Body image-related cognitive fusion as a main mediational process between body-related experiences and women’s quality of life

  • Cláudia Ferreira
  • Inês A. TrindadeEmail author
Original Article



Although the experience of body image has been considered an important indicator of women’s psychological quality of life (QoL), it has also been suggested that the impact of unwanted body-related experiences on QoL may be mediated by emotional regulation processes. The aim of the current study was therefore to explore for the first time the role of body image-related cognitive fusion on these associations.


This study comprised 779 young females who completed self-report measures. A path analysis was conducted to explore whether BMI, body dissatisfaction and feelings of inferiority based on physical appearance would impact on psychological QoL through body image-related cognitive fusion.


The model explained 39 % of psychological health, and revealed an excellent fit. Results showed that BMI did not directly impact on psychological health. Furthermore, the effects of increased body dissatisfaction and feelings of inferiority based on physical appearance on psychological health were fully and partially mediated by body image-related cognitive fusion, respectively.


These findings suggest that the presence of body image-related negative experiences does not necessarily lead to impairment in women’s QoL, which is rather dependent upon one’s ability to observe these unwanted experiences as transient and subjective. Therefore, intervention programmes aiming at increasing women’s QoL should focus on targeting emotional regulation processes in order to develop the ability to pursue life goals and values, even in the presence of unwanted experiences concerning body image.


Quality of life Psychological health Body image-related cognitive fusion Body dissatisfaction Feelings of inferiority based on physical appearance BMI 



Quality of life


Body mass index


Figure rating scale


Body dissatisfaction


Social comparison through physical appearance scale


Cognitive fusion questionnaire-body image


World Health Organization Brief Quality of Life Assessment Scale


Conflict of interest

The authors report no conflicts of interest.


  1. 1.
    Mond J, Mitchison D, Latner J, Hay P, Owen C, Rodgers B (2013) Quality of life impairment associated with body dissatisfaction in a general population sample of women. BMC Public Health 3:920. doi: 10.1186/1471-2458-13-920 CrossRefGoogle Scholar
  2. 2.
    Grogan S (2008) Body image understanding body dissatisfaction in men, women, and children. Routledge, LondonGoogle Scholar
  3. 3.
    Mikkilä V, Lahti-Koski M, Pietinen P, Virtanen SM, Rimpela M (2003) Associates of obesity and weight dissatisfaction among Finnish adolescents. Public Health Nutr 6(Suppl 1):49–56. doi: 10.1079/PHN2002352 PubMedGoogle Scholar
  4. 4.
    Rodin J, Silberstein L, Striegel-Moore R (1983) Women and weight: a normative discontent. In: Sonderegger TB (ed) Psychology and gender. University of Nebraska Press, Lincoln, pp 267–307Google Scholar
  5. 5.
    Mond J, Hay PJ, Rodgers B, Owen C (2011) Mental health impairment associated with eating-disorder features in a community sample of women. JMH 20(Suppl 5):456–466. doi: 10.3109/09638237.2011.577112 Google Scholar
  6. 6.
    Muennig P, Jia H, Lee R, Lubetkin E (2008) I think therefore I am: perceived ideal weight as a determinant of health. Am J Public Health 13:501–506. doi: 10.2105/AJPH.2007.114769 CrossRefGoogle Scholar
  7. 7.
    Stice E, Marti N, Durant S (2011) Risk factors for onset of eating disorders: evidence of multiple risk pathways from an 8-year prospective study. Behav Res Ther 49(Suppl 10):622–627. doi: 10.1016/j.brat.2011.06.009 CrossRefPubMedCentralPubMedGoogle Scholar
  8. 8.
    Pinto-Gouveia J, Ferreira C, Duarte C (2014) Thinness in the pursuit for social safeness: an integrative model of social rank mentality to explain eating psychopathology. Clin Psychol Psychother 21(Suppl 2):154–165. doi: 10.1002/cpp.1820 CrossRefPubMedGoogle Scholar
  9. 9.
    Ferreira C, Pinto-Gouveia J, Duarte C (2013) Physical appearance as a measure of social ranking: the role of a new scale to understand the relationship between weight and dieting. Clin Psychol Psychother 20:55–66. doi: 10.1002/cpp.769 CrossRefPubMedGoogle Scholar
  10. 10.
    Gilbert P (2002) Body shame: a biopsychosocial conceptualisation and overview with treatment implications. In: Gilbert P, Miles J (eds) Body shame: conceptualisation, research and treatment. Routledge, New York, pp 3–54Google Scholar
  11. 11.
    Sypeck MF, Gray JJ, Etu SF, Ahrens AH, Mosimann JE, Wiseman CV (2006) Cultural representations of thinness in women, redux: playboy magazine’s depictions of beauty from 1979 to 1999. Body Image 3:229–235. doi: 10.1016/j.bodyim.2006.07.001 CrossRefPubMedGoogle Scholar
  12. 12.
    Webster M, Driskell JE (1983) Beauty as status. Am J Sociol 89:140–165CrossRefGoogle Scholar
  13. 13.
    Buote VM, Wilson AE, Strahan EJ, Gazzola SB, Papps FA (2011) Setting the bar: sociocultural norms for women’s and men’s ideal appearance in real-world contexts. Body Image 8(Suppl. 4):322–334. doi: 10.1016/j.bodyim.2011.06.002 CrossRefPubMedGoogle Scholar
  14. 14.
    Segal ZV, Teasdale JD, Williams JMG, Mindfulness-Based Cognitive Therapy (2004) Theoretical rationale and empirical status. In: Hayes S, Follette V, Linehan MM (eds) Mindfulness and acceptance. Guilford Press, New York, pp 45–65Google Scholar
  15. 15.
    Hayes SC, Strosahl K, Wilson KG (1999) Acceptance and commitment therapy: an experiential approach to behavior change. Guilford Press, New YorkGoogle Scholar
  16. 16.
    Merwin RM, Timko CA, Moskovich AA, Ingle KK, Bulik CM, Zucker NL (2011) Psychological inflexibility and symptom expression in anorexia nervosa. Eat Disord 19:62–82. doi: 10.1080/10640266.2011.53360616 CrossRefPubMedGoogle Scholar
  17. 17.
    Hayes SC, Strosahl K, Bunting K, Twohig M, Wilson KG (2004) What is acceptance and commitment therapy? In: Hayes SC, Strosahl KD (eds) A practical guide to acceptance and commitment therapy. Springer, New York, pp 3–29CrossRefGoogle Scholar
  18. 18.
    Luoma JB, Hayes SC (2003) Cognitive Defusion. In: O’Donahue W, Fisher JE, Hayes SC (eds) Empirically supported techniques of cognitive behavioral therapy: a step-by-step guide for clinicians, 2nd edn. Wiley, New York, pp 71–78Google Scholar
  19. 19.
    Hayes SC, Luoma JB, Bond F, Masuda A, Lillis J (2006) Acceptance and commitment therapy: model, processes and outcomes. Behav Res Ther 44:1–25. doi: 10.1016/j.brat.2005.06.006 CrossRefPubMedGoogle Scholar
  20. 20.
    Ferreira C, Palmeira L, Trindade IA (2014) Turning eating psychopathology risk factors into action: the pervasive effect of body image-related cognitive fusion. Appetite. doi: 10.1016/j.appet.2014.05.019 PubMedGoogle Scholar
  21. 21.
    Trindade IA, Ferreira C (2014) The impact of body image-related cognitive fusion on eating psychopathology. Eat Behav 15(Suppl 1):72–75. doi: 10.1016/j.eatbeh.2013.10.014 CrossRefPubMedGoogle Scholar
  22. 22.
    Carter JC, Stewart DA, Fairburn CG (2001) Eating Disorder Examination Questionnaire: norms for young adolescent girls. Behav Res Ther 39:625–632. doi: 10.1016/S0005-7967(00)00033-4 CrossRefPubMedGoogle Scholar
  23. 23.
    Thompson JK, Altabe MN (1991) Psychometric qualities of the figure rating scale. Int J Eat Disord 10:615–619. doi: 10.1002/1098-108X(199109 CrossRefGoogle Scholar
  24. 24.
    Ferreira C (2003) Anorexia Nervosa: A expressão visível do invisível. Contributos para a avaliação de atitudes e comportamentos em relação ao peso e à imagem corporal [Anorexia Nervosa: The visible expression of the invisible. Contributions for the assessment of attitudes and behaviors in relation to weight and body image]. Master’s thesis. University of Coimbra, Faculty of Psychology and Educational SciencesGoogle Scholar
  25. 25.
    Ferreira C, Trindade IA, Duarte C, Pinto-Gouveia J (2013) Getting entangled with body image: Development and validation of a new measure (submitted manuscript)Google Scholar
  26. 26.
    Gillanders DT, Bolderston H, Bond FW, Dempster M, Flaxman PE, Campbell L, Kerr S, Tansey L, Noel P, Ferenbach C, Masley S, Roach L, Lloyd J, May L, Clarke S, Remington R (2014) The development and initial validation of the cognitive fusion questionnaire. Behav Ther 45:83–101. doi: 10.1016/j.beth.2013.09.001
  27. 27.
    WHOQOL Group (1998) Development of world health organization WHOQOL-BREF quality of life assessment. Psychol Med 28:551–558CrossRefGoogle Scholar
  28. 28.
    Canavarro MC, Simões MR, Serra AV, Pereira M, Rijo D, Quartilho M, Gameiro S, Paredes T, Carona C (2007) WHOQOL-BREF Instrumento de Avaliação da Qualidade de Vida da Organização Mundial de Saúde [WHOQOL-BREF Quality of Life Assessment Instrument from the World Health Organization]. In: Simões MR, Gonçalves MM, Almeida LS (eds) Avaliação Psicológica: 46 Instrumentos válidos para a população portuguesa, vol 3. Quarteto, Coimbra, pp 77–100Google Scholar
  29. 29.
    Cohen J, Cohen P, West S, Aiken L (2003) Applied multiple regression/correlation analysis for the behavioural sciences. Lawrence Erlbaum Associates, New JerseyGoogle Scholar
  30. 30.
    MacKinnon DP (2008) Introduction to statistical mediation analysis. Erlbaum, MahwahGoogle Scholar
  31. 31.
    Kline RB (2005) Principles and practice of structural equation modeling. The Guilford Press, New YorkGoogle Scholar
  32. 32.
    Ferreira C, Pinto-Gouveia J, Duarte C (2013) Drive for thinness as a women’s strategy to avoid inferiority. Int J Psychol Psychol Ther 13(Suppl 1):15–29Google Scholar

Copyright information

© Springer International Publishing Switzerland 2014

Authors and Affiliations

  1. 1.Cognitive-Behavioural Research CentreUniversity of CoimbraCoimbraPortugal
  2. 2.CINEICC, Faculdade de Psicologia e Ciências da EducaçãoUniversidade de CoimbraCoimbraPortugal

Personalised recommendations