Modeling of Eating Attitudes based on Perfectionism and Body Dissatisfaction with the Mediating Role of Anxiety in College Students

Rahimi, Milad; Noury, Robabeh; Tajfar, Elahe

doi:10.30473/hpj.2025.71291.6069

Document Type : Scientific Research

Authors

¹ M.A. Student in Child and Adolescent Clinical Psychology, Faculty of Psychology and Educational sciences, Kharazmi University, Tehran, Iran

² Associate Professor in Clinical Psychology, Kharazmi University, Tehran, Iran

10.30473/hpj.2025.71291.6069

Abstract

Objective: Entering college is a critical developmental stage that can make students vulnerable to disordered eating attitudes and eating disorders. Therefore, the aim of this study was to investigate the relationship between perfectionism and body dissatisfaction in relation to eating attitudes, with the mediating role of anxiety among college students. Method: The current research utilized a correlational design with path analysis. The statistical population of this study consisted of 19-24-year-old undergraduate students at Kharazmi University, Tehran, who were enrolled in the first semester of the academic year, which fell in 2023. From this population, 478 students were selected using a random one-stage cluster sampling method. Ethical principles such as the informed consent of the participants and maintaining the confidentiality of the data were taken into consideration. In order to collect data, the 26-item version of Eating Attitudes Test (EAT-26), Beck Anxiety Inventory (BAI), Body Shape Questionnaire (BSQ), and Frost Multidimensional Perfectionism Scale (FMPS) were used. Data analysis was carried out with SPSS-26 and Amos-24 software. Results: The results of this study showed that the effects of perfectionism (β = 0.46, p < 0.01), body dissatisfaction (β = 0.36, p < 0.01), and anxiety (β = 0.13, p < 0.01) on eating attitudes were positive and significant. Additionally, perfectionism (β = 0.33, p < 0.01) and body dissatisfaction (β = 0.38, p < 0.01) had positive and significant effects on anxiety, and perfectionism (β = 0.21, p < 0.01) had a positive and significant effect on body dissatisfaction. The indirect effects of perfectionism and body dissatisfaction on eating attitudes through anxiety were also positive and significant. Moreover, perfectionism had a positive and significant indirect effect on anxiety through body dissatisfaction. Thus,these findings clearly indicate the mediating role of anxiety in the relationship between perfectionism and body dissatisfaction with eating attitudes, as well as the mediating role of body dissatisfaction in the relationship between perfectionism and anxiety. The measured model demonstrated a good fit (x2/df = 2.43, CFI = 0.97, RMSEA = 0.04, NFI = 0.98, IFI = 0.98, GFI = 0.96). These results indicate an acceptable fit of the measured model and the overall goodness of fit indices. Conclusion: Generally, The study's findings indicated that perfectionism, by influencing body dissatisfaction, leads to elevated levels of anxiety, which subsequently affects individuals' eating attitudes. In essence, various dimensions of perfectionism impose strict standards on individuals, thereby impacting their body dissatisfaction and anxiety levels. Furthermore, body dissatisfaction exacerbates anxiety, further influencing eating attitudes. Overall, the study highlights the intricate interplay between perfectionism, body dissatisfaction, and anxiety, and their combined impact on eating attitudes. Recognizing these interconnected factors can enhance our comprehension of eating attitudes and contribute to more effective clinical interventions. Educational programs aimed at raising awareness and improving perfectionism, body image, and eating attitudes among college students are recommended. Considering the strong correlation between anxiety and eating attitudes, training in emotional awareness and anxiety management could serve as effective preventive measures, enhancing overall well-being and therapeutic outcomes. Understanding these elements is vital for developing comprehensive preventive strategies and therapeutic approaches.

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Main Subjects

References

Aghagedi, P., & Etemadi, A. (2015). Efficacy of instructing cognitive-behavioral stress management on attitude changes towards sub-scales of eating disorders among female students. Social Cognition, 3(special), 44-58. (in Persian)

Aparicio-Martinez, P., Perea-Moreno, A. J., Martinez-Jimenez, M. P., Redel-Macías, M. D., Pagliari, C., & Vaquero-Abellan, M. (2019). Social media, thin-ideal, body dissatisfaction and disordered eating attitudes: An exploratory analysis. International journal of environmental research and public health, 16(21), 4177.https://doi.org/10.3390/ijerph16214177

Argyrides, M., & Kkeli, N. (2015). Predictive factors of disordered eating and body image satisfaction in cyprus. International Journal of Eating Disorders, 48(4), 431-435.https://doi.org/10.1002/eat.22310

Arnett, J. J. (2023). Emerging adulthood: The winding road from the late teens through the twenties. Oxford University Press.

Auerbach, R. P., Alonso, J., Axinn, W. G., Cuijpers, P., Ebert, D. D., Green, J. G., ... & Bruffaerts, R. (2016). Mental disorders among college students in the World Health Organization world mental health surveys. Psychological medicine, 46(14), 2955-2970. https://doi.org/10.1017/S0033291716001665

Azhaar, M., Anwaar, M., Dawood, M., Ali, M., & Shoaib, S. (2020). Relationship between Body Dissatisfaction. Depression and Anxiety among Young Adults. International Journal of Social Sciences, 2, 21-39. http://dx.doi.org/10.20472/SS2020.9.2.002

Bacopoulou, F., Foskolos, E., Stefanaki, C., Tsitsami, E., & Vousoura, E. (2018). Disordered eating attitudes and emotional/behavioral adjustment in Greek adolescents. Eating and Weight Disorders-Studies on Anorexia, Bulimia and Obesity, 23, 621-628.

https://doi.org/10.1007/s40519-017-0466-x

Baradaran, M. (2020). The Mediating Role of Cognitive Emotion Regulation Strategies and Defense Mechanisms in the Relationship between Perfectionism and Anxiety Sensitivity in Cosmetic Surgery Applicants Students. Quarterly journal of health psychology, 9(34), 57-74.https://doi.org/10.30473/hpj.2020.48109.4517

Barnes, M., Abhyankar, P., Dimova, E., & Best, C. (2020). Associations between body dissatisfaction and self-reported anxiety and depression in otherwise healthy men: A systematic review and meta-analysis. PloS one, 15(2), e0229268.

Bazo Perez, M., & Frazier, L. D. (2024). Risk and resilience in eating disorders: differentiating pathways among psychosocial predictors. Journal of Eating Disorders, 12(1), 62. https://doi.org/10.1186/s40337-024-01023-x

Claydon, E., & Zullig, K. J. (2020). Eating disorders and academic performance among college students. Journal of American College Health, 68(3), 320-325.https://doi.org/10.1080/07448481.2018.1549556

Costarelli, V., & Stamou, D. (2009). Emotional intelligence, body image and disordered eating attitudes in combat sport athletes. Journal of Exercise Science & Fitness, 7(2), 104-111. https://doi.org/10.1016/S1728-869X(09)60013-7

Curran, T., & Hill, A. P. (2019). Perfectionism is increasing over time: A meta-analysis of birth cohort differences from 1989 to 2016. Psychological bulletin, 145(4), 410. http://dx.doi.org/10.1037/bul0000138

Drieberg, H., McEvoy, P. M., Hoiles, K. J., Shu, C. Y., & Egan, S. J. (2019). An examination of direct, indirect and reciprocal relationships between perfectionism, eating disorder symptoms, anxiety, and depression in children and adolescents with eating disorders. Eating behaviors, 32, 53-59.https://doi.org/10.1016/j.eatbeh.2018.12.002

Ebrahim, M., Alkazemi, D., Zafar, T. A., & Kubow, S. (2019). Disordered eating attitudes correlate with body dissatisfaction among Kuwaiti male college students. Journal of Eating disorders, 7, 1-13. https://doi.org/10.1186/s40337-019-0265-z

Fathi-Ashtiani, A., & Dastani, M. (2009). Psychological tests: Personality and mental health. Tehran: besat, 46. (in Persian)

Fichter, M. M., & Quadflieg, N. (2016). Mortality in eating disorders‐results of a large prospective clinical longitudinal study. International Journal of Eating Disorders, 49(4), 391-401. https://doi.org/10.1002/eat.22501

Fortes, L. D. S., Meireles, J. F. F., Neves, C. M., Almeida, S. S., & Ferreira, M. E. C. (2015). Disordered eating, body dissatisfaction, perfectionism, and mood state in female adolescents. Revista de Nutrição, 28, 371-383. http://dx.doi.org/10.1590/1415-52732015000400004

Frost, R. O., Marten, P., Lahart, C., & Rosenblate, R. (1990). The dimensions of perfectionism. Cognitive therapy and research, 14, 449-468.https://doi.org/10.1007/BF01172967

Gargari, B. P., Kooshavar, D., Sajadi, N. S., Safoura, S., Behzad, M. H., & Shahrokhi, H. (2011). Disordered eating attitudes and their correlates among Iranian high school girls. Health promotion perspectives, 1(1), 41. https://doi.org/10.5681/hpp.2011.003

Garner, D. M., Olmsted, M. P., Bohr, Y., & Garfinkel, P. E. (1982). The eating attitudes test: psychometric features and clinical correlates. Psychological medicine, 12(4), 871-878. https://doi.org/10.1017/S0033291700049163

Gross, M. J. (2014). High Expectations: The Impact of Perfectionism and Religiosity on Female Body Image.

Güneş, F. E., & Calik, K. B. T. (2015). The relationship between eating attitude and behaviors with self-esteem of the university students. Anatolian Journal of Psychiatry/Anadolu Psikiyatri Dergisi, 16(6). http://dx.doi.org/10.5455/apd.170412

Hamidinejad, N., Dolatshahi, B., & Bagheri, F. (2023). Investigating the relationship between perfectionism and childhood trauma with disordered eating behaviors with the mediating role of body image dissatisfaction. Quarterly Journal of Health Psychology. https://hpj. journals. pnu. ac. ir/article_9864. html, 12(2), 77-99. https://doi.org/10.30473/hpj.2023.64030.5546 (in Persian)

Harrer, M., Adam, S. H., Messner, E. M., Baumeister, H., Cuijpers, P., Bruffaerts, R., ... & Ebert, D. D. (2020). Prevention of eating disorders at universities: A systematic review and meta‐analysis. International Journal of Eating Disorders, 53(6), 813-833.

https://doi.org/10.1002/eat.23224

Hashmi, Z. S., Ijaz, T., & Ijaz, S. (2022). Perfectionistic Self-Presentation and Body Dissatisfaction: The Role of Anxiety and Depression. Pakistan Journal of Psychological Research, 37(4), 515-532.https://doi.org/10.33824/PJPR.2022.37.4.31

Hawkins, R. C., & Clement, P. F. (1984). Binge eating: Measurement problems and a conceptual model. The binge purge syndrome: Diagnosis, treatment, and research, 229-251.

Holmqvist Larsson, K., Lowén, A., Hellerstedt, L., Bergcrona, L., Salerud, M., & Zetterqvist, M. (2020). Emotion regulation group skills training: a pilot study of an add-on treatment for eating disorders in a clinical setting. Journal of eating disorders, 8, 1-11.

https://doi.org/10.1186/s40337-020-00289-1

Hu, P., Xie, T., Qian, W., Liu, X., & Wang, J. (2023). The relationship between perfectionism and eating pathology: the mediating roles of body dissatisfaction and alexithymia. Current Psychology, 42(35), 30939-30948.http://dx.doi.org/10.1007/s12144-022-04068-w

Karababa, A. (2020). The moderating role of hope in the relationship between maladaptive perfectionism and anxiety among early adolescents. The Journal of Genetic Psychology, 181(2-3), 159-170.https://doi.org/10.1080/00221325.2020.1745745

Karadzic, A. (2022). Perfectionism and The Relationship Between Personality and Eating Attitudes: Testing a Mediation Model (Doctoral dissertation).

Keski-Rahkonen, A., & Mustelin, L. (2016). Epidemiology of eating disorders in Europe: prevalence, incidence, comorbidity, course, consequences, and risk factors. Current opinion in psychiatry, 29(6), 340-345.https://doi.org/10.1097/yco.0000000000000278

Liaghat, R., & Ghasemi, F. (2014). The Examination of Psychometric Properties of Frost Perfectionism Questionnaire and its Relationship with Examination Anxiety (Case Study: Tehran High Schools). Journal of Psychological Research, 23(6), 60-70.

Limburg, K., Watson, H. J., Hagger, M. S., & Egan, S. J. (2017). The relationship between perfectionism and psychopathology: A meta‐analysis. Journal of clinical psychology, 73(10), 1301-1326. https://doi.org/10.1002/jclp.22435

Locke, A., & Arnocky, S. (2020). Department of Psychology, Faculty of Arts and Sciences, Nipissing University, North Bay, ON, Canada. https://doi.org/10.1007/978-3-319-16999-6_696-1

Merhy, G., Moubarak, V., Hallit, R., Obeid, S., & Hallit, S. (2023). The indirect role of orthorexia nervosa and eating attitudes in the association between perfectionism and muscle dysmorphic disorder in Lebanese male University students–results of a pilot study. BMC psychiatry, 23(1), 55. https://doi.org/10.1186/s12888-023-04549-7

Mohammadzadeh, A., Najafi, M., & Rezaei, A.. (2013). Comparing the explanatory role of perfectionism in obsessive compulsive features and pathological eating attitudes. journal of clinical psychology, 5(1 (17)), 69-78

https://doi.org/10.22075/jcp.2017.2117(in Persian)

Momeni, M., Ghorbani, A., & Arjeini, Z. (2020). Disordered eating attitudes among Iranian university students of medical sciences: The role of body image perception. Nutrition and health, 26(2), 127-133.https://doi.org/10.1177/0260106020912657

Monteleone, A. M., Cascino, G., Ruzzi, V., Pellegrino, F., Patriciello, G., Barone, E., ... & Maj, M. (2021). Emotional traumatic experiences significantly contribute to identify a maltreated ecophenotype sub‐group in eating disorders: Experimental evidence. European eating disorders review, 29(2), 269-280. https://doi.org/10.1002/erv.2818

Petisco-Rodríguez, C., Sánchez-Sánchez, L. C., Fernández-García, R., Sánchez-Sánchez, J., & García-Montes, J. M. (2020). Disordered eating attitudes, anxiety, self-esteem and perfectionism in young athletes and non-athletes. International journal of environmental research and public health, 17(18), 6754.https://doi.org/10.3390/ijerph17186754

Rafiei, M., & Seifi, A. (2013). An investigation into the reliability and validity of beck anxiety inventory among the university students. Iran J Psychiatry Clin Psychol, 7(27), 37-46. (in Persian)

Rezaei, M., Aflakseir, A., Mohammadi, N., Yavari, A. H., & Ghayour, M. (2015). Study of the perfectionism role and Body Mass Index in prediction of eating disorders with mediating the role of body dissatisfaction among female students of university. Journal of Rafsanjan University of Medical Sciences, 14(3), 223-234. (in Persian)

Rezaei, M., Aflakseir, A., Yavari, A. H., Mohamadi, N., & Ghayour, M. (2015). Designing and testing a model of thin internalization, self-objectification and body dissatisfaction as precedents of eating disorder risk in female university students. Iranian Journal of Nutrition Sciences & Food Technology, 10(2), 11-18.‏ (in Persian)

Rostampour, N., Naderi, M., Kheiri, S., & Safavi, P. (2022). The relationship between body mass index and depression, anxiety, body image, and eating attitudes in adolescents in Iran. Advanced Biomedical Research, 11(1), 51.https://doi.org/10.4103/abr.abr_259_20

Rousseau, A., Knotter, R. M., Barbe, R. M., Raich, R. M., & Chabrol, H. (2005). Étude de validation de la version française du Body Shape Questionnaire. L'encéphale, 31(2), 162-173. https://doi.org/10.1016/S0013-7006(05)82383-8

Sander, J., Moessner, M., & Bauer, S. (2021). Depression, anxiety and eating disorder-related impairment: moderators in female adolescents and young adults. International journal of environmental research and public health, 18(5), 2779. https://doi.org/10.3390/ijerph18052779

Sharif-Nia, H., Sivarajan Froelicher, E., Gorgulu, O., Osborne, J. W., Błachnio, A., Rezazadeh Fazeli, A., ... & Kaveh, O. (2024). The relationship among positive body image, body esteem, and eating attitude in Iranian population. Frontiers in Psychology, 15, 1304555.https://doi.org/10.3389/fpsyg.2024.1304555

Shofiyah, S., & Sovitrina, R. (2022, April). The effect of perfectionism, social comparison and gratitude on body dissatisfaction among female students. In 3rd Tarumanagara International Conference on the Applications of Social Sciences and Humanities (TICASH 2021) (pp. 1736-1742). Atlantis Press.https://doi.org/10.2991/assehr.k.220404.282

Slane, J. D., Klump, K. L., McGue, M., & Iacono, W. G. (2014). Developmental trajectories of disordered eating from early adolescence to young adulthood: A longitudinal study. International Journal of Eating Disorders, 47(7), 793-801.https://doi.org/10.1002/eat.22329

Smith, M. M., Vidovic, V., Sherry, S. B., Stewart, S. H., & Saklofske, D. H. (2018). Are perfectionism dimensions risk factors for anxiety symptoms? A meta-analysis of 11 longitudinal studies. Anxiety, Stress, & Coping, 31(1), 4-20. https://doi.org/10.1080/10615806.2017.1384466

Solomon, S., Shank, L. M., Lavender, J. M., Higgins Neyland, M. K., Gallager-Teske, J., Markos, B., ... & Tanofsky‐Kraff, M. (2023). The relationship between anxiety, coping, and disordered-eating attitudes in adolescent military-dependents at high-risk for excess weight gain. Military Psychology, 35(2), 95-106.https://doi.org/10.1080/08995605.2022.2083448

Stice, E., & Shaw, H. E. (2002). Role of body dissatisfaction in the onset and maintenance of eating pathology: A synthesis of research findings. Journal of psychosomatic research, 53(5), 985-993.https://doi.org/10.1016/S0022-3999(02)00488-9

Stice, E., Marti, C. N., & Rohde, P. (2013). Prevalence, incidence, impairment, and course of the proposed DSM-5 eating disorder diagnoses in an 8-year prospective community study of young women. Journal of abnormal psychology, 122(2), 445.

https://doi.org/10.1037/a0030679

Stoeber, J. (2018). The psychology of perfectionism: Critical issues, open questions, and future directions.

Tanofsky-Kraff, M., Cohen, M. L., Yanovski, S. Z., Cox, C., Theim, K. R., Keil, M., ... & Yanovski, J. A. (2006). A prospective study of psychological predictors of body fat gain among children at high risk for adult obesity. Pediatrics, 117(4), 1203-1209. https://doi.org/10.1542/peds.2005-1329

Toda, H. Y., & Yamamoto, T. (1995). Statistical inference in vector autoregressions with possibly integrated processes. Journal of econometrics, 66(1-2), 225-250.https://doi.org/10.1016/0304-4076(94)01616-8

Uchôa, F. N. M., Uchôa, N. M., Daniele, T. M. D. C., Lustosa, R. P., Garrido, N. D., Deana, N. F., ... & Alves, N. (2019). Influence of the mass media and body dissatisfaction on the risk in adolescents of developing eating disorders. International journal of environmental research and public health, 16(9), 1508. https://doi.org/10.3390/ijerph16091508

Üstün, D., & Yilmaz, S. (2023). Determining the effect of stress and anxiety on eating attitudes in healthcare providers working on COVID-19 wards. Ecology of Food and Nutrition, 62(1-2), 88-105. https://doi.org/10.1080/03670244.2023.2187384

Vartanian, L. R., & Hayward, L. E. (2020). Dimensions of internalization relevant to the identity disruption model of body dissatisfaction. Body Image, 32, 1-4. https://doi.org/10.1016/j.bodyim.2019.10.008

Wade, T. D., & Tiggemann, M. (2013). The role of perfectionism in body dissatisfaction. Journal of eating disorders, 1, 1-6.https://doi.org/10.1186/2050-2974-1-2

Wade, T. D., O’Shea, A., & Shafran, R. (2016). Perfectionism and eating disorders. Perfectionism, health, and well-being, 205-222. https://doi.org/10.1007/978-3-319-18582-8_9

Wunyala-Bukari, A. T. (2020). Relationship between body image dissatisfaction and disordered eating: mediating effect of selfesteem and depression among female university students

Modeling of Eating Attitudes based on Perfectionism and Body Dissatisfaction with the Mediating Role of Anxiety in College Students

References

References

Volume 14, Issue 53June 2025Pages 45-60

Volume 14, Issue 53
June 2025
Pages 45-60