Body dissatisfaction in adolescents with eating disorders



This study aims to analyze and compare the level of body dissatisfaction (BD) in different eating disorders (ED) subtypes. Also, the relationship between BD and certain aesthetic body shape model influence and psychological variables was analyzed.


The sample consisted of 204 adolescent patients, who were attending in an ED Unit in Zaragoza (Spain). The following instruments were applied: the Spanish Children’s Depression Questionnaire (CEDI-II), the Rosenberg Self-Esteem Scale (RSES), the Eating Attitudes Test (EAT-40), the Body Shape Questionnaire (BSQ-34) and the Questionnaire of Influences of Aesthetic Body shape Model (CIMEC-40).


The group of Bulimia Nervosa (BN) showed the greatest BD. Those patients who showed higher levels of BD had lower self-esteem, more depressive symptoms, a greater presence of disordered eating attitudes, and more influence of the aesthetic body shape model.


This study contributes to highlight the idea of implementing effective prevention programs and specific interventions related to BD in the treatment of ED.

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  1. 1.

    Lawler M, Nixon E (2011) Body dissatisfaction among adolescents boys and girls: the effects of body mass, peer appearance culture and internalization of appearance ideals. J Youth Adolesc 40(1):59–71. doi:10.1007/s10964-009-9500-2

    Article  PubMed  Google Scholar 

  2. 2.

    Helfert S, Warschburger P (2013) The face of appearance-related social pressure: gender, age and body mass variations in peer and parental pressure during adolescence. Child Adolesc Psychiatry Ment Health 7:16. doi:10.1186/1753-2000-7-16

    Article  PubMed  PubMed Central  Google Scholar 

  3. 3.

    Bun CJ, Schwiebbe L, Schütz FN, Bijlsma-Schlösser JF, Hirasing RA (2012) Negative body image and weight loss behavior in Dutch school children. Eur J Public Health 22(1):130–133. doi:10.1093/eurpub/ckr027

    Article  PubMed  Google Scholar 

  4. 4.

    Davison TE, McCabe MP (2006) Adolescent body image and psychosocial functioning. J Soc Psychol 146(1):15–30. doi:10.3200/SOCP.146.1.15-30

    Article  PubMed  Google Scholar 

  5. 5.

    Lee J, Lee Y (2016) The association of body image distortion with weight control behaviors, diet behaviors, physical activity, sadness, and suicidal ideation among Korean high school students: a cross-sectional study. BCM Public Health 16:39. doi:10.1186/s12889-016-2703-z

    Article  Google Scholar 

  6. 6.

    Rodgers RF, Paxton SJ, McLean SA (2014) A biopsychosocial model of body image concerns and disordered eating in early adolescents girls. J Youth Adolesc 43(5):814–823. doi:10.1007/s10964-013-0013-7

    Article  PubMed  Google Scholar 

  7. 7.

    Espinoza P, Penelo E, Raich RM (2010) Disordered eating behaviors and body image in a longitudinal pilot study of adolescent girls: what happens 3 years later? Body Image 7:70–73. doi:10.1016/j.bodyim.2009.09.002

    Article  PubMed  Google Scholar 

  8. 8.

    Jones DC, Newman JB (2009) Early adolescent adjustment and critical evaluations by self and other: the prospective impact of body image dissatisfaction and peer appearance teasing on global self-esteem. Eur J Dev Sci 3(1):17–26. doi:10.3233/DEV-2009-3104

    Article  Google Scholar 

  9. 9.

    Rosenström T, Jokela M, Hintsanen M, Josefsson K, Juonala M, Kivimäki M, Pulkki-Raback L, Viikari J, Hutri-Kähönen N, Heinonen E, Raitakari OT, Keltikangas-Järvinen L (2013) Body-image dissatisfaction is strongly associated with chronic dysphoria. J Affect Disord 150(2):253–260. doi:10.1016/j.jad.2013.04.003

    Article  PubMed  Google Scholar 

  10. 10.

    Rohde P, Stice E, Marti CN (2015) Development and predictive effects of eating disorder risk factors during adolescence: implications for prevention efforts. Int J Eat Disord 48(2):187–198. doi:10.1002/eat.22270

    Article  PubMed  Google Scholar 

  11. 11.

    Mäkinen M, Puuko-Viertomies LR, Lindberg N, Siimes MA, Aalberg V (2012) Body dissatisfaction and body mass in girls and boys transitioning from early to mid-adolescence: additional role of self-esteem and eating habits. BMC Psychiatry 12:1–9. doi:10.1186/1471-244X-12-35

    Article  Google Scholar 

  12. 12.

    Van den Berg PA, Mond J, Eisenberg M, Ackard D, Neumark-Sztainer D (2010) The link between body dissatisfaction and self-esteem in adolescents: similarities across gender, age, weight status, race/ethnicity, and socioeconomic status. J Adolesc Health 47(3):290–296. doi:10.1016/j.jadohealth.2010.02.004

    Article  PubMed  PubMed Central  Google Scholar 

  13. 13.

    Brechan I, Lundin I (2015) Relationship between body dissatisfaction and disordered eating: mediating role of self-esteem and depression. Eat Behav 17:49–58. doi:10.1016/j.eatbeh.2014.12.008

    Article  PubMed  Google Scholar 

  14. 14.

    Kong F, Zhang Y, You Z, Fan C, Tian Y, Zhou Z (2013) Body dissatisfaction and retrained eating: mediating effects of self-esteem. Soc Behav Personal 41(7):1165–1170. doi:10.2224/sbp.2013.41.7.1165

    Article  Google Scholar 

  15. 15.

    Stice E, Bearman SK (2001) Body image and eating disturbances prospectively predict increases in depressive symptoms in adolescent girls: a growth curve analysis. Dev Psychol 37:597–607. doi:10.1037/0012-1649.37.5.597

    Article  PubMed  CAS  Google Scholar 

  16. 16.

    Ferreiro F, Seoane G, Senra C (2014) Toward understanding the role of body dissatisfaction in the gender differences in depressive symptoms and disordered eating: a longitudinal study during adolescence. J Adolesc 37(1):73–84. doi:10.1016/j.adolescence.2013.10.013

    Article  PubMed  Google Scholar 

  17. 17.

    Haynos AF, Watts AW, Loth KA, Pearson CM, Neumark-Stzainer D (2016) Factors predicting an escalation of restrictive eating during adolescence. J Adolesc Health 59(4):391–396. doi:10.1016/j.jadohealth.2016.03.011

    Article  PubMed  PubMed Central  Google Scholar 

  18. 18.

    Rodgers RF, Paxton SJ, Chabrol H (2010) Depression as a moderator of sociocultural influences on eating disorder symptoms in adolescent females and males. J Youth Adolesc 39:393–402. doi:10.1007/s10964-009-9431-y

    Article  PubMed  Google Scholar 

  19. 19.

    Dakanalis A, Favagrossa L, Clerici M, Prunas A, Colmegna F, Zanetti MA, Riva G (2015) Body dissatisfaction and eating disorder symptomatology: a latent structural equation modeling analysis of moderating variables in 18-to-28-year-old males. J Psychol 149(1):85–112. doi:10.1080/00223980.2013.842141

    Article  PubMed  Google Scholar 

  20. 20.

    Sharpe H, Damazer K, Treasure J, Schmidt U (2013) What are adolescents’ experiences of body dissatisfaction and dieting, and what do they recommend for prevention? A qualitative study. Eat Weight Disord 18(2):133–141. doi:10.1007/s40519-013-0023-1

    Article  PubMed  Google Scholar 

  21. 21.

    Jackson T, Chen H (2014) Risk factors for disordered eating during early and middle adolescence: a two year longitudinal study of mainland Chinese boys and girls. J Abnorm Child Psychol 42(5):791–802. doi:10.1007/s10802-013-9823-z

    Article  PubMed  PubMed Central  Google Scholar 

  22. 22.

    Harrison K (2000) Television viewing, fat stereotyping, body shape standards and eating disorder symptomatology in Grade School children. Commun Res 27:617–640. doi:10.1177/009365000027005003

    Article  Google Scholar 

  23. 23.

    Sung-Yeon P (2005) The influence of presumed media influence on women’s desire to be thin. Commun Res 32(5):594–614. doi:10.1177/0093650205279350

    Article  Google Scholar 

  24. 24.

    Rajagopalan J, Shejwal B (2014) Influence of sociocultural pressures on body image dissatisfaction. Psychol Stud 59(4):357–364. doi:10.1007/s12646-014-0245-y

    Article  Google Scholar 

  25. 25.

    Homan K (2010) Athletic-ideal and thing-ideal internalization as prospective predictors of body dissatisfaction, dieting, and compulsive exercise. Body Image 7:240–245. doi:10.1016/j.bodyim.2010.02.004

    Article  PubMed  Google Scholar 

  26. 26.

    Zanetti T, Santonastaso P, Sgaravatti E, Degortes D, Favaro A (2013) Clinical and temperamental correlates of body image disturbance in eating disorders. Eur Eat Disord Rev 21:32–37. doi:10.1002/erv.2190

    Article  PubMed  Google Scholar 

  27. 27.

    Ruuska J, Kaltiala-Heino R, Rantanen P, Koivisto AM (2005) Are there differences in the attitudinal body image between adolescent anorexia nervosa and bulimia nervosa? Eat Weight Disord 10:98–106. doi:10.1007/BF03327531

    Article  PubMed  CAS  Google Scholar 

  28. 28.

    Cash T, Deagle E (1997) The nature and extent of body image disturbance in anorexia nervosa and bulimia nervosa: a meta-analysis. Int J Eat Disord 22:107–125. doi:10.1002/(SICI)1098-108X(199709)22:2<107:AID-EAT1>3.0.CO;2-J

    Article  PubMed  CAS  Google Scholar 

  29. 29.

    Sepulveda AR, Botella J, Leon JA (2001) La alteración de la imagen corporal en los trastornos de la alimentación: un meta-análisis. Psicothema 13:7–16

    Google Scholar 

  30. 30.

    American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders, 5th edn. American Psychiatric Publishing, Arlington

    Google Scholar 

  31. 31.

    Rodríguez-Sacristán J, Cadorze D, Rodríguez J, Gómez-Añón ML, Benjumea P, Pérez J (1984) Sistemas objetivos de medida: experiencia con el Inventario Español de Depresiones Infantiles (CEDI). Modificado de Kovacs y Beck. Revista de Psiquiatría Infanto-Juvenil 3:65–74

    Google Scholar 

  32. 32.

    Kovacs M (1992) Children’s depression inventory, CDI. Multi-Health Systems Inc, Toronto

    Google Scholar 

  33. 33.

    Rosenberg M (1965) La autoimagen del adolescente y la sociedad. Paidós, Buenos Aires

    Google Scholar 

  34. 34.

    Vázquez A, Jiménez R, Vázquez R (2004) Escala de Autoestima de Rosenberg. Fiabilidad y validez en población clínica española. Apuntes de Psicología 22:247–255

    Google Scholar 

  35. 35.

    Garner DM, Garfinkel PE (1979) The eating attitudes test: an index of the symptoms of anorexia nervosa. Psychol Med 9:273–279. doi:10.1017/S0033291700030762

    Article  PubMed  CAS  Google Scholar 

  36. 36.

    Castro J, Toro J, Salamero M (1991) The eating attitudes test: validation of the Spanish version. Evaluación Psicológica 7:175–190

    Google Scholar 

  37. 37.

    Garner DM, Olmsted MP, Bohr Y, Garfinkel PE (1982) The eating attitudes test: psychometric features and clinical correlates. Psychol Med 12:871–878. doi:10.1017/S0033291700049163

    Article  PubMed  CAS  Google Scholar 

  38. 38.

    Merino H, Pombo MG, Godás A (2001) Evaluación de las actitudes alimentarias y la satisfacción corporal en una muestra de adolescentes. Psicothema 13:539–545

    Google Scholar 

  39. 39.

    Cooper PJ, Taylor MJ, Cooper Z, Fairburn CG (1987) The development and validation of the Body Shape Questionnaire. Int J Eat Disord 6:485–494. doi:10.1002/1098-108X(198707)6:4<485:AID-EAT2260060405>3.0.CO;2-O

    Article  Google Scholar 

  40. 40.

    Raich RM, Mora M, Soler A, Ávila C, Clos I, Zapater L (1996) Adaptación de un instrumento de evaluación de la insatisfacción corporal. Clínica y Salud 7:51–66

    Google Scholar 

  41. 41.

    Toro J, Salamero M, Martínez E (1994) Assessment of sociocultural influences on the aesthetic body shape model in anorexia nervosa. Acta Psychiat Scand 89:147–151. doi:10.1111/j.1600-0447.1994.tb08084.x

    Article  PubMed  CAS  Google Scholar 

  42. 42.

    Cooper PJ, Taylor MJ (1988) Body image disturbance in bulimia nervosa. Br J Psychiatry 153:32–36

    Article  Google Scholar 

  43. 43.

    Rawana JS, Morgan AS, Nguyen H, Craig SG (2010) The relation between eating- and weight-related disturbances and depression in adolescence: a review. Clin Child Fam Psychol Rev 13(3):213–230. doi:10.1007/s10567-010-0072-1

    Article  PubMed  Google Scholar 

  44. 44.

    Amaya A, Álvarez GL, Mancilla JM (2010) Insatisfacción corporal en interacción con autoestima, influencia de pares y dieta restrictiva: Una revisión. Revista Mexicana de Trastornos Alimentarios 1:76–89

    Google Scholar 

  45. 45.

    Smith AJ (2010) Body image, eating disorders and self-esteem problems during adolescence. In: Guindon MH (ed) Self-esteem across the lifespan: issues and interventions. Taylor & Francis Group, New York, pp 125–141

    Google Scholar 

  46. 46.

    Whale K, Gillison FB, Smith PC (2014) ‘Are you still on that stupid diet?’: women’s experiences of societal pressure and support regarding weight loss, and attitudes towards health policy intervention. J Health Psychol 19(12):1536–1546. doi:10.1177/1359105313495072

    Article  PubMed  Google Scholar 

  47. 47.

    Giordano S (2015) Eating disorders and the media. Curr Opin Psychiatry 28(6):478–482. doi:10.1097/YCO.0000000000000201

    Article  PubMed  Google Scholar 

  48. 48.

    Grabe S, Ward L, Hyde J (2008) The role of the media in body image concerns among women: a meta-analysis of experimental and correlational studies. Psychol Bull 134:460–476. doi:10.1037/0033-2909.134.3.460

    Article  PubMed  Google Scholar 

  49. 49.

    Stice E, Shaw HE (2002) Role of body dissatisfaction in the onset and maintenance of eating pathology: a synthesis of research findings. J Psychosom Res 53(5):985–993. doi:10.1016/S0022-3999(02)00488-9

    Article  PubMed  Google Scholar 

  50. 50.

    Skemp-Arlt KM (2006) Body image dissatisfaction and eating disturbances among children and adolescents: prevalence, risk factors and prevention strategies. J Pshys Educ Recreat Dance 75:32–39. doi:10.1080/07303084.2006.10597813

    Article  Google Scholar 

  51. 51.

    Espina A (2003) Eating disorders and MMPI profiles in a Spanish sample. Eur J Psychiatry 17(4):201–211. doi:10.1037/t06908-000

    Article  Google Scholar 

  52. 52.

    Thomas JJ, Crosby RD, Wonderlich SA, Striegel-Moore RH, Beckler AE (2011) A latent profile analysis of the typology of bulimic symptoms in an indigenous Pacific population: evidence of cross-cultural variation in phenomenology. Psychol Med 41(1):195–206. doi:10.1017/S003329170000255

    Article  PubMed  CAS  Google Scholar 

  53. 53.

    Linville D, Cobb E, Lenee-Bluhm T, López-Zerón G, Gau JM, Stice E (2015) Effectiveness of an eating disorder preventative intervention in primary care medical settings. Behav Res Ther 75:32–39. doi:10.1016/j.brat.2015.10.004

    Article  PubMed  Google Scholar 

  54. 54.

    Stice E, Marti N, Spoor S, Presnell K, Shaw H (2008) Dissonance and healthy weight eating disorder prevention programs: long-term effects from a randomized efficacy trial. J Consult Clin Psychol 76:329–340. doi:10.1037/0022-006X.76.2.329

    Article  PubMed  PubMed Central  Google Scholar 

  55. 55.

    Stice E, Rohde P, Gau J, Shaw H (2012) Effect of a dissonance-based prevention program on risk for eating disorder onset in the context of eating disorder risk factors. Prev Sci 13(2):129–139. doi:10.1007/s11121-011-0251-4

    Article  PubMed  PubMed Central  Google Scholar 

  56. 56.

    Stice E, Butryn M, Rohde P, Shaw H, Marti N (2013) An effectiveness trial of a new enhanced dissonance eating disorder prevention program among female college students. Behav Res Ther 51:862–871. doi:10.1016/j.brat.2013.10

    Article  PubMed  PubMed Central  Google Scholar 

  57. 57.

    Rohde P, Auslander BA, Shaw H, Raineri KM, Gau JM, Stice E (2014) Dissonance-based prevention of eating disorder risk factors in middle school girls: results from two pilot trials. Int J Eat Disord 47(5):483–494. doi:10.1002/eat.22253

    Article  PubMed  PubMed Central  Google Scholar 

  58. 58.

    Yager Z, O’Dea JA (2008) Preventions programs for body image and eating disorders on university campus: a review of large controlled interventions. Health Promot Int 23:173–189. doi:10.1093/heapro/dan004

    Article  PubMed  Google Scholar 

  59. 59.

    Levine MP, Smolak L (2016) The role of protective factors in the prevention of negative body image and disordered eating. Eat Disord 24(1):39–46. doi:10.1080/10640266.2015.1113826

    Article  PubMed  Google Scholar 

  60. 60.

    Ciao AC, Loth K, Neumark-Sztainer D (2014) Preventing eating disorder pathology: common and unique features of successful eating disorders programs. Curr Psychiatry Rep 16(7):453. doi:10.1007/s11920-014-0453-0

    Article  PubMed  PubMed Central  Google Scholar 

  61. 61.

    Góngora V (2010) Hacia una integración de los paradigmas positivos y de enfermedad en la prevención de los trastornos de la conducta alimentaria en adolescentes. Psicodebate 10:279–296

    Article  Google Scholar 

  62. 62.

    Parkinson KN, Drewett RF, Le Couter AS, Adamson AJ (2012) Earlier predictors of eating disorder symptoms in 9-year-old children. A longitudinal study. Appetite 59(1):161–167. doi:10.1016/j.appet.2012.03.022

    PubMed  Article  Google Scholar 

  63. 63.

    Jendrzyca A, Warschburger P (2016) Weight stigma and eating behaviours in elementary school children: a prospective population-based study. Appetite 102:51–59. doi:10.1016/j.appet.2016.02.005

    Article  PubMed  Google Scholar 

  64. 64.

    Hui M, Brown J (2013) Factors that influence body dissatisfaction: comparisons across culture and gender. J Hum Behav Soc Environ 23:312–329. doi:10.1080/10911359.2013.763710

    Article  Google Scholar 

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Correspondence to Isabel Laporta-Herrero.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required (retrospective study).

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Laporta-Herrero, I., Jáuregui-Lobera, I., Barajas-Iglesias, B. et al. Body dissatisfaction in adolescents with eating disorders. Eat Weight Disord 23, 339–347 (2018).

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  • Eating disorders
  • Body dissatisfaction
  • Adolescence
  • Aesthetic body shape model
  • Self-esteem