The role of body image flexibility in the relationship between disordered eating cognitions and disordered eating symptoms among non-clinical college students

Exploring the moderating roles of dispositional mindfulness and body image flexibility in the association between body dissatisfaction and disordered eating in Chinese adolescents

OBJECTIVES

Previous research suggests potential moderating roles of dispositional mindfulness and body image flexibility in the association between body dissatisfaction and disordered eating. However, relevant research is mainly conducted on adult women from Western countries, and limited evidence exists for adolescent samples, especially from non-Western contexts (e.g., China). Thus, this study aimed to examine the moderating roles of dispositional mindfulness and body image flexibility in the relationship between body dissatisfaction and disordered eating in Chinese adolescents.

METHOD

We recruited 545 Chinese adolescents (53.9% boys, aged 12-16 years) who completed measures of body dissatisfaction, dispositional mindfulness, body image flexibility, and disordered eating. Moderation analyses were examined with PROCESS macro on SPSS.

RESULTS

In separate models, both higher dispositional mindfulness and body image flexibility weakened relationships between body dissatisfaction and disordered eating. However, when both dispositional mindfulness and body image flexibility were entered into the same moderation model, only body image flexibility showed a significant moderating effect.

DISCUSSION

Both dispositional mindfulness and body image flexibility may weaken the association between body dissatisfaction and disordered eating in adolescents. However, body image flexibility might have a stronger effect than dispositional mindfulness. These findings suggest that interventions aimed at reducing body dissatisfaction to prevent disordered eating in adolescents may pay more attention to adolescents' body image flexibility.

Self-compassion and body image inflexibility as mediators of outcomes in a residential eating disorder sample

Eating disorders are serious mental health conditions that are accompanied by negative health outcomes, high mortality rates, impaired functioning, and comorbid mental health conditions. Despite many empirically supported interventions for eating disorders, it remains one of the most challenging mental disorders to treat, as individuals often struggle to maintain treatment gains. One method of improving our understanding of effective eating disorder treatment is to identify important processes of change to target during therapy. The aim of the current study was to test two candidate mediators of disordered eating symptom change during residential treatment: self-compassion and body image inflexibility. In the present study, women and adolescent girls (N = 132) completed a battery of measures, including eating disorder severity, self-compassion, and body image inflexibility, at admission to and discharge from a residential eating disorder facility. Our results indicated that changes in body image inflexibility and self-compassion, specifically self-judgment, were both mediators between ED symptom severity from pre- to post-treatment. These results have potential treatment implications, pointing to the possible importance of targeting body image inflexibility, self-judgment, and self-compassion while treating eating disorders.

Associations Among Sleep, Emotional Eating, and Body Dissatisfaction in Adolescents

The literature on adolescent sleep has shown a bidirectional relationship between sleep difficulties and altered eating habits, including emotional eating. However, it is unclear if this relationship is related to preexisting body concerns, or if poor sleep is the prime contributor to emotional eating patterns. This study therefore seeks to examine body dissatisfaction as a moderator of the sleep-emotional eating relationship in an at-risk sample. Adolescents (N = 106) presenting for overnight polysomnography self-reported on time-in-bed, insomnia, body dissatisfaction, and emotional eating. Less time-in-bed was correlated with a greater desire for thinness and greater insomnia severity was related to overall emotional eating and eating in response to anxiety, anger, and frustration and in response to depression. Moderation analyses revealed that the relationships between time-in-bed and eating in response to feeling unsettled (b =  -.002, 95% CI[- .003,  - .001], p < .005) and eating in response to anxiety, anger, and frustration (b =  -.01, 95% CI[- .01,  - .001], p < .05) were exacerbated by worse body dissatisfaction. Optimizing sleep may attenuate the risk for disordered eating, particularly for adolescents with high body dissatisfaction.

Neural correlates of Type A personality: Type A personality mediates the association of resting-state brain activity and connectivity with eating disorder symptoms

BACKGROUND

Type A personality (TAP) was characterized by impatience, competitiveness, aggressiveness, and hostility. Higher TAP was proved to be associated with more eating disorder symptoms (EDS). While little is known about the underlying neural substrates of TAP and how TAP is linked to EDS at the neural level.

METHODS

To investigate the neural basis of TAP, we adopted fractional amplitude of low-frequency fluctuations (fALFF) and resting-state functional connectivity (RSFC) via resting-state functional magnetic resonance imaging (rs-fMRI) (N = 1620). Mediation models were examined to explore the relationship between TAP, EDS, and brain activity.

RESULTS

TAP was associated with decreased fALFF in the left middle frontal gyrus (MFG) and increased fALFF in the left precentral gyrus (PreCG). Furthermore, TAP was positively correlated to RSFC between the left MFG and left inferior temporal gyrus (ITG) and between the left PreCG and right middle temporal gyrus (MTG). Mediation analysis showed TAP fully mediated the association of the left MFG activity, MFG-ITG connectivity, and PreCG-MTG connectivity with EDS.

LIMITATIONS

The cross-sectional design of this study precludes us from specifying the causal relationship in the associations we observed.

CONCLUSIONS

Our results suggested spontaneous activity in the left MFG and PreCG is associated with TAP, and even in general sample, people with higher TAP showed more EDS. The present study is the first to investigate the neurobiological underpinnings of TAP in a large sample and further offered new insights into the relation between TAP and EDS from a neural basis perspective.

The relationships between social media exposure, food craving, cognitive impulsivity and cognitive restraint

BACKGROUND

Young adults are increasingly exposed to social media and their image/video-based activities. They use these platforms to share images, videos and advice in different fields like food and nutrition with: recipe ideas, nutritional opinions or specific diets. Along with the rise of digital technologies, the prevalence of eating disorders in young adults continues to grow. The present study analyzes the psychological and eating processes through which exposure to social media may lead to the development of food craving and problematic eating behaviors.

METHODS

A total of 103 young adult men (n = 15) and women (n = 88) answered questionnaires measuring their impulsivity (Barratt Impulsiveness Scale), eating habits (Three-Factor Eating Questionnaire), food craving (Food Cravings Questionnaire-Trait-reduced), and time exposure to social media.

RESULTS

The results showed two significant serial mediations. We found a correlational link between time exposure to social media and food craving scores. This positive relation is indirectly mediated by cognitive impulsivity. We also found a positive correlation between cognitive impulsivity and food craving scores that was mediated by cognitive restraint.

CONCLUSION

A better understanding of the existing links between social media, food craving and eating behaviors such as cognitive restraint could help researchers and clinicians to better guide young adults in their use and appropriation of social media food contents.

Body mass index and quality of life in individuals with polycystic ovary syndrome: Dysmorphic concerns and eating disorders as mediators

Objective

Weight issues, dysmorphic concerns and eating disorders are common among individuals with polycystic ovary syndrome (PCOS) and are linked to poor quality of life (QoL). The goal of the current study was to examine whether the association between body mass index (BMI) and QoL was mediated by dysmorphic concerns, examining also the relations with eating disorder symptomatology.

Methods

Questionnaires were administered to 435 individuals with PCOS aged between 18 and 40 years (M = 27.62; SD = 4.83) to measure dysmorphic concerns, eating disorder symptoms and QoL. Participants were also asked to report their height and weight to compute their BMI.

Results

Structural equation modeling was used to observe the relationship between the variables. The results revealed a direct relationship between QoL, BMI, dysmorphic concerns and eating disorder symptomatology. In addition, dysmorphic concerns were related to BMI and eating disorder symptomatology. Furthermore, the results showed the mediating role of dysmorphic concerns and eating disorder symptoms in the relationship between BMI and QoL.

Conclusion

The current results highlight the potential importance of harmful relationships with one's own body and food, explaining why weight issues may be linked to different levels of QoL in PCOS individuals. The implications of these findings are discussed.

The powerful effect of body image inflexibility on the explanation of eating psychopathology severity

PURPOSE

Feelings of shame and social comparison focused on physical appearance have been identified as important risk factors for the engagement in disordered eating behaviours. Further, recent studies have emphasized the role of body-image psychological (in)flexibility in the association between several risk factors and eating psychopathology. The current study intended to explore, in two different path models, the effects of external shame, physical appearance-related social comparison, and body image inflexibility on the explanation of eating psychopathology severity.

METHODS

This study follows a cross-sectional design and was conducted in a sample of 776 emerging-adult women, aged between 18 and 28, who completed an online battery of self-report measures. Path analyses were conducted using a structural equation modeling.

RESULTS

Model 1's results showed that external shame and unfavourable social comparison based on physical appearance directly accounts for 26% of the variance in disordered eating. In turn, when body image inflexibility is introduced as a mediator in the relationship presented in Model 1, variance in disordered eating increases to 60% (Model 2). These results suggest that both external shame and unfavourable physical appearance-related social comparison have an impact on disordered eating behaviours. However, when body image inflexibility is introduced, the mentioned relationships change and reveal that psychological inflexibility is a significant mediator of these associations.

CONCLUSION

These findings seem to demonstrate that body image inflexibility is a key process for the engagement in disordered eating, so the promotion of psychological flexibility focused on one's body is crucial for the prevention and treatment of disordered eating behaviours and attitudes.

LEVEL OF EVIDENCE

Level IV: Cross-sectional study.

Using machine learning to explore core risk factors associated with the risk of eating disorders among non-clinical young women in China: A decision-tree classification analysis

BACKGROUND

Many previous studies have investigated the risk factors associated with eating disorders (EDs) from the perspective of emotion regulation (ER). However, limited research has investigated interactions between co-existing risk factors for EDs, especially in China where research in EDs is underrepresented.

METHODS

This study examined core risk factors related to maladaptive eating behaviors and ER, and how their interactions affect the detection of EDs. Using machine learning, a decision tree model was constructed on a data set of 830 non-clinical Chinese young women with an average age of 18.91 years (SD = 0.95). The total data set was split into training and testing data sets with a ratio of 70 to 30%.

RESULTS

Body image inflexibility was identified as the major classifier for women at high risk of EDs. Furthermore, interactions between body image inflexibility, psychological distress, and body dissatisfaction were important in detecting women at high risk of EDs. Overall, the model classifying women at high-risk for EDs had a sensitivity of 0.88 and a specificity of 0.85 when applied to the testing data set.

CONCLUSIONS

Body image inflexibility, psychological distress, and body dissatisfaction were identified as the major classifiers for young women in China at high risk of EDs. Researchers and practitioners may consider these findings in the screening, prevention, and treatment of EDs among young women in China.

The relationship between body weight and dietary restraint is explained by body dissatisfaction and body image inflexibility among young adults in China

OBJECTIVE

Eating disorders and obesity are commonly recognized as key public health concerns worldwide. Although rates of obesity and disordered eating have traditionally been lower in China than Western countries, these rates are on the rise. As such, interest is growing in identifying mechanisms that may address these conditions. While associations between body weight and dissatisfaction are well established, burgeoning research aims to examine how these factors are related to dietary restraint and body image inflexibility. This study aimed to explore the possible mediation effect of body dissatisfaction and body image inflexibility between body weight (body mass index) and dietary restraint. Furthermore, we explored how these relationships differed across men and women.

METHODS

A sample of 1068 young adults (563 females and 505 males) in China participated in the study. Participants completed the Eating Disorder Inventory and Three-Factor Eating Questionnaire as well as the Body Image-Acceptance and Action Questionnaire.

RESULTS

Results showed that: (1) body dissatisfaction and body image inflexibility fully mediated the relationship between body mass index and dietary restraint; (2) this model fit both genders, although differences were found in the regression coefficients between the mediation model for men and women.

CONCLUSION

These findings support body image dissatisfaction and inflexibility as mediators of the relationship between body weight and dietary restraint, highlighting these as potential mechanisms for treatment.

LEVEL OF EVIDENCE

Level III, case-control analytic study.

Body image flexibility and its correlates: A meta-analysis

Body image flexibility refers to the ability to openly experience thoughts or feelings about the body without acting on them or trying to change them. Accumulating evidence has demonstrated that body image flexibility is connected to numerous adaptive processes, and that it is sensitive to change during psychological interventions. However, a quantitative synthesis of empirical research on body image flexibility is lacking. We conducted the first meta-analysis on body image flexibility and its correlates. Sixty-two studies were included. Random effects meta-analyses were conducted on 19 psychological correlates, divided into three clusters: eating and body image disturbances, positive body-related and general psychological constructs, and general psychopathology. Meta-analyses showed inverse correlations between body image flexibility and each construct within the eating and body image disturbances cluster (rs= -.45 to -.67), and the general psychopathology cluster (rs= -.37 to -.58). Body image flexibility was positively associated with each positive psychology construct (rs = .23 - .58). Men reported higher levels of body image flexibility than women (d = 0.32). Psychological interventions were more effective than control groups at enhancing body image flexibility in randomized controlled trials (d = 0.42). Findings confirm that body image flexibility is consistently connected to indices of mental health, and that it can be enhanced during psychological interventions.

Validation of the Chinese Version of the Body Image Acceptance and Action Questionnaire and the Mediating Role of Body Image Flexibility in the Relationship Between Body Dissatisfaction and Psychological Distress

The psychometric properties of the Chinese version of the Body Image Acceptance and Action Questionnaire (C-BI-AAQ) and its short form (C-BI-AAQ-5) were examined with a sample of Chinese undergraduates (n =1,068, 52.6% female). The factor structure, measurement reliability, measurement invariance across gender, and latent gender mean difference of the two scales were explored. Confirmatory factor analysis was used to examine the factor structure of the C-BI-AAQ and the C-BI-AAQ-5. The original one-factor structure was replicated for both the C-BI-AAQ and the C-BI-AAQ-5. Both the C-BI-AAQ and C-BI-AAQ-5 showed good internal consistency, test-retest reliability, and convergent and discriminant validity (e.g., relationship patterns in the expected directions with theoretically similar psychological flexibility, and with theoretically dissimilar body dissatisfaction, and psychological distress). The C-BI-AAQ-5 was shown to be equivalent to the C-BI-AAQ. Furthermore, strict measurement invariance across gender was confirmed for both the C-BI-AAQ and C-BI-AAQ-5, and latent mean difference tests showed that men had higher levels of body image flexibility than women. Thus, both the C-BI-AAQ and C-BI-AAQ-5 appear to be psychometrically sound instruments for use in the Chinese young adult population. In addition, body image flexibility measured by both the C-BI-AAQ and the C-BI-AAQ-5 fully mediated the relationship between body dissatisfaction and psychological distress.

Appearance Comparisons and Eating Pathology: A Moderated Serial Mediation Analysis Exploring Body Image Flexibility and Body Appreciation as Mediators and Self-Compassion as Moderator

Comparing one's body against the bodies of others is related to lower positive body image and higher eating pathology. Underlying mechanisms as well as protective factors of these relationships are yet to be discovered. The present study examined body image flexibility and body appreciation as potential mediators of the association between appearance comparisons and eating disorder psychopathology. Additionally, it was tested whether self-compassion moderates the mediation effects. In an online sample comprising 250 women (M_age = 42.66, SD = 12.24), the inverse relationship between appearance comparisons and body appreciation was mediated by body image flexibility and the positive relationship between appearance comparisons and eating disorder psychopathology was mediated by body image flexibility and serially mediated by body image flexibility and body appreciation, when controlling for body mass index and age. Simple mediations were further moderated by self-compassion, such that indirect effects were attenuated at high levels of self-compassion. Promoting body image flexibility may be one potential target for helping women to engage in less maladaptive and more adaptive ways of treating the body when comparing one's appearance. Building self-compassion may be another potential target that may protect body image flexibility and its correlates in the face of appearance comparisons.

Examining the factor structure, sex invariance, and psychometric properties of the Body Image Acceptance and Action Questionnaire and the Functionality Appreciation Scale

Body image flexibility and functionality appreciation are two facets of positive body image gaining significant research attention. The measures that assess these constructs- the Body Image Acceptance and Action Questionnaire (BI-AAQ) and Functionality Appreciation Scale (FAS), respectively-have produced a unidimensional structure with adequate psychometric properties. However, the cross-sex invariance of the BI-AAQ has yet to be established, and replicating the FAS' one-factor structure is needed. We examined the factor structure, cross-sex invariance, and psychometric properties of the BI-AAQ and FAS. Data were analyzed from 383 men and 631 women who completed questionnaires (participants were not restricted to a specific country). An unacceptable model fit for the BI-AAQ was found for men and women, indicating that the unidimensional structure was not replicated. The unidimensional structure of the FAS and an abbreviated 5-item BI-AAQ was replicated, and tests of measurement invariance between men and women were upheld. Evidence of internal consistency, convergent validity, and incremental validity for the abbreviated BI-AAQ and FAS was found. Overall, the abbreviated BI-AAQ and the FAS appear to be psychometrically sound measures of positive body image. Findings suggest that sex comparisons on the abbreviated BI-AAQ and FAS are permissible.

Psychometric Properties of the Body Image Acceptance and Action Questionnaire in Patients with Somatic Symptom and Related Disorders in Kashan City

Background: The Body Image Acceptance and Action Questionnaire (BI-AAQ) assesses cognitive flexibility and acceptance of body image. Objectives: This study was done to assess the validity and reliability of the Persian version of BI-AAQ, as an instrument to measure body image flexibility, in patients with somatic symptom and related disorders. Methods: This descriptive psychometric study was done in 2017 on 357 patients with somatic symptom and related disorders selected through a convenient sampling method from Kashan University of Medical Sciences clinics. They responded to the BI-AAQ, Depression, Anxiety, and Stress Scale (DASS), Acceptance and Action Questionnaire-II (AAQ-II), and Freiburg Mindfulness Inventory (FMI). The reliability of the BI-AAQ was calculated using Cronbach’s alpha coefficient. To assess its validity, the exploratory and confirmatory factor analyses were used. The gathered data were analyzed via SPSS-22 and Amos-22 software. Results: This version retained a one-factor structure, similar to the original version of the questionnaire, which explained 42.55% of the variance. It had high internal consistency (0.84), split-half method (0.77), and correlates with AAQ (0.45), mindfulness (0.39) and correlates contrastingly with stress (0.11), anxiety (0.36) and depression (0.43). Conclusions: According to the results of the current research, the BI-AAQ is a reliable instrument with valid psychometric properties to measure the body image acceptance of individuals in Iranian patients with somatic symptom and related disorders.

Validation of the greek version of the body image-acceptance and action questionnaire

The present study aimed to examine the psychometric properties and factorial structure of the Greek version of the Body Image-Acceptance and Action Questionnaire (BI-AAQ). The BI-AAQ assesses cognitive flexibility and acceptance relative to body image. Two samples: an all female middle and high school sample (N = 85; Age M = 17.97, SD = 2.74) and a college student sample (N = 240; Age M = 21.50; SD = 2.98) in Cyprus completed a set of self-reported eating-related questionnaires. Reliability analysis showed that the Greek BI-AAQ has high internal consistency and good item-total correlations. Principal Component Analysis (Sample 1) and Confirmatory Factor Analysis (Sample 2) supported a one-factor solution, as in the case of the original BI-AAQ. Hierarchical multiple regression predicting eating disorder behaviors (as assessed by the EDE-Q) from Weight Concerns (WCS) and BI-AAQ scores after controlling for BMI, produced a significant model, which accounted for 67% of variance. The BI-AAQ remained a significant predictor of eating disorder behaviors after controlling for BMI and weight concerns scores. The Greek version of the BI-AAQ questionnaire is thus a robust and reliable instrument. It adds to previous knowledge and research on the role of psychological flexibility and acceptance of body image in eating disorder behaviours and psychological difficulties.

An investigation of the affective experience of females at high risk for eating disorders in general and pathology-specific contexts

OBJECTIVE

Difficulties with emotional experiences have long been implicated in the development or maintenance of eating disorders (EDs). However, the vast majority of this work is theoretical or self-report, with few studies examining the somatic-affective experience of individuals with EDs under experimental conditions. The aim of the current study was to: i) examine physiological reactivity and subjective report of emotional experiences in response to ED pathology-specific and general affective film clips, and ii) examine the impact of film on body size estimation in females at risk for EDs.

METHOD

Females aged 14-24 years old of either high (N = 42) or low (N = 43) risk for EDs viewed pathology-specific and general affective film clips and provided their affective ratings and body-size estimations post film clips. Heart Rate and Skin Conductance Levels were recorded during each clip.

RESULTS

High risk participants evidenced greater physiological arousal across conditions and in both general and pathology-specific affective contexts. Negative affect induced via the ED-pathology specific film clip had a greater impact on the high risk group's body-size estimations.

CONCLUSIONS

Individuals at risk for EDs seem to experience greater physiological arousal and this may influence the experience of their bodies, or direct attention to their body as a way to attenuate unwanted emotion or due to somatic feedback.

Food Cravings and Eating: The Role of Experiential Avoidance

Food cravings have been associated with problematic eating behaviors, such as emotional eating. Late adolescence is an important developmental period to examine this association, as late adolescents have greater independence in food choices as well as potentially higher demands during a transitional period of their lives. Mechanisms underlying the association between food cravings and problematic eating remain unclear. This study examined whether experiential avoidance (EA) may be one possible mechanism mediating the association between higher levels of food cravings and problematic eating behaviors. Late adolescents (n = 174) completed measures assessing EA, food cravings, and three problematic eating behaviors: emotional eating, cognitive restraint, and uncontrolled eating. Height and weight were measured objectively to calculate body mass index (BMI). Food cravings were positively associated with emotional eating and mediated by EA. EA also significantly mediated the association between greater cognitive restraint and greater food cravings. No significant mediation was detected for food cravings and uncontrolled eating. Future research may consider EA as a treatment target in intervention strategies for late adolescents seeking to decrease emotional or restrained eating behaviors.

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.

Understanding self-concealment within a framework of eating disorder cognitions and body image flexibility: Conceptual and applied implications

Although self-concealment has been long recognized in the context of body image disturbance and disordered eating concerns, empirical evidence remains limited. Following cognitive behavioral therapy (CBT) models of disordered eating and body image concerns, the present cross-sectional study examined whether the construct of self-concealment was related to disordered eating and body image concerns. More specifically, we investigated whether eating disorder cognitions and body image flexibility, two factors linked to the maintenance of disordered eating concerns, are uniquely associated with self-concealment, while controlling for key demographic and sociocultural variables. Three-hundred thirty-six undergraduate women completed a web-based survey that included measures of interest. Results revealed that eating disorder cognitions associated with the fear of weight gain and body image flexibility were uniquely related to self-concealment in expected directions.

Mindfulness as a Moderator of the Association Between Eating Disorder Cognition and Eating Disorder Behavior Among a Non-clinical Sample of Female College Students: A Role of Ethnicity

The present cross-sectional study examined whether mindfulness moderated the association between eating disorder cognition and eating disorder behaviors among Asian American, Black American, and White American female college students in the United States. Participants (N = 463, age range = 18–25 years) completed self-report measures online. Results revealed that mindfulness moderated the association between eating disorder cognition and eating disorder behavior in the White American group, but not in Asian American or Black American samples. Future research should replicate these differential findings across ethnic groups and investigate the factors that may contribute to this group difference.

Effect of acceptance and commitment therapy on body image flexibility and body awareness in patients with psychosomatic disorders: a randomized clinical trial

OBJECTIVE

The aim of this research was to examine the effectiveness of the acceptance and commitment therapy (ACT) for body image flexibility and body awareness in these patients.

METHODS

A randomized clinical trial was conducted at Kashan University of Medical Sciences clinics in Kashan, Iran, from December 1, 2017 to March 30, 2018. A sample of 75 patients with psychosomatic disorders was selected by convenience sampling. The selected patients were randomly divided into three 25-member groups. The experimental group received medicinal treatment combined with the (ACT). The active control group received the usual treatment plus psycho education in general psychology, and the treatment group solely received the medicinal treatment usually used in the treatment centers. The results were obtained using the following scales in the pretest and posttest phases and the two-month follow-up: the demographic questionnaire; Shields' body awareness questionnaire; and Sandoz's body image flexibility questionnaire. The data were analyzed using the descriptive statistics tests (mean and standard deviation) and the repeated measures analysis of variance and chi-square tests in IBM-SPSS version 21.

RESULTS

There was no significant difference among the three groups in terms of body image flexibility, body awareness, somatic symptoms, and demographic variables. The results of the posttest and follow-up examinations suggested that the ACT group more effectively and significantly improved body image flexibility and body awareness as compared to both of the control groups (p=0.02).

CONCLUSIONS

The ACT successfully improves body image flexibility and body awareness in patients with psychosomatic disorders.

CLINICAL TRIAL REGISTRATION

This research was registered at the Iranian Registry of Clinical Trials (http://www.irct.ir) with the IRCT ID: IRCT2017092532057N2.

FUNDING

Research and Technology Department of Kashan University of Medical Sciences funded the study (Ref: 96053).

Increasing body image flexibility in a residential eating disorder facility: Correlates with symptom improvement

OBJECTIVE

The purpose of this study was to examine the effects of changes in body image psychological flexibility over the course of treatment on various outcome variables.

METHOD

Participants included 103 female, residential patients diagnosed with an eating disorder. Pretreatment and posttreatment data were collected that examined body image psychological flexibility, general psychological flexibility, symptom severity, and other outcome variables.

RESULTS

Changes in body image psychological flexibility significantly predicted changes in all outcome measures except for obsessive-compulsive symptoms after controlling for body mass index, depression, and anxiety. Additionally, these results were maintained after controlling for general psychological flexibility, contributing to the incremental validity of the BI-AAQ.

DISCUSSION

This study suggests that changes in body image psychological flexibility meaningfully predict changes in various treatment outcomes of interest, including eating disorder risk, quality of life, and general mental health. Findings indicate that body image psychological flexibility might be a viable target for eating disorder treatment.

Body-Image Acceptance and Action Questionnaire: Its deleterious influence on binge eating and psychometric validation

Background/Objectives: This study aimed to explore the psychometric properties of BI-AAQ (Body-Image Acceptance and Action Questionnaire) and the body image psychological flexibility role as a mediator in a pervasive path towards binge eating in Brazilian samples. Method: This cross-sectional study was conducted in clinical (overweight or obese women currently in treatment for weight loss; n= 330) and non-clinical (general population; n= 682) groups of women. Results: BI-AAQ has one-factor structure, excellent internal consistency, ability to detect differences between groups and measurement invariance across samples. It was also negatively associated with self-compassion and positively associated with binge eating severity, drive for thinness and self-criticism. Conclusions: This study provides data confirming the robust psychometric properties of BI-AAQ in qualitatively different samples. Furthermore, an additional study conducted in a clinical sample of women with overweight or obesity revealed that body image psychological inflexibility has emerged as a partial and significant mediator of the effect of self-criticism and drive for thinness on binge eating severity.

BEfree: A new psychological program for binge eating that integrates psychoeducation, mindfulness, and compassion

Binge eating disorder (BED) is associated with several psychological and medical problems, such as obesity. Approximately 30% of individuals seeking weight loss treatments present binge eating symptomatology. Moreover, current treatments for BED lack efficacy at follow‐up assessments. Developing mindfulness and self‐compassion seem to be beneficial in treating BED, although there is still room for improvement, which may include integrating these different but complimentary approaches. BEfree is the first program integrating psychoeducation‐, mindfulness‐, and compassion‐based components for treating women with binge eating and obesity.

Objective

To test the acceptability and efficacy up to 6‐month postintervention of a psychological program based on psychoeducation, mindfulness, and self‐compassion for obese or overweight women with BED.

Design

A controlled longitudinal design was followed in order to compare results between BEfree (n = 19) and waiting list group (WL; n = 17) from preintervention to postintervention. Results from BEfree were compared from preintervention to 3‐ and 6‐month follow‐up.

Results

BEfree was effective in eliminating BED; in diminishing eating psychopathology, depression, shame and self‐criticism, body‐image psychological inflexibility, and body‐image cognitive fusion; and in improving obesity‐related quality of life and self‐compassion when compared to a WL control group. Results were maintained at 3‐ and 6‐month follow‐up. Finally, participants rated BEfree helpful for dealing with impulses and negative internal experiences.

Conclusions

These results seem to suggest the efficacy of BEfree and the benefit of integrating different components such as psychoeducation, mindfulness, and self‐compassion when treating BED in obese or overweight women.

Key Practitioner Message

The current study provides evidence of the acceptability of a psychoeducation, mindfulness, and compassion program for binge eating in obesity (BEfree);

Developing mindfulness and self‐compassionate skills is an effective way of diminishing binge eating, eating psychopathology and depression, and increasing quality of life in women with obesity;

Integrating psychoeducation, mindfulness, and compassion seem to be effective in diminishing binge eating, with results maintained up to 6‐month postintervention.

Body image flexibility mediates the effect of body image-related victimization experiences and shame on binge eating and weight

OBJECTIVES

The current study examined a path model testing the indirect effect of negative body-image related memories of being teased and bullied in childhood and adolescence on binge eating severity symptoms, via its effect on current body image shame and body image flexibility.

METHODS

Participants were 853 Portuguese women from the general community who completed a set of self-report measures of body image-related bullying and teasing experiences in childhood and adolescence, current body image shame, body image flexibility, binge eating symptoms, body mass index (BMI) and depressive symptoms.

RESULTS

The path model accounted for 40% of the variance of binge eating symptoms and 14% of the variance of BMI, and revealed a very good fit. Findings corroborated the plausibility of the hypothesized associations suggesting that negative body image-related memories and emotional experiences are significantly associated with binge eating symptoms and BMI, and that body image flexibility is a significant mediator of these associations. The examined relationships were preserved after controlling for the effect of depressive symptoms.

CONCLUSIONS

The current study's findings contribute to clarify the role that body image-related memories and emotional experiences may play on individuals' difficulties in regulating eating behaviour and weight, and provides preliminary support for the potential effect of body image flexibility as a self-regulatory process that operates in these associations.

The role of body image psychological flexibility on the treatment of eating disorders in a residential facility

OBJECTIVE

The purpose of this study was to test whether pre-treatment levels of psychological flexibility would longitudinally predict quality of life and eating disorder risk in patients at a residential treatment facility for eating disorders.

METHOD

Data on body image psychological flexibility, quality of life, and eating disorder risk were collected from 63 adolescent and 50 adult, female, residential patients (N=113) diagnosed with an eating disorder. These same measures were again collected at post-treatment. Sequential multiple regression analyses were performed to test whether pre-treatment levels of psychological flexibility longitudinally predicted quality of life and eating disorder risk after controlling for age and baseline effects.

RESULTS

Pre-treatment psychological flexibility significantly predicted post-treatment quality of life with approximately 19% of the variation being attributable to age and pre-treatment psychological flexibility. Pre-treatment psychological flexibility also significantly predicted post-treatment eating disorder risk with nearly 30% of the variation attributed to age and pre-treatment psychological flexibility.

DISCUSSION

This study suggests that levels of psychological flexibility upon entering treatment for an eating disorder longitudinally predict eating disorder outcome and quality of life.

Anxiety as a Moderator of the Relationship Between Body Image and Restrained Eating

PURPOSE

To examine three indicators of psychopathology (stress, anxiety, and depression) as potential moderators of the relationship between body image dissatisfaction (BID) and restrained, emotional, and external eating, while controlling for family-related variables (i.e., household income, living situation, and psychopathology in the family) and individual variables (i.e., body mass index, physical activity, and major life events).

DESIGN AND METHODS

A descriptive, correlational cross-sectional design was used. A sample of 894 female undergraduates aged between 18 and 25 completed a self-reported questionnaire.

FINDINGS

Moderation analyses indicated that anxiety significantly moderated the relationship between BID and restrained eating, whereas depression and stress did not.

PRACTICE IMPLICATIONS

Findings may be used in the development and implementation of education and prevention programs for disordered eating in college campuses. The usefulness of these findings for nursing practice is discussed.

Body image inflexibility mediates the relationship between body image evaluation and maladaptive body image coping strategies

Body image inflexibility, the unwillingness to experience negative appearance-related thoughts and emotions, is associated with negative body image and eating disorder symptoms. The present study investigated whether body image inflexibility mediated the relationship between body image evaluation and maladaptive body image coping strategies (appearance-fixing and experiential avoidance) in a college and community sample comprising 156 females aged 18-51 years (M=22.76, SD=6.96). Controlling for recruitment source (college vs. community), body image inflexibility fully mediated the relationship between body image evaluation and maladaptive body image coping strategies. Results indicated that an unwillingness to experience negative appearance-related thoughts and emotions is likely responsible for negative body image evaluation's relationship to appearance-fixing behaviours and experiential avoidance. Findings support extant evidence that interventions that explicitly target body image inflexibility, such as Acceptance and Commitment Therapy, may have utility in treating body dissatisfaction in nonclinical populations.

Explaining rigid dieting in normal-weight women: the key role of body image inflexibility

Restrictive dieting is an increasing behavior presented by women in modern societies, independently of their weight. There are several known factors that motivate diet, namely a sense of dissatisfaction with one's body and unfavorable social comparisons based on physical appearance. However, dieting seems to have a paradoxical effect and has been considered a risk factor for weight gain and obesity in women and for maladaptive eating. Nevertheless, the study of the emotional regulation processes that explain the adoption of inflexible and rigid eating behaviors still remains little explored. In this line, the present study aims to explore why normal-weight women engage in highly rigid and inflexible diets. We hypothesize that body and weight dissatisfaction and unfavorable social comparisons based on physical appearance explain the adoption of inflexible eating rules, through the mechanisms of body image inflexibility. The current study comprised 508 normal-weight female college students. Path analyses were conducted to explore the study's hypotheses. Results revealed that the model explained 43 % of inflexible eating and revealed excellent fit indices. Furthermore, the unwillingness to experience unwanted events related to body image (body image inflexibility) mediated the impact of body dissatisfaction and unfavorable social comparisons on the adoption of inflexible eating rules. This study highlights the relevance of body image inflexibility to explain rigid eating attitudes, and it seems to be an important avenue for the development of interventions focusing on the promotion of adaptive attitudes towards body image and eating in young women.

Not hating what you see: Self-compassion may protect against negative mental health variables connected to self-objectification in college women

Self-objectification is related to maladaptive mental health variables, but little is known about what could ameliorate these associations. Self-compassion, a construct associated with mindfulness, involves taking a non-judgmental attitude toward the self. In this study, 306 college-aged women were recruited; those who were highest (n=106) and lowest (n=104) in self-compassion were retained for analyses. Levels of body surveillance, body shame, depression, and negative eating attitudes were lower in the high self-compassion group. Furthermore, the fit of a path model wherein body surveillance related to body shame, which, in turn, related to negative eating attitudes and depressive symptomatology was compared for each group, controlling for body mass index. The model fit significantly differently such that the connections between self-objectification and negative body and eating attitudes were weaker in the high self-compassion group. Treatment implications of self-compassion as a potential means to interrupt the self-objectification process are discussed.

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.

Body image flexibility moderates the association between disordered eating cognition and disordered eating behavior in a non-clinical sample of women: a cross-sectional investigation

Body image flexibility, a regulation process of openly and freely experiencing disordered eating thoughts and body dissatisfaction, has been found to be a buffering factor against disordered eating symptomatology. The present cross-sectional study investigates whether body image flexibility accounts for disordered eating behavior above and beyond disordered eating cognition, mindfulness, and psychological inflexibility in a sample of nonclinical women, and whether body image flexibility moderates the associations between these correlates and disordered eating behavior. Participants were 421 women, age 21±5.3 years old on average, who completed a web-based survey that included the self-report measures of interest. Results demonstrate the incremental effects of body image flexibility on disordered eating behavior above and beyond disordered eating cognition, mindfulness, and psychological inflexibility. Women with greater body image flexibility endorse disordered eating behavior less so than those with lower body image flexibility. Body image flexibility moderates the association between disordered eating cognition and disordered eating behavior; for women with greater body image flexibility, disordered eating cognition is not positively associated with disordered eating behavior.

Self-compassion moderates the relationship between body mass index and both eating disorder pathology and body image flexibility

The current study examined whether self-compassion, the tendency to treat oneself kindly during distress and disappointments, would attenuate the positive relationship between body mass index (BMI) and eating disorder pathology, and the negative relationship between BMI and body image flexibility. One-hundred and fifty-three female undergraduate students completed measures of self-compassion, self-esteem, eating disorder pathology, and body image flexibility, which refers to one's acceptance of negative body image experiences. Controlling for self-esteem, hierarchical regressions revealed that self-compassion moderated the relationships between BMI and the criteria. Specifically, the positive relationship between BMI and eating disorder pathology and the negative relationship between BMI and body image flexibility were weaker the higher women's levels of self-compassion. Among young women, self-compassion may help to protect against the greater eating disturbances that coincide with a higher BMI, and may facilitate the positive body image experiences that tend to be lower the higher one's BMI.

Considering an affect regulation framework for examining the association between body dissatisfaction and positive body image in Black older adolescent females: does body mass index matter?

The present study provided an initial evaluation of an affect regulation model describing the association between body dissatisfaction and two contemporary measures of positive body image among 247 Black college-bound older adolescent females. We further tested whether possessing a higher body mass index (BMI) would strengthen these associations. Self-reported height and weight were used to calculate BMI. Respondents also completed a culturally-sensitive figure rating scale along with assessments of body appreciation and body image flexibility. Results indicated a robust positive association between the two measures of positive body image; BMI was the strongest predictor of both body appreciation and body image flexibility with body size discrepancy (current minus ideal) contributing incremental variance to both models tested. Implications for improving our understanding of the association between positive and negative body image and bolstering positive body image to promote health-protective behaviors among Black young women at this developmental juncture are discussed.

Comparing Japanese College Students’ and U.S. College Students’ Disordered Eating, Distress, and Psychological Inflexibility

The present study investigated whether psychological inflexibility is related to disordered eating in Japanese undergraduate students and compared the strength and pattern of the associations with effects in a sample of undergraduate students from the United States. Data from 200 Japanese ( nfemale = 100) and 481 U.S. ( nfemale = 380) college students were used. Contrary to prediction, female gender and higher body mass index (BMI), but not psychological inflexibility, were uniquely related to higher levels of disordered eating while controlling for age and psychological distress in the Japanese group. In the U.S. group, greater psychological inflexibility was the only variable that was uniquely related to higher levels of disordered eating after controlling for other study variables. Our findings suggest that psychological inflexibility may not be a useful concept for understanding disordered eating within Japanese college students.

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.

Body image flexibility as a protective factor against disordered eating behavior for women with lower body mass index

The purpose of the current study was to examine whether body dissatisfaction and body image flexibility would be uniquely and significantly associated with disordered eating behavior. In addition, the study examined if body mass index (BMI) moderated the relationships between each of the body image related variables and disordered eating. Two-hundred-fifty-eight female participants completed the web-based survey. Body dissatisfaction and body image flexibility were significantly related to disordered eating behavior, after controlling for ethnicity and BMI, and BMI moderated the relation between body image flexibility and disordered eating. Specifically, for those with low BMI, greater body image flexibility was associated with reduced disordered eating behavior. Body image flexibility was not associated with disordered eating behavior among those with average or high BMI. These results suggest that greater body image flexibility may serve as a protective factor against disordered eating behaviors for those with low BMI.