Skip to main content

The powerful effect of body image inflexibility on the explanation of eating psychopathology severity



Feelings of shame and social comparison focused on physical appearance have been identified as important risk factors for the engagement in disordered eating behaviours. Further, recent studies have emphasized the role of body-image psychological (in)flexibility in the association between several risk factors and eating psychopathology. The current study intended to explore, in two different path models, the effects of external shame, physical appearance-related social comparison, and body image inflexibility on the explanation of eating psychopathology severity.


This study follows a cross-sectional design and was conducted in a sample of 776 emerging-adult women, aged between 18 and 28, who completed an online battery of self-report measures. Path analyses were conducted using a structural equation modeling.


Model 1’s results showed that external shame and unfavourable social comparison based on physical appearance directly accounts for 26% of the variance in disordered eating. In turn, when body image inflexibility is introduced as a mediator in the relationship presented in Model 1, variance in disordered eating increases to 60% (Model 2). These results suggest that both external shame and unfavourable physical appearance-related social comparison have an impact on disordered eating behaviours. However, when body image inflexibility is introduced, the mentioned relationships change and reveal that psychological inflexibility is a significant mediator of these associations.


These findings seem to demonstrate that body image inflexibility is a key process for the engagement in disordered eating, so the promotion of psychological flexibility focused on one’s body is crucial for the prevention and treatment of disordered eating behaviours and attitudes.

Level of evidence

Level IV: Cross-sectional study.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2


  1. 1.

    Arnett JJ (2014) Emerging adulthood: The winding road from the late teens through the twenties. Oxford University Press, Oxford

    Book  Google Scholar 

  2. 2.

    Nelson LJ, Badger S, Wu B (2004) The influence of culture in emerging adulthood: perspectives of Chinese college students. Int J Behav Dev 28(1):26–36.

    Article  Google Scholar 

  3. 3.

    Arnett JJ, Žukauskienė R, Sugimura K (2014) The new life stage of emerging adulthood at ages 18–29 years: implications for mental health. Lancet Psychiatry 1(7):569–576.

    Article  PubMed  Google Scholar 

  4. 4.

    Ng M, Fleming T, Robinson M, Thomson B, Graetz N, Margono C, Abera SF (2014) Global, regional, and national prevalence of overweight and obesity in children and adults during 1980–2013: a systematic analysis for the Global Burden of Disease Study 2013. Lancet 384(9945):766–781.

    Article  PubMed  PubMed Central  Google Scholar 

  5. 5.

    Potterton R, Richards K, Allen K, Schmidt U (2020) Eating disorders during emerging adulthood: a systematic scoping review. Front Psychol 10:3062.

    Article  PubMed  PubMed Central  Google Scholar 

  6. 6.

    Hasselle AJ, Howell KH, Dormois M, Miller-Graff LE (2017) The influence of childhood polyvictimization on disordered eating symptoms in emerging adulthood. Child Abuse Negl 68:55–64.

    Article  PubMed  Google Scholar 

  7. 7.

    Gonidakis F, Lemonoudi M, Charila D, Varsou E (2018) A study on the interplay between emerging adulthood and eating disorder symptomatology in young adults. Eat Weight Disord 23(6):797–805.

    Article  PubMed  Google Scholar 

  8. 8.

    Preti A, de Girolamo G, Vilagut G, Alonso J, de Graaf R, Bruffaerts R, ESEMeD-WMH Investigators (2009) The epidemiology of eating disorders in six European countries: results of the ESEMeD-WMH project. J Psychiatr Res 43(14):1125–1132.

    Article  PubMed  Google Scholar 

  9. 9.

    Warrender D (2020) How use of social media and social comparison affect mental health. Nurs Times 116(3):58–61

    Google Scholar 

  10. 10.

    Verduyn P, Gugushvili N, Massar K, Täht K, Kross E (2020) Social comparison on social networking sites. Curr Opin Psychol.

    Article  PubMed  Google Scholar 

  11. 11.

    Nesi J, Prinstein MJ (2015) Using social media for social comparison and feedback-seeking: gender and popularity moderate associations with depressive symptoms. J Abnorm Child Psychol 43(8):1427–1438.

    Article  PubMed  PubMed Central  Google Scholar 

  12. 12.

    Jiang S, Ngien A (2020) The effects of instagram use, social comparison, and self-esteem on social anxiety: a survey study in Singapore. Social Media Soc 6(2):205630512091248.

    Article  Google Scholar 

  13. 13.

    Vogel EA, Rose JP, Roberts LR, Eckles K (2014) Social comparison, social media, and self-esteem. Psychol Pop Media Cult 3(4):206–222.

    Article  Google Scholar 

  14. 14.

    Festinger L (1954) A theory of social comparison processes. Hum Relat 7:117–140.

    Article  Google Scholar 

  15. 15.

    Allan S, Gilbert P (1995) A social comparison scale: psychometric properties and relationship to psychopathology. Pers Indiv Differ 19(3):293–299.

    Article  Google Scholar 

  16. 16.

    Troop NA, Allan S, Treasure JL, Katzman M (2003) Social comparison and submissive behaviour in eating disorder patients. Psychol Psychother 76(3):237–249.

    Article  PubMed  Google Scholar 

  17. 17.

    Lim M, Yang Y (2015) Effects of users’ envy and shame on social comparison that occurs on social network services. Comput Human Behav 51:300–311.

    Article  Google Scholar 

  18. 18.

    Mitchell MA, Schmidt NB (2014) An experimental manipulation of social comparison in social anxiety. Cogn Behav Ther 43(3):221–229.

    Article  PubMed  Google Scholar 

  19. 19.

    Hamel AE, Zaitsoff SL, Taylor A, Menna R, Grange DL (2012) Body-related social comparison and disordered eating among adolescent females with an eating disorder, depressive disorder, and healthy controls. Nutrients 4(9):1260–1272.

    Article  PubMed  PubMed Central  Google Scholar 

  20. 20.

    Fitzsimmons-Craft EE (2017) Eating disorder-related social comparison in college women’s everyday lives. Int J Eat Disorders 50(8):893–905.

    Article  Google Scholar 

  21. 21.

    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(1):55–66.

    Article  PubMed  Google Scholar 

  22. 22.

    Buote VM, Wilson AE, Strahan EJ, Gazzola SB, Papps F (2011) Setting the bar: divergent sociocultural norms for women’s and men’s ideal appearance in real-world contexts. Body Image 8(4):322–334.

    Article  PubMed  Google Scholar 

  23. 23.

    Homan KJ, Tylka TL (2015) Self-compassion moderates body comparison and appearance self-worth’s inverse relationships with body appreciation. Body Image 15:1–7.

    Article  PubMed  Google Scholar 

  24. 24.

    Trottier K, Polivy J, Herman CP (2007) Effects of exposure to thin and overweight peers: evidence of social comparison in restrained and unrestrained eaters. J Soc Clin Psychol 26(2):155–172.

    Article  Google Scholar 

  25. 25.

    Sypeck MF, Gray JJ, Etu SF, Ahrens AH, Mosimann JE, Wiseman CV (2006) Cultural representations of thinness in women, redux: playboy magazine’s depiction of beauty from 1979 to 1999. Body Image 3(3):229–235.

    Article  PubMed  Google Scholar 

  26. 26.

    Allan S, Gilbert P, Goss K (1994) An exploration of shame measures: II. Psychopathology. Personality Indiv Differ 17(5):719–722.

    Article  Google Scholar 

  27. 27.

    Gilbert P (2002) Body shame: A biopsychosocial conceptualization and overview, with treatment implications. In: Gilbert P, Miles J (eds) Body shame: conceptualisation, research and treatment. Brunner Routledge, New York, pp 3–54

    Google Scholar 

  28. 28.

    Gilbert P (2007) The evolution of shame as a marker for relationship security. In: Tracy JL, Robins RW, Tangney JP (eds) The self-conscious emotions: theory and research. Guilford, New York, NY, pp 283–309

    Google Scholar 

  29. 29.

    Gee A, Troop NA (2003) Shame, depressive symptoms and eating, weight and shape concerns in a non-clinical sample. Eat Weight Disord 8(1):72–75.

    CAS  Article  PubMed  Google Scholar 

  30. 30.

    Murray C, Waller G, Legg C (2000) Family dysfunction and bulimic psychopathology: the mediating role of shame. Int J Eat Disord 28(1):84–89.;2-r

    CAS  Article  PubMed  Google Scholar 

  31. 31.

    Troop NA, Allan S, Serpell L, Treasure JL (2008) Shame in women with a history of eating disorders. Eur Eat Disord Rev 16(6):480–488.

    Article  PubMed  Google Scholar 

  32. 32.

    Benetti-McQuoid J, Bursik K (2005) Individual differences in experiences of and responses to guilt and shame: examining the lenses of gender and gender role. Sex Roles 53(1–2):133–142.

    Article  Google Scholar 

  33. 33.

    Galhardo A, Cunha M, Pinto-Gouveia J, Matos M (2013) The mediator role of emotion regulation processes on infertility-related stress. J Clini Psychol Med Settings 20(4):497–507.

    Article  Google Scholar 

  34. 34.

    Hayes SC, Luoma JB, Bond FW, Masuda A, Lillis J (2006) Acceptance and commitment therapy: model, process and outcomes. Behav Res Therapy 44:1–25.

    Article  Google Scholar 

  35. 35.

    Rawal A, Park RJ, Williams JMG (2010) Rumination, experiential avoidance, and dysfunctional thinking in eating disorders. Behav Res Ther 48(9):851–859.

    Article  PubMed  PubMed Central  Google Scholar 

  36. 36.

    Levin ME, MacLane C, Daflos S, Seeley JR, Hayes SC, Biglan A, Pistorello J (2014) Examining psychological inflexibility as a transdiagnostic process across psychological disorders. J Contextual Behav Sci 3(3):155–163.

    Article  PubMed  PubMed Central  Google Scholar 

  37. 37.

    Ferreira C, Pinto-Gouveia J, Duarte C (2011) The validation of the body image acceptance and action questionnaire: exploring the moderator effect of acceptance on disordered eating. Rev Int Psicol Ter Psicol 11:327–345

    Google Scholar 

  38. 38.

    Sandoz EK, Wilson KG, Merwin RM, Kellum KK (2013) Assessment of body image flexibility: the body image-acceptance and action questionnaire. J Contextual Behav Sci 2(1–2):39–48.

    Article  Google Scholar 

  39. 39.

    Cardoso A, Oliveira S, Ferreira C (2020) Negative and positive affect and disordered eating: the adaptive role of intuitive eating and body image flexibility. Clin Psychol 24(2):176–185.

    Article  Google Scholar 

  40. 40.

    Duarte C, Pinto-Gouveia J (2016) Body image flexibility mediates the effect of body image-related victimization experiences and shame on binge eating and weight. Eat Behav 23:13–18

    Article  Google Scholar 

  41. 41.

    Hill ML, Masuda A, Latzman RD (2013) Body image flexibility as a protective factor against disordered eating behavior for women with lower body mass index. Eat Behav 14(3):336–341.

    Article  PubMed  Google Scholar 

  42. 42.

    Morton C, Mooney TA, Lozano LL, Adams EA, Makriyianis HM, Liss M (2020) Psychological inflexibility moderates the relationship between thin-ideal internalization and disordered eating. Eat Behav 36:101345.

    Article  PubMed  Google Scholar 

  43. 43.

    Wendell JW, Masuda A, Le JK (2012) The role of body image flexibility in the relationship between disordered eating cognitions and disordered eating symptoms among non-clinical college students. Eat Behav 13(3):240–245.

    Article  PubMed  Google Scholar 

  44. 44.

    Duarte C, Pinto-Gouveia J, Ferreira C (2014) Escaping from body image shame and harsh self-criticism: exploration of underlying mechanisms of binge eating. Eat Behav 15(4):638–643.

    Article  PubMed  Google Scholar 

  45. 45.

    Kelly AC, Vimalakanthan K, Miller KE (2014) Self-compassion moderates the relationship between body mass index and both eating disorder pathology and body image flexibility. Body Image 11(4):446–453.

    Article  PubMed  Google Scholar 

  46. 46.

    WHO (1995) Physical status: the use and interpretation of anthropometry. Reports of a 5 WHO Expert Committee. WHO technical report series 854. World Health Organization, Geneva

  47. 47.

    Matos M, Pinto-Gouveia J, Gilbert P, Duarte C, Figueiredo C (2015) The other as Shamer Scale-2: development and validation of a short version of a measure of external shame. Pers Individ Differ 74:6–11.

    Article  Google Scholar 

  48. 48.

    Machado PP, Martins C, Vaz AR, Conceição E, Bastos AP, Gonçalves S (2014) Eating disorder examination questionnaire: psychometric properties and norms for the Portuguese population. Eur Eat Disord Rev 22(6):448–453

    Article  Google Scholar 

  49. 49.

    Fairburn C, Beglin S (1994) Assessment of eating disorders: interview or self-report questionnaire? Int J Eat Disord 16(4):363–370.;2-#

    CAS  Article  PubMed  Google Scholar 

  50. 50.

    Cohen J, Cohen P, West SG, Aiken LS (2003) Applied multiple regression/correlation analysis for the behavioral sciences, 3rd edn. Lawrence Erlbaum Associates Publishers, New Jersey

    Google Scholar 

  51. 51.

    Kline RB (2011) Principles and practice of structural equation modelling, 3rd edn. Guilford Press, New York

    Google Scholar 

  52. 52.

    Arbuckle JL (2013) Amos (Version 22.0) [Computer Program]. SPSS

  53. 53.

    Fitzsimmons-Craft EE (2017) Eating disorder-related social comparison in college women’s everyday lives. Int J Eat Disord 50(8):893–905.

    Article  PubMed  PubMed Central  Google Scholar 

  54. 54.

    Sandoz EK, Wilson KG, Merwin RM, Kellum KK (2013) Assessment of body image acceptance: the body image-acceptance questionnaire. J Context Behav Sci 2(1–2):39–48.

    Article  Google Scholar 

Download references


Research by Ana Laura Mendes is supported by a Ph.D. Grant (SFRH/BD/119286/2016) sponsored by the Portuguese Foundation for Science and Technology (FCT), the Human Capital Operational Programme (POCH), and the European Union (UE).

Author information



Corresponding author

Correspondence to Ana Laura Mendes.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures followed were under the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000.

Informed consent

Informed consent was obtained from all participants for being included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Mendes, A.L., Coimbra, M., Canavarro, M.C. et al. The powerful effect of body image inflexibility on the explanation of eating psychopathology severity. Eat Weight Disord (2021).

Download citation


  • External shame
  • Social comparison
  • Body image inflexibility
  • Eating psychopathology severity
  • Emerging adulthood