EXAMINING THE RELATIONSHIPS BETWEEN EATING DISORDER SYMPTOMS, SELF-ESTEEM, AND PSYCHOLOGICAL WELL-BEING IN EMERGING ADULTS

Abstract

This study aimed to examine the mediating role of self-esteem between eating disorder symptoms and psychological well-being in emerging adults. The study group consists of 272 individuals, aged 18–29, 183 [67.3%] females and 89 [32.7%] males. Socio-demographic data form, anthropometric measurements, Eating Disorder Examination Questionnaire (EDE-Q-13)-Short Form, Psychological Well-Being Scale and Self-Liking/Self-Competence Scale were used as data collection tools. The proposed model was tested using bootstrapping and structural equation modeling. The results showed a significant and positive relationship between self-esteem and psychological well-being (r=.76, p<.001), a significant and negative relationship between eating disorder symptoms and psychological well-being (r=-.18, p<.001) and a significant and negative relationship (r=-.34, p<.001) between eating disorder symptoms and self-esteem. Additionally, self-esteem mediates the path between the eating disorder symptoms and psychological well-being. The research findings were discussed in the context of existing literature and research. Addressing eating disorders through a multidisciplinary collaboration involving dietitians, psychological counselors, and psychiatrists is thought to enhance self-esteem and improve psychological well-being.

Keywords

• Eating Disorder Symptoms;
• Psychological Well-Being;
• Self-Esteem;
• Emerging Adulthood

BELİREN YETİŞKİNLERDE YEME BOZUKLUĞU BELİRTİLERİ, BENLİK SAYGISI VE PSİKOLOJİK İYİ OLUŞ ARASINDAKİ İLİŞKİLERİN İNCELENMESİ

Abstract

Bu çalışma, beliren yetişkinlerde yeme bozukluğu belirtileri ile psikolojik iyi oluş arasında benlik saygısının aracı rolünü incelemeyi amaçlamıştır. Çalışma grubu 18-29 yaşlarında 183'ü (%67,3) kadın ve 89'u (%32,7) erkek olmak üzere 272 kişiden oluşmaktadır. Veri toplama aracı olarak sosyo-demografik veri formu, antropometrik ölçümler, Yeme Bozukluğu Değerlendirme Ölçeği (EDE-Q-13)-Kısa Form, Psikolojik İyi Oluş Ölçeği ve Kendini Sevme/Öz-Yeterlik Ölçeği kullanılmıştır. Önerilen model bootstrapping ve yapısal eşitlik modellemesi kullanılarak test edilmiştir. Sonuçlar benlik saygısı ile psikolojik iyi oluş arasında anlamlı ve pozitif yönde (r=.76, p<.001), yeme bozukluğu belirtileri ile psikolojik iyi oluş arasında anlamlı ve negatif yönde (r=-.18, p<.001) ve yeme bozukluğu belirtileri ile benlik saygısı arasında ise anlamlı ve negatif yönde (r=-.34, p<.001) ilişki olduğunu göstermiştir. Ayrıca benlik saygısının, yeme bozukluğu belirtileri ile psikolojik iyi oluş arasında aracılık etkisi olduğu görülmüştür. Araştırma bulguları mevcut literatür ve araştırmalar bağlamında tartışılmıştır. Diyetisyenlerin, psikolojik danışmanların ve psikiyatristlerin yer aldığı multidisipliner bir işbirliği yoluyla yeme bozukluklarının ele alınmasının, benlik saygısını artıracağı ve psikolojik refahı iyileştireceği düşünülmektedir.

Keywords

• Yeme Bozukluğu Belirtileri;
• Psikolojik İyi Oluş;
• Benlik Saygısı;
• Beliren Yetişkinlik

References

1. Altınel, Ş. (2018). The relationships of eating disorder symptoms with perceived parenting styles, difficulties of emotion regulation, psychological well-being and eating attitudes in females [Master’s thesis, Maltepe University]. Counsil of Higher Education Thesis Center. https://tez.yok.gov.tr/UlusalTezMerkezi/tezSorguSonucYeni.jsp.
2. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). https://doi.org/10.1176/appi.books.9780890425596
3. Arnett, J. J. (2007). Emerging adulthood: What is it, and what is it good for? Child Development Perspectives, 1(2), 68–73. https://doi.org/10.1111/j.1750-8606.2007.00016.x
4. Arnett, J.J., Žukauskienė, R., & Sugimura, K. (2014). The new life stage of emerging adulthood at ages 18-29 years: Implications for mental health. The Lancet Psychiatry, 1(7), 569–576. https://doi.org/10.1016/S2215-0366(14)00080-7
5. Ayaz, E. ve Doğan, O. (2023). Üniversite Öğrencilerinde Özsaygı Düzeyleri ve Psikolojik İyi Oluş Arasındaki İlişki. Atlas Journal of Medicine, 2(6), 30-41. https://doi.org/10.54270/atljm.2023.29
6. Bardone-Cone, A. M., Schaefer, L. M., Maldonado, C. R., Fitzsimmons, E. E., Harney, M. B., Lawson, M. A., ... & Smith, R. (2010). Aspects of self-concept and eating disorder recovery: what does the sense of self look like when an individual recovers from an eating disorder?. Journal of Social and Clinical Psychology, 29(7), 821-846. https://doi.org/10.1521/jscp.2010.29.7.821
7. Baron, R. M., & Kenny, D. A. (1986). The moderator-mediator variable distinction in social psychological research: Conceptual, strategic, and statistical considerations. Journal of Personality and Social Psychology, 51(6), 1173-1182. https://doi.org/10.1037//0022-3514.51.6.1173
8. Birkeland, M. S., Melkevik, O., Holsen, I., and Wold, B. (2012). Trajectories of global self-esteem development during adolescence. Journal of Adolescence, 35(1), 43–54. https://doi.org/10.1016/j.adolescence.2011.06.006

9. Brannan M. E., & Petrie T. A. (2011). Psychological well-being and the body dissatisfaction-bulimic symptomatology relationship: An examination of moderators. Eating Behaviors, 12(4), 233–241. https://doi.org/10.1016/j.eatbeh.2011.06.002
10. Brown, K. M., McMahon, R. P., Biro, F. M., Crawford, P., Schreiber, G. B., Similo, S. L., Waclawiw, M., & Striegel-Moore, R. (1998). Changes in self-esteem in black and white girls between the ages of 9 and 14 years. The NHLBI Growth and Health Study. The Journal of adolescent health: official publication of the Society for Adolescent Medicine, 23(1), 7–19. https://doi.org/10.1016/s1054-139x(97)00238-3
11. Byrne, B. M. (2013). Structural equation modeling with AMOS: Basic concepts, applications, and programming. Routledge.
12. Çelenk, B. ve Peker, A. (2020). Ergenlerde benlik saygisinin, stresle başa çikma tarzlari ile psikolojik iyi oluş arasindaki ilişkideki aracilik rolü. Avrasya Sosyal ve Ekonomi Araştırmaları Dergisi, 7(4), 147-162.
13. de Vos, J. A., Radstaak, M., Bohlmeijer, E. T., & Westerhof, G. J. (2018). Having an eating disorder and still being able to flourish? Examination of pathological symptoms and well-being as two continua of mental health in a clinical sample. Frontiers in Psychology, 9, 2145. https://doi.org/10.3389/fpsyg.2018.02145
14. Dhandra, T. K. (2020). Does self-esteem matter? A framework depicting role of self-esteem between dispositional mindfulness and impulsive buying. Journal of Retailing and Consumer Services, 55, 102135.
15. Diener, E., Wirtz, D., Tov, W., Kim-Prieto, C., Choi, D.-w., Oishi, S., & Biswas-Diener, R. (2010). New well-being measures: Short scales to assess flourishing and positive and negative feelings. Social Indicators Research, 97(2), 143–156. https://doi.org/10.1007/s11205-009-9493-y
16. Doğan, T. (2011). Two-dimensional self-esteem: Adaptation of the Self-liking/self-competence Scale into Turkish: A validity and reliability study. Education and Science, 36(162), 126-137.
17. Doll, H. A., Petersen, S. E., & Stewart-Brown, S. L. (2005). Eating disorders and emotional and physical well-being: Associations between student self-reports of eating disorders and quality of life as measured by the SF-36. Quality of Life Research, 14(3), 705-717. https://doi.org/10.1007/s11136-004-0792-0
18. Esin, K., & Ayyıldız, F. (2022). Validity and reliability of the Turkish version of the Eating Disorder Examination Questionnaire (EDE-Q-13): Short-form of EDE-Q. Journal of Eating Disorders, 10(1), 102. https://doi.org/10.1186/s40337-022-00628-4
19. Erol, A., Toprak, G., Yazici, F., ve Erol, S. (2000). Üniversite öğrencilerinde yeme bozukluğu belirtilerini yordayıcı olarak kontrol odağı ve benlik saygısının karşılaştırılması. Klinik Psikiyatri, S, 3, 147-152.
20. Fairburn, C. G. (2008). Cognitive behavior therapy and eating disorders. Guilford Press.
21. Fairburn, C. G., & Beglin, S. J. (1994). Assessment of eating disorders: interview or self-report questionnaire?. The International journal of eating disorders, 16(4), 363–370.
22. Farello, G., Ranieri, J., Cilli, E., Guerra, F., Cogodi, E., Martelli, A., & Di Giacomo, D. (2023). Binge eating disorders and psychological well-being in prolonged COVID-19 pandemic: Retrospective cross-sectional study on undergraduate students. Personalized Medicine in Psychiatry, 41-42, 100109. https://doi.org/10.1016/j.pmip.2023.100109
23. Finney, S. J., &DiStefano, C. (2006). Nonnormal and Categorical Data in Structural Equation Models. In G. R. Hancock, and R. O. Mueller (Eds.), A Second Course in Structural Equation Modeling (pp. 269-314). Greenwich, CT: Information Age.
24. Gila, A., Castro, J., Gómez, M. J., & Toro, J. (2005). Social and body self-esteem in adolescents with eating disorders. International Journal of Psychology and Psychological Therapy, 1(1), 63-71.
25. Halvorsen, I., & Heyerdahl, S. (2006). Girls with anorexia nervosa as young adults: Personality, self-esteem, and life satisfaction. International Journal of Eating Disorders, 39(4), 285–293. https://doi.org/10.1002/eat.20248
26. Hay, P. (2020). Current approach to eating disorders: a clinical update. İnternal Medicine Journal, 50(1), 24-29. https://doi.org/10.1111/imj.14691
27. Hayes, A. F. (2013). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. Guilford Press.
28. Hu, L. T., & Bentler, P. M. (1999). Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural Equation Modeling, 6(1), 1-55. https://doi.org/10.1080/10705519909540118
29. Jenkins, P. E., Hoste, R. R., Meyer, C., & Blissett, J. M. (2011). Eating disorders and quality of life: a review of the literature. Clinical Psychology Review, 31(1), 113–121. https://doi.org/10.1016/j.cpr.2010.08.003
30. Karababa, A., Mert, A. ve Çetiner, P. (2018). Üniversite öğrencilerinde psikolojik iyi olmanın bir yordayıcısı olarak benlik ayrımlaşması. Ahi Evran Üniversitesi Kırşehir Eğitim Fakültesi Dergisi, 19 (2), 1235-1248. https://doi.org/10.29299/kefad.2018.19.02.004
31. Kenny, B., Fuller-Tyszkiewicz, M., Moodie, M., Brown, V., & Williams, J. (2022). Bi-directional associations between depressive symptoms and eating disorder symptoms in early adolescence. Body Image, 42, 246–256. https://doi.org/10.1016/j.bodyim.2022.06.012
32. Kermen, S., Kermen, U., Dinçer, F., & Muslu, M. (2019). Determination of eating disorder risk in university students by logistic regression. Life Skills Journal of Psychology, 3(6), 149-163. https://doi.org/10.31461/ybpd.593436
33. Keyes, C. L., Shmotkin, D., & Ryff, C. D. (2002). Optimizing well-being: the empirical encounter of two traditions. Journal of Personality and Social Psychology, 82(6), 1007–1022.
34. Kline, R. B. (2019). Principles and practice of structural equation modeling. Guilford.
35. Krauss, S., Dapp, L. C., & Orth, U. (2023). The link between low self-esteem and eating disorders: A meta-analysis of longitudinal studies. Clinical Psychological Science, 11(6), 1141-1158. https://doi.org/10.1177/21677026221144255
36. Lev-Ari, L., Bachner-Melman, R., & Zohar, A. H. (2021). Eating Disorder Examination Questionnaire (EDE-Q-13): expanding on the short form. Journal of Eating Disorders, 9(1), 57. https://doi.org/10.1186/s40337-021-00403-x
37. Levinson, D. J. (1986). A conception of adult development. American Psychologist, 41(1), 3–13. https://doi.org/10.1037/0003-066X.41.1.3
38. Linardon, J., Kothe, E. J., & Fuller-Tyszkiewicz, M. (2019). Efficacy of psychotherapy for bulimia nervosa and binge-eating disorder on self-esteem improvement: Meta-analysis. European Eating Disorders Review: The Journal of the Eating Disorders Association, 27(2), 109–123. https://doi.org/10.1002/erv.2662
39. Lyubomirsky, S., Tkach, C., & Dimatteo, M. R. (2006), What are the differences between happiness and self-esteem?. Social Indicators Research, 78, 363-404. https://doi.org/10.1007/s11205-005-0213-y
40. Mann, M. M., Hosman, C. M., Schaalma, H. P., & De Vries, N. K. (2004). Self-esteem in a broad-spectrum approach for mental health promotion. Health Education Research, 19(4), 357–372. https://doi.org/10.1093/her/cyg041
41. Mendelson, B. K., McLaren, L., Gauvin, L., & Steiger, H. (2002). The relationship of self-esteem and body esteem in women with and without eating disorders. The International Journal of Eating Disorders, 31(3), 318–323. https://doi.org/10.1002/eat.10011
42. Moksnes, U. K., & Espnes, G. A. (2013). Self-esteem and life satisfaction in adolescents – gender and age as potential moderators. Quality of Life Research, 22(10), 2921-2928. https://doi.org/10.1007/s11136-013-0427-4
43. Mora, F., Rojo, S. F., Banzo, C.,& Quintero, J. (2017). The impact of self-esteem on eating disorders. European Psychiatry, 41, 558. https://doi.org/10.1016/j.eurpsy.2017.01.802
44. Nwankwo, C. B., Okechi, B. C., & Nweke, P. O. (2015). Relationship between perceived self-esteem and psychological well-being among student athletes. Academic Research Journal of Psychology and Counselling, 2(1), 8-16. https://doi.org/10.14662/IJALIS2015.040
45. Okcu, C. (2020). Examination of the relationships between self-esteem and well-beings with structural equation modeling. İstanbul Kent Üniversitesi İnsan ve Toplum Bilimleri Dergisi 1(1), 52-69.
46. Orth, U., Robins, R. W., Trzesniewski, K. H., Maes, J., & Schmitt, M. (2009). Low self-esteem is a risk factor for depressive symptoms from young adulthood to old age. Journal of Abnormal Psychology, 118(3), 472–478. https://doi.org/10.1037/a0015922
47. Pardo, A. & Román, M. (2013). Reflections on the Baron and Kenny model of statistical mediation. Anales de Psicología, 29(2), 614-623.
48. Peck, L. D., & Lightsey, O. R., Jr. (2008). The eating disorders continuum, self-esteem, and perfectionism. Journal of Counseling & Development, 86(2), 184–192. https://doi.org/10.1002/j.1556-6678.2008.tb00496.x
49. Romano, K. A., & Ebener, D. (2019). Disparities in psychological well-being based on subjective and objective eating disorder recovery statuses, and recovery status concordance. Eating disorders, 27(1), 82-99. https://doi.org/10.1080/10640266.2018.1477674
50. Ryff, C. D. (1989). Happiness is everything, or is it? Explorations on the meaning of psychological wellbeing. Journal of Personality and Social Psychology, 57(6), 1069–1081. https://doi.org/10.1037/0022-3514.57.6.1069
51. Ryff, C. D. (2014). Psychological well-being revisited: Advances in the science and practice of eudaimonia. Psychotherapy and Psychosomatics, 83, 10–28. https://doi.org/10.1159/000353263
52. Ryff, C. D., & Singer, B. H. (2008). Know thyself and become what you are: A eudaimonic approach to psychological well-being. Journal of Happiness Studies: An Interdisciplinary Forum on Subjective Well-Being, 9(1), 13–39. https://doi.org/10.1007/s10902-006-9019-0
53. Shrout, P. E. & Bolger, N. (2002). Mediation in experimental and nonexperimental studies: New procedures and recommendations. Psychological Methods, 7(4), 422-445. https://doi.org/10.1037/1082-989X.7.4.422
54. Silverstone P. H. (1990). Low self-esteem in eating disordered patients in the absence of depression. Psychological reports, 67(1), 276–278. https://doi.org/10.2466/pr0.1990.67.1.276
55. Simone, M., Emery, R. L., Hazzard, V. M., Eisenberg, M. E., Larson, N., & Neumark Sztainer, D. (2021). Disordered eating in a population‐based sample of young adults during the COVID 19 outbreak. International Journal of Eating Disorders, 54(7), 1189-1201. https://doi.org/10.1002/eat.23505
56. Singhal, S., & Prakash, N. (2020). Relationship between self-esteem and psychological well-being among Indian college students. Journal of Interdisciplinary Cycle Research, 12(8), 748-756.
57. Strauss R. S. (2000). Childhood obesity and self-esteem. Pediatrics, 105(1), e15. https://doi.org/10.1542/peds.105.1.e15
58. Tabachnick, B. & Fidell, L. (2013). Using multivariate statistics. Pearson Education.
59. Tafarodi, R. W., & Swann, W. B., Jr. (1995). Self-liking and self-competence as dimensions of global self-esteem: Initial validation of a measure. Journal of Personality Assessment, 65(2), 322–342. https://doi.org/10.1207/s15327752jpa6502_8
60. Tafarodi, R. W., & Swann, W. B. (2001). Two-dimensional self-esteem: Theory and measurement. Personality and Individual Differences, 31(5), 653–673. https://doi.org/10.1016/S0191-8869(00)00169-0
61. Tanrıverdi, D., Savaş, E., Gönüllüoğlu, N., Kurdal, E. ve Balık, G. (2011). Lise öğrencilerinin yeme tutumları, yeme davranışları ve benlik saygılarının incelenmesi. Gaziantep Medical Journal, 17(1), 33-39.
62. Tatoğlu, N. (2006). Zonguldak il merkezinde 15-17 yaş grubu genel lise öğrencilerinde benlik saygısının akademik başarıya etkisi. Yayımlanmamış yüksek lisans tezi. Karaelmas Üniversitesi, Sağlık Bilimler Enstitüsü, Zonguldak.
63. Telef, B. B. (2013). The adaptation of Psychological Well-Being into Turkish: A validity and reliability study. Hacettepe University Journal of Education, 28(3), 374-384.
64. Tomba, E., Offidani, E., Tecuta, L., Schumann, R., & Ballardini, D. (2014). Psychological well‐being in out‐patients with eating disorders: A controlled study. International Journal of Eating Disorders, 47(3), 252-258. https://doi.org/10.1002/eat.22197
65. Tomba, E., Tecuta, L., Schumann, R., & Ballardini, D. (2017). Does psychological well-being change following treatment? An exploratory study on outpatients with eating disorders. Comprehensive psychiatry, 74, 61–69. https://doi.org/10.1016/j.comppsych.2017.01.001.
66. Voica, S.A., Kling, J., Frisen, A., & Piran, N. (2021). Disordered eating through the lens of positive psychology: The role of embodiment, self-esteem and identity coherence. Body Image, 39, 103-113. https://doi.org/10.1016/j.bodyim.2021.06.006
67. Williams, G. J., Power, K. G., Millar, H. R., Freeman, C. P., Yellowlees, A., Dowds, T., Walker, M., Campsie, L., MacPherson, F., & Jackson, M. A. (1993). Comparison of eating disorders and other dietary/weight groups on measures of perceived control, assertiveness, self-esteem, and self-directed hostility. The International journal of eating disorders, 14(1), 27–32. https://doi.org/10.1002/1098-108x(199307)14:1<27::aid-eat2260140104>3.0.co;2-f