Eating disorders among middle-school students: The role of psychological inflexibility and self-esteem

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ABSTRACT

This cross-sectional study aims to shed further light on the relation between self-esteem and Eating Disorders (EDs) as part of prevention efforts by testing the mediating role of psychological inflexibility in a sample of young teenagers. Four hundred and eighteen Greek-speaking students from one representative public middle school in Cyprus (43.90% males and 56.10% females; M_age = 13.71, SD = 1.00) were screened for ED pathology using the Eating Attitudes Questionnaire-26 (EAT-26) and completed the Rosenberg Self-Esteem Scale (RSE) and the Avoidance and Fusion Questionnaire for Youth (AFQ-Y8). Screening was part of a school-wide psychoeducational Campaign titled “Love Your Body-Young Teens”, which aimed to raise awareness on healthy body image and EDs within the school community. Correlations and bootstrapping mediation analyses were conducted to evaluate the relations between ED pathology, self-esteem, and psychological inflexibility. Mediation analyses results showed that psychological inflexibility partly mediates the relationship between self-esteem and ED pathology. These preliminary findings highlight the contributions of both the individual’s negative internal events and their meta-response to these events in the development of EDs. It lays the foundation for the delivery of research-informed psychological prevention efforts in the schools, aiming to increase psychological flexibility among students.

KEYWORDS:

• Eating disorders
• self-esteem
• psychological flexibility
• mediation analysis
• prevention

Acknowledgments

We are immensely grateful to the administration and teaching staff of the participating Middle School for their organizational support and to the research assistants, especially Andria Christodoulou, Chara Demetriou, and Ioanna Kapetaniou, who offered valuable assistance with the data collection and entry process.

Disclosure statement

All other authors declare that they have no conflicts of interest.

Role of funding sources

Partial funding for this study was provided by the Ministry of Education and Culture, Cyprus. The Ministry of Education and Culture had no role in the study design, collection, analysis, or interpretation of the data, writing the manuscript, or the decision to submit the paper for publication.

Additional information

Notes on contributors

Maria Koushiou

Maria Koushiou, PhD, is a licensed clinical and school psychologist in Cyprus. She is working as a lecturer at the University of Nicosia, Cyprus. Her research interests include examining emotional, cognitive and contextual factors in the development of eating and other disorders in children and adolescents.

Anthi Loutsiou

Anthi Loutsiou, PsyD., is the Principal Investigator of the research team and a trainer of School Psychologists at the Department of Psychology, University of Cyprus. She is fully qualified as a psychologist in Cyprus and the USA and she is EuroPsy Certified. Her primary research interests include investigating dynamic psychological and contextual variables that can be targeted to disrupt maladaptive patterns of behavior and emotional problems.

Maria Karekla

Maria Karekla, PhD, is a licensed clinical psychologist and a peer-reviewed Acceptance and Commitment Therapy trainer. She is an Assistant Professor at the University of Cyprus. Her research focuses on areas of health promotion and the investigation of individual difference factors as they relate to the development and maintenance of various behavioral difficulties. Additionally, she examines the treatment of these difficulties utilizing Acceptance and Commitment-based principles and innovative delivery methods (e.g., digital interventions, virtual reality).