Anxiety and depression mediate the role of low self-esteem and low self-directedness in the development of eating disorders
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Matteo Aloi
Abstract
Objective:
Low self-esteem and low self-directedness (SD) are considered a risk factor for the development of eating disorders (EDs). The aim of this study was to test the hypothesis that low self-esteem and low SD lead to a higher risk for EDs through the mediation of anxiety and depression.
Methods:
Seventy-seven female teenagers answered the Eating Disorder Inventory 3 (EDI-3), the Intolerance of Uncertainty Scale (IUS), the Temperament and Character Inventory-Revised (TCI-R), the Rosenberg Self-Esteem Scale (RSES), and the State and Trait Anxiety Inventory (STAI), and the Symptom Checklist-90-Revised (SCL-90-R). To test the hypothesis, a structural equation model (SEM) was used.
Results:
According to the EDI3-EDRC scores, 23/77 (29.9%) participants demonstrated positive results in the screening. Participants who had positive results in the screening had significantly higher scores on trait and state anxiety, depression, and IU, and lower means of self-esteem and SD. The SEM demonstrated good fit indices and all paths were significant in the predicted directions, confirming the hypothesized model.
Conclusions:
The current results confirm the role of self-esteem and SD in the development of an ED among adolescent females through the mediating action of IU, anxiety, and depression.
References
1. Spear LP. The adolescent brain and age-related behavioral manifestations. Neurosci Biobehav Rev 2000;24:417–63.10.1016/S0149-7634(00)00014-2Suche in Google Scholar PubMed
2. Hall GS. Adolescence: in psychology and its relation to physiology, anthropology, sociology, sex, crime, religion, and education (Vol. I & II) Englewood Cliffs, NJ: Prentice-Hall, 1904.Suche in Google Scholar
3. Golden NH, Katzman DK, Kreipe RE, Stevens S, Sawyer S, et al. Eating disorders in adolescents: position paper of the society for adolescent medicine. J Adolesc Health 2003;33:496e503.10.1016/S1054-139X(03)00326-4Suche in Google Scholar
4. Alm ME, Neumark-Sztainer D, Story M, Boutelle KN. Self-weighing and weight control behaviors among adolescents with a history of overweight. J Adolesc Health 2009;44:424–30.10.1016/j.jadohealth.2008.08.016Suche in Google Scholar PubMed
5. Stice E, Rohde P, Gau J, Shaw H. An effectiveness trial of a dissonance based eating disorder prevention program for high-risk adolescent girls. J Consult Clin Psychol 2009;77:825–3410.1037/a0016132Suche in Google Scholar PubMed
6. Carter JC, Stewart DA, Dunn VJ, Fairburn CG. Primary prevention of eating disorders: might it do more harm than good? Int J Eat Disord 1997;22:167–72.10.1002/(SICI)1098-108X(199709)22:2<167::AID-EAT8>3.0.CO;2-DSuche in Google Scholar PubMed
7. Mora M, Penelo E, Gutiérrez T, Espinoza P, González ML, et al. Assessment of two school-based programs to prevent universal eating disorders: media literacy and theatre-based methodology in Spanish adolescent boys and girls. ScientificWorldJ 2015;2015:328753.10.1155/2015/328753Suche in Google Scholar
8. Tanofsky-Kraff M, Shomaker LB, Wilfley DE, Young JF, Sbrocco T, et al. Targeted prevention of excess weight gain and eating disorders in high-risk adolescent girls: a randomized controlled trial. Am J Clin Nutr 2014;100:1010–8.10.3945/ajcn.114.092536Suche in Google Scholar PubMed
9. Tirlea L, Truby H, Haines TP. Investigation of the effectiveness of the “Girls on the Go!” program for building self-esteem in young women: trial protocol. Springerplus 2013;2:683.10.1186/2193-1801-2-683Suche in Google Scholar PubMed
10. Dea J, Abrahams S. Improving the body image, body attitudes and behaviors of young male and female adolescents: a new educational approach that focuses on self-esteem. Int J Eat Disorder 2000;28:43–57.10.1002/(SICI)1098-108X(200007)28:1<43::AID-EAT6>3.0.CO;2-DSuche in Google Scholar
11. Stice E, South K, Shaw H. Future directions in etiologic, prevention, and treatment research for eating disorders. J Clin Child Adolesc Psychol 2012;41:845–55.10.1080/15374416.2012.728156Suche in Google Scholar PubMed
12. Kaye WH, Bulik CM, Thornton L, Barbarich N, Masters K. Comorbidity of anxiety disorders with anorexia and bulimia nervosa. Am J Psychiatry 2004;161:2215–21.10.1176/appi.ajp.161.12.2215Suche in Google Scholar PubMed
13. Frank GK, Roblek T, Shott ME, Jappe LM, Rollin MD, et al. Heightened fear of uncertainty in anorexia and bulimia nervosa. Int J Eat Disord 2012;45:227–32.10.1002/eat.20929Suche in Google Scholar PubMed
14. Freeston MH, Rheaume J, Letarte H, Dugas MJ, Ladouceur R. Why do people worry? Pers Indiv Differ 1994;17:791–802.10.1016/0191-8869(94)90048-5Suche in Google Scholar
15. Cloninger CR. The temperament and character inventory—revised. St. Louis, MO: Center for Psychobiology of Personality, Washington University, 1999.Suche in Google Scholar
16. Segura-García C, Chiodo D, Sinopoli F, De Fazio P. Temperamental factors predict long-term modifications of eating disorders after treatment. BMC Psychiatry 2013;13:288.10.1186/1471-244X-13-288Suche in Google Scholar PubMed
17. Svrakic DM, Whitehead C, Przybeck TR, Cloninger CR. Differential diagnosis of personality disorders by the seven-factor model of temperament and character. Arch Gen Psychiatry 1993;50:991–9.10.1001/archpsyc.1993.01820240075009Suche in Google Scholar PubMed
18. Vitousek KB, Hollon SD. The investigation of schematic content and processing in eating disorders. Cognitive Ther Res 1990;14:191–214.10.1007/BF01176209Suche in Google Scholar
19. Fairburn CG, Cooper Z, Shafran R. Cognitive behaviour therapy for eating disorders: a “transdiagnostic” theory and treatment. Behav Res Ther 2003;41:509–28.10.1016/S0005-7967(02)00088-8Suche in Google Scholar PubMed
20. Fairburn CG. Eating disorders: the transdiagnostic view and the cognitive behavioral theory. In: Fairburn CG, editor. Cognitive behavior therapy and eating disorders. New York: Guilford, 2008:7–22.Suche in Google Scholar
21. Fairburn CG, Harrison PJ. Eating disorders. Lancet 2003;361:407–16.10.1016/S0140-6736(03)12378-1Suche in Google Scholar PubMed
22. Garner DM. The eating disorder inventory-3: professional manual. Odessa, FL: Psychological Assessment Resources Inc, 2004.Suche in Google Scholar
23. Buhr K, Dugas MJ. The intolerance of uncertainty scale: psychometric properties of the English version. Behav Res Ther 2002;40:931–45.10.1016/S0005-7967(01)00092-4Suche in Google Scholar PubMed
24. Rosenberg M. Society and the adolescent self-image. Princeton, NJ: Princeton University Press, 1965.10.1515/9781400876136Suche in Google Scholar
25. Spielberger CD, Gorsuch RL, Lushene RE. STAI manual for the state trait anxiety inventory. Palo Alto, CA: Consulting Psychologists Press, 1970.Suche in Google Scholar
26. Derogatis LR. SCL-90: administration, scoring & procedures manual for the R(evised) version. Baltimore, MD: John Hopkins Univ., School of Medicine, Clinical Psychometrics Unit, 1977.Suche in Google Scholar
27. Cohen J. Statistical power analysis for the behavioral sciences. Hillsdale: Lawrence Erlbaum Associates Inc, 1988.Suche in Google Scholar
28. Hooper D, Coughlan J, Mullen M. Structural modelling: guidelines for determining model fit. Electron J Bus Res Meth 2008;6:53–60.Suche in Google Scholar
29. Hu L, Bentler P. Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives. Struct Equation Model 1999;6:1–55.10.1080/10705519909540118Suche in Google Scholar
30. Lau JY, Eley TC, Stevenson J. Examining the state-trait anxiety relationship: a behavioural genetic approach. J Abnorm Child Psychol 2006;34:19–27.10.1007/s10802-005-9006-7Suche in Google Scholar PubMed
31. Stallard P. Think good – feel good: a cognitive behaviour therapy workbook for children and young people. Chichester: John Wiley, 2002.Suche in Google Scholar
32. Tse WS, Rochelle TL, Cheung JC. The relationship between personality, social functioning, and depression: a structural equation modeling analysis. Int J Psychol 2011;46:234–40.10.1080/00207594.2011.554553Suche in Google Scholar PubMed
33. Klein DN, Riso LP. Psychiatric disorders: problems of boundaries and comorbidity. In: Costello CG, editor. Basic issues in psychopathology. New York, NY, US: Guilford Press, 1993: 19–66.Suche in Google Scholar
34. Brand-Gothelf A, Leor S, Apter A, Fennig S. The impact of comorbid depressive and anxiety disorders on severity of anorexia nervosa in adolescent girls. J Nerv Ment Dis 2014;202:759–62.10.1097/NMD.0000000000000194Suche in Google Scholar PubMed
35. Braet C, Wante L, Van Beveren ML, Theuwis L. Is the cognitive triad a clear marker of depressive symptoms in youngsters? Eur Child Adolesc Psychiatry 2015;24:1261–8.10.1007/s00787-015-0674-8Suche in Google Scholar PubMed
36. Godart NT, Flament MF, Lecrubier Y, Jeammet P. Anxiety disorders in anorexia nervosa and bulimia nervosa: co-morbidity and chronology of appearance. Eur Psychiatry 2000;15:38–45.10.1016/S0924-9338(00)00212-1Suche in Google Scholar PubMed
37. Zaider TI, Johnson JG, Cockell SJ. Psychiatric comorbidity associated with eating disorder symptomatology among adolescents in the community. Int J Eat Disord 2000;28:58–67.10.1002/(SICI)1098-108X(200007)28:1<58::AID-EAT7>3.0.CO;2-VSuche in Google Scholar PubMed
38. Godart NT, Perdereau F, Rein Z, Berthoz S, Wallier J, et al. Comorbidity studies of eating disorders and mood disorders. Critical review of the literature. J Affect Disord 2007;97:37–49.10.1016/j.jad.2006.06.023Suche in Google Scholar PubMed
39. O’Brien KM, Vincent NK. Psychiatric comorbidity in anorexia and bulimia nervosa: nature, prevalence, and causal relationships. Clin Psychol Rev 2003;23:57–74.10.1016/S0272-7358(02)00201-5Suche in Google Scholar PubMed
40. Garner DM. Pathogenesis of anorexia nervosa. Lancet 1993;341:1631–5.10.1016/0140-6736(93)90768-CSuche in Google Scholar PubMed
41. Favaro A, Caregaro L, Tenconi E, Bosello R, Santonastaso P. Time trends in age at onset of anorexia nervosa and bulimia nervosa. J Clin Psychiatry 2009;70:1715–21.10.4088/JCP.09m05176bluSuche in Google Scholar PubMed
42. Bandura A. Social foundations of thought and action: a social cognitive theory. Englewood Cliffs: Prentice Hall, 1986.Suche in Google Scholar
43. Edwards JR, Lambert LS. Methods for integrating moderation and mediation: a general analytical framework using moderated path analysis. Psychol Methods 2007;12:1–22.10.1037/1082-989X.12.1.1Suche in Google Scholar PubMed
© 2019 Walter de Gruyter GmbH, Berlin/Boston
Artikel in diesem Heft
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- Anxiety and depression mediate the role of low self-esteem and low self-directedness in the development of eating disorders
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- Meningococcal disease awareness and meningoccocal vaccination among Greek students planning to travel abroad
- Parent educators for teenage smoking behavior
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Artikel in diesem Heft
- Editorial
- Adverse effects of stimulant medications in children and adolescents: focus on cardiovascular issues
- Original Articles
- Factors contributing to intentional injuries in Iranian university students
- Anxiety and depression mediate the role of low self-esteem and low self-directedness in the development of eating disorders
- The effects of music therapy on transition outcomes in adolescents and young adults with sickle cell disease
- Reducing barriers to primary school education for girls in rural Kenya: reusable pads’ intervention
- Pubertal gynecomastia: years of progress – the Hacettepe experience
- A web-based anger management program for parent-female adolescents’ conflicts: a cluster randomized controlled trial
- Chronic pain in high school students is associated with physical activity and sleeping hours but not with screen time
- Effect of Melissa officinalis capsule on the mental health of female adolescents with premenstrual syndrome: a clinical trial study
- Meningococcal disease awareness and meningoccocal vaccination among Greek students planning to travel abroad
- Parent educators for teenage smoking behavior
- Identification of common words to improve self-confidence in Japanese students with subthreshold depression
- Diet quality, overweight and daily monetary allowance of Greek adolescents
