Adolescent (ICAT-A) is feasible and beneficial for adolescents. This study evaluated the feasibility of ICAT-A for adolescents with BN or subthreshold BN.

METHODS

Eight adolescents with BN or subthreshold BN (mean age = 16.1) were enroled in the study. At baseline and end of treatment, adolescents who participated in ICAT-A completed the Eating Disorder Examination (EDE) and self-report measures of eating disorder symptoms, depression, anxiety, self-esteem and functional impairment.

RESULTS

Retention for the intervention (75%) suggests that the majority of participants found the intervention acceptable. Although all treatment completers participated in the clinician-administered assessment (EDE), compliance with end of treatment self-report questionnaires was compromised by the COVID-19 pandemic, which occurred during the treatment course of the majority of the sample. At the end of treatment, all 6 adolescents who completed the ICAT-A intervention were in full eating disorder remission based on EDE scores, with large effect sizes identified for reductions in EDE global scores (d = 2.71), objective binge episodes (d = 0.91), subjective binge episodes (d = 1.06) and compensatory behaviours (d = 1.72).

CONCLUSION

Results suggest that ICAT-A is a feasible treatment that has promise for the treatment of adolescents with BN. Future studies are necessary to establish the efficacy of ICAT-A for adolescent BN.

Religious coping and young adult's mental well-being during Covid-19: Testing a double moderated mediation model

The literature describes religious coping as an important predictor of mental well-being. Present study is aimed at extending this knowledge by assessing whether specific religious coping regulates specific cognitive emotional responses to improve well-being during Covid pandemic, an extreme international event with significant impacts on individuals and communities. A sample of young adults responded to self-report measures of negative and positive religious coping, positive reappraisal, self-blaming, and mental well-being. Results revealed that positive religious coping was a positive predictor of mental well-being and positive reappraisal mediated this positive link. Also, gender and physical health status significantly interacted with positive reappraisal to predict mental well-being in these mediational associations. More specifically, indirect effects of positive reappraisal were positive and significant for men and for participants with better physical health compared with women and those with poor physical health. However, negative religious coping was not a significant correlate of mental well-being but a positive correlate of self-blame. Results suggest that positive religious coping facilitates positive regulation of emotions for improved mental well-being in young adults and particularly young men.

Non-Suicidal Self-Injury: A School-Based Peer Education Program for Adolescents During COVID-19 Pandemic

Introduction: Non-suicidal self-injury (NSSI) constitutes a major health concern among youth. However, less is known about the useful ways to prevent NSSI. As such, the NSSI- Peer Education Program (NSSI-PEP) aims to intervene on the vulnerability factors that predispose to NSSI by applying a peer education approach. The NSSI-PEP is grounded on the psychoanalytic tradition's tenets, implementing modules targeting four crucial risk factors for NSSI: pubertal transformation, body image, self-esteem, and emotion regulation. Methods: Selected 8th grade students were trained to serve as peer educators and held a peer-education intervention for 6th and 7th grade students. Pre- and post-intervention assessments were conducted in order to evaluate the program's effectiveness. Results: Results revealed preliminary support for the program's feasibility, as students reported greater emotion regulation abilities (p = 0.038) and significant changes in self-esteem (p<0.001), personal alienation (p = 0.005), body image (p < 0.001), and maturity fear (p < 0.001). Also, NSSI-PEP was positively evaluated by participants. Discussion: Our pilot study provides preliminary empirical support for the NSSI-PEP, representing a promising way to address areas of vulnerability for NSSI onset. Findings may also help current policies to promote targeted preventive activities and produce sizable benefits to society.

Gender Differences in Body Appreciation and Its Associations With Psychiatric Symptoms Among Chinese College Students: A Nationwide Survey

BACKGROUND

Body appreciation (BA hereafter), which reflects approval, acceptance, and respect for one's body while also rejecting media-promoted appearance ideals as the only form of human beauty, is an important aspect of positive body image. Much of the BA literature has been conducted on samples from Western nations but less is known about BA or its correlates in Asian cultural contexts wherein concerns with body image are also common. Toward addressing this gap, we examined gender differences in BA and its associations with common psychiatric symptoms (i.e., depressive symptoms, anxiety symptoms, and suicidality) within a national college student sample from China.

METHOD

This cross-sectional, nationwide study was conducted between December 27, 2020, and January 18, 2021, based on snowball sampling. Aside from measures of demographics and background factors, Chinese versions of the Body Appreciation Scale-2 (BAS-2), Patient Health Questionnaire (PHQ-9), Generalized Anxiety Disorder Scale-7 (GAD-7), and a standard item on suicidal ideation and planning were administered to assess BA, depressive and anxiety symptoms, and suicidality, respectively.

RESULTS

In total, 2,058 college students (665 men, 1,393 women) in China were assessed. An analysis of covariance revealed that the men had a significantly higher average BA level than did women [F _(1,2058) = 13.244, P < 0.001, Cohen's d = 0.193]. Hierarchical multiple regression analyses revealed BA was negatively associated with symptoms of depression, anxiety, and suicidality within the entire sample (depressive symptoms, β = -0.129, P < 0.001; anxiety symptoms, β = -0.101, P < 0.001; suicidality, OR = 0.788 P = 0.020) and among women (depressive symptoms, β = -0.172, P < 0.001; anxiety symptoms, β = -0.131, P < 0.001; suicidality, OR = 0.639 P = 0.001) but not men.

CONCLUSION

Chinese college women reported lower BA than their male peers did. Furthermore, among women but not men, elevations in BA corresponded with protective mental health experiences including lower levels of depressive symptoms, anxiety symptoms and suicidality. Findings underscore the potential utility of including BA in mental health assessments of Chinese college students, especially women. Findings also provide foundations for continued research on interventions to increase BA among at-risk young women in China.

Effectiveness of Positive Psychotherapy on Depression and Alexithymia in Women Applying for a Divorce

BACKGROUND

The new therapeutic approach of positive psychotherapy has successfully treated severe mental disorders such as depression and mood disorders. However, existing research has not sufficiently measured the usefulness of this treatment in reducing depression and alexithymia.

OBJECTIVES

This study thus examined the effectiveness of positive psychotherapy in reducing these two conditions in a specific population: Iranian women applying for the divorce.

METHODS

A total of 40 participants aged 20-40 with a high score in the Beck Depression Inventory and Toronto Alexithymia Questionnaire were recruited from women referred to a psychology clinic for divorce-related problems. The pretest, posttest, and follow-up were conducted with all participants, who were randomly placed in two groups: the experimental and control groups, which each consisted of 20 people. We provided eight positive psychotherapy sessions for only the experimental group.

RESULTS

After MANCOVA was conducted, the results showed that positive psychotherapy significantly decreased alexithymia and depression in the test population.

Expressive suppression as an obstacle to social change: Linking system justification, emotion regulation, and collective action

Research on system justification theory suggests that justifying the societal status quo decreases negative emotions, leading to less collective action. In this investigation, we propose that the degree to which negative emotions mediate the link between system justification and collective action may depend upon whether individuals tend to suppress the expression of their negative emotions. We tested this hypothesis in the diverse socio-political contexts of Turkey, Israel, and the U.S. In one correlational study (Study 1) and three experimental studies (Studies 2-4), we observed that the link between system justification and willingness to participate in collective action through anger (Studies 1-2 and 4) and guilt (Study 3) was moderated by expressive suppression. We found that negative emotions mediated the association between system justification and collective action among those who suppress the expression of their emotions less frequently, but not those who use expressive suppression more frequently. These findings suggest that emotion regulation may undermine, rather than facilitate, efforts to engage in collective action even among people who are low in system justification.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11031-021-09883-5.

Emotion dysregulation moderates the relationship between alcohol use and eating pathology among heavy-drinking college men

OBJECTIVES

There is limited research examining the relationship between alcohol use and eating pathology in men or factors that may moderate this association. The current study investigated the relationship between alcohol use and eating pathology, and examined emotion dysregulation as a moderator of this association, among heavy-drinking college men.

METHOD

Men mandated to receive an alcohol intervention (N = 88; average age = 19 years) completed questionnaires related to alcohol use, emotion dysregulation, and eating pathology.

RESULTS

Results demonstrated positive relationships between alcohol use and some eating pathology, and a significant interaction between alcohol use and emotion dysregulation. However, results were contrary to hypotheses, such that there was a positive relationship between alcohol use and eating pathology at low levels of emotion dysregulation.

CONCLUSION

Future studies should continue to examine the overall presentation of eating pathology in men and investigate factors that may impact the relationship between alcohol use and eating pathology.

Emotion regulation and support from others: Buffering of body dysmorphic symptoms in adolescent and young adult men but not women

INTRODUCTION

Adolescents and young adults who overemphasize the social values placed on an attractive appearance may develop body dysmorphic symptoms (BDS), defined as over-preoccupation with perceived appearance flaws and repetitive behaviors to conceal the flaws. Further, research has found that a heightened expectation of judgement and rejection by others because of appearance (i.e., appearance-based rejection sensitivity [appearance-RS]) is both a maintaining and an aggravating factor in BDS. This study focused on emotion regulation (ER), appearance-related support from others and self-acceptance, expecting they would buffer the negative impact of appearance-RS on BDS.

METHODS

Participants included 782 Australian high school and young university students, aged 14-28 years (M = 17.94 years, 40% male) who completed a survey to report their BDS, appearance-RS, ER, appearance-related support from others and self-acceptance.

RESULTS

Multiple regression analyses revealed that youth reported more BDS when they were higher in appearance-RS but reported less self-acceptance, ER, and support from others. Further, the association between appearance-RS and BDS was weaker when young people reported higher (relative to lower) ER and support from others. However, when three-way interactions with gender were tested, these buffering effects were only significant for young men.

CONCLUSION

Findings suggest that ER and appearance-related support from important others are promising targets for intervention, given they could mitigate the risk of appearance-RS in young men. However, further research is needed to consider additional factors that buffer against the negative effects of appearance-RS on BDS for young women.

Depression is associated with lower levels of physical activity, body image dissatisfaction, and obesity in Chilean preadolescents

Mental health during the preadolescent years may be determinant for later periods of life; therefore, the factors that influence it need to be studied deeply. The aim of this study was to determine the association between depressive symptoms with physical activity (PA), body image dissatisfaction and weight status in preadolescents. A total of 269 girls and 329 boys (age 12.02 ± 0.98 years) were included in this study. Body mass index (BMI), waist circumference, body image dissatisfaction, PA and depressive symptoms were assessed. The PA reported an inverse association with depression in girls (β:-2.12, P < 0.0001) and boys (β:-1.13, P = 0.001). Instead, BMI in girls (β: 1.00, P < 0.0001) and boys (β: 0.70, P < 0.0001), and body image dissatisfaction in girls (β: 0.05, P = 0.017) and boys (β: 0.04, P = 0.003) reported positive association with depression. In the same way, depression was associated with obesity (odds ratio [OR] = 2.05, P = 0.020), but, the boys had higher risk (OR = 18.4, P < 0.001) than girls. In conclusion, depression in Chilean preadolescents presented association with low levels of PA, obesity and body image dissatisfaction. Therefore, schools should target and promote PA to improve psychological and physical health in preadolescents, which may reduce the future burden of mental illness.

An investigation of distress tolerance and difficulties in emotion regulation in the drive for muscularity among women

Despite the negative emotional experiences that often accompany the pursuit of an idealized appearance, we know little about emotion regulation in the context of female drive for muscularity. To address this knowledge gap, we examined whether distress tolerance and difficulties in emotion regulation were significantly associated with the drive for toned muscularity among women. In this study, 221 Australian university women completed an online survey assessing drive for muscularity, distress tolerance, and emotion regulation difficulties. Results revealed that low distress tolerance and emotion regulation difficulties were positively associated with drive for muscularity attitudes and behaviors, after controlling for body mass index and general negative affect. Our findings suggest that women with a range of distress tolerance and emotion regulation difficulties, particularly the urgent need to regulate, and non-acceptance of, distress may experience a higher drive for muscularity. This study provides preliminary evidence that specific aspects of distress tolerance and poor emotion regulation may be promising targets in prevention and treatment interventions aimed to address the excessive drive for muscularity among women.

Emotion regulation across eating pathology: A meta-analysis

The goal of this meta-analysis was to examine the associations between specific emotion regulation abilities (emotional awareness, emotional clarity) and strategies (acceptance of emotions, reappraisal, problem-solving, rumination, avoidance of emotions, and suppression), and eating pathology. A total of 96 studies and 239 effect sizes were included in the analysis. Relations between global and specific emotion regulation abilities and strategies and eating disorders and eating-related symptoms were examined. Results indicated medium-to-large effect sizes for the associations between adaptive emotion regulation and eating disorder and eating-related symptoms, and medium-to-large effect sizes for the associations between maladaptive emotion regulation and eating disorders and eating-related symptoms. In terms of specific emotion regulation strategies, large magnitude of associations were identified for the relations between lack of emotional awareness, clarity, acceptance, reappraisal, problem-solving, and eating disorders. Rumination, avoidance of emotions, and suppression also showed large associations with anorexia nervosa and bulimia nervosa. Overall, emotion regulation did not differ across eating disorders, a finding supporting the transdiagnostic character of emotion regulation problems in eating pathology. These findings have important theoretical and practical implications for prevention and intervention programs.

A systematic review of the roles of body image flexibility as correlate, moderator, mediator, and in intervention science (2011-2018)

The emergence of body image flexibility into the positive body image nomenclature has innovatively expanded the conceptualization of how individuals may adaptively respond to body image threats. Given the notable growth of interest in researching this construct over nearly the past decade, the present analysis provides a systematic and critical review of evidence examining the roles of body image flexibility as correlate, mediator, moderator, and in intervention research. Results indicated that body image flexibility tended to demonstrate a pattern of relationships with correlates in directions predicted by its conceptualization and showed promise in functioning as both effect modifier and as an explanatory variable in the associations evaluated. Multiple studies demonstrated susceptibility to change following intervention. Although the current state of the literature is bound by notable limitations, the results of this review point to pertinent future steps in advancing the theory and application of body image flexibility scholarship.

Body Image Dissatisfaction and Anxiety Trajectories During Adolescence

The primary goal of this study was to examine the associations between baseline body image dissatisfaction (BID) and subsequent anxiety trajectories in a diverse, community sample of adolescent girls and boys. Participants were 581 adolescents (baseline age: M = 16.1, SD = 0.7; 58% female; 65% non-Hispanic White) from U.S. public high schools. Self-report questionnaires were administered during school at 3 annual assessment waves. Latent growth curve modeling examined the association between baseline BID and growth factors of anxiety disorder symptom trajectories. Covariates included baseline gender, age, race/ethnicity, parental education attainment, body mass index standard scores, and depressive symptoms. Higher BID at baseline was significantly associated with higher initial symptoms of generalized anxiety disorder (GAD), panic disorder (PD), social anxiety disorder (SAD), and significant school avoidance (SSA; ps = .001-.04) but was unrelated to initial separation anxiety disorder (SEP) symptoms (p = .27). Higher baseline BID also was associated with attenuated decreases in SAD symptoms across time (p = .001). Among adolescents with low baseline anxiety symptoms only, higher BID was associated with more attenuated decreases in SAD symptoms (p = .01) and greater increases in PD symptoms (p = .02). BID was unrelated to changes in GAD, SEP, and SSA symptoms (ps = .11-.94). Findings suggest that BID is associated with concurrent symptoms of multiple anxiety disorders and may have a prospective link to SAD and PD symptoms during adolescence. As such, assessing body image issues may be important to assess when identifying adolescents at risk for exacerbated SAD and PD symptoms.

A prospective study of adolescents' body dysmorphic symptoms: Peer victimization and the direct and protective roles of emotion regulation and mindfulness

In this study, we examined whether peer appearance-related victimization was associated with adolescents' increasing body dysmorphic disorder (BDD) symptoms over 12 months. Also, given emotion regulation and mindfulness have been associated with less body dissatisfaction, we expected that they would protect against the negative impact of peer victimization on BDD symptoms. Participants were 367 Australian adolescents (M_age=13years). In multiple regressions, two aspects of emotion regulation, strategies and clarity, and two components of mindfulness, acting with awareness and being non-judgmental, were uniquely associated with fewer BDD symptoms at T2 relative to T1. There was evidence that one mindfulness component, observing, was a risk factor for more BDD symptoms. Further, acting with awareness and observing moderated the prospective relationship between victimization and BDD symptoms; low acting with awareness and high observing were risks for symptoms regardless of victimization, whereas high acting with awareness and low observing appeared protective of BDD symptoms, but only for adolescents who reported lower victimization.

Repressive coping among British college women: A potential protective factor against body image concerns, drive for thinness, and bulimia symptoms

Repressive coping, as a means of preserving a positive self-image, has been widely explored in the context of dealing with self-evaluative cues. The current study extends this research by exploring whether repressive coping is associated with lower levels of body image concerns, drive for thinness, bulimic symptoms, and higher positive rational acceptance. A sample of 229 female college students was recruited in South London. Repressive coping was measured via the interaction between trait anxiety and defensiveness. The results of moderated regression analysis with simple slope analysis show that compared to non-repressors, repressors reported lower levels of body image concerns, drive for thinness, and bulimic symptoms while exhibiting a higher use of positive rational acceptance. These findings, in line with previous evidence, suggest that repressive coping may be adaptive particularly in the context of body image.

Emotional Competence and Anxiety in Childhood and Adolescence: A Meta-Analytic Review

Anxiety is conceptualized as a state of negative emotional arousal that is accompanied by concern about future threat. The purpose of this meta-analytic review was to evaluate the evidence of associations between emotional competence and anxiety by examining how specific emotional competence domains (emotion recognition, emotion expression, emotion awareness, emotion understanding, acceptance of emotion, emotional self-efficacy, sympathetic/empathic responses to others' emotions, recognition of how emotion communication and self-presentation affect relationships, and emotion regulatory processes) relate to anxiety in childhood and adolescence. A total of 185 studies were included in a series of meta-analyses (N's ranged from 573 to 25,711). Results showed that anxious youth are less effective at expressing (r = -0.15) and understanding emotions (r = -0.20), less aware of (r = -0.28) and less accepting of their own emotions (r = -0.49), and report less emotional self-efficacy (r = -0.36). More anxious children use more support-seeking coping strategies (r = 0.07) and are more likely to use less adaptive coping strategies including avoidant coping (r = 0.18), externalizing (r = 0.18), and maladaptive cognitive coping (r = 0.34). Emotion acceptance and awareness, emotional self-efficacy, and maladaptive cognitive coping yielded the largest effect sizes. Some effects varied with children's age. The findings inform intervention and treatment programs of anxiety in youth and identify several areas for future research.

Body Image and Risk Behaviors in Youth with HIV

Body image concerns are common among people living with HIV. Among adults with HIV, body image concerns have been shown to be related to risky sexual behaviors; little research has been conducted among youth living with HIV (YLWH). The current study examined the predictors, including body image, of sexual risk behaviors among YLWH. Adolescents from a single clinic (n = 143; age range, 16-24 years; 69% male; 95% African American) completed a computerized self-report survey to assess demographic, behavioral, and body image domains. Demographic and clinical data were abstracted from the medical record. Logistic regression analyses assessed associations between risk factors and risky sexual behaviors. Results indicated that YLWH who reported less favorable body image perceptions (p = 0.04) and more sexual partners (p = 0.05) were less likely to use condoms during their last sexual encounter. YLWH with six or more sexual partners were more likely to use drugs or alcohol during their last sexual encounter (p = 0.03). A belief that their HIV medications changed their body physically (p = 0.05), history of HIV-related complications (p = 0.03), an undetectable viral load at their most recent clinical laboratory draw (p = 0.01), and having a high school diploma or equivalent (p = 0.001) were independently associated with disclosure of participant's HIV status to a romantic/sexual partner. Findings suggest that body image perceptions may influence risky sexual behavior in YLWH. Further study is warranted to understand and intervene upon this relationship to improve individual and public health outcomes.

Body image and adolescence: A behavioral impairment model

Adolescence is a period marked by important physical and social changes that can lead to a negative body image. The purpose of this study was to find a model enabling the appearance of behavioral impairment related to body image (restrictions, avoidance, and checking) to be predicted by body image attitudes (concern or Appearance Orientation, and dissatisfaction or Appearance Evaluation), Gender, emotional symptomatology, self-consciousness, ideas of reference (IR) and age. A total of 661 participants (67.47% girls) with an average age of 17.14 years (SD=2.34) filled in the GHQ-28, SCS on self-consciousness, REF referential thinking scale, MBSRQ (AO and AE), and BIAQ. A partial mediation model was found for IR, age and depressive symptomatology between dissatisfaction and concern about body image and Gender, to behavioral impairment related to body image. The results found suggest that age, depressive symptomatology, and IR may be mediator variables in the relationship between dissatisfaction and concern about body image, on body image behavioral impairment. This relationship implies a severity to be considered in intervention and monitoring of body image behavioral impairments in adolescents.

Thin-ideal internalization and body dissatisfaction in Sri Lankan adolescents

In this study, a survey of Sri Lankan adolescents explored relationships between thin-ideal internalization and body dissatisfaction-issues that have received greater research attention in East Asia and the West. Girls scored lower in thin-ideal internalization and awareness and higher in self-esteem compared to boys; however, unlike in previous studies, body dissatisfaction did not differ significantly by gender. Hierarchical linear multiple regression analyses revealed that self-esteem moderated the relationship between thin-ideal internalization and body dissatisfaction among girls, but this was not observed for boys. Self-esteem as a protective factor against body dissatisfaction among Sri Lankan female adolescents was confirmed.

Assessing positive body image: Contemporary approaches and future directions

Empirical and clinical interest in positive body image has burgeoned in recent years. This focused attention is generating various measures and methods for researchers and psychotherapists to assess an array of positive body image constructs in populations of interest. No resource to date has integrated the available measures and methods for easy accessibility and comparison. Therefore, this article reviews contemporary scales for the following positive body image constructs: body appreciation, positive rational acceptance, body image flexibility, body functionality, attunement (body responsiveness, mindful self-care), positive/self-accepting body talk, body pride, body sanctification, broad conceptualization of beauty, and self-perceived body acceptance by others. Guidelines for the qualitative assessment of positive body image and recommendations for integrating positive body image assessment within psychotherapy and applied research settings are also offered. The article concludes with articulating broad future directions for positive body image assessment, including ideas for expanding its available measures, methods, and dynamic expressions.

Pediatric feeding and eating disorders: current state of diagnosis and treatment

The Diagnostic and Statistical Manual of Mental Disorders now recognizes six primary feeding and eating disorders including pica, rumination disorder, avoidant/restrictive food intake disorder, anorexia nervosa, bulimia nervosa and binge-eating disorder. Guided by research from the past 3 years, the current review outlines diagnostic criteria for each disorder, their clinical correlates and treatment options. Recent modifications to diagnostic criteria will likely help to improve treatment outcomes and prognosis. Nevertheless, several concerns remain regarding the validity of current diagnostic criteria for youth, including the clinical relevance of the size and frequency of binge eating episodes. Additionally, the lack of randomized controlled trials has led to an overreliance on data from quasi-experimental studies, case series and single case studies that impede development of strong clinical recommendations for treating feeding and eating disorders. Recommendations for future research include identifying empirically supported treatments and prevention programs focused on early markers of pediatric feeding and eating concerns.

Developmental trajectories to male borderline personality disorder

Due to the higher diagnostic prevalence of borderline personality disorder (BPD) in females, there exists a dearth of literature on the manifestations of BPD in men and minimal information on male developmental trajectories to the disorder. To identify precursors of BPD in males, surveys were administered to parents about their BPD male offspring and non-BPD male siblings. Questions covered aspects of probands' lives from infancy to late adolescence. BPD offspring were identified through self-reported clinical diagnoses and standardized diagnostic criteria embedded within the survey. A total of 263 male offspring (97 meeting strict criteria for BPD and 166 non-BPD siblings) were studied. The authors found that parents describe the early emergence of a constellation of symptoms in their BPD sons that include separation anxiety starting in infancy, body image concerns in childhood, and impulsivity, emptiness, and odd thinking in adolescence. This trajectory differs from the developmental course found in females diagnosed with BPD.

Do children emotionally rehearse about their body image?

This study examined the association between propensity for emotional rehearsal, body image self-perception and weight status in Chinese Hong Kong pre-adolescents. Children 8-12 years of age (n = 278) completed measurement of body mass index, body image and emotional rehearsal. Multinomial regression analyses revealed that body mass index was positively associated with body image dissatisfaction and a significant predictor of body size estimation. However, only body size underestimation was associated with lower rehearsal tendencies. The prevalence of body image dissatisfaction and body size estimation was also reported for this population. Future research is suggested for greater understanding of emotional coping in body image dissatisfaction in young children.