Document Type : Original Article
Authors
Abstract
BACKGROUND: Individuals with disordered eating are at an increased of having one or more
additional risks for comorbid disorders, such as anxiety disorder, depressive disorder, and insomnia.
Therefore, the present study aimed to investigate the mediating role of self‑compassion in the
relationship between positive reactivity, negative reactivity, and perfectionism with disordered eating.
MATERIALS AND METHODS: The study method was descriptive‑correlational through
structural equation modeling (SEM). The present study population included all students of the
University of Tehran in the city of Tehran in 2018–2019. A total of 302 students were selected
by convenience sampling method and completed questionnaires on eating attitudes test‑8,
self‑compassion scale (short form), eating disorder inventory‑perfectionism scale, and Perth emotional
reactivity scale. The SEM path analysis and Pearson correlation coefficient were conducted to analyze
the obtained data in SPSS‑23 and Lisrel‑8.80.
RESULTS: The finding of the path analysis showed that self‑compassion acts as a mediating role in
the relationship of disordered eating with positive and negative emotional reactivity and perfectionism.
Only the direct effect coefficient of general positive reactivity on disordered eating was not significant.
CONCLUSION: Based on the results of this study, self‑compassion can serve as a protective factor
against negative emotional reactivity and perfectionism. Therefore, self‑compassion can be considered
in the development of prevention and treatment programs for disordered eating.
Keywords
- Azzouzi N, Ahid S, Bragazzi NL, Berhili N, Aarab C,
Aalouane R, et al. Eating disorders among Moroccan medical
students: Cognition and behavior. Psychol Res Behav Manag
2019;12:129.
2. Swanson SA, Crow SJ, Le Grange D, Swendsen J, Merikangas KR.
Prevalence and correlates of eating disorders in adolescents:
Results from the national comorbidity survey replication
adolescent supplement. Arch Gen Psychiatry 2011;68:714‑23.
3. Esfahani BN, Kolahdouzan M, Aflakseir A, Gharipour M.
Predicting body mass index in women: The value of the
psychological components of depression, anxiety, dietary
restraint, and nutritional habits. J Edu Health Promot 2017;6:9.
4. Micali N, Hagberg KW, Petersen I, Treasure JL. The incidence of
eatingdisordersin the UK in 2000–2009: Findings from the General
Practice Research Database. BMJ open. 2013 Jan 1;3(5).
5. Sweeting H, Walker L, MacLean A, Patterson C, Räisänen U,
Hunt K. Prevalence of eating disorders in males: A review of rates
reported in academic research and UK mass media. International
journal of men’s health. 2015;14(2).
6. Aspen V, Weisman H, Vannucci A, Nafiz N, Gredysa D, Kass AE,
et al. Psychiatric co‑morbidity in women presenting across the
continuum of disordered eating. Eating Behav 2014;15:686‑93.
7. Hilbert A, De Zwaan M, Braehler E. How frequent are eating
disturbances in the population? Norms of the eating disorder
examination‑questionnaire. PloS One 2012;18;7:e29125.
8. Berger U, Wick K, Hölling H, Schlack R, Bormann B, Brix C, et al.
Screening of disordered eating in 12 year old girls and boys:
Psychometric analysis of the german versions of SCOFF and
EAT‑26. Europ Psychiatry 2011;26:712.
9. Stice E, Marti CN, Shaw H, Jaconis M. An 8‑year longitudinal
study of the natural history of threshold, subthreshold, and
partial eating disorders from a community sample of adolescents.
J Abnormal Psychol 2009;118:587.
10. Pacheco JP, Giacomin HT, Tam WW, Ribeiro TB, Arab C,
Bezerra IM, et al. Mental health problems among medical students
in Brazil: A systematic review and meta‑analysis. Brazilian J
Psychiatry 2017;39:369‑78.
11. Herpertz‑Dahlmann B, Dempfle A, Konrad K, Klasen F,
Ravens‑Sieberer U, BELLA Study Group. Eating disorder
symptoms do not just disappear: The implications of adolescent
eating‑disordered behaviour for body weight and mental
health in young adulthood. Europ Child Adolescent Psychiatry
2015;24:675‑84.
12. Loth KA, MacLehose R, Bucchianeri M, Crow S,
Neumark‑Sztainer D. Predictors of dieting and disordered eating
behaviors from adolescence to young adulthood. J Adolescent
Health 2014;55:705‑12.
13. Sanftner JL. Quality of life in relation to psychosocial risk
variables for eating disorders in women and men. Eating Behav
2011;12:136‑42.
14. Pullmer R, Zaitsoff SL, Coelho JS. Self‑compassion and
eating pathology in female adolescents with eating disorders.
The mediating role of psychological distress. Mindfulness
2019;10:2716‑23.
15. Rahimi‑Ardabili H, Reynolds R, Vartanian LR, McLeod LV,
Zwar N. A systematic review of the efficacy of interventions
that aim to increase self‑compassion on nutrition habits,
eating behaviours, body weight and body image. Mindfulness
2018;9:388‑400.
16. Braun TD, Park CL, Gorin A. Self‑compassion, body image,
and disordered eating: A review of the literature. Body Image
2016;17:117‑31.
17. Hasking P, Boyes ME, Finlay‑Jones A, McEvoy PM, Rees CS.
Common pathways to NSSI and suicide ideation: The roles of
rumination and self‑compassion. Arch Suicide Res 2019;23:247‑60.
18. Muris P, Petrocchi N. Protection or vulnerability? A meta-analysis
of the relations between the positive and negative components of
self-compassion and psychopathology. Clin Psychol Psychother
2017;24:373‑83.
19. Trompetter HR, de Kleine E, Bohlmeijer ET. Why does positive
mental health buffer against psychopathology? An exploratory
study on self‑compassion as a resilience mechanism and
adaptive emotion regulation strategy. Cognitive Ther Res
2017;41:459‑68.
20. Fresnics AA, Wang SB, Borders A. The unique associations
between self‑compassion and eating disorder psychopathology
and the mediating role of rumination. Psychiatry research
2019;274:91‑7.
21. StoeberJ, Lalova AV, Lumley EJ. Perfectionism,(self‑) compassion,
and subjective well‑being: A mediation model. Personality and
Individual Differences. 2020 Feb 1;154:109708.
22. BangJW, ChungEJ. Relationship between prescribed perfectionism
and disordered eating behaviors: The double mediating effects
of self‑compassion and body shame in obesity clinical women.
J Korea Contents Assoc 2019;19:588‑601.
23. FerrariM, YapK, ScottN, EinsteinDA, CiarrochiJ. Self‑compassion
moderates the perfectionism and depression link in both
adolescence and adulthood. PloS One 2018;13:e0192022.
24. Frost RO, Lahart CM, Rosenblate R. The development of
perfectionism: A study of daughters and their parents. Cognitive
Therapy Res 1991;15:469‑89.
25. Finlay‑Jones AL, Rees CS, Kane RT. Self‑compassion, emotion
regulation and stress among Australian psychologists: Testing
an emotion regulation model of self‑compassion using structural
equation modeling. PloS One 2015;10:e0133481.
26. Diedrich A, Grant M, Hofmann SG, Hiller W, Berking M.
Self‑compassion as an emotion regulation strategy in major
depressive disorder. Behav Res Ther 2014;58:43‑51. - 27. Leary MR, Tate EB, Adams CE, Batts Allen A, Hancock J.
Self‑compassion and reactions to unpleasant self‑relevant events:
The implications of treating oneself kindly. J Personality Soc
Psychol 2007;92:887.
28. BecerraR, PreeceD, CampitelliG, Scott‑PillowG. The assessmentof
emotional reactivity across negative and positive emotions:
Development and validation of the Perth Emotional Reactivity
Scale (PERS). Assessment. 2019 Jul; 26(5):867‑79.
29. Bardone‑Cone AM, Lin SL, Butler RM. Perfectionism and
contingent self‑worth in relation to disordered eating and anxiety.
Behav Ther 2017;48:380‑90.
30. Bouguettaya A, Moulding R, King RM, Harrold G. The
relationships between socially prescribed perfectionism, in-group
affect, negative urgency, and disordered eating in women.
Scandinavian journal of psychology. 2019 Aug; 60(4):369‑76.
31. Evans BC, Felton JW, Lagacey MA, Manasse SM, Lejuez CW,
Juarascio AS. Impulsivity and affect reactivity prospectively
predict disordered eating attitudes in adolescents: A 6‑year
longitudinal study. Europ Child Adolescent Psychiatry 2019;29:1.
32. Becker KR, Fischer S, Crosby RD, Engel SG, Wonderlich SA.
Dimensional analysis of emotion trajectories before and after
disordered eating behaviors in a sample of women with bulimia
nervosa. Psychiatry Res 2018;268:490‑500.
33. Smith KE, Hayes NA, Styer DM, Washburn JJ. Emotional
reactivity in a clinical sample of patients with eating disorders
and nonsuicidal self‑injury. Psychiatry Res 2017;257:519‑25.
34. Racine SE, Hebert KR, Benning SD. Emotional reactivity and
appraisal of food in relation to eating disorder cognitions and
behaviours: Evidence to support the motivational conflict
hypothesis. Europ Eating Disor Rev 2018;26:3‑10.
35. Cardi V, Leppanen J, Leslie M, Esposito M, Treasure J. The use
of a positive mood induction video‑clip to target eating behavior
in people with bulimia nervosa or binge eating disorder: An
experimental study. Appetite 2019;133:400‑4.
36. Rouzitalab T, Gargari BP, Izadi A, Amirsasan R, Azarmanesh D,
Jafarabadi MA. The prevalence of disordered eating attitude
and its relation to exercise participation in a sample of physical
education students. Prog Nutr 2019;21:281‑7.
37. Sanaei H, Dabiran S, Seddigh L. Eating attitudes among adolescent
girls in Tehran: A schoolbased survey between 2010‑2011. Soc
Determ Health 2016;2:98‑105.
38. Kline RB. Principles and Practice of Structural Equation Modeling
Guilford publications. 2015.
39. Raes F, Pommier E, Neff KD, Van Gucht D. Construction and
factorial validation of a short form of the self‑compassion scale.
Clin Psychol Psychother 2011;18:250‑5.
40. Mousavi Asl E, Mohammadian Y, Gharraee B, Khanjani S,
Pazouki A. Assessment of the emotional reactivity through the
positive and negative emotions: The psychometric properties of
the Persian version of the Perth emotional reactivity scale, Iran J
Psychiatry Behav Sci 2020;14:e98057.
41. Lampard AM, Byrne SM, McLean N, Fursland A. The eating
disorder inventory‑2 perfectionism scale: Factor structure and
associations with dietary restraint and weight and shape concern
in eating disorders. Eating Behav 2012;13:49‑53.
42. Richter F, StraussB, BraehlerE, AltmannU, BergerU. Psychometric
properties of a short version of the Eating Attitudes Test (EAT‑8)
in a German representative sample. Eat Behav 2016;21:198‑204.
43. Mousavi Asl E, Khanjani S, Mahaki B, Mohammadian Y.
Disordered eating: The psychometric properties of the Persian
version of the Eating Attitudes Test‑8. Journal of Education and
Health Promotion. 2020 Jan 1;9 (1):307.
44. Kinchen E, Loerzel V, Portoghese T. Yoga and perceived stress,
self‑compassion, and quality of life in undergraduate nursing
students. J Educ Health Promot 2020;9:292.
45. Baharvand P, Malekshahi F, Mahdiyan P. Prevalence of body
image concern among schoolgirls aged 12–17 years in Iran. J Edu
Health Promot 2020;9:210.
46. Johnston J, Shu CY, Hoiles KJ, Clarke PJ, Watson HJ, Dunlop PD,
et al. Perfectionism is associated with higher eating disorder
symptoms and lower remission in children and adolescents
diagnosed with eating disorders. Eating Behav 2018;30:55‑60.
47. Ram A. The relationship of positive and negative perfectionism to
academic achievement, achievement motivation, and well‑being
in tertiary students.
48. Claes L, Smits D, Bijttebier P. The Dutch version of the Emotion
Reactivity Scale: Validation and relation with various behaviors
in a sample of high school students. Eur J Psychol Assess
2014;30:73‑79.
49. Smith KE, Mason TB, Crosby RD, Engel SG, Crow SJ,
Wonderlich SA, et al. State and trait positive and negative
affectivity in relation to restraint intention and binge eating among
adults with obesity. Appetite 2018;120:327‑34.
50. Sultson H, Kukk K, Akkermann K. Positive and negative
emotional eating have different associations with overeating and
binge eating: Construction and validation of the Positive‑Negative
Emotional Eating Scale. Appetite 2017;116:423‑30.
51. Thompson ER. Development and validation of an internationally
reliable short‑form of the positive and negative affect
schedule (PANAS). J Cross‑Cultural Psychol 2007;38:227‑42.
52. Barnett MD, Sharp KJ. Maladaptive perfectionism, body image
satisfaction, and disordered eating behaviors among US college
women: The mediating role of self‑compassion. Personality
Individual Diff 2016;99:225‑34.
53. Foroughi A, Khanjani S, Mousavi Asl E. Relationship of Concern
About Body Dysmorphia with External Shame, Perfectionism, and
Negative Affect: The Mediating Role of Self‑Compassion, Iran J
Psychiatry Behav Sci 2019;13:e80186.
54. Stuart J. Maladaptive Perfectionism and Disordered Eating
in College Women: The Mediating Role of Self‑Compassion.
University of Florida; 2009.
55. Mousavi Asl E, Mahaki B, Gharraee B, Asgharnejad Farid AA,
Shahverdi‑Shahraki A. Beliefs about binge eating: The
psychometric properties of the Persian version of the eating
beliefs questionnaire. J Res Med Sci 2020;25:73.
56. Ogden P, Minton K, Pain C. Trauma and the body:
A sensorimotor approachto psychotherapy (norton series
on interpersonal neurobiology). New York: W.W. Norton &
Company; 2006 Oct 17.