Relationships of Attitudes toward Eating and Eating Behaviors with Invalidating Childhood Environment in Adults: The Mediating Role of Self-Compassion, Distress Tolerance, and Impulsivity
-
Farima Rahmati
,
Simin Alipour Marjghal
,
Maryam Aslzaker
,
Fatemeh Rafeie
,
Mohammad Noori
,
Imaneh Abasi
Abstract
Objective: Eating disorders (EDs) are prevalent in adulthood and often originate in adolescence, influenced by various psychological factors, including childhood experiences. This research investigated how self-compassion, distress tolerance, and impulsivity function as mediators between early experiences of emotional invalidation during childhood and individuals’ eating patterns and attitudes in adulthood.
Method: The study involved 1,217 students (86.2% female), recruited through convenience sampling. Participants completed standardized questionnaires assessing eating behaviors, eating attitudes, self-compassion, distress tolerance, and impulsivity. The proposed model was tested using structural equation modeling (SEM).
Results: Impulsivity and self-compassion significantly mediated the relationship between childhood invalidation and both eating behavior (β = 0.161, P < 0.05) and eating attitude (β = 0.077, P < 0.01). Distress tolerance did not serve as a significant mediator in the model. Invalidating childhood environment was directly related to impulsivity (β = 0.303, P < 0.001) and self-compassion (β = -0.350, P < 0.001). Self-compassion and impulsivity were significant predictors of eating behavior and attitudes.
Conclusion: Childhood experiences of invalidation contribute to maladaptive eating behaviors and attitudes through the mediating roles of impulsivity and self-compassion. Notably, impulsivity had a stronger indirect effect on both outcomes compared to self-compassion. The results indicate that fostering self-compassion and managing impulsive tendencies may serve as important focal points for interventions designed to prevent or treat eating disorders.
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2. Regier DA, Kuhl EA, Kupfer DJ. The DSM-5: Classification and criteria changes. World Psychiatry. 2013;12(2):92-8.
3. Qian J, Wu Y, Liu F, Zhu Y, Jin H, Zhang H, et al. An update on the prevalence of eating disorders in the general population: a systematic review and meta-analysis. Eat Weight Disord. 2022;27(2):415-28.
4. Sander J, Moessner M, Bauer S. Depression, Anxiety and Eating Disorder-Related Impairment: Moderators in Female Adolescents and Young Adults. Int J Environ Res Public Health. 2021;18(5):2779.
5. Barakat S, McLean SA, Bryant E, Le A, Marks P, Touyz S, et al. Risk factors for eating disorders: findings from a rapid review. J Eat Disord. 2023;11(1):8.
6. Day S, Hay P, Tannous WK, Fatt SJ, Mitchison D. A Systematic Review of the Effect of PTSD and Trauma on Treatment Outcomes for Eating Disorders. Trauma Violence Abuse. 2024;25(2):947-64.
7. Ivanova V. Family Dynamics in Psychotherapy in Adolescents with Anorexia. The Global Psychotherapist. 2021;1(1):34-8.
8. Day S, Bussey K, Trompeter N, Hay P, Lonergan A, Mitchison D. Associations of weight- or shape-related bullying with diverse disordered eating behaviors in adolescents. Int J Eat Disord. 2021;54(9):1641-51.
9. Pastore M, Indrio F, Bali D, Vural M, Giardino I, Pettoello-Mantovani M. Alarming Increase of Eating Disorders in Children and Adolescents. J Pediatr. 2023;263:113733.
10. Hanras E, Boujut E, Ruffault A, Messager D, Rives-Lange C, Barsamian C, et al. Vegetarianism and weight status: What are the differences in eating styles, impulsivity, and emotional competences? A preliminary study. Obes Res Clin Pract. 2022;16(4):288-94.
11. Leppanen J, Brown D, McLinden H, Williams S, Tchanturia K. The Role of Emotion Regulation in Eating Disorders: A Network Meta-Analysis Approach. Front Psychiatry. 2022;13:793094.
12. Lie S, Bulik CM, Andreassen OA, Rø Ø, Bang L. Stressful life events among individuals with a history of eating disorders: a case-control comparison. BMC Psychiatry. 2021;21(1):501.
13. Mountford V, Corstorphine E, Tomlinson S, Waller G. Development of a measure to assess invalidating childhood environments in the eating disorders. Eat Behav. 2007;8(1):48-58.
14. Perlstein S, Waller R, Wagner NJ, Saudino KJ. Low social affiliation predicts increases in callous‐unemotional behaviors in early childhood. J Child Psychol Psychiatry. 2022;63(1):109-17.
15. Cerniglia L, Cimino S, Tafà M, Marzilli E, Ballarotto G, Bracaglia F. Family profiles in eating disorders: family functioning and psychopathology. Psychol Res Behav Manag. 2017;10:305-12.
16. Bluth K, Lathren C, Park J. Self-compassion as a protective factor for adolescents experiencing adversity. Post-Traumatic Growth to Psychological Well-Being: Coping Wisely with Adversity: Springer; 2022. p. 111-26.
17. Ewert C, Vater A, Schröder-Abé M. Self-compassion and coping: A meta-analysis. Mindfulness. 2021;12:1063-77.
18. Linardon J. Positive body image, intuitive eating, and self-compassion protect against the onset of the core symptoms of eating disorders: A prospective study. Int J Eat Disord. 2021;54(11):1967-77.
19. Wisener M, Khoury B. Which emotion-regulation strategies explain the relationship between dispositional mindfulness, self-compassion, and eating to cope? Appetite. 2022;172:105912.
20. Boswell RG, Grilo CM. General impulsivity in binge-eating disorder. CNS Spectr. 2021;26(5):538-44.
21. Jeffries ER, McLeish AC, Kraemer KM, Avallone KM, Fleming JB. The Role of Distress Tolerance in the Use of Specific Emotion Regulation Strategies. Behav Modif. 2016;40(3):439-51.
22. Corstorphine E, Mountford V, Tomlinson S, Waller G, Meyer C. Distress tolerance in the eating disorders. Eat Behav. 2007;8(1):91-7.
23. Leys C, Kotsou I, Goemanne M, Fossion P. The influence of family dynamics on eating disorders and their consequence on resilience: a mediation model. Am J Fam Ther. 2017;45(2):123-32.
24. Ferreira C, Dias B, Oliveira S. Behind women's body image-focused shame: Exploring the role of fears of compassion and self-criticism. Eat Behav. 2019;32:12-7.
25. Schreiber LR, Grant JE, Odlaug BL. Emotion regulation and impulsivity in young adults. J Psychiatr Res. 2012;46(5):651-8.
26. Chung A, Vieira D, Donley T, Tan N, Jean-Louis G, Kiely Gouley K, et al. Adolescent Peer Influence on Eating Behaviors via Social Media: Scoping Review. J Med Internet Res. 2021;23(6):e19697.
27. Qian J, Hu Q, Wan Y, Li T, Wu M, Ren Z, et al. Prevalence of eating disorders in the general population: a systematic review. Shanghai Arch Psychiatry. 2013;25(4):212-23.
28. World Medical Association Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Participants. Jama. 2025;333(1):71-4.
29. Simons JS, Gaher RM. The Distress Tolerance Scale: Development and validation of a self-report measure. Motivation and emotion. 2005;29(2):83-102.
30. Mahmoudpour A, Shariatmadar A, Borjali A, Shafiabadi A. Psychometric Properties of the Distress Tolerance Scale (DTS) in the Elderly. Quarterly of Educational Measurement. 2021;12(46):49-64.
31. Vasconcelos AG, Malloy-Diniz L, Correa H. Systematic review of psychometric proprieties of Barratt Impulsiveness Scale Version 11 (BIS-11). Clin Neuropsychiatry. 2012;9(2).
32. Stanford MS, Mathias CW, Dougherty DM, Lake SL, Anderson NE, Patton JH. Fifty years of the Barratt Impulsiveness Scale: An update and review. Pers Individ Dif. 2009;47(5):385-95.
33. Javid M, Mohammadi N, Rahimi C. Psychometric properties of an Iranian version of the Barratt Impulsiveness Scale-11 (BIS-11). Psychological Models and Methods. 2012;2(8):23-34.
34. Neff KD. The development and validation of a scale to measure self-compassion. Self and identity. 2003;2(3):223-50.
35. Azizi A, Mohammadkhani P, Lotfi S, Bahramkhani M. The validity and reliability of the Iranian version of the Self-Compassion Scale. Practice in Clinical Psychology. 2013;1(3):149-55.
36. Van Strien T, Frijters JE, Bergers GP, Defares PB. The Dutch Eating Behavior Questionnaire (DEBQ) for assessment of restrained, emotional, and external eating behavior. Int J Eat Disord. 1986;5(2):295-315.
37. Doostfatemeh M, Haem E, Sarbaraninan M, Ajdari Tafti M. Multidimensional item Response theory to assess the psychometric properties of persian version of dutch eating behavior questionnaire (DEBQ) in university students. Curr Psychol. 2023;42(16):13400-10.
38. Garner DM, Olmsted MP, Bohr Y, Garfinkel PE. The eating attitudes test: psychometric features and clinical correlates. Psychol Med. 1982;12(4):871-8.
39. Asl EM, Mahaki B, Bardezard YA, Mohammadian Y. Eating Disorders Screening Tools: The Psychometric Properties of the Persian version of Eating Attitude Test. Int J Prev Med. 2021;12:122.
40. Hu Lt, Bentler PM. Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural equation modeling: a multidisciplinary journal. 1999;6(1):1-55.
41. Gkintoni E, Kourkoutas E, Vassilopoulos SP, Mousi M. Clinical Intervention Strategies and Family Dynamics in Adolescent Eating Disorders: A Scoping Review for Enhancing Early Detection and Outcomes. J Clin Med. 2024;13(14):4084.
42. Zheng J, Huang L, Li S, Lajoie SP, Chen Y, Hmelo-Silver CE. Self-regulation and emotion matter: A case study of instructor interactions with a learning analytics dashboard. Computers & Education. 2021;161:104061.
43. Pullmer R, Zaitsoff SL, Coelho JS. Self-compassion and eating pathology in female adolescents with eating disorders: The mediating role of psychological distress. Mindfulness. 2019;10:2716-23.
44. Haslam M, Arcelus J, Farrow C, Meyer C. Attitudes towards emotional expression mediate the relationship between childhood invalidation and adult eating concern. Eur Eat Disord Rev. 2012;20(6):510-4.
2. Regier DA, Kuhl EA, Kupfer DJ. The DSM-5: Classification and criteria changes. World Psychiatry. 2013;12(2):92-8.
3. Qian J, Wu Y, Liu F, Zhu Y, Jin H, Zhang H, et al. An update on the prevalence of eating disorders in the general population: a systematic review and meta-analysis. Eat Weight Disord. 2022;27(2):415-28.
4. Sander J, Moessner M, Bauer S. Depression, Anxiety and Eating Disorder-Related Impairment: Moderators in Female Adolescents and Young Adults. Int J Environ Res Public Health. 2021;18(5):2779.
5. Barakat S, McLean SA, Bryant E, Le A, Marks P, Touyz S, et al. Risk factors for eating disorders: findings from a rapid review. J Eat Disord. 2023;11(1):8.
6. Day S, Hay P, Tannous WK, Fatt SJ, Mitchison D. A Systematic Review of the Effect of PTSD and Trauma on Treatment Outcomes for Eating Disorders. Trauma Violence Abuse. 2024;25(2):947-64.
7. Ivanova V. Family Dynamics in Psychotherapy in Adolescents with Anorexia. The Global Psychotherapist. 2021;1(1):34-8.
8. Day S, Bussey K, Trompeter N, Hay P, Lonergan A, Mitchison D. Associations of weight- or shape-related bullying with diverse disordered eating behaviors in adolescents. Int J Eat Disord. 2021;54(9):1641-51.
9. Pastore M, Indrio F, Bali D, Vural M, Giardino I, Pettoello-Mantovani M. Alarming Increase of Eating Disorders in Children and Adolescents. J Pediatr. 2023;263:113733.
10. Hanras E, Boujut E, Ruffault A, Messager D, Rives-Lange C, Barsamian C, et al. Vegetarianism and weight status: What are the differences in eating styles, impulsivity, and emotional competences? A preliminary study. Obes Res Clin Pract. 2022;16(4):288-94.
11. Leppanen J, Brown D, McLinden H, Williams S, Tchanturia K. The Role of Emotion Regulation in Eating Disorders: A Network Meta-Analysis Approach. Front Psychiatry. 2022;13:793094.
12. Lie S, Bulik CM, Andreassen OA, Rø Ø, Bang L. Stressful life events among individuals with a history of eating disorders: a case-control comparison. BMC Psychiatry. 2021;21(1):501.
13. Mountford V, Corstorphine E, Tomlinson S, Waller G. Development of a measure to assess invalidating childhood environments in the eating disorders. Eat Behav. 2007;8(1):48-58.
14. Perlstein S, Waller R, Wagner NJ, Saudino KJ. Low social affiliation predicts increases in callous‐unemotional behaviors in early childhood. J Child Psychol Psychiatry. 2022;63(1):109-17.
15. Cerniglia L, Cimino S, Tafà M, Marzilli E, Ballarotto G, Bracaglia F. Family profiles in eating disorders: family functioning and psychopathology. Psychol Res Behav Manag. 2017;10:305-12.
16. Bluth K, Lathren C, Park J. Self-compassion as a protective factor for adolescents experiencing adversity. Post-Traumatic Growth to Psychological Well-Being: Coping Wisely with Adversity: Springer; 2022. p. 111-26.
17. Ewert C, Vater A, Schröder-Abé M. Self-compassion and coping: A meta-analysis. Mindfulness. 2021;12:1063-77.
18. Linardon J. Positive body image, intuitive eating, and self-compassion protect against the onset of the core symptoms of eating disorders: A prospective study. Int J Eat Disord. 2021;54(11):1967-77.
19. Wisener M, Khoury B. Which emotion-regulation strategies explain the relationship between dispositional mindfulness, self-compassion, and eating to cope? Appetite. 2022;172:105912.
20. Boswell RG, Grilo CM. General impulsivity in binge-eating disorder. CNS Spectr. 2021;26(5):538-44.
21. Jeffries ER, McLeish AC, Kraemer KM, Avallone KM, Fleming JB. The Role of Distress Tolerance in the Use of Specific Emotion Regulation Strategies. Behav Modif. 2016;40(3):439-51.
22. Corstorphine E, Mountford V, Tomlinson S, Waller G, Meyer C. Distress tolerance in the eating disorders. Eat Behav. 2007;8(1):91-7.
23. Leys C, Kotsou I, Goemanne M, Fossion P. The influence of family dynamics on eating disorders and their consequence on resilience: a mediation model. Am J Fam Ther. 2017;45(2):123-32.
24. Ferreira C, Dias B, Oliveira S. Behind women's body image-focused shame: Exploring the role of fears of compassion and self-criticism. Eat Behav. 2019;32:12-7.
25. Schreiber LR, Grant JE, Odlaug BL. Emotion regulation and impulsivity in young adults. J Psychiatr Res. 2012;46(5):651-8.
26. Chung A, Vieira D, Donley T, Tan N, Jean-Louis G, Kiely Gouley K, et al. Adolescent Peer Influence on Eating Behaviors via Social Media: Scoping Review. J Med Internet Res. 2021;23(6):e19697.
27. Qian J, Hu Q, Wan Y, Li T, Wu M, Ren Z, et al. Prevalence of eating disorders in the general population: a systematic review. Shanghai Arch Psychiatry. 2013;25(4):212-23.
28. World Medical Association Declaration of Helsinki: Ethical Principles for Medical Research Involving Human Participants. Jama. 2025;333(1):71-4.
29. Simons JS, Gaher RM. The Distress Tolerance Scale: Development and validation of a self-report measure. Motivation and emotion. 2005;29(2):83-102.
30. Mahmoudpour A, Shariatmadar A, Borjali A, Shafiabadi A. Psychometric Properties of the Distress Tolerance Scale (DTS) in the Elderly. Quarterly of Educational Measurement. 2021;12(46):49-64.
31. Vasconcelos AG, Malloy-Diniz L, Correa H. Systematic review of psychometric proprieties of Barratt Impulsiveness Scale Version 11 (BIS-11). Clin Neuropsychiatry. 2012;9(2).
32. Stanford MS, Mathias CW, Dougherty DM, Lake SL, Anderson NE, Patton JH. Fifty years of the Barratt Impulsiveness Scale: An update and review. Pers Individ Dif. 2009;47(5):385-95.
33. Javid M, Mohammadi N, Rahimi C. Psychometric properties of an Iranian version of the Barratt Impulsiveness Scale-11 (BIS-11). Psychological Models and Methods. 2012;2(8):23-34.
34. Neff KD. The development and validation of a scale to measure self-compassion. Self and identity. 2003;2(3):223-50.
35. Azizi A, Mohammadkhani P, Lotfi S, Bahramkhani M. The validity and reliability of the Iranian version of the Self-Compassion Scale. Practice in Clinical Psychology. 2013;1(3):149-55.
36. Van Strien T, Frijters JE, Bergers GP, Defares PB. The Dutch Eating Behavior Questionnaire (DEBQ) for assessment of restrained, emotional, and external eating behavior. Int J Eat Disord. 1986;5(2):295-315.
37. Doostfatemeh M, Haem E, Sarbaraninan M, Ajdari Tafti M. Multidimensional item Response theory to assess the psychometric properties of persian version of dutch eating behavior questionnaire (DEBQ) in university students. Curr Psychol. 2023;42(16):13400-10.
38. Garner DM, Olmsted MP, Bohr Y, Garfinkel PE. The eating attitudes test: psychometric features and clinical correlates. Psychol Med. 1982;12(4):871-8.
39. Asl EM, Mahaki B, Bardezard YA, Mohammadian Y. Eating Disorders Screening Tools: The Psychometric Properties of the Persian version of Eating Attitude Test. Int J Prev Med. 2021;12:122.
40. Hu Lt, Bentler PM. Cutoff criteria for fit indexes in covariance structure analysis: Conventional criteria versus new alternatives. Structural equation modeling: a multidisciplinary journal. 1999;6(1):1-55.
41. Gkintoni E, Kourkoutas E, Vassilopoulos SP, Mousi M. Clinical Intervention Strategies and Family Dynamics in Adolescent Eating Disorders: A Scoping Review for Enhancing Early Detection and Outcomes. J Clin Med. 2024;13(14):4084.
42. Zheng J, Huang L, Li S, Lajoie SP, Chen Y, Hmelo-Silver CE. Self-regulation and emotion matter: A case study of instructor interactions with a learning analytics dashboard. Computers & Education. 2021;161:104061.
43. Pullmer R, Zaitsoff SL, Coelho JS. Self-compassion and eating pathology in female adolescents with eating disorders: The mediating role of psychological distress. Mindfulness. 2019;10:2716-23.
44. Haslam M, Arcelus J, Farrow C, Meyer C. Attitudes towards emotional expression mediate the relationship between childhood invalidation and adult eating concern. Eur Eat Disord Rev. 2012;20(6):510-4.
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| Childhood Invalidation Eating Behaviors Impulsivity Mediation Self-Compassion | ||
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How to Cite
1.
Rahmati F, Alipour Marjghal S, Aslzaker M, Rafeie F, Noori M, Abasi I. Relationships of Attitudes toward Eating and Eating Behaviors with Invalidating Childhood Environment in Adults: The Mediating Role of Self-Compassion, Distress Tolerance, and Impulsivity. Iran J Psychiatry. 2025;:1-11.
