An Update On The Underlying Risk Factors of Eating Disorders Onset During Adolescence A Systematic Review

TYPE Systematic Review
PUBLISHED 08 November 2023

DOI 10.3389/fpsyg.2023.1221679
An update on the underlying risk

OPEN ACCESS factors of eating disorders onset
during adolescence: a systematic
EDITED BY
Nicholas T. Bello,
Rutgers, The State University of New Jersey,
United States
REVIEWED BY
review
Gemma Sharp,
Monash University, Australia
Arlette Setiawan,
Carmen Varela 1,2,3*, Ángela Hoyo 3, María Eugenia Tapia-Sanz 3,
Padjadjaran University, Indonesia Ana Isabel Jiménez-González 3, Benito Javier Moral 3,
*CORRESPONDENCE Paula Rodríguez-Fernández 4, Yadirnaci Vargas-Hernández 4 and
Carmen Varela
[email protected] Luis Jorge Ruiz-Sánchez 3
RECEIVED 12May 2023 1
Universitat de Barcelona, Barcelona, Spain, 2 Departamento de Ciencias de la Salud, Facultad de
ACCEPTED 16 October 2023 Ciencias de la Salud, Universidad de Burgos, Burgos, Spain, 3 Área de Psicología, Facultad de Ciencias de
PUBLISHED 08 November 2023 la Salud, Universidad Isabel I, Burgos, Spain, 4 Facultad de Humanidades y Ciencias Sociales, Universidad
CITATION
Isabel I, Burgos, Spain
Varela C, Hoyo Á, Tapia-Sanz ME,
Jiménez-González AI, Moral BJ,
Rodríguez-Fernández P, Introduction: Eating disorders (EDs) are serious psychological problems that
Vargas-Hernández Y and affect not only the individual, but also their entire environment. The prevalence
Ruiz-Sánchez LJ (2023) An update on the
underlying risk factors of eating disorders onset
rates of EDs are higher among the adolescent population. A better understanding
during adolescence: a systematic review. of ED risk factors is essential to design effective prevention and intervention
Front. Psychol. 14:1221679. programs that focus beyond the areas of weight and appearance.
doi: 10.3389/fpsyg.2023.1221679
Methods: The main objective of this systematic review was to identify the risk
COPYRIGHT
© 2023 Varela, Hoyo, Tapia-Sanz, factors of EDs and provide a comprehensive approach, analyzing the interplay
Jiménez-González, Moral, Rodríguez- between individuals, their inner circle, and the society characteristics. The Web of
Fernández, Vargas-Hernández and Ruiz- Science, Scopus, CENTRAL and PsycInfo databases were searched.
Sánchez. This is an open-access article
distributed under the terms of the Creative Results: The initial search produced 8,178 references. After removing duplicates
Commons Attribution License (CC BY). The and performing the selection process by three independent reviewers, 42 articles
use, distribution or reproduction in other
forums is permitted, provided the original were included in the systematic review according to the pre-specified inclusion
author(s) and the copyright owner(s) are criteria. The results suggest the relevance of society and the inner circle on the
credited and that the original publication in this development of EDs.
journal is cited, in accordance with accepted
academic practice. No use, distribution or Discussion: The internalization of the thin ideal, promoted by the current society,
reproduction is permitted which does not
and living in an unsupportive, unaffectionate, non-cohesive environment were
comply with these terms.
associated with the onset of EDs symptomatology. Other associated variables
with this ED indicator were poor-quality relationships and feeling judged about
appearance. These aspects seem to be essential for the development of individual
characteristics like self-esteem or adaptative coping during adolescence. This
systematic review has shown the complex etiology of EDs and the relevance of
the interplay between the different areas involved. Furthermore, this information
could be relevant to improve the design of innovative and more effective
prevention and intervention programs.
Systematic review registration: PROSPERO, identifier CRD42022320881.
KEYWORDS
eating disorders, adolescence, prevention, risk factors, protective factors
Frontiers in Psychology 01 frontiersin.org

Varela et al. 10.3389/fpsyg.2023.1221679
1. Introduction with eating disorder symptomatology in adolescents (Suarez-Albor

et al., 2022). Factors that have shown such an association include
Eating disorders (EDs) are psychological conditions characterized body dissatisfaction, (e.g., Fortes et al., 2013; Lazo et al., 2015;
by specific and severe disturbances in eating behavior, resulting from Gismero-González, 2020), social difficulties, poor to no support
distressing thoughts and emotions mainly related to weight, body network (Cardi et al., 2018), tendency toward perfectionism
shape. However, some EDs like avoidant/restrictive food intake (Pamies and Quiles, 2014; Laporta et al., 2020), impulsivity (Nuño-
disorder (ARFID) or Binge Eating Disorder (BED) are more focused Gutiérrez et al., 2009), low self-esteem in relation to weight and
on aspects like food or intake (López and Treasure, 2002; Gaete and image (Fairburn et al., 2003; Serpell and Troop, 2003), emotional
López, 2020). These are serious and potentially life-threatening dysregulation (Monell et al., 2018), and family environment
disorders that can affect people’s emotional and physical health as well (Cerniglia et al., 2017). Despite this evidence, there have been no
as their social functioning (O’Brien et al., 2017; Gaete and López, systematic reviews published in recent years that have specifically
2020). Types of eating disorders include anorexia nervosa (AN), identified the psychological risk factors that may predict the onset
bulimia nervosa (BN), BED, ARFID, and other specified feeding, and of EDs in adolescents. Stating the art of this question is essential to
eating disorder (OSFED; American Psychiatry Association, 2013). design prevention and intervention programs that effectively
The prevalence of EDs is variable and complex due to changes in address the right psychological targets (Stice et al., 2021). The focus
diagnostic criteria and differences between geographical regions. In on psychological factors is due to improvements in psychological
the last decade, different reviews (Smink et al., 2012; López, 2017) interventions and current eating disorder prevention programs. For
have shown that the countries with the highest prevalence of EDs are that reason, biological and genetic factors have not been included
Switzerland (12%), Chile (8.3%), and Spain (6.2%), followed by in this systematic review, although their knowledge is relevant to
Colombia (4.5%), the United Kingdom (3.7%), and Portugal (3.1%; provide a comprehensive approach. A multidisciplinary team must
López, 2017). In countries such as the United States, EDs lifetime be involved in the development of future proposals Therefore, the
prevalence varies between 0.5 and 1.5% (Smink et al., 2012). aim of the present study is to conduct a systematic review to provide
Prevalence also varies between different age and gender groups, but a a comprehensive and updated view of the psychological risk factors
common feature is that EDs are more frequent in women than in men, that predict the onset of EDs in adolescents. This information could
in all countries and at all ages. Concretely, one study showed that the be useful to design innovative prevention and intervention
weighted means of lifetime EDs were 2.2% for men and 8.4% for programs for adolescent population, highlighting areas beyond
women (Galmiche et al., 2019). Moreover, EDs usually begin in weight and appearance.
adolescence, a time when major psychological changes related to
identity and physical appearance, as well as the development of self-
regulation, occur (Smink et al., 2012; Galmiche et al., 2019; Stice 2. Methods
et al., 2021).
Considering the above-described evidence, it is not surprising A systematic review of the literature was conducted. The
that the World Health Organization (WHO) has considered EDs as a international prospective register for systematic reviews (PROSPERO)
priority problem among adolescents, given the health risk that these accepted the protocol of this systematic review on 3rd June 2022,
disorders imply, and the high rate of comorbidity with other types of registration number CRD42022320881. This systematic review follows
disorders (Gibson et al., 2019; Stice et al., 2021). Some of the disorders the guideline of Preferred Reporting Items for Systematic Reviews and
that show the highest comorbidity in adolescents are the following: Meta-Analyses (PRISMA) (Page et al., 2021).
depression, anxiety, and obsessive-compulsive disorder (Gaete and
López, 2020; Hambleton et al., 2022). They are also associated with
personality disorders, substance abuse, and self-harming behaviors 2.1. Eligibility criteria
(Hambleton et al., 2022). Finally, there is also a high association
between EDs and suicidal behavior in adolescents (Gibson et al., Adapted for a systematic review of association, the Population,
2019). In this regard, during the pandemic a study showed that 65% Intervention, Comparator, Outcome and Study (PICOS) framework
of female adolescents with EDs had suicidal ideation and 45% had was used to establish the eligibility criteria of this study (Higgins and
attempted suicide. Although the quarantine situation could increase Green, 2008; Moola et al., 2015). As a result, the following inclusion
suicide rates, there is a significant association between suicidal criteria’s were: (a) population: adolescents between 11 and 19 years
thoughts and behaviors and EDs (Semenova et al., 2022). This makes old; (b) exposure variables: psychological risk variables related to the
EDs one of the disorders that require further research in the field of onset of an ED (i.e., impulsivity, emotional dysregulation, social
prevention and intervention in adolescence, especially given that the network exposure, perfectionism, self-demand, self-esteem,
current intervention programs have shown mixed efficacy (Pratt and interpersonal relationships -social anxiety or social skills-, fear of
Woolfenden, 2002; Swanson et al., 2011; Fairburn et al., 2015; Stice maturing, low social or family support, and expressed emotion); (c)
et al., 2021). outcome: presence of ED symptomatology assessed by self-report or
Understanding the risk factors involved in the onset of EDs is standardized/validated tools; and (d) type of study: observational
essential for the development of effective prevention and early studies that establish an association between exposure variables and
intervention programs. Research has shown that a variety of risk outcome. Thus, adolescents who did not fall within the defined age
factors may be involved, such as biological, psychological, familiar, range were excluded, as well as comorbidity with other serious
and socio-cultural factors (Stice, 2016; Solmi et al., 2020; Barakat physical or psychological problems, editorials, and conference
et al., 2023), with psychological-type factors being most associated abstracts. Table 1 shows the criteria for considering studies.

TABLE 1 Eligibility criteria to select studies for the systematic review.
Eligibility criteria
Population Adolescents between 11 and 19 years old
Exposure variables* Psychological risk variables related to the onset of an ED (i.e., impulsivity, emotional dysregulation, social network exposure, perfectionism, self-
demand, self-esteem, interpersonal relationships -social anxiety or social skills-, fear of maturing, low social or family support, and expressed
emotion)
Outcome Presence of ED symptomatology assessed by self-report or standardized/validated tools
Study Observational studies that establish an association between exposure variables and outcome
*The PICOS framework is adapted for association systematic reviews. In this case there is no comparison (C), and the intervention (I) is replaced by Exposure Variables.
2.2. Information sources Cochrane, Quality in Prognosis Studies (QUIPS; Grooten et al., 2019).
To specifically analyze the risk of bias, six main domains were
The search was carried out using the electronic databases Web evaluated: (i) study participation; (ii) study attrition; (iii) prognostic
of Science (WoS), Scopus, Cochrane Central Register of factor measurement; (iv) outcome measurement; (v) study
Controlled Trials (CENTRAL) and PsycInfo. The search was confounding; and (vi) statistical analysis and reporting.
closed on 23rd November 2021. An update of the search was Several descriptors are presented in each domain, which were
conducted on the 4th of October 2023.There were no limits ranked on a three-point scale (high, medium, or low level of risk),
regarding the publication year. The only limitation imposed on according to the tool specification, assess the risk of potential bias in
the search was the language, including only documents in English the results (Grooten et al., 2019).
or Spanish.
3. Results
2.3. Search strategy
The initial number of identified articles was 8,700, including the
In consideration of the format of each database, the following initial search and the update. After removing duplicates, 5,455
keywords in English were used in combination with the Boolean logic studies were screened by three independent reviewers and 101 were
operators: (“eating disorders” OR “anorexia” OR “bulimia” OR “binge selected for full-text screening. Finally, 47 studies met the
eating” OR “binge eating disorder” OR “unspecified eating disorder”) pre-specified criteria and were included in the systematic review
AND (impuls* OR “emotional dysregulation” OR “social media (Figure 1).
exposure” OR “social media misuse” OR “social media use” OR
“perfecctio*” OR “self-demand” OR “self-esteem” OR “social support”
OR “maturity fear*” OR “expressed emotion”) AND (“high school” 3.1. Descriptive data
OR adoles* OR teen*).
A total of 47 studies were finally included in this systematic review
after meeting the pre-specified inclusion criteria. These articles were
2.4. Data extraction and coding conducted from 1996 to 2023 to cover the widest possible range and
provide in-depth analysis of eating disorder predictors. The total
All identified documents were imported into Rayyan, a research sample comprised 41,115 teenagers, mean age = 14.9 years and ranged
tool designed to work with systematic reviews, to eliminate from 11 to 19 years. Most of the sample were women, 17 studies
duplicates. The screening process was performed by three presented 100% women, 18 studies ≥50% women, 11 studies <50%
independent reviewers, and disagreements were solved by women and only 1 study 100% men.
discussion. If consensus was not achieved, the reviewer with the The studies were carried out in the United States (n = 6), Australia
most experience in the area made the final decision. Data extraction (n = 4), Spain (n = 5), Italy (n = 3); China, Iran, Belgium, Portugal,
was conducted by the same independent reviewers. The extracted Brazil, Mexico, United Kingdom, Greece, Cyprus (each country, n = 2);
information includes the following: (a) study identification: Chile, Germany, Israel, Canada, Thailand, New Zealand, Malaysia,
authorship, year, and country; (b) characteristics of the participants: Netherlands, India, Bosnia Herzegovina and Turkey (each country,
sample size, gender and age; (c) characteristics of the exposure n = 1). Almost 70% of the studies (n = 33) were carried out in countries
variables mentioned above, types and measuring instrument; (d) considered Western Societies. However, the risk factors identified in
characteristics of the outcome variable: measuring instrument e) the included studies did not present relevant differences in terms of
characteristics of statistical analysis: type and results. country or culture. All studies had a cross-sectional design except for
eight longitudinal studies (Shomaker and Furman, 2009; Bachar et al.,
2010; Boone et al., 2014; Dakanalis et al., 2014; Wade et al., 2015; Pace
2.5. Quality and risk of bias assessment et al., 2018; Evans et al., 2019; Beckers et al., 2023). Most of the studies
used regression and structured equation modeling analysis. The
The methodological quality of the selected articles was assessed by number of participants selected in longitudinal studies were indicated
four independent reviewers using the tool recommended by by the authors to carry out the statistical analysis indicated in Table 2.

FIGURE 1
Flow diagram of study selection.
3.2. Risk of bias assessment associations between this variable and negative eating behaviors (Shroff
and Thompson, 2006; Baylan et al., 2009; Rodgers et al., 2014; Garrusi
Table 3 presents results of the estimated risk of bias for each et al., 2016; Kaewpradub et al., 2017; Argydes et al., 2020; Pamies-Aubalat
study using QUIPS tool. Further analysis provides the frequency et al., 2022).
of the six assessed domains and (percentages were presented for A total of 12 studies showed self-esteem as a predictive factor with
each label; see Table 4). Most included studies showed low risk for a direct influence on EDs symptomatology. Adolescents with lower self-
all domains, except for the confounding variables, where the esteem scores were more likely to develop disordered eating behaviors
majority presented medium risk. Not all relevant potential variables (McCabe and Vincent, 2003; Altamirano et al., 2011; Gomes et al., 2015;
were considered in the study design or were not reported by Teixeira et al., 2016; Gan et al., 2018; Rosewall et al., 2018; Jones et al.,
the authors. 2020; Zamani et al., 2020; Cella et al., 2021; Mora et al., 2022; Beckers
et al., 2023; Ćorić et al., 2023). In two studies analyzing the role of
gender, self-esteem was a strong predictor of the onset EDs
3.3. Synthesis of primary outcomes symptomatology in both women and men (McCabe and Vincent, 2003;
Cella et al., 2021).
3.3.1. Individual variables Some studies found an interaction between self-esteem and
different body attitudes. For example, Cella et al. (2021) observed that
3.3.1.1. Self-esteem negative body feelings and body protection mediate the association
Traditionally, low self-esteem has been associated with a greater between self-esteem and binge eating symptoms for both genders. Two
likelihood of ED symptoms, particularly in adolescents. more studies found the same effect regarding body shame (Iannaccone
Almost half of the included studies, concretely 24, have analyzed this et al., 2016) and body dissatisfaction (Fortes et al., 2016). Thus,
variable and its relationship with disordered eating. Generally, low self- presenting negative body attitudes is related with low self-esteem scores
esteem has been identified as a predictive factor of the onset of EDs and, consequently, a greater presence of disordered eating behaviors
symptomatology. However, seven studies did not find significant during adolescence.

TABLE 2 Summary table of the included studies.
Frontiers in Psychology
Varela et al.
Author, year, Age (M, Female Outcome Statistical
N Exposure variables Results Conclusions
and country SD/Range) (%) variables analysis
Females High Risk Eating Disorder: Higher Body dissatisfaction (OR = 2.0, 95%CI
[1.3–3.0], p < 0.001) and Self-esteem (OR = 1.2, 95%CI [1.2–1.3], p < 0.001) than
Body dissatisfaction and low Self-esteem
Altamirano et al. (2011) 16.3 (1.0) - Self-esteem Scale Logistic multinomial females with no risk of eating disorder.
1982 100 BQREB were predictive factors of the onset of
Mexico 15–19 - Figure Rating Scale Regression Females Moderate Risk Eating Disorder: Higher Body dissatisfaction (OR = 1.8, 95%CI
eating disorders for female teenagers.
[1.5–2.2], p < 0.001) and Self-esteem (OR = 1.1, 95%CI [1.1–1.2], p < 0.001) than
females with no risk of eating disorder.
Female Models
Overweight Preoccupation → EAT-26 (R2 = 0.33, β = 0.32, p < 0.001); Body
Appreciation → EAT-26 (R2 = 0.46, β = −0.35, p < 0.001); Body Dysphoria → EAT-26 The findings emphasized the role of
- MBSRQ-AS (R2 = 0.50, β = 0.17, p < 0.001); Media Influence → EAT-26 (R2 = 0.51, β = 0.12, weight/ appearance-related anxiety and
Argydes et al. (2020) 15.2(1.2) - RSES Stepwisemultiple p < 0.001) situational body image dysphoria as the
2,605 59.2 EAT-26
Cyprus 13–16 - SATAQ-3 regression analyses Male Models most significant risk factors in the
- BAS-21 Overweight Preoccupation → EAT-26 (R2 = 0.40, β = 0.10, p < 0.001);Body development of eating disorders in both
Appreciation → EAT-26 (R2 = 0.35, β = −0.51, p < 0.001); Body Dysphoria → EAT-26 male and female adolescents.
(R2 = 0.39, β = 0.11, p < 0.001); Body Satisfaction → EAT −26 (R2 = 0.41, β = −0.06,
p < 0.05); Media Influence → EAT-26 (R2 = 0.41, β = 0.09, p < 0.01)
Students who substantially increased

their scores for EAT-26 from 7th grade
Bachar et al. (2010). 16.1 (0.52) - Selflessness Scale Hierarchical Selflessness at 7th grade → EAT-26 at 10th grade (R2 = 0.05, p < 0.001) to 10th grade, also presented higher
114 100 EAT-26
Israel 15–16 - MPS regression analysis EAT-26 at 7th grade → EAT-26 at 10th grade (R2 = 0.36, p < 0.001) scores for Selflessness at 10th grade.
Perfectionism did not find to predict any
05
eating behaviors.
YSR Anxiety was a predictor of negative eating behaviors (b = 0.30, p = 0.04). Gender
Multivariate Elevated anxiety levels were a risk factor
Bacopoulou et al. (2017) moderates the relationship between YSR anxiety and eating behaviors (b = 0.59,
90 14.0 (1.8) 73.3 YSR EAT-26 Linear regression for disordered behaviors, especially
Greece p = 0.01). This effect held true for bulimia subscale (b = 0.20, p = 0.03) but not for the
analysis bulimic symptomatology in girls.
other subscales diet and oral control.
BITE Model, the variables presented significant associations were:

Obsessive Compulsive Subscale (R2 = 0.12, F = 153.05, β = 0.341, p < 0.000); Depression The predictors of anorectic and bulimic
- BDI
(R2 = 0.13, F = 23.98, β = 0.162, p < 0.000); Affective Involvement (FAD) (R2 = 0.16, symptoms were similar (obsessive
- RSES
F = 12.87, β = 0.104, p < 0.000) EAT Model, the variables presented significant compulsive symptoms, depression, and
Baylan et al. (2009) 15.2 (0.42) - Obsessive Compulsive -EAT Multiple regression
1,201 100 associations were: Affective Involvement (FAD) (R2 = 0.19, F = 134.8, β = 0.135, family involvement). However, obsessive
Turkey 14–16 Subscale (SCL-90-R) -BITE analysis
p < 0.000); Obsessive Compulsive Subscale (R2 = 0.22, F = 83.1, β = 0.129, p < 0.000); compulsive symptoms were stronger for
- FAD
Depression (R2 = 0.16, F = 221.8, β = 0.277, p < 0.000); Problem Solving (FAD) bulimia, meanwhile depression was
- BPS
(R2 = 0.23, F = 70.0, β = − 0.134, p < 0.000); Roles (FAD) (R2 = 0.24, F = 59.3, β = 0.078, more present for anorexia.
p < 0.000)
In any model Interpersonal peer problems (Time 1) were significantly associated with More research is needed to support the
10.3389/fpsyg.2023.1221679
Self-Esteem or Negative Affect (Time 2). mediator role of self-esteem and
Full Model 1 Overeating. (TLI = 0.959, CFI = 0.988, RMSEA = 0.035): negative affectivity between
- OBVQ
-DEBQ -Self-esteem (Time 2) ➔ Overeating (Time 3) (β = −0.141, p < 0.001) interpersonal peer problems and
Beckers et al. (2023) 13.8 (0.72) - RSES
2051 48.5 -EDI (overeating SEM Full Model 2 Emotional eating. (TLI = 0.964, CFI = 0.990, RMSEA = 0.034): disordered eating.
Netherlands 11.4–16.9 - Negative Affectivity
frontiersin.org
items) -Self-esteem (Time 2) ➔ Emotional Eating (Time 3) (β = −0.158, p < 0.001) However, self-esteem showed a
Subscale (Type D Scale 14)
Full Model 3 Restrained eating: TLI = 0.955, CFI = 0.987, RMSEA = 0.040). significant and stronger association with
-Self-esteem (Time 2) ➔ Restrained eating (Time 3) (β = −0.345, p < 0.001) the three types of subsequent disordered
-Interpersonal Peer Problems (Time 1) ➔ Restrained eating (Time 3) (β = −0.214, p < 0.001) eating behaviors than negative affectivity.
(Continued)
TABLE 2 (Continued)
Varela et al.
Full Model Drive for Thinness. (R2 = 0.01, p < 0.01). Predictors: Body Dissatisfaction
(β = 0.11, p < 0.05); Personal Standards Perfectionism × Body Dissatisfaction (β = 0.09,
p < 0.01) Body dissatisfaction moderated some of
Full Model Bulimic Symptoms (R2 = 0.01, p < 0.05). Predictors: Evaluative Concerns the effects of perfectionism on changes
- F-MPS Perfectionism (β = 0.10, p < 0.05) in eating disorder symptoms.
Boone et al. (2014) EDI-2
455 13.3 (0.85) 12–15 100 - Body Dissatisfaction Regression analysis Full Model Over Evaluation Weight and Shape (R2 = 0.09, p < 0.001). Predictors: Concretely, personal standards of
Belgium EDEQ
subscale (EDI-2) Evaluative Concerns Perfectionism (β = 0.15, p < 0.001); Body Dissatisfaction (β = 0.33, Perfectionism for Drive for Thinness
p < 0.001) and, Evaluative Concerns for Over
Full Model Over Evaluation Weight and Shape (R2 = 0.01, p < 0.01). Predictors: Evaluation Weight and Shape.
Evaluative Concerns × Body Dissatisfaction
(β = 0.11, p < 0.001)
Females model 27% variance in binge eating.

Direct effect self-esteem – binge eating (β = −0.395, p < 0.001)
Indirect effect self-esteem -binge eating (β = −0.153, p = 0.01). Mediators: body image
These results show that reduced body
feelings (β = −0.202, 95%CI [−0.276, −0.130] p < 0.001) and body protection
protection and negative body feelings
14.4 (1.5) - RSES (β = −0.064, 95%CI [−0.096, −0.037] p < 0.001)
Cella et al. (2021) Italy 1,046 45.1 BES Path Model analysis mediate the relationship between self-
11–19 - BIS Males model 26% variance in binge eating.
esteem and binge eating both female and
Direct effect self-esteem – binge eating (β = −0.272, p < 0.001)
male
Indirect effect self-esteem -binge eating (β = −0.034, p = 0.5). Mediators: body image
feelings (β = −0.158, 95%CI [−0.225, −0.096] p < 0.001) and body protection
(β = −0.044, 95%CI [−0.072, −0.025] p = 0.001)
06
Female Model EAT-26. (R2 = 0.236, p < 0.01).

The most significant risk factors for
- BAS2 Predictors: Body Appreciation (β = −0-379, p = 0.001)
Ćorić et al. (2023) 16.7 (1.1) Multiple regression developing disordered eating in
724 62.7 - RSES EAT-26 Female Model EAT-26. (R2 = 0.125, p < 0.01).
Bosnia-Herzegovina 14–19 analysis adolescents are body appreciation and
- KOBI Predictors: Body Appreciation (β = −0.199, p = 0.010), Self-esteem (β = −0.211,
self-esteem
p < 0.022)
- SPPA Higher scores on anxiety levels and

- IECA lower punctuations on perceived
Costarelli et al. (2011) Binary Anxiety levels → EAT-26 (β = 0.30, p = 0.019) Perceived Physical Appearance →
202 16.7 (0.60) 15–18 46 - STAI EAT-26 physical appearance were the two
Greece Regression analysis EAT-26 (β = −1.269, p = 0.01)
- Overweight Preoccupation variables found as predictors of
Subscale (MBSRQ) developing eating disorders.
Female Model. Significant effect of body dissatisfaction on Disordered eating (B = 0.83,

p < 0.001). Also, significant effect of body dissatisfaction through negative affect on
disordered eating (B = 0.042, Boot SE = 0.013, 95% CI = 0.021–0.071). Finally,
- Body dissatisfaction Body dissatisfaction presented both
-Drive for sequential indirect effect of body dissatisfaction through negative self-esteem and
subscale (EDI-2) indirect and direct effects on disordered
thinness negative affect (B = 0.057, Boot SE = 0.012, 95% CI = 0.036–0.085).
Cruz-Sáez et al. (2018) 16.8 (0.83) - Negative self-beliefs eating. However, the role of negative
10.3389/fpsyg.2023.1221679
806 61.8 subscale (EDI-2) Mediation model Male Model. Significant effect of body dissatisfaction on Disordered eating (B = 0.68,
Spain 16–19 subscale (EDBQ) affect and self-esteem as mediators of
-Bulimia p < 0.001). Also, significant effect of body dissatisfaction through negative affect on
- Anxiety and Depression this relationship was significant to both
subscale (EDI-2) disordered eating (B = 0.020,
subscales (GHQ) girls and boys.
Boot SE = 0.013, 95% CI = 0.002–0.056). Finally, sequential indirect effect of body
dissatisfaction through negative self-esteem and negative affect (B = 0.036, Boot
frontiersin.org
SE = 0.015, 95% CI = 0.012–0.071).
(Continued)
TABLE 2 (Continued)
Varela et al.
Full Model. (X2 (df = 317) = 601.65, p < 0.001; CFI = 0.97; SRMR = 0.06)
Female/Male Models. Indirect Effects EDE:
Regardless of gender, self-objectification
- General and Athletic -Media-ideal Internalization → Self-Objectification → Body Shame (β = 0.11/0.10, p < 0.05)
(via body surveillance) may serve as a
Internalization Subscales -Self-Objectification → Body Shame → EDE (β = 0.05/0.04, p < 0.05)
mechanism which translates the media-
(SATAQ-3) -Media-ideal Internalization → Self-Objectification → Appearance Anxiety
ideal internalization into negative
- internalization (β = 0.06/0.05, p < 0.05)
body-feelings.
Dakanalis et al. (2014) 14.5 (0.28) - Body Surveillance EDE -Self-Objectification → Appearance Anxiety → EDE (β = 0.03/0.03, p < 0.05)
627 52.1 SEM Body shame and appearance anxiety
Germany 14–15 subscale (OBCS) OBE Female/Male Models. Indirect Effects OBE:
may constitute the mechanisms through
- Body shame -Media-ideal Internalization → Self-Objectification → Body Shame (β = 0.11/0.10,
which thinking and scrutinizing of one’s
subscale (OBCS) p < 0.05)
own body from an external observer’s
- SAAS -Self-Objectification → Body Shame → OBE (β = 0.08/0.07, p < 0.05)
perspective contributes to dietary
- K-SADS-P -Media-ideal Internalization → Self-Objectification → Appearance Anxiety
restraint and binge eating.
(β = 0.06/0.05, p < 0.05)
-Self-Objectification → Appearance Anxiety → OBE (β = 0.04/0.03, p < 0.05)
Following the full model (X2 (df = 41) = 69.6, p = 0.004; CFI = 0.96; TLI = 0.96;
RMSEA = 0.05). These results suggest that higher levels
Evans et al. (2019) 13.0 (0.89) - PANAS-C Negative affect (b = 0.15, p < 0.05), impulsivity (b = 0.21, p < 0.01) and gender of impulsivity and affect reactivity were
238 46 COEDS Latent growth curve
United States 11–15 - EI-7 (b = −0.40, p < 0.01) were significantly associated with ED-Attitudes at baseline. identified as risk factors for the
Impulsivity × negative affect was significantly associated with the growth curve of development of ED-Attitudes
ED-Attitudes (b = −0.60, p < 0.05) for high negative affect reactivity group.
High levels of depressive symptoms,
07
- RSES
Prediction Model (R2 = 0.17, F = 15.056, p < 0.001). Predictors: Depressive symptoms high levels of body dissatisfaction, low
- FES
Gan et al. (2018) 14.3(1.0) Multiple linear (β = 0.19, p < 0.001); Family Cohesion (β = −0.21, p < 0.001); Perceptions of body size levels of self-esteem and low levels of
356 57.3 - CES-D BES
Malaysia 13–16 regression analysis (β = 0.16, p = 0.002) and self-esteem (β = −0.15, p = 0.003) contributed significantly to family cohesion have been identified as
- Contour Drawing
binge eating behaviors predictive factors of binge eating
Rating Scale
symptomatology
Passive coping strategies like
intropunitive avoidance and avoidance
of social support presented positive and
Intropunitive avoidance (R = 0.29; β = 0.54, p < 0.001), Problem-focused action
2
García-Grau et al. 15.9 (1.5) Hierarchical significant associations with EDI-2 total
216 100 ACS EDI-2 (R2 = 0.30; β = −0.15, p < 0.01) and Avoidance of social support (R2 = 0.32; β = 0.14,
(2002) Spain 14–18 regression model score. However, active coping strategies
p < 0.05) showed a significant association with the risk of suffer an eating disorder
like problem-focused action presented
negative associations with EDI-2 total
score.
- BSI Body dissatisfaction was the only
Body Dissatisfaction → EDDS (OR = 1.23, 95%CI: 1.01 to 1.50, p = 0.04)
Garrusi et al. (2016) 15.9 (0.80) - Socio-cultural Logistic regression psychological variable significantly
433 0 EDDS One unit increase in body dissatisfaction score was associated with 23% increase in
Iran 14–18 pressure instrument model associated with the risk of developing an
10.3389/fpsyg.2023.1221679
risk of eating disorders.
- RSES eating disorder.
- Dieting status measure
- PAQ-A Exercise Frequency → EDE-Q (R2 = 0.03, F (1, 173) = 5.20, β = 0.17, p < 0.05); Desire Ideal Regular exercise seems to be associated
Regression analysis
Gomes et al. (2015) 15.6 (1.4) - Goal orientation in Weight → EDE-Q (R2 = 0.45, F (4, 170) = 34.02, β = −0.56, p < 0.001); Psychological with psychological well-being and with a
frontiersin.org
192 53.1 EDE-Q with blocked entry

Portugal 13–18 exercise measure dimensions → EDE-Q (R2 = 0.76, F (9, 165) = 56.47, p < 0.001); Social Physique Anxiety lower propensity for eating disordered
procedures
- SPAS-R (β = 0.48, p < 0.001); Self-esteem (β = −0.19, p < 0.01) behaviors in adolescents.
- RSES
(Continued)
TABLE 2 (Continued)
Varela et al.
Pressure to be thin was associated
with eating behaviors. This
Female Model. (X2 (df = 2) = 6.06, p = 0.05; CFI = 0.93; SRMR = 0.03).
relationship was moderated by social
Indirect Effect. Weight pressure → Eating Behaviors. Mediators: Social Comparisons
comparisons, internalization of thin
(b = 0.19, p < 0.05) → Internalization (b = − 0.14, p < 0.05) → Body Dissatisfaction
- MBSRQ ideals and body dissatisfaction. High
Halliwell and Harvey 13.2 (1.6) (b = 0.13, p < 0.05).
507 49.3 - SATAQ ChEAT SEM scores on social comparisons were the
(2006) United Kingdom 11–16 Male Model. (X2 (df = 3) = 6.79, non-significant; CFI = 0.98; SRMR = 0.04).
- PSPS most strongly related mediator. The
Indirect Effect. Weight pressure → Eating Behaviors. Mediators: Social Comparisons
pressure to be thin and develop an
(b = 0.12, p < 0.05) → Internalization (b = − 0.06, p < 0.05) → Body Dissatisfaction
eating disorder is higher in
(b = 0.06, p < 0.05).
adolescents with higher scores in
social comparisons.
Following the full model for participants with obesity (R2 = 0.39; F (14, 96) = 5.97;
p < 0.001)
Experienced body shame was the only variable significantly associated with EDRC
(β = 0.43, p < 0.01). Body shame mediates the association between self-esteem and
Body shame presented the strongest
- PBI EDRC. Self-esteem and body shame (β = −0.54, p < 0.001), body shame and EDRC
relationship with eating disorder risk for
Iannaccone et al. (2016) 15.5 (1.5) - RSES Hierarchical (β = 0.53, p < 0.001)
222 38.7 EDRC both groups, acting as a mediator
Italy 13–19 - ESS regression model Following the full model for participants with normal weight (R2 = 0.48; F (14,
between low self-esteem and eating
- MPS 96) = 8.16; p < 0.001). The variables significantly associated with Eating Disorder
disorder risk.
Risk were gender (β = 0.22, p < 0.05), BMI (β = 0.31, p < 0.001), maternal care
(β = −0.24, p < 0.01) and experienced body shame (β = 0.47, p < 0.001). Body
08
shame mediates the association between self-esteem and EDRC. Self-esteem and
body shame (β = −0.54, p < 0.001), body shame and EDRC (β = 0.57, p < 0.001)
Full Model. (X2 = 1.02, p < 0.001; CFI = 1; SRMR = 0.009)

Low self-esteem and mood intolerance
- Interpersonal Problems Indirect Effects through Self-esteem between:
were directly associated with eating
Subscale (EDI-3) -Perfectionism → Eating Concerns (b = 0.16, p < 0.001); Perfectionism → Weight
disorder symptoms. Perfectionism was
- Affective Problems Concerns (b = 0.29, p < 0.001); -Perfectionism → Shape Concerns (b = 0.29, p < 0.001);
Jones et al. (2020) Child- indirectly associated with eating
270 14.9 (0.83) 13–18 95.2 Subscale (EDI-3) Pathway analysis -Perfectionism → Dietary Restraint (b = 0.23, p < 0.001)
Australia EDE disorder symptoms through self-esteem,
- Perfectionism Indirect Effects through mood intolerance between: -Perfectionism → Eating
and mood intolerance. There were no
Subscale (EDI-3) Concerns (b = 0.27, p < 0.001); Perfectionism → Weight Concerns (b = 0.17, p = 0.003);
significant associations for interpersonal
- RSES Perfectionism → Shape Concerns (b = 0.08, p = 0.047); Perfectionism → Dietary
difficulties.
Restraint (b = 0.14, p = 0.021)
Internet use in relation to eating problems (OR = 1.13, 95%CI = 1.08–1.17,

p < 0.001)
Internet use in relation to binge eating (OR = 1.05, 95%CI = 1.01–1.08, p < 0.01)
- RSES Internet use in relation to purging behavior (OR = 1.10, 95%CI = 1.06–1.14,
Time spent on Internet and using social
10.3389/fpsyg.2023.1221679
Kaewpradub et al. - Social media and internet Multiple regression p < 0.001)
620 15.7 (1.9) 60.3 EAT-26 media were associated with different
(2017) Thailand use/behaviors (ad hoc) analysis Internet use in relation to taking laxatives (OR = 1.06, 95%CI = 1.04–1.09, p < 0.001)
types of eating problematic behaviors
- BESAA Social network use to eating problems (OR = 1.07, 95%CI = 1.04–1.09, p < 0.001)
Social network use to binge eating (OR = 1.03, 95%CI = 1.01–1.05, p < 0.05)
Social network use to purging behavior (OR = 1.06, 95%CI = 1.04–1.09, p < 0.05)
frontiersin.org
Social network use taking laxatives (OR = 1.05, 95%CI = 1.03–1.08, p < 0.05)
(Continued)
TABLE 2 (Continued)
Varela et al.
Female model. Personal Variables: Bulimia (R2 = 0.31). Predictors: Interoceptive
Awareness (β = 0.55, p < 0.001).
These series of regression analysis
Male model. Personal Variables: Bulimia (R2 = 0.21). Predictors: Interoceptive
showed that the variables mainly related
Awareness (β = 0.43, p < 0.001).
with the onset of bulimia were
Female model. Temperament Variables: Bulimia (R2 = 0.16). Predictors: Behavioral
interoceptive awareness, behavioral
- BIS/BAS 1
Inhibition System (β = 0.26, p < 0.01), Effortful Control (β = −0.35, p < 0.01). This
Kerremans et al. (2010) 16.8 (1.3) inhibition system, effortful control,
339 64.9 - EBP EDI-2 Regression analysis model did not present significant associations for men.
Belgium 14.3–19.5 depressive symptoms, and global self-
- SPPA Female model. Depressive symptoms and Antisocial behavior: Bulimia (R = 0.21). 2
esteem for female. For males, these

Predictors: Depressive symptomatology (β = 0.40, p < 0.01).
variables were interoceptive awareness,
Male model. Depressive symptoms and Antisocial behavior: Bulimia (R = 0.35).
2
depressive symptoms, and covert

Depressive Symptomatology (β = 0.26, p < 0.01), Covert Delinquency (β = 0.46, p < 0.01).
delinquency.
Female model Self-Competence: Bulimia (R = 0.23). Global Self-Esteem (β = 0.28,
2
p < 0.05). This model did not present significant associations for men.
The amount of variance in eating disorder explained by psychological inflexibility and

The relationship between self-esteem
Koushiou et al. (2020) 13.7 (1.0) - RSES self-esteem was 22.25% (F (2, 415) = 59.37, p < 0.001)
418 55.9 EAT-26 Mediation analysis and eating pathology was partiality
Cyprus 13–15 - AFQ-Y8 Self-esteem was related with Psychological Inflexibility (b = −0.60, p < 0.001).
mediated by psychological inflexibility.
Psychological inflexibility was related with Eating Pathology (b = 0.54, p < 0.001)
Tiredness → Binge Eating. Mediators: Family Cohesion (β = − 0.16, p < 0.05); Family Momentary moods like stress,
satisfaction (β = −0.12, p < 0.05); Family Balance (β = −0.71, p < 0.01) frustration, boredom, tiredness, or
Binge Eating Stress → Binge Eating. Mediators: Family Balance (β = −0.91, p < 0.05) negative affect were significantly
Lee et al. (2018) 15.1 (2.2) - FACES-IV
09
158 57.0 Subscale Mediation model Left-out → Binge Eating. Mediators: Family Cohesion (β = 0.52, p < 0.05) associated with binge eating measures.
United States 14–18 - Momentary Moods
(EDDS) Happiness → Binge Eating. Mediators: Family Cohesion (β = 0.019, p < 0.05) Family variables, especially, family
Embarrassed → Binge Eating. Mediators: Family Cohesion (β = 0.047, p < 0.05) cohesion were mediators of these
Boredom → Binge Eating. Mediators Family Cohesion (β = −0.014, p < 0.05) associations.
Lifetime prevalence of binge eating was

1.13 times higher with escape-avoidance
Lee-Win et al. (2016) 15.3 (1.5) - ZKPQ Escape-avoidance coping in relation to lifetime binge eating disorder (OR = 1.13,
10,028 50.8 CIDI Regression analysis coping strategy. The other coping styles
USA 13–18 - WOCS 95%CI = 1.10–1.18, p < 0.001)
or personality traits did not present
significant associations with binge eating.
Following the full model (X2 (df = 40) = 353.47, p < 0.001; CFI = 0.92; NFI = 0.92).
Family preoccupation with weight and appearance had direct effects (b = 0.32,
- FACES-III p < 0.001) on negative eating behaviors. Also, indirect effects through body Family preoccupation with weight and
- RSES dissatisfaction (b = 0.40, p < 0.001) with negative eating behaviors (b = 0.17, p < 0.001). appearance and family functioning were
Leung et al. (1995) 14.6 (1.4)
918 100 - Body Dissatisfaction EAT-26 SEM Family preoccupation with weight and appearance effects through body dissatisfaction related to negative eating behaviors.
Canada 12–17
Subscale (EDI) were also mediated by self-esteem deficit (b = 0.11, p < 0.001) on negative eating These associations were mediated by
- FNE behaviors. body dissatisfaction and low self-esteem.
10.3389/fpsyg.2023.1221679
Family functioning presented an indirect effect, mediated by self-esteem (b = −0.39,
p < 0.001), on negative eating behaviors (b = −0.09, p < 0.001)
Body-esteem leads to emotional

Body-esteem → Eating Disorder Risk (R2 = 0.45, p < 0.001). Predictors: Body-esteem intelligence. The relationship between
15.4 (1.4) - BESAA Hierarchical multiple
frontiersin.org
Li and Li (2021) China 256 40.6 EAT-26 (β = −. 35, p < 0.001), Emotional Intelligence was identified as moderator (β = −0.017, body-esteem and eating disorder risk
13–18 - WLEIS regressions
p < 0.01) was stronger with higher scores of
emotional intelligences.
(Continued)
TABLE 2 (Continued)
Varela et al.
- SATAQ-3 EAT-26 Hierarchical multiple Female Model. (R2 = 0.44, F (1, 525) = 404.71, p = 0.000). Predictors: Body Dissatisfaction Body dissatisfaction was found as a
- BSQ linear regression (β = 0.660, t = 20.12, p = 0.000) predictor of eating disorders for both
Male Model. (R2 = 0.36, F (2, 418) = 135.20, p = 0.000). Predictors: Body Dissatisfaction genders. Mass media influence was
Macedo-Uchôa et al. 15.7 (1.1)
1,011 52.1 (β = 0.539, t = 13.20, p = 0.000), Mass Media Influence (β = 0.119, t = 2.94, p = 0.003) found as a predictor of ED only for boys.
(2019) Chile 14–18
For girls, SATAQ-3 was not found as a
predictor and was excluded from the
model.
McCabe and Vincent 603 13.8 (1.1) 50,7 - RSES BULIT-R Multiple regression Females. There were differences between the
(2003) Australia 11–17 - DASS analysis -Model for Extreme Weight Loss (R2 = 0.12, F (8, 299) = 4.47, p < 0.001). Anxiety (β = 0.24, predictors of negative eating behaviors
- Ineffectiveness and p = 0.03). between girls and boys. The predictors
Perfectionism -Model for Binge Eating (R2 = 0.37, F (8, 299) = 18.6, p < 0.001). Self-esteem (β = 0.21, for girls were anxiety, self-esteem, and
subscales (EDI) p = 0.02) and depression as significant predictors (β = 0.23, p = 0.02). depression. For boys, the associated
- PDS -Model for Bulimic Symptoms (R2 = 0.40, F (8, 299) = 25.98, p < 0.001). Self-esteem variables were ineffectiveness, anxiety,
(β = 0.25, p = 0.02) and depression as significant predictors (β = 0.24, p = 0.02). self-esteem, and perfectionism.
Males.
-Model for Extreme Weight Loss (R2 = 0.09, F (8, 292) = 3.03, p < 0.001). Ineffectiveness
(β = 0.16, p = 0.02) and Anxiety (β = 0.17, p = 0.02) as significant predictors.
-Model for Binge Eating (R2 = 0.31, F (8, 292) = 14.5, p < 0.001). Self-esteem (β = 0.17,
p = 0.02), Anxiety (β = 0.27, p = 0.04) and Perfectionism as significant predictors
(β = 0.13, p = 0.02).
-Model for Bulimic Symptoms (R2 = 0.40, F (8, 292) = 18.36, p < 0.001). Anxiety (β = 0.16,
10
p = 0.02) and Ineffectiveness as significant predictors (β = 0.28, p = 0.02).
Mora et al. (2022) Spain 579 13.7 42.7 - RSES EAT-26 Logistic regression Self-esteem ➔ Disordered Eating Behaviors (OR = 0.91; 95% CI 0.88–0.94: p < 0.001). Subjects with higher self-esteem have a
12–16 analysis lower risk of developing EDs. Per each
increase of one point in the self-esteem
dimension, the risk of belonging to the
risk group for eating disorders was
reduced by 9.0%
Pace et al. (2018) Italia 482 17.9 (0.57) 49.2 - DAPCS EAT-26 Regression analysis Final model (R2 = 0.24, F (1, 477) = 20.93, p < 0.001). Predictors: Paternal achievement Results showed that peer perceived
17–18 - SSQ oriented psychological control (β = 0.38, p < 0.001), perceived peer support (β = −0.21, support was a moderator in the
p < 0.001) and the interaction of these variables (β = −0.34, p < 0.000) relationship between father’s
psychological control and negative
eating attitudes and behaviors.
Pamies-Aubalat et al. 1,630 14 (1.34) 55 - RSES EAT-40 Logistic regression Female Model (R2 = 74.2%,) Girls who experienced dieting, body
(2022) Spain 12–18 - CAPS analysis Predictors: Diet × Body Dissatisfaction × Affective Social Comparison (OR = 3.772, dissatisfaction and social comparison
- Body Dissatisfaction 95%CI = 2.08–6.82, p < 0.001) together are 3.8 times more likely to
10.3389/fpsyg.2023.1221679
subscale (EDI-2) Male Model (R2 = 48.4%,) have disordered eating attitudes. In the
- DCS Predictors: Body Dissatisfaction × Pressure to lose weight (OR = 3.282, 95%CI = 1.94– model for the boys, the odds ratio
- Pressure from significant 5.54, p < 0.001) indicated that boys who experienced
others to lose weight body dissatisfaction and the pressure to
lose weight together are 3.3 times more
frontiersin.org
likely to have disordered eating attitudes
(Continued)
TABLE 2 (Continued)
Varela et al.
Piko et al. (2023) India 112 16.01 (1.08) 47.3 - SAS-SV EAT-26 Binary logistic Full Model (χ2 = 34.72, df = 10, R2 = 0.60) Adolescents who presented smartphone
14–18 - K-GSADS-A regression analysis Predictors for EAT-26: Smartphone Addiction (OR = 1.07, 95% CI = 1.01–1.14, addiction were more likely to present
- MSPSS p < 0.01); Social Anxiety (OR = 1.05, 95% CI = 1.01–1.10, p < 0.01); Social Avoidance social anxiety and social avoidant. These
(OR = 1.07, 95% CI = 1.02–1.13, p < 0.01); Social Support (OR = 0.95, 95% CI = 0.92– participants were more likely to present
0.98, p < 0.01) disordered eating behavior. Social support
was identified as a protective factor.
Rodgers et al. (2014) 488 12.4 (0.53) 100 - CDI-SF Bulimia Scale of SEM Following the full model (X2 (df = 37) = 148.4, p < 0.001; CFI = 0.962; RMSEA = 0.080). The relationship between negative affect
Australia 12–13 - RSES EDI Negative affected (b = 0.36, p < 0.01) and Sociocultural influence (b = 0.71, p < 0.01) and social cultural influence with
- PSPS were related with internalization and comparison. The last one was related with body bulimic symptoms was mediated by
- PWT image concerns (b = 0.79, p < 0.01) and finally, this variable presented an association internalization and comparison and
- Internalization of thin ideal with bulimia symptoms (b = 0.14, p < 0.05). At the same time, negative affect presented body image concerns. However, negative
subscale (SATAQ) a direct association with bulimic symptoms (b = 0.37, p < 0.01). affect also presented a direct effect on
- Body dissatisfaction bulimic symptoms.
subscale (EDI)
- Shape and Weight
Concerns subscale (EDEQ)
- Restrained eating behavior
subscale (DEBQ)
- Appearance Comparison
Rosewall et al. (2018) 231 15.5 (1.1) 100 - CAPS EAT-26 Regression analysis Moderation effects between body dissatisfaction and eating pathology for the Participants that presented high or
New Zealand 14–18 - RSES following variables: medium levels of the moderating
11
- PANAS Self-oriented perfectionism (R2 = 0.08, b = 0.41, p < 0.001); Socially prescribed variables were likely to present eating
- POTS perfectionism (R2 = 0.06, b = 0.37, p < 0.001); Self-esteem (R2 = 0.02, b = 0.41, p < 0.05); pathology symptoms
- Perceive pressure to lose Negative affect (R2 = 0.05, b = 0.33, p < 0.01); Media pressure (R2 = 0.05, b = 0.79,
weight (SIBIBCQ) p < 0.01)
Salafia and Lemer 136 13.8 (0.88) 52.9 - AMSI -DEBQ SEM Female models: For girls, performance, relationships,
(2012) United States 12–15 - BDS -Bulimia -Performance Stress (β = 0.23, p < 0.05) - > Body Dissatisfaction (β = 0.40, p < 0.05) and family stress drive the process to
Subscale (EDI) - > Dieting Behaviors (β = 0.26, p < 0.05) - > Bulimic Symptoms dieting behaviors and bulimic symptoms
-Relationship Stress (β = 0.25, p < 0.05) - > Body Dissatisfaction (β = 0.40, p < 0.05) in the end. For boys, all kinds of stress
- > Dieting Behaviors (β = 0.26, p < 0.05) - > Bulimic Symptoms were associated with dieting processes,
-Family Stress (β = 0.27, p < 0.05) through body dissatisfaction, however
-Body Dissatisfaction (β = 0.41, p < 0.05) there were no significant associations
-Dieting Behaviors (β = 0.26, p < 0.05) with bulimic symptoms
-Bulimic Symptoms
Male Models:
-Performance Stress (β = 0.30, p < 0.05) - > Body Dissatisfaction (β = 0.55, p < 0.05)
- > Dieting Behaviors
10.3389/fpsyg.2023.1221679
-Relationship Stress (β = 0.37, p < 0.05) - > Body Dissatisfaction (β = 0.55, p < 0.05)
-Education Stress (β = 0.33, p < 0.05) - > Body Dissatisfaction (β = 0.55, p < 0.05)
-Financial Stress (β = 0.30, p < 0.05) - > Body Dissatisfaction (β = 0.55, p < 0.05)
frontiersin.org

-Family Stress (β = 0.33, p < 0.05) - > Body Dissatisfaction (β = 0.55, p < 0.05)
(Continued)
TABLE 2 (Continued)
Varela et al.
Sepúlveda et al. (2021) 180 14.8 (1.5) 100 - BSQ EDI-II Conditional logistic Eating Disorder group reported higher scores than control groups in: At the final model, self-oriented
Spain 12–17 - CDI regressions -Drive for thinness (OR = 16.17, 95%CI = 2.78–94.06, p < 0.01) perfectionism, and family emotional
- STAIC -Anxiety state (OR = 5.07, 95%CI = 1.54–16.64, p < 0.01) overinvolvement were the most relevant
- LOI-CV -Obsessive Symptoms (OR = 2.34, 95%CI = 0.90–6.11, p < 0.10) variables to predict eating disorders
- CAPS -Self-Oriented Perfectionism (OR = 5.03, 95%CI = 1.72–14.69, p < 0.01) compared to control groups
- FACES-II -Father’s overinvolvement (OR = 7.94, 95%CI = 2.72–23.19, p < 0.01)
- FQ -Mother’s overinvolvement (OR = 5.52, 95%CI = 1.96–15.54, p < 0.01)
-Mother’s anxiety-state (OR = 6.09, 95%CI = 2.12–17.53, p < 0.01)
Sharpe et al. (2014) 216 13.6 (0.63) 100 - BES EDE-Q Hierarchical lineal Eating Pathology was significantly predicted by more conflict with friends (β = 0.19, Characteristics related with low-quality
United Kingdom 13–16 - DASS-21 regression p = 0.006), feeling more alienated from friends (β = 0.27, p < 0.001), perceive friends to friendship were associated with more
- FCS be less helpful to them (β = −0.21, p = 0.002) and provide less self-validation probabilities of presenting disordered
- MFQ-RA (β = −0.23, p = 0.001). eating symptomatology
- Peer Scale (IPPA) After controlling the variable depression, only better communication with friends was
- MFQ-FF associated with eating pathology (β = 0.20, p = 0.002).
- Friendship Questionnaire
Shomaker and Furman 199 18 (0.51) 49,8 - PPAQ EAT-26 SEM Following the full model (X2 (df = 123) = 216.1, p = 0.001; CFI = 0.91; RMSEA = 0.06). These results suggest that interpersonal
(2009) United States 16–19 - PSPS Interpersonal pressure to be thin (b = 0.27, p < 0.001), interpersonal criticism (b = 0.16, criticism and interpersonal pressure to
- SDBPS p < 0.05) and disordered eating (b = 0.63, p < 0.001) at time 1 were significantly be thin provided by mothers, friends,
associated with disordered eating at time 2 and romantic partners are associated
Interpersonal pressure to be thin from mothers (b = 0.17, p = 0.01), close friends with the onset of disordered eating.
12
(b = 0.16, p = 0.02) and romantic partners (b = 0.14, p = 0.05) at time 1 predicted

disordered eating at time 2
Shroff and Thompson 344 14.6 (1.0) 100 - PFPWDS Bulimia Scale of Multiple regression Following the full model (F = 14.12; R2 = 0.24). Predictors: Composite peer influence Peer preoccupation with weight/diet,
(2006) United States 14–17 - ACF EDI (this variable is a combination of the peer influence measures) (β = 0.21, p < 0.01), Peer conversations about appearance, peer
- SSS Suppression of feelings (β = 0.36, p < 0.001) ideas about perfect body/weight-loss
- PAS strategies, experienced weight teasing,
- FSIS and self-judgment by external standards.
- PTSF Putting external needs before one’s self
- FADS or inhibiting one’s self-expression,
- RSES presented an association with the risk of
- SIAQ suffering from bulimia.
Fortes et al. (2015) 371 13.0 (1.6) 100 - BSQ EAT-26 Multiple linear For the subscale Diet. Predictors: Body Dissatisfaction (R2 = 0.64, F (1, 370) = 119.05, p = 0.001). Mainly, body dissatisfaction explained
Brazil 12–16 - MPS regression For the subscale Bulimia and Concern about Food. Predictors: Body dissatisfaction the variance in disordered eating, across
- BRUMS (R2 = 0.10, F (1, 370) = 45.98, p = 0.001); Perfectionism (R2 = 0.008, F (2, 369) = 5.32, the different subscales. However,
p = 0.001); General Mood (R2 = 0.04, F (3, 368) = 5.07, p = 0.001) perfectionism and mood state also
For the subscale Oral Self-Control. Predictors: Body Dissatisfaction (R2 = 0.10, F (1, presented significant associations.
10.3389/fpsyg.2023.1221679
370) = 7.57, p = 0.007); General Mood (R2 = 0.04, F (3, 368) = 2.33, p = 0.05).
Fortes et al. (2016) 1,358 13.9(1.0) 100 - RSES EAT-26 SEM General Model explains 76% variance. All the exposure variables, except for
Brazil 12–15 - SATAQ-3 The results indicated that Body Dissatisfaction mediates the relationship between perfectionism, were related to the onset
- MPS media pressure (b = 0.36, p < 0.05), self-esteem (b = 0.14, p < 0.05) and mood of disordered eating behaviors. Body
frontiersin.org
- MDI disturbance (b = 0.09, p < 0.05) with disordered eating behavior (b = 0.62, p < 0.01). dissatisfaction acted as a mediator
- BRUMS Media pressure (b = 0.27, p < 0.01) and depressive symptoms. (b = 0.11, p < 0.05) also between exposure variables and
- BSQ showed a direct relationship with disordered eating behaviors. disordered eating behaviors.
(Continued)
TABLE 2 (Continued)
Varela et al.
Teixeira et al. (2016) 575 15.8 (1.6) 100 - CAPS ChEAT Multiple hierarchical Following the full model (R2 = 0.20; F (5, 539) = 26.69, p < 0.001). Predictors: Body Dysfunctional eating behaviors showed
Portugal 11–18 - CDFRS regression and Dissatisfaction (β = −0.33, p < 0.001), Self-Oriented Perfectionism (β = 0.13, p = 0.001), a strong association with the presence of
- RSES mediation analysis Self-Esteem (β = −0.21, p = 0.001). self-esteem, self-oriented perfectionism,
Mediation analysis revealed that self-oriented perfectionism mediated the association and body dissatisfaction.
between body dissatisfaction and ChEAT score (95%CI -4.5915 to −0.3610).
Unikel et al. (2013) 2,357 16.2 (1.0) 100 - FMRS BQREB SEM Following the full model (X2 (df = 32) = 93.55, p < 0.05; CFI = 0.975; RMSEA = 0.04). The strongest and direct relationship
Mexico 15–19 - MCS Affection acted through depressive symptoms (b = −0.165) and self-esteem (b = 0.407) with disordered eating was with
- SRS to internalization of body aesthetic thin ideal. Criticism was also related to internalization of body aesthetic thin
- IBATI internalization thin ideal (b = 0.226). ideal. The association between affection
- SES Finally, internalization of body aesthetic thin ideal primarily explained disordered and internalization was mediated by
- CES-D eating behavior (b = 0.536). self-esteem and depressive symptoms.
Wade et al. (2015) 926 13 (0.75) 100 - MPS EDE-Q Latent growth curve Following the full model (X2 (df = 41) = 69.6, p = 0.004; CFI = 0.96; TLI = 0.96; Mean levels of ineffectiveness over time
Australia - Ineffectiveness RMSEA = 0.05). mediated the relationship between
subscale (EDI) Negative affect (b = 0.15, p < 0.05), impulsivity (b = 0.21, p < 0.01) and gender concerns over mistakes perfectionism at
- Eating disorder risk (b = −0.40, p < 0.01) were significantly associated with ED-Attitudes at baseline. baseline and the change in both of our
Impulsivity × negative affect was significantly associated with the growth curve of eating disorder risk variables over time.
ED-Attitudes (b = −0.60, p < 0.05) for high negative affect reactivity group. No support was found for a role of
personal standards perfectionism in the
mediating relationship.
Zamani et al. (2020) 263 15.8 (1.7) 100 - RSES EAT-26 Multiple regression Following the full model (R = 0.59; R2 = 0.35; p = 0.004). Predictors: Self-esteem These results are contradictory with
13
Iran 13–18 - FRS (β = 0.59, t = 11.9, p < 0.001) previous literature, where lower self-
- PAQ-A esteem scores were associated with
higher eating disorder behaviors
Zhu et al. (2016) China 2,172 13.1 (0.84) 56.7 - ASLECL DSM-5 (Binge Mediation analysis EMS mediated the association between Life Stress Events and Binge Eating (b = 0.12, These results show that adolescents with
11–14 - YSQ-SF Eating) p < 0.001). more life stress events, more EMS, and
- Impulsivity Subscale of Impulsivity moderated the relationship between life stress events and EMS (b = 0.03, higher levels of impulsivity are likely to
NEO-PI-R p < 0.05). present binge eating.
The relationship between life stress events and EMS was positive and significant when
levels of impulsivity were high (b = 0.69, t = 8.38, p < 0.001)
ACF, Appearance Conversations with Friends; ACS, Adolescent Coping Scale; AFQ-Y8, Avoidance and Fusion Questionnaire for Youth; AMSI, Adolescent Minor Stress Inventory; ASLECL, The Adolescent Self-Rating Life Events Check List; BAS1, Behavioral
Activation System; BAS2, Body Appreciation Scale; BDI, Beck Depression Inventory; BDS, Body Dissatisfaction Scale; BES, Binge Eating Scale; BESAA, Body-Esteem Scale for Adolescents and Adults; BIS, Behavioral Inhibition system; BITE, Bulimic Investigatory Test
Edinburgh; BPS, Body Perception Scale; BQREB, Brief Questionnaire on Risky Eating Behaviors; BRUMS, Brunel Mood Scale; BSI, Body Satisfaction Instrument; BSQ, Body Shape Questionnaire; BULIT-R, Bulimia Test-Revised; CAPS, Child and Adolescent
Perfectionism Scale; CDFRS, Contour Drawing Figure Rating Scale; CDI, Child Depression Inventory; CES-D, Depression Scale from Center for Epidemiological Studies; ChEAT, Children Eating Attitudes Test; CIDI, Composite International Diagnostic Interview;
COEDS, The College Eating Disorders Screen; DAPCS, Dependency-oriented and Achievement-oriented Parental Psychological Control Scale; DASS, Depression, Anxiety and Stress Scale; DCS, Diet Competitiveness Scale; DEBQ, The Dutch Eating Behavior
Questionnaire; EAT-26, Eating Attitude Test − 26; EBP, Emotional Behavioral Problems; EDBQ, Eating Disorder Belief Questionnaire; EDDS, Eating Disorder Diagnostic Scale; EDEQ, Eating Disorders Examination Questionnaire; EDI, Eating Disorders Inventory;
EDRC, Eating Disorder Risk Composite Scale; EI-7, Eysenck Impulsivity Inventory; EMS, Early Maladaptive Schemas; ESS, Experience of Shame Scale; FACES-II, Family Adaptability and Cohesion Scale; FAD, Family Assessment Device; FADS, The Friend Anti-
Dieting Scale; FCS, Friends Conflict Scale; FES, Family Environment Scale; FNE, Fear of Negative Evaluation Scale; FQ, Family Questionnaire; FRS, Figure Rating Scale; FMRS, Father and Mother Relationship Scale; FSIS, Friends as a Source of Influence Scale; GHQ,
10.3389/fpsyg.2023.1221679
General Health Questionnaire; IBATI, Internalization of body aesthetic thin ideal; IECA, Index of Empathy for Children and Adolescents; IPPA, Inventory of Peer and Parents Attachment; K-GSADS-A, Kutcher Generalized Social Anxiety Scale for Adolescents; KOBI,
Quality of Family Interaction Scale; LOI-CV, Leyton Obsessional Inventory Child Version; MBSRQ, Multidimensional Body Self-Relations Questionnaire; MCS, Marshall Criticism Scale; MDI, Major Depression Inventory; MFQ-FF, The McGill Friendship
Questionnaire Friend’s Functions; MFQ-RA, The McGill Friendship Questionnaire Respondent’s Affection; MPS, The Multidimensional Perfectionism Scale; MSPSS, Multidimensional Scale of Perceived Social Support; NEO-PI-R, Revised Neuroticism Extraversion
Openness Personality Inventory; OBCS, Objectified Body Consciousness Scale; OBVQ, Olweus Bully/Victim Questionnaire; PANAS-C, Positive and Negative Affect Schedule for Children; PAQ -A, Physical Activity Questionnaire for Adolescent; PAS, Peer Attribution
frontiersin.org
Scale; PBI, Parental Bonding Inventory; PDS, Pubertal Developing Scale; PFPWDS, The Perceived Friend Preoccupation with Weight and Dieting Scale; POTS, Perception of Teasing Scale; PPAQ, Pressure to be Physically Attractive Questionnaire; PSPS, Perceived
Sociocultural Pressure Scale; PTSF, The Perception of Teasing Scale for Friends; PWT, Peer Weight Teasing; RSES, Rosenberg Self-Esteem Scale; SAAS, Social Appearance Anxiety Scale; SAS-SV, Smartphone Addiction Scale Short Version; SATAQ, Sociocultural
Attitudes toward Appearance Questionnaire; SCL-90-R, The Symptom Checklist-90-R; SEM, Structural Equation Modeling; SES, Self-esteem Scale; SIAQ, The Sociocultural Internalization of Appearance Questionnaire; SIBIBCQ, Sociocultural Influences on Body
Image and Body Change; SPAS-R, Social Physique Anxiety Scale Revised; SPPA, Self-Perception Profile for Adolescents; SRS, Siblings Relationship Scale; SSQ, Social Support Questionnaire; SSS, The Silencing the Self Scale; STAIC, Staite-Trait Anxiety Inventory for
Children; USA, United States of America; WLEIS, Wong and Law Emotional Intelligence Scale; WOCS, Ways of Coping Scale; YSQ-SF, Young Schema Questionnaire Short Form; YSR, Youth Self-Report; ZKPQ, Zuckerman Kuhlman Personality Questionnaire.
TABLE 3 Level of risk of bias assessment using QUIPS tool.
Study Study Prognostic factor Outcome Statistical analysis

Author and year Study confounding
participant attrition measurement measurement and reporting
Altamirano et al. (2011) Low Low Low Low Moderate Low
Argydes et al. (2020) Low Low Low Low Low Low
Bachar et al. (2010) Low Low Moderate Low Moderate Moderate
Bacopoulou et al. (2017) Moderate Low Moderate Low Moderate Low
Baylan et al. (2009) Low Low Low Low Low Low
Beckers et al. (2023) Low Low Low Low Low Low
Boone et al. (2014) Moderate Low Moderate Moderate Low Low
Cella et al. (2021) Moderate Low Low Low Low Low
Ćorić et al., 2023 Low Low Low Low Low Low
Costarelli et al. (2011). Moderate Low Low Low Moderate Moderate
Cruz-Sáez et al. (2018) Low Low Low Moderate Moderate Low
Dakanalis et al. (2014) Low Low Low Low Low Low
Evans et al. (2019) Moderate Moderate Low Low Moderate Low
Fortes et al. (2015) Low Low Low Low Moderate Low
Fortes et al. (2016) Low Low Low Low Low Low
Gan et al. (2018) Low Low Low Low Moderate Low
García-Grau et al. (2002) Low Low Low Low Moderate Low
Garrusi et al. (2016) Low Low Moderate Moderate Moderate Moderate
Gomes et al. (2015) Low Low Low Low Low Low
Halliwell and Harvey (2006) Low Low Low Low Moderate Low
Iannaccone et al. (2016) Low Low Low Low Moderate Low
Jones et al. (2020) Moderate Moderate Low Low Moderate Low
Kaewpradub et al. (2017) Low Low Low Low Moderate Low
Kerremans et al. (2010) Moderate Moderate Low Low Moderate Low
Koushiou et al. (2020) Moderate Low Low Low Moderate Moderate
Lee et al. (2018) Low Low Low Low Low Moderate
Lee-Win et al. (2016) Low Low Low Low Moderate Low
Leung et al. (1995) Moderate Moderate Low Low Moderate Low
Li and Li (2021) Low Low Low Low Moderate Low
Macedo-Uchôa et al. (2019) Low Low Moderate Moderate Moderate Moderate
McCabe and Vincent (2003) Moderate Low Low Moderate Moderate Low
Mora et al. (2022) Low Low Low Low Low Low
Pace et al. (2018) Low Low Low Low Moderate Low
Pamies-Aubalat et al. (2022) Low Low Low Low Low Low
Piko et al. (2023) Low Low Low Low Low Low
Rodgers et al. (2014) Low Low Low Low Moderate Low
Rosewall et al. (2018) Moderate Low Low Low Moderate Low
Salafia and Lemer (2012) Moderate Moderate Low Moderate High Low
Sepúlveda et al. (2021) Low Moderate Low Low Moderate Low
Sharpe et al. (2014) Moderate Moderate Moderate Low Low Low
Shomaker and Furman (2009) Low Low Low Low Low Low
Shroff and Thompson (2006) Moderate Low Low Low Moderate Low
Teixeira et al. (2016) Low Low Moderate Low Low Low
Unikel et al. (2013) Low Low Low Low Moderate Low
Wade et al. (2015) Low Moderate Low Low Low Low
Zamani et al. (2020) Moderate Moderate Low Low Moderate Low
Zhu et al. (2016) Low Low Low Low Moderate Low
Moreover, self-esteem was also related with other concerns about weight in boys. Also, adolescents who perceived
characteristics besides body attitudes. Jones et al. (2020) found that less affection presented lower self-esteem and more disordered
perfectionism was significantly associated with concerns about eating behaviors (Unikel et al., 2013). Self-esteem also mediates the
weight and body through self-esteem. Low scores in this variable effect of family functioning and family preoccupation on weight
were associated with higher scores on perfectionism and more and appearance, therefore participants with low self-esteem were

TABLE 4 Risk of bias summary.
Criterium Low risk n(%) Medium risk n(%) High risk n(%)
Study participant 32(68.1) 15(31.9) 0
Study attrition 38(80.9) 9(19.1) 0
Prognostic factor measurement 40(85.1) 7(14.9) 0
Outcome measurement 41(87.2) 6(12.8) 0
Study confounding 17(36.2) 29(61.7) 1(2.1)
Statistical analysis and reporting 41(87.2) 6(12.8) 0

n = number of studies.
more vulnerable to their family situation, and presented more found that overweight preoccupation and body dysphoria were risk
negative eating behaviors (Leung et al., 1995). The association factors, while body appreciation was identified as a protective factor
between self-esteem and EDs symptomatology was also mediated for both genders. Li and Li (2021) also showed body esteem as a
by psychological inflexibility, the adolescents with higher scores in protective factor against the onset of EDs symptoms. One study
this variable are the ones who presented a lower self-esteem and showed the influence of media-ideal internalization on body shame
more likely to present disordered eating behaviors (Koushiou and appearance anxiety was mediated by self-objectification for both
et al., 2020). genders, being the participants with higher scores on these variables
and more likely to present dietary restraint or binge eating (Dakanalis
3.3.1.2. Body dissatisfaction and attitudes toward body et al., 2014). Finally, regular exercise was associated with psychological
Body dissatisfaction and attitudes toward the body were also well-being and with a lower propensity for disordered eating behaviors
variables traditionally related to the onset of EDs symptomatology. in adolescents (Gomes et al., 2015).
Their relationship with self-esteem and the consequences in the
presence of disordered eating behaviors has been analyzed (Fortes 3.3.1.3. Depression, anxiety, and stress
et al., 2016; Iannaccone et al., 2016; Cella et al., 2021). Because of the higher comorbidity between depression and eating
Due to its relevance, 11 articles included body dissatisfaction as a disorders, their relationship has been widely studied. Concretely, 12
variable of interest. It was observed in 8 studies that body articles of this systematic review analyzed this association. Except for
dissatisfaction has been commonly associated with the appearance of two studies (Unikel et al., 2013; Cruz-Sáez et al., 2018), depressive
EDs symptomatology, and that lower body dissatisfaction was related symptoms or negative affect presented a significant and strong
to a greater presence of disordered eating behaviors for both genders association with the appearance of EDs symptomatology for both
(Altamirano et al., 2011; Boone et al., 2014; Fortes et al., 2015; Garrusi genders (McCabe and Vincent, 2003; Baylan et al., 2009; Kerremans
et al., 2016; Teixeira et al., 2016; Cruz-Sáez et al., 2018; Macedo-Uchôa et al., 2010; Rodgers et al., 2014; Fortes et al., 2015, 2016; Wade et al.,
et al., 2019; Argydes et al., 2020; Pamies-Aubalat et al., 2022; Ćorić 2015; Gan et al., 2018; Rosewall et al., 2018; Evans et al., 2019).
et al., 2023). This association was also significant in the only study Moreover, depressive symptoms lead to an easier internalization of
with an entire sample of men (Garrusi et al., 2016). esthetic ideal and developing disordered eating behaviors (Unikel
Boone et al. (2014) also observed interaction effects between body et al., 2013). Previously, it has been analyzed as the mediator role of
dissatisfaction, personal standards perfectionism, and evaluative negative effect between body dissatisfaction and eating behaviors for
concerns perfectionism. Adolescents with higher scores on both genders (Cruz-Sáez et al., 2018).
perfectionism variables presented higher scores in body dissatisfaction In the previous section, body dissatisfaction was a mediator
and, consequently, more overvaluation of their weight and shape, as between different kinds of stress with diet and bulimic symptoms
well as more bulimic symptoms. The same relationship was found for (Salafia and Lemer, 2012). Zhu et al. (2016) also observed a direct
self-oriented perfectionism in another study (Teixeira et al., 2016). association between life stress events and binge eating. Moreover, this
Besides, Salafia and Lemer (2012) showed that high scores on body relationship was stronger the higher the levels of impulsivity.
dissatisfaction were related with higher levels of different kinds of Regarding anxiety, 3 studies found an influence of this variable on
stress for women (family, relationship, and performance stress) and developing eating disorders for both genders (McCabe and Vincent,
for men (performance, relationship, family, financial and educational 2003; Costarelli et al., 2011; Bacopoulou et al., 2017). Concretely,
stress). These participants were more likely to present dieting McCabe and Vincent (2003) observed that anxiety was a strong
behaviors, and for women these behaviors could lead to bulimic predictor for bulimic symptoms in men and for extreme weight loss
symptoms. Cruz-Sáez et al. (2018) observed that the association in both women and men.
between body dissatisfaction and disordered eating was mediated by
negative self-esteem and negative affect for both genders. 3.3.1.4. Personal characteristics
Regarding attitudes toward the body, 7 studies found significant High levels of perfectionism have been significantly associated
associations between these variables and EDs symptomatology. with the onset of EDs symptomatology for both genders (McCabe
Negative perception of physical appearance (Costarelli et al., 2011), and Vincent, 2003; Fortes et al., 2015; Teixeira et al., 2016).
perception of body size (Gan et al., 2018), social physique anxiety However, it also presented an indirect relation through self-esteem,
(Gomes et al., 2015) and drive for thinness (Sepúlveda et al., 2021) mood intolerance (Jones et al., 2020) and body dissatisfaction
were directly associated with symptoms of EDs. Argydes et al. (2020) (Boone et al., 2014). Two studies found a relationship between

self-oriented perfectionism and disordered eating for girls significant association between media pressure and EDs symptomatology
(Rosewall et al., 2018; Sepúlveda et al., 2021). Rosewall et al. (2018) for men (see Table 2).
also observed an association of socially prescribed perfectionism, Finally, Kaewpradub et al. (2017) conducted a study to analyze
proving that social pressure could be a stronger predictor of EDs the influence of internet and social network use in EDs
symptoms in women compared to men. symptomatology. Moreover, Piko et al. (2023) found that adolescents
It has also been observed that other personal characteristics, such as with smartphone addiction presented more probabilities of
high psychological inflexibility (Koushiou et al., 2020), low emotional developing EDs symptoms. Table 1 showed significant associations
intelligence (Li and Li, 2021) and interoceptive awareness (Kerremans between these variables with eating problems, binge eating, purging
et al., 2010) are associated with EDs symptomatology for both genders. behavior and taking laxatives.
Ineffectiveness (McCabe and Vincent, 2003) and covert delinquency
(Kerremans et al., 2010) were observed only for men, while inhibited 3.3.3. Family and peers’ influence
behavior and low effortful control were presented only for women Eight studies analyzed the influence of family variables on the
(Kerremans et al., 2010). Obsessive compulsive symptoms were found to appearance of EDs symptomatology.
be a strong predictor for girls in two studies (Baylan et al., 2009; Sepúlveda Some protective factors against the appearance of disordered
et al., 2021). Finally, three studies showed an association between eating were identified, such as maternal care (Iannaccone et al., 2016),
impulsivity and the development of disordered eating behavior during affective involvement (Baylan et al., 2009) and family cohesion (Gan
adolescence. In two of the studies, it was observed not only as a significant et al., 2018). Specifically, Lee et al. (2018) showed family cohesion to
relationship but also a strong interaction with negative affect, and the be a positive mediator in the associations between tiredness, boredom,
negative affect reactivity groups presenting more symptoms of eating and stress with binge eating (see Table 2).
disorders for both genders (Wade et al., 2015; Evans et al., 2019). Zhu et al. However, family variables such as paternal achievement oriented
(2016) showed that the relationship between life stress events and early psychological control (Pace et al., 2018), parental overinvolvement,
maladaptive schemas in female and male adolescents was stronger when mother’s anxiety (Sepúlveda et al., 2021) and family stress (Salafia and
impulsivity was high, increasing the odds of presenting EDs symptoms. Lemer, 2012) presented significant associations with EDs
symptomatology. The chances of presenting disordered eating
3.3.1.5. Coping strategies behaviors increase in the presence of these variables. In addition, poor
Two studies focused on analyzing the coping strategies of family functioning and family concerns about weight and appearance
adolescents and their associations with the appearance of disordered are related, mediated by self-esteem and body dissatisfaction, with
eating behaviors Intropunitive avoidance, avoidance of social support negative eating behaviors in adolescents (Leung et al., 1995; Table 2).
(García-Grau et al., 2002) and escape-avoidance (Lee-Win et al., 2016) Regarding interpersonal relationships, seven studies identified the
showed a direct association with EDs symptoms. Concretely, lifetime influence of these variables on eating behaviors. Perceived peer
prevalence of binge eating was 1.13 times higher with escape- support was identified as a protective moderator in the relationship
avoidance coping strategy (Lee-Win et al., 2016). These results were between paternal achievement oriented psychological control and EDs
supported by Unikel et al. (2013), who included criticism in the symptomatology (Pace et al., 2018; Piko et al., 2023). However,
analysis and found a positive association with internalization of thin characteristics related with low-quality friendships such as conflicts
ideal. Finally, two studies found that problem solving could be a among friends (Beckers et al., 2023), provide less self-validations,
protective coping strategy for disordered eating, especially for girls feelings of alienation and perception of less helpful friendships are
(García-Grau et al., 2002; Baylan et al., 2009). associated with more probabilities of presenting symptoms of EDs
(Sharpe et al., 2014). Moreover, peers’ negative attitudes against body
3.3.2. Sociocultural and social media influence and weight, experienced weight, or appearance teasing (Shomaker and
Eleven articles showed significant associations between the Furman, 2009), and poor communication were more likely to lead to
exposure to sociocultural or social media and the onset of EDs bulimia symptomatology (Shroff and Thompson, 2006).
symptomatology. Four studies, with 100% women, presented a Finally, being in a romantic adolescent relationship has been
significant relationship between sociocultural influence (Rodgers identified as another source of pressure and was associated with
et al., 2014), media pressure (Fortes et al., 2016; Rosewall et al., 2018) negative eating behaviors (Shomaker and Furman, 2009; Salafia and
and internalization of aesthetic thin ideal with disordered eating Lemer, 2012).
(Unikel et al., 2013).
Another five studies showed significant associations between media
pressure and EDs symptoms according to gender. Argydes et al. (2020) 4. Discussion
found significant relationships between media pressure and EDs
symptomatology in both women and men. Dakanalis et al. (2014) showed This systematic review aimed to identify the risk factors for EDs
the influence of media-ideal internalization on body shame and symptomatology onset during adolescence, by focusing on both
appearance anxiety mediated by self-objectification for both genders. Two individual and environmental factors.
studies (Halliwell and Harvey, 2006; Pamies-Aubalat et al., 2022), found This study was conducted without limitations for years, in order
a significant indirect association between weight pressure and body to provide the most comprehensive overview about EDs risk factors.
dissatisfaction for both genders, mediated by social comparisons, pressure In fact, the oldest identified article is from almost 30 years ago and was
to lose weight and internalization. Concretely, the odds of presenting focused on family characteristics and the association with EDs
disordered eating behaviors increase in participants with higher scores on symptoms (Leung et al., 1995). Observations over the past decades,
social comparisons. However, Macedo-Uchôa et al. (2019) only found a have shown a growing interest in this field, most likely due to the

increasing prevalence rates, especially, at early ages (Smink et al., 2012; and a correct interpretation of the media information with respect
López, 2017; Galmiche et al., 2019). For that reason, the design of to appearance should be pillars in the EDs prevention programs. The
effective prevention and intervention programs has been a priority. inclusion of these factors could prevent the appearance of body
However, up to now the proposals in that regard have not shown dissatisfaction, body shame or self-objectification symptoms, which
consistent effective results (Pratt and Woolfenden, 2002; Swanson are commonly associated with the onset of EDs symptoms
et al., 2011; Fairburn et al., 2015; Stice et al., 2021). (Dakanalis et al., 2014; Saunders et al., 2020).
Consequently, risk factors for EDs should be thoroughly analyzed to Considering this information, not only the individual is exposed
identify what is missing from current programs to achieve greater to the current society, but also their closest and most significant circle,
effectiveness, especially in terms of prevention. This systematic review has family, and peers. Therefore, the relationship and interactions between
contributed to fill this gap, as it has identified that, although environmental the adolescent with their family and peers have been identified as
risk factors (i.e., friends, family and society) were also found to another risk factor of EDs symptomatology (Leung et al., 1995; Shroff
be associated with ED occurrences, prevention programs mainly focus on and Thompson, 2006; Baylan et al., 2009; Shomaker and Furman,
characteristics like appearance, body weight, and body dissatisfaction, 2009; Salafia and Lemer, 2012; Sharpe et al., 2014; Iannaccone et al.,
therefore reducing or removing the attention from other relevant areas 2016; Gan et al., 2018; Lee et al., 2018; Pace et al., 2018; Sepúlveda
(Stice et al., 2021). According to this data, the amount of research about et al., 2021). For that reason, family concerns about weight and
the association of peers, family and society characteristics with EDs appearance were associated with features such as low self-esteem
symptomatology during adolescence are reduced, compared to that of (Leung et al., 1995). Also, parental characteristics, like mothers’
studies about individual characteristics and EDs. For example, from the anxiety, or parenting styles, such as overinvolvement or psychological
47 included studies in this systematic review, only 10 (Halliwell and control, were associated with more presence of disordered eating
Harvey, 2006; Unikel et al., 2013; Dakanalis et al., 2014; Rodgers et al., behaviors (Salafia and Lemer, 2012; Pace et al., 2018; Sepúlveda et al.,
2014; Fortes et al., 2016; Kaewpradub et al., 2017; Rosewall et al., 2018; 2021). However, there is no agreement about the role of family factors
Macedo-Uchôa et al., 2019; Argydes et al., 2020; Pamies-Aubalat et al., for the onset of EDs symptomatology. Evidence supports that these
2022), eight (Leung et al., 1995; Baylan et al., 2009; Salafia and Lemer, factors are associated with the exacerbation and maintenance of the
2012; Iannaccone et al., 2016; Gan et al., 2018; Lee et al., 2018; Pace et al., symptoms (Sepúlveda et al., 2021).
2018; Sepúlveda et al., 2021) and six (Shroff and Thompson, 2006; Furthermore, characteristics like maternal care (Iannaccone et al.,
Shomaker and Furman, 2009; Salafia and Lemer, 2012; Sharpe et al., 2014; 2016), affective involvement (Baylan et al., 2009) and family cohesion
Pace et al., 2018; Beckers et al., 2023) studied the relationship between (Gan et al., 2018; Lee et al., 2018) were identified as protective factors
society, family and peers with disordered eating behaviors, respectively. against disordered eating. It appears that more cohesive families are
Regarding society, women have always been under more pressure likely to promote a more stable environment, which in turn is
to pursue unrealistic and unattainable appearance ideals. Normally, associated with characteristics necessary to deal with the influences of
the standards promoted by current society were based on extreme current society, such as higher self-esteem.
thinness and looking perfect, and these characteristics were associated However, the influence of peers during adolescence could be just
with success. The promotion of the thin-ideal and the rejection of as significant as that of the family. In fact, peer support could be a
other body shapes leaded to a greater body dissatisfaction and the protective factor of the appearance of EDs symptoms for adolescents
practice of behaviors like dieting, purging or restrictions (Izydorczyk whose parents own a controlling parenting style. These individuals
and Sitnik-Warchulska, 2018; Dondzilo et al., 2019). For those reasons, perceive the positive reinforcement they need in their equal
research in this area has focused on women, especially adolescents. In relationships (Pace et al., 2018; Piko et al., 2023). On the contrary,
this systematic review, 33 of the included studies had a sample low-quality relationships based on lack of support, feeling alienated or
composed entirely or mostly by females. However, in recent years, the less self-validation have been identified as risk factors of EDs (Sharpe
investigation with male samples has increased, finding no significant et al., 2014; Beckers et al., 2023). Moreover, adolescents have been
differences compared to women, for the association between identified as a common audience of appearance-focused accounts on
sociocultural or media influence with EDs symptomatology (Halliwell social networking sites (Vall-Roqué et al., 2021) which could lead to
and Harvey, 2006; Dakanalis et al., 2014; Kaewpradub et al., 2017; exacerbate negative attitudes against weight and body, even suffering
Macedo-Uchôa et al., 2019; Argydes et al., 2020). from appearance teasing and poor communication (Shroff and
In the past decades, communication media was the main way to Thompson, 2006; Shomaker and Furman, 2009).
promote the unrealistic aesthetic ideal (Unikel et al., 2013; Rodgers In addition to friendship relationships, adolescence is also
et al., 2014; Fortes et al., 2016; Rosewall et al., 2018; Macedo-Uchôa characterized at the beginning of romantic relationships. This has
et al., 2019; Argydes et al., 2020). However, in recent years, internet been identified as another source of pressure, as adolescents desire to
and social networking sites have increased and intensified the be liked by others (Shomaker and Furman, 2009; Salafia and Lemer,
internalization process of the thin-ideal and social comparisons 2012). When pursuing to fulfill this need, they may take celebrities as
(Halliwell and Harvey, 2006; Kaewpradub et al., 2017; Pamies- reference. Therefore, they could practice negative behaviors, normally
Aubalat et al., 2022). The access to the information and unrealistic related to EDs symptomatology, with the aim of mirroring famous
aesthetic models are easier and faster, based on an immediate reward people who promote unrealistic aesthetic ideals (Unikel et al., 2013;
system. For example, the use of Instagram in the lockdown was Rodgers et al., 2014; Fortes et al., 2016; Rosewall et al., 2018; Macedo-
associated with an increase of body dissatisfaction and drive for Uchôa et al., 2019; Argydes et al., 2020). Consequently, the
thinness among young people, who followed more appearance- development and the maintenance of EDs symptoms could be reduced
focused accounts (Vall-Roqué et al., 2021). Therefore, it seems that if relationships and aesthetic ideals were included in prevention
the education to use social networking sites, personal empowerment, programs, together with training strategies oriented to family

members and preparing them to cope with the problem (Moreno- goals (Rosewall et al., 2018). This pressure could lead to obsessive-
Encinas et al., 2021). compulsive behaviors to achieve weight and appearance ideals (Baylan
Adolescence is a period characterized by identity formation and et al., 2009; Sepúlveda et al., 2021). Consequently, body dissatisfaction
emerging independence. Many significant constructs like self-esteem, and negative body attitudes increase as well as the probabilities of
self-concept, or self-efficacy play an important role in this period. For developing disordered eating behaviors (Boone et al., 2014; Teixeira
that reason, it is relevant to develop these characteristics, so they are et al., 2016; Jones et al., 2020; Koushiou et al., 2020).
adaptive and useful for managing stressful events and preventing the However, perfectionism was not the only personal characteristic
onset of psychological problems like EDs (Bardone-Cone et al., 2018). identified as a risk factor of EDs symptomatology. Ineffectiveness and
The relevance of individual characteristics in the appearance of EDs covert delinquency (McCabe and Vincent, 2003; Kerremans et al.,
symptomatology has promoted a great deal of research in this area. 2010) were associated with disordered eating in men, while inhibited
However, this systematic review also showed that the inner circle and behavior and low effortful control were the features observed in
the society are key risk factors. For example, if parents were trained in women (Kerremans et al., 2010). Low emotional intelligence was
emotion-regulation skills, they could teach these abilities to their identified as a risk factor for both genders, supporting the individuals
children in a more adaptive way. Likewise, if family and friends provide with non-adaptive emotion-regulation skills are likely to use strategies
a cohesive, supportive, and validating environment, the likelihood of like maladaptive eating behaviors to cope with stressful situations (Li
developing ED symptoms will be reduced. The adolescent is more likely and Li, 2021). Impulsivity was analyzed in three studies of this
to develop protective personal variables such as strong self-esteem and systematic review, being a risk factor for both genders. This trait
self-concept. Therefore, the influence of society will have less power, mediated the relationship between life stress and negative affect with
having more skills to manage the pressures to achieve an unrealistic and disordered eating, the participants with more symptomatology were
unhealthy ideal of beauty. If adolescents feel safe in their immediate those in the negative affect reactivity groups (Wade et al., 2015; Zhu
circle, they will have to make less efforts to try to fit into social standards et al., 2016; Evans et al., 2019). In fact, negative affect has been
(Lafrance et al., 2015; Moreno-Encinas et al., 2021). associated with EDs symptoms, playing a relevant role in the
Regarding individual characteristics, self-esteem has been internalization of the aesthetic ideal and appearing normally after
identified as an essential factor in the appearance of EDs symptoms body dissatisfaction. The dissonance generated between the ideal and
(Shroff and Thompson, 2006; Baylan et al., 2009; Rodgers et al., 2014; the failure to achieve it despite the efforts made leads to not only
Garrusi et al., 2016; Kaewpradub et al., 2017; Argydes et al., 2020; negative affect (McCabe and Vincent, 2003; Baylan et al., 2009;
Mora et al., 2022; Beckers et al., 2023). Therefore, low self-esteem Kerremans et al., 2010; Rodgers et al., 2014; Fortes et al., 2015, 2016;
during adolescence showed a significant association with EDs for both Wade et al., 2015; Gan et al., 2018; Rosewall et al., 2018; Evans et al.,
genders (McCabe and Vincent, 2003; Altamirano et al., 2011; Gomes 2019), also high levels of anxiety and stress (McCabe and Vincent,
et al., 2015; Teixeira et al., 2016; Gan et al., 2018; Rosewall et al., 2018; 2003; Costarelli et al., 2011; Salafia and Lemer, 2012; Zhu et al., 2016;
Jones et al., 2020; Zamani et al., 2020; Cella et al., 2021; Ćorić et al., Bacopoulou et al., 2017). Therefore, if adolescents are in a period of
2023). However, self-esteem was also a moderator between other changing, living in a society focused on thinness and feeling the
characteristics and EDs, especially body dissatisfaction or attitudes pressure from their closest circle, they should present active and
toward the body. These characteristics also presented a significant adaptive coping strategies to face this reality. However, growing in an
association with EDs (Altamirano et al., 2011; Costarelli et al., 2011; unsupportive environment which tends to judge appearance leads to
Boone et al., 2014; Fortes et al., 2015; Gomes et al., 2015; Garrusi et al., develop passive coping strategies, normally related to EDs
2016; Teixeira et al., 2016; Cruz-Sáez et al., 2018; Gan et al., 2018; symptomatology. Intropunitive avoidance, criticism, avoidance of
Macedo-Uchôa et al., 2019; Argydes et al., 2020; Ćorić et al., 2023). social support and escape-avoidance have been associated with the
This systematic review showed how society could lead to pursue greater presence of disordered eating behaviors (García-Grau et al.,
unattainable appearance ideals, failure to achieve these unrealistic 2002; Unikel et al., 2013; Lee-Win et al., 2016).
goals and the comparisons with models or peers could lead to body This systematic review showed an integrative and comprehensive
dissatisfaction or negative attitudes toward the body (Fortes et al., update on the risk factors that are more likely to lead to EDs symptoms
2016; Iannaccone et al., 2016; Cella et al., 2021). It has been observed during adolescence. The Supplementary material of this article
that adolescents with higher self-esteem presented less internalization provides an additional figure to understand the interaction between
of the thin-ideal and consequently less probabilities of developing risk factors. The results presented data from the last 3 decades, from
disordered eating behaviors (Bardone-Cone et al., 2018). The presence 21 different countries and for both genders, observing non relevant
of low self-esteem and poor family functioning has also influenced the differences by these two variables. Besides, most studies showed a high
onset of EDs symptoms. Adolescents living in an invalidating methodological quality. Although the risk factors for EDs
environment or being victims of appearance teasing tend to present symptomatology have been extensively studied, more research is
lower self-esteem and more probabilities of developing negative eating needed to fully understand the interplay between society, inner circle,
behaviors (Leung et al., 1995; Unikel et al., 2013). and individual characteristics. It has been observed that the etiology
Self-esteem (Jones et al., 2020), body dissatisfaction and attitudes of these disorders is complex and involves many factors. However,
toward body (Boone et al., 2014; Teixeira et al., 2016) were also prevalence rates are still growing, especially at early ages (Smink et al.,
influenced by perfectionism (McCabe and Vincent, 2003; Fortes et al., 2012; López, 2017; Galmiche et al., 2019). Intervention programs have
2015; Teixeira et al., 2016), psychological inflexibility (Koushiou et al., not shown consistent results of long-term effectiveness and up to 80%
2020) or obsessive-compulsive symptoms (Baylan et al., 2009; of people with an ED do not receive an appropriate intervention (Pratt
Sepúlveda et al., 2021). These associations could be related to and Woolfenden, 2002; Swanson et al., 2011; Fairburn et al., 2015;
establishing unrealistic goals or expectations. Moreover, society, Stice et al., 2021). For these reasons, research and constant updating
family, and peers could be pressuring the adolescent to pursue those are essential in this area, to identify current gaps and design innovative

prevention programs. Knowing the risk factors and the interaction programs to adapt them to specific needs, providing the most
between them, the inclusion of family members in treatments is appropriate resources in relation to the age of the participant.
essential. Training in emotional management and parenting skills is a The third limitation is that, biological factors were not included, as
fundamental point to include in treatments. Furthermore, the we focused on psychological factors with the aim to provide
integration of these tools in the school dynamics, involving peers and information for designing more effective prevention and intervention
families, could be a measure to take into account from the political programs. However, as this may limit the scope of conclusions of this
sphere. In this way, in addition to information about EDs, practical systematic review, future research could include biological factors.
tools would be provided for adolescents to form their identity in Setting of the reviewed studies was another limitation that could bias
environments where cohesion, support and validation predominate. interpretation and generalization of results: as there were no country
At the same time, parents could be trained to set limits in a way that restrictions during the search, the included studies are mostly from
is assertive and tolerant, rather than authoritarian and/or Europe. However, significant differences were not found in terms of
overprotective. Moreover, expanding the training offer for healthcare country or culture. Therefore, it seems that beauty ideals are
professionals including family and peer therapy would also be a increasingly similar through diverse societies. Since individual risk
measure to consider. For example, the New Maudsley Method is a factors are similar in all cultures, for example, low self-esteem has been
novel approach that has demonstrated positive results when seen as a risk factor in most of the articles included. Studies that have
administered to parents. This strategy involves training parenting analyzed sociocultural, family and peer influences are mostly located
skills in the treatment of disorders. This training method and its in Western societies. However, this only indicates that these variables
extension, including skills for dealing with peers and social pressures, have been more studied in these places, and that more research is
could be a current and innovative solution (Toubøl et al., 2019). needed into these factors in a wider range of countries. Finally, most of
the studies were focused on one area, namely, society, the inner circle,
or individual characteristics. To widen the knowledge on the interplay
4.1. Implications and limitations between these three areas in the etiology of EDs, more studies should
be carried out in a more integrative and comprehensive way.
Future directions could focus primarily on prevention. With To conclude, in future lines of research, the implementation of
the provision of psychoeducational information by experts in randomized controlled and longitudinal trials is recommended,
secondary schools, not only for the adolescents but also for specifically, to test and validate the effectiveness of new treatments and
educators and families, and the training to promote a safe prevention programs for EDs. Primarily, these programs should focus
environment at both school and home, where adolescents can on the psychological variables identified as risk factors, rather than
develop and explore their identities and notice the warning signs aspects related to food or body shape. Furthermore, the role that
of the EDs’ onset as soon as possible. The consideration of parents play as a fundamental part of the treatment must
biological and genetic risk factors involved in EDs could provide be considered; in accordance, parents can not only provide support,
a more comprehensive explanation of the onset of these disorders. but also act as therapists if trained on emotional and parenting skills.
In this regard, early identification has been associated with a Likewise, the inclusion of the management of social pressures, the
better prognosis (Le Grange and Loeb, 2007). Thus, improvement media and relationships with peers should be relevant elements within
is needed in intervention programs, especially regarding treatment and prevention.
prevention, which should include in a relevant way the society,
family, and peers’ relationships, as well as individual
characteristics beyond weight and appearance. Another gap that 5. Conclusion
should be covered is the inclusion of the adolescents’
environments in these programs, to inform about the risks, In conclusion, adolescence has traditionally been regarded as a
management of these situations, and effectively prevent them period of changing and identity formation. Adolescents are vulnerable
from homes and schools. to develop psychological problems if they do not feel they are in a safe
Despite its implications and strengths, this systematic review has environment to define a stable self-concept and self-esteem (Bardone-
some limitations. Firstly, although the included studies have analyzed Cone et al., 2018). This systematic review has shown the importance
the risk factors for both genders, there are other studies that have only of including society, family, and peers relationships in interventions
focused on the female population. It’s true that this population has and also prevention programs. It is essential that adolescents know the
traditionally been more affected by EDs; however, increasing prevalence current society and the continuous unrealistic information that people
rates of these problems are also being observed in men. For this reason, receive about having the perfect body or appearance, and the
further studies involving both genders are required. Secondly, there are dangerous behaviors promoted to achieve these goals. It has also been
more cross-sectional than longitudinal studies included in this review. identified that the individual needs to feel affection, support, and
This type of studies is needed to understand the onset and progression cohesion in the family. Moreover, adolescents need to learn how to
of EDs, as well as testing the long-term effectiveness of prevention and develop healthy romantic relationships characterized by validation
intervention programs. Longitudinal studies require more resources and positive reinforcement. Considering these aspects from an early
and time, but this type of analysis is also necessary to capture the age, it is likely that the adolescent develops a stronger self-esteem with
relative importance that risk factors have at different stages of less possibility of showing high body dissatisfaction. Consequently,
adolescence. This information could be very useful to identify the risk negative affect, anxiety, stress, and personal associated traits are likely
factors involved in the onset and early stages of EDs. This early to result in a more adaptive way, using protective coping strategies
identification would allow an earlier and more effective action in terms such as problem solving. Understanding the etiology of EDs in a
of prevention and intervention, with the possibility of customize comprehensive way could not only have scientific implications but

also clinical, for designing innovative and integrative prevention and Funding
intervention programs.
This study is part of a larger project with reference FUI1-014. The
project was funded by the “la Caixa” Foundation and the “Caja de
Data availability statement Burgos” Foundation, under the agreement LCF/PR/PR18/51130008.
The original contributions presented in the study are included in

the article/Supplementary material, further inquiries can be directed Conflict of interest
to the corresponding author.
The authors declare that the research was conducted in the
absence of any commercial or financial relationships that could
Ethics statement be construed as a potential conflict of interest.
Ethical approval was not necessary for the current systematic

review as no new participants were recruited for the purpose of the Publisher’s note
research. However, this study is part of a larger project, approved by
the ethical standards of Bioethics Committee of the University Isabel All claims expressed in this article are solely those of the authors
I (Reference: FUI1-014). and do not necessarily represent those of their affiliated organizations,
or those of the publisher, the editors and the reviewers. Any product
that may be evaluated in this article, or claim that may be made by its
Author contributions manufacturer, is not guaranteed or endorsed by the publisher.
CV, ÁH, MT-S, AJ-G, BM, PR-F, YV-H, and LR-S contributed to
design the systematic review. CV designed and conducted the search Supplementary material
strategy. CV, ÁH, and MT-S carried out independently the title-
abstract and full-text screening. Disparities were solved by discussion. The Supplementary material for this article can be found online
All authors contributed to write the manuscript and approved the at: https://www.frontiersin.org/articles/10.3389/fpsyg.2023.1221679/
submitted version. full#supplementary-material
References
Altamirano, M. B., Vizmanos, B., and Unikel, C. (2011). Continuum of risky eating Cella, S., Cipriano, A., Aprea, C., and Cotrufo, P. (2021). Self-esteem and binge eating
behaviors in Mexican adolescents. Rev. Panam. Salud Publica 30, 401–407. doi: 10.1590/ among adolescent boys and girls: the role of body disinvestment. Int. J. Environ. Res.
s1020-49892011001100001 Public Health 18:7496. doi: 10.3390/ijeph18147496
American Psychiatry Association (2013). Guía de consulta de los criterios diagnósticos Cerniglia, L., Cimino, S., Tafà, M., Marzilli, E., Ballarotto, G., and Bracaglia, F. (2017).
del DSM-5 [Diagnostic and statistical manual of mental disorders: DSM-5]. Washington: Family profiles in eating disorders: family functioning and psychopathology. Psychol.
American Psychiatry Publishing. Res. Behav. Manag. 10, 305–312. doi: 10.2147/PRBM.S145463
Argydes, M., Anastasiades, E., and Alexiou, E. (2020). Risk and protective factors of Ćorić, M. K., Graovac, M., Pravdić, N., Raguž, A. B., and Kaštelan, A. (2023).
disordered eating in adolescents based on gender and body mass index. Int. J. Environ. Predictive factors of disordered eating among adolescents in Bosnia and Herzegovina.
Res. Public Health 17:9238. doi: 10.3390/ijerph17249238 J. Educ. Health Promot. 12:258. doi: 10.4103/jehp.jehp_1560_22
Bachar, E., Gur, E., Canetti, L., Berry, E., and Stein, D. (2010). Selflessness and Costarelli, V., Antonopoulou, K., and Mavrovounioti, C. (2011). Psychosocial
perfectionism as predictors of pathological eating attitudes and disorders: a longitudinal characteristics in relation to disordered eating attitudes in Greek adolescents. Eur. Eat.
study. Eur. Eat. Disorders Rev. 18, 496–506. doi: 10.1002/erv.984 Disorders Rev. 19, 322–330. doi: 10.1002/erv.1030
Bacopoulou, F., Foskolos, E., Stefanaki, C., Tsitsami, E., and Vousoura, E. (2017). Cruz-Sáez, S., Pascual, A., Wlodarczyk, A., and Echeburúa, E. (2018). The effect of
Disordered eating attitudes and emotional/behavioral adjustment in Greek adolescents. body dissatisfaction on disordered eating: the mediating role of self-esteem and negative
Eat. Weight Disord. 23, 621–628. doi: 10.1007/s40519-017-0466-x affect in male and female. J. Health Psychol. 25, 1098–1108. doi:
10.1177/1359105317748734
Barakat, S., McLean, S. A., Bryant, E., le, A., Marks, P., National Eating Disorder
Research Consortium (2023). Risk factors for eating disorders: findings from a rapid Dakanalis, A., Carrà, G., Calogero, R. M., Fida, R., Clerici, M., Zanetti, M. A., et al.
review. J. Eat. Disord. 11:8. doi: 10.1186/s40337-022-00717-4 (2014). The developmental effects of media-ideal internalization and self-objectification
processes on adolescents’ negative body-feelings, dietary restraint, and binge eating. Eur.
Bardone-Cone, A. M., Thompson, K. A., and Miller, A. J. (2018). The self and eating Child Adolesc. Psychiatry 24, 997–1010. doi: 10.1007/s00787-014-0649-1
disorders. J. Pers. 88, 59–75.
Dondzilo, L., Rieger, E., Jayawarden, N., and Bell, J. (2019). Drive for thinness versus
Baylan, G., Erol, A., and Kilicoglu, A. (2009). Predictors of Anoretic and bulimic fear of fat: approach and avoidance motivation regarding thin and non-thin images in
symptoms in adolescent girls. Klinik Psikofarmakol. Bülteni. 19, 407–413. women. Cognit. Ther. Res. 43, 585–593. doi: 10.1007/s10608-018-9989-3
Beckers, D., Laresen, J. L., and Burk, W. J. (2023). Self-esteem and negative affectivity Evans, B. C., Felton, J. W., Lagacey, M. A., Manasse, S. M., Lejuez, C. W., and
as mediators of the prospective links between adolescent interpersonal peer problems Juarascio, A. S. (2019). Impulsivity and affect reactivity prospectively predict disordered
and disordered eating behaviors. Appetite 186:106558. doi: 10.1016/j.appet.2023.106558 eating attitudes in adolescents: a 6-year longitudinal study. Eur. Child Adolesc. Psychiatry
Boone, L., Soenens, B., and Luyten, P. (2014). When or why does perfectionism 28, 1193–1202. doi: 10.1007/s00787-018-01267-4
translate into eating disorder pathology? A longitudinal examination of the moderating Fairburn, C., Bailey-Straebler, S., Basden, S., Doll, H., Jones, R., Murphy, R., et al.
and mediation role of body dissatisfaction. J. Abnorm. Psychol. 123, 412–418. doi: (2015). A transdiagnostic comparison of enhanced cognitive behaviour therapy (CBT-E)
10.1037/a0036254 and interpersonal psychotherapy in the treatment of eating disorders. Behav. Res. Ther.
70, 64–71. doi: 10.1016/j.brat.2015.04.010
Cardi, V., Mallorqui-Bague, N., Albano, G., Monteleone, A. M., Fernandez-Aranda, F.,
and Treasure, J. (2018). Social difficulties as risk and maintaining factors in anorexia Fairburn, C. G., Cooper, Z., and Shafran, R. (2003). Cognitive behaviour therapy for
nervosa: a mixed-method investigation. Front. Psych. 9:e0012. doi: 10.3389/fpsyt. eating disorders: a “transdiagnostic” theory and treatment. Behav. Res. and Ther. 41,
2018.00012 509–528. doi: 10.1016/s0005-7967(02)00088-8

Fortes, L. S., Amaral, A. C. S., Almeida, S. S., and Ferreira, M. E. C. (2013). Efeitos de Le Grange, D., and Loeb, K. (2007). Early identification and treatment of eating
variáveis psicológicas, morfológicas e sociodemográficas sobre comportmento alimentar disorders: prodrome to syndrome. Early Interv. Psychiatry 1, 27–39. doi:
de adolescentes. Rev. Paul. Ped. 31, 182–188. doi: 10.1590/S0103-05822013000200008 10.1111/j.1751-7893.2007.00007.x
Fortes, L. S., Filgueiras, J. F., Oliveria, F. C., Almieda, S. S., and Ferreira, M. E. C. Lee, A. Y., Reynolds, K. D., Stacy, A., Niu, Z., and Xie, B. (2018). Family functioning,
(2016). Etiological model of disordered eating behaviors in Brazilian adolescent girls. moods, and binge eating among urban adolescents. J. Behav. Med. 42, 511–521. doi:
Cad. Saude Publica 32: e000024115. doi: 10.1590/0102-311X00024115 10.1007/s10865-018-9994-8
Fortes, L. S., Meireles, J. F. F., Neves, C. M., Almeida, S. S., and Ferreira, M. E. C. Lee-Win, A. E., Townsend, L., Reinblatt, S. P., and Mendelson, T. (2016). Associations
(2015). Disordered eating, body dissatisfaction perfectionism, and mood state in female of neuroticism-impulsivity and coping with binge eating in a nationally representative
adolescents. Rev. Nutri. Campinas. 28, 371–383. doi: 10.1590/1415-52732015000400004 sample of adolescents in the United States. Eat. Behav. 22, 133–140. doi: 10.1016/j.
eatbeh.2016.06.009
Gaete, V., and López, C. (2020). Trastornos de la conducta alimentaria en adolescentes.
Una mirada integral [Eating disorders in adolescents. A comprehensive approach]. Rev. Leung, F., Schwartzman, A., and Steiger, H. (1995). Testing a dual-process family
Chil. Pediatr. 91, 784–793. doi: 10.32641/rchped.vi91i5.1534 model in understanding the development of eating pathology: a structural equation
modeling analysis. Int. J. Eat. Disord. 20, 367–375. doi: 10.1002/(SICI)1098-108X
Galmiche, M., Déchelotte, P., Lambert, G., and Tavolacci, M. P. (2019). Prevalence of
(199612)20:4<367::AID-EAT4>3.0.CO;2-L
eating disorders over the 2000-2018 period: a systematic literature review. Am. J. Clin.
Nutr. 109, 1402–1413. doi: 10.1093/ajcn/nqy342 Li, Y., and Li, J. (2021). The boundary conditions by which body-esteem leads to eating
disorders risk among adolescents. J. Gen. Psychol. 149, 97–115. doi: 10.1080/00221309.
Gan, W. Y., Mohamad, N., and Law, L. S. (2018). Factors associated with binge eating
2021.1915741
behavior among Malaysian adolescents. Nutrients 10:66. doi: 10.3390/nu1001006
López, A. P. S. (2017). Prevalencia de trastornos de la conducta alimentaria en seis
García-Grau, E., Fusté, A., Miró, A., Saldaña, C., and Bados, A. (2002). Coping style
países europeos. Metas de enfermería [Prevalence of eating behaviour disorders in six
and Distrubed eating attitudes in adolescent girls. Int. J. Eat. Disord. 32, 116–120. doi:
European countries]. 20:9. doi: 10.35667/MetasEnf.2019.20.1003081094
10.1002/eat.10060
López, C., and Treasure, J. (2002). Eating disorders in adolescents: description and
Garrusi, B., Baneshi, M. R., and Pakgohar, M. (2016). Eating disorders among Iranian
management. Rev. Méd. Clín. Las Condes. 22, 85–97. doi: 10.1016/S0716-8640(11)70396-0
male adolescents. Iran J. Pyschiatry Behav. Sci. 10:e5352. doi: 10.17785/ijpbs-5352
Macedo-Uchôa, F. N., Macêdo-Uchôa, N., Medeiros da Costa-Daniele, T.,
Gibson, D., Workman, C., and Mehler, P. S. (2019). Medical complications of anorexia
Pinheiro-Lustosa, R., Domingos-Garrido, N., Figueiredo-Deana, N., et al. (2019).
nervosa and bulimia nervosa. Psychiatr. Clin. N. Am. 42, 263–274. doi: 10.1016/j.
Influence of the mass media and body dissatisfaction on the risk in adolescents of
amjmed.2015.06.031
developing eating disorders. Int. J. Environ. Res. Public Health 16:1508. doi: 10.3390/
Gismero-González, M. E. (2020). Factores de riesgo psicosociales en los Trastornos ijerph16091508
de la Conducta Alimentaria: Una revisión y algunas consideraciones Para la prevención
McCabe, M. P., and Vincent, M. A. (2003). The role of biodevelopmental and
y la intervención [psychosocial risk factors for eating disorders: a review and some
psychological factors in disordered eating among adolescent males and females. Eur.
considerations for prevention and intervention]. Revista de Psicoterapia. 31, 33–47. doi:
Eat. Disorders. Rev. 11, 315–328. doi: 10.1002/erv.500
10.33898/rdp.v31i115.354
Monell, E., Clinton, D., and Bigegard, A. (2018). Emotion dysregulation and eating
Gomes, R., Gonçalves, S., and Costa, J. (2015). Exercise, eating disordered behaviors
disorders- associations with diagnostic presentation and key symptoms. Int. J. Eat.
and psychological well-being: a study with Portuguese adolescents. Rev. Latinoam.
Disord. 51, 921–930. doi: 10.1002/eat.22925
Psicol. 47, 66–74. doi: 10.1016/S0120-0534(15)30008-X
Moola, S., Munn, Z., Sears, K., Sfetcu, R., Currie, M., Lisy, K., et al. (2015). Conducting
Grooten, W. J. A., Tseli, E., Äng, B. O., Boersma, K., Stånacke, B. M., Gerdle, B., et al.
systematic reviews of association (etiology): the Joanna Briggs Institute’s approach. Int.
(2019). Elaborating on the assessment of the risk of bias in prognostic studies in pain
J. Evid. Based Healthc. 13, 163–169. doi: 10.1097/XEB.0000000000000064
rehabilitation using QUIPS-aspects of interrater agreement. Diagn. Progn. Res. 3, 5–11.
doi: 10.1186/s41512-019-0050-0 Mora, F., Álvarez-Mon, M. A., Fernández-Rojo, S., Ortega, M. A., Félix-Alcántara, M. P.,
Morales-Gil, I., et al. (2022). Psychosocial factors in adolescence and risk of development
Halliwell, E., and Harvey, M. (2006). Examination of a sociocultural model of
of eating disorders. Nutrients 14:1481. doi: 10.3390/nu14071481
disordered eating among male and female adolescents. Br. J. Health Psychol. 11, 235–248.
doi: 10.1348/1359070X39214 Moreno-Encinas, A., Graell, M., Martínez-Huertas, M. F., Treasure, J., and
Sepúlveda, A. R. (2021). Adding maintaning factors to develpmental models of anorexia
Hambleton, A., Pepin, G., Le, A., Maloney, D., Touyz, S., and Maguire, S. (2022).
nervosa: an emprical examination in adolescents. Eur. Eat. Disorders. Res. 29, 548–558.
Psychiatric and medical comorbidities of eating disorders: findings from a rapid review
doi: 10.1002/erv.2826
of the literature. J. Eat. Disord. 10, 132–123. doi: 10.1186/s40337-022-00654-2
Nuño-Gutiérrez, B. L., Celis-de la Rosa, A., and Unikel-Santoncini, C. (2009).
Higgins, J., and Green, S. (2008). Cochrane handbook for systematic reviews of
Prevalence and associated factors related to disordered eating in student adolescents of
interventions. The Cochrane collaboration. Chichester: John Wiley & Sons.
Guadalajara across sex. Rev. Investig. Clin. 61, 286–293.
Iannaccone, M., D’Olimpio, F., Cella, S., and Cotrufo, P. (2016). Self-esteem, body
O’Brien, K. M., Whelan, D. R., Sandler, D. P., Hall, J. E., and Weinberg, C. R. (2017).
shame and eating disorder risk in obese and normal weigth adolescents: a mediation
Predictors and long-term health outcomes of eating disorders. PLoS One 12:e0181104.
model. Eat. Behav. 21, 80–83. doi: 10.1016/j.eatbeh.2015.12.010
doi: 10.1371/journal.pone.0181104
Izydorczyk, B., and Sitnik-Warchulska, K. (2018). Sociocultural appearance standards
Pace, U., D’Urso, G., and Zappulla, C. (2018). Negative eating attitudes and behaviors
and risk factors for eating disorders in adolescents and women of various ages. Front.
among adolescents: the role of parental control and perceived peer support. Appetite 121,
Psychol. 9:e00429. doi: 10.3389/fpsyg.2018.00429
77–82. doi: 10.1016/j.appet.2017.11.001
Jones, E. J., Egan, S. J., Howell, J. A., Hoiles, K. J., and Mazzucchelli, T. G. (2020). An
Page, M. J., Moher, D., Bossuyt, P. M., Boutron, I., Hoffmann, T. C., Mulrow, C. D., et al.
examination of the transdiagnostic cognitive-behavioural model of eating eating
(2021). PRISMA 2020 explanation and elaboration: updated guidance and exemplars for
disorders in adolescents. Eat. Behav. 39:101445. doi: 10.1016/j.eatbeh.2020.101445
reporting systematic reviews. Brit. Med. J. 372:n160. doi: 10.1136/bmj.n160
Kaewpradub, N., Kiatrungrit, K., Hongsanguansri, S., and Pavasuthipaisit, C. (2017).
Pamies, L., and Quiles, Y. (2014). Perfectionism and risk factors for the development
Association among internet usage, body image and eating behaviors of secondary school
of eating disorders in Spanish adolescents of both genders. An. de Psicol. 30, 620–626.
students. Shanghai Arch. Psychiatry 29, 208–217. doi: 10.11919/j.issn.1002-0829.216092
doi: 10.6018/analesps.30.2.158441
Kerremans, A., Claes, L., and Bitjttebier, P. (2010). Disordered eating in adolescent
Pamies-Aubalat, L., Quiles, Y., and Torregrosa, M. L. (2022). Psychosocial profle
males and females: associations with temperament, emotional and behavioral problems
and perceived self-competence. Pers. Individ. Differ. 49, 955–960. doi: 10.1016/j. related to disordered eating attitudes in Spanish adolescents. Curr. Psychol. 42,
paid.2010.08.003 20193–20202. doi: 10.1007/s12144-022-03164-1
Koushiou, M., Loutsiou, A., and Karekla, M. (2020). Eating disorders among middle- Piko, B. F., Patel, K., and Kiss, H. (2023). Risk of disordered eating among a sample of
school students: the role of psychological inflexibility and self-esteem. J. Sch. Educ. Indian adolescents: the role of online activity. Soc. Anx. Soc. Supp. 18, 315–321. doi:
Psychol. 9, S58–S68. doi: 10.1080/21683603.2020.1742259 10.1177/09731342231163391
Lafrance, A., Dolhanty, J., and Greenberg, L. (2015). Emotion-focused family therapy Pratt, B. M., and Woolfenden, S. (2002). Interventions for preventing eating disorders
for eating disorders in children and adolescents. Clin. Psychol. Psychother. 22, 75–82. doi: in children and adolescents. Cochrane Database Syst. Rev. 2002. doi: 10.1002/14651858.
10.1002/cpp.1861 CD002891
Laporta, I., Delgado, M., Reboyar, S., and Lahuerta, C. (2020). Perfectionism in Rodgers, R. F., Paxton, S. J., and McLean, S. A. (2014). A biopsychosocial model of
adolescents with eating disorders. Eur J Health Research. 6, 97–107. doi: 10.30552/ejhr. body image concerns in early adolescent girls. J. Youth Adolesc. 43, 814–823. doi:
v6i1.205 10.1007/s10964-013-0013-7
Lazo, Y., Quenaya, A., and Mayta-Tristán, P. (2015). Influencia de los medios de Rosewall, J. K., Gleaves, D. H., and Latner, J. D. (2018). An examination of risk factors
comunicación y el riesgo de padecer trastornos de la conducta alimentaria en escolares that moderate the body dissatisfaction-eating pathology relationship among
mujeres en Lima, Perú. Arch. Argent. Pediatr. 113, 519–525. doi: 10.5546/aap.2015.519 New Zealand adolescent girls. J. Eat. Disord. 6:38. doi: 10.1186/s40337-018-0225-z

Salafia, E. H., and Lemer, J. L. (2012). Associations between multiple types of stress Stice, E., Onipede, Z. A., and Marti, G. (2021). A meta-analytic review of trials that
and disordered eating among girls and boys in middle school. J. Child Fam. Stud. 21, tested whether eating disorder prevention programs prevent eating disorder onset. Clin.
148–157. doi: 10.1007/s10826-011-9458-z Psychol. Rev. 87:102046. doi: 10.1016/j.cpr.2021.102046
Saunders, J. F., Eaton, A. A., and Aguilar, S. (2020). From self(ie)-objectification Suarez-Albor, C. L., Galletta, M., and Gómez-Bustamante, E. M. (2022). Factors
to self-empowerment: the meaning of selfies on social media in eating disorder associated with eating disorders in adolescents: a systematic review. Acta Biomed
recovery. Comput. Hum. Behav. 111:106420. doi: 10.1016/j.chb.2020.106420 93:e2022253. doi: 10.23750/abm.v93i3.13140
Semenova, N., Slobodskaya, H., and Rezun, E. (2022). Suicidal behavior in adolescent girls Swanson, S. A., Crow, S. J., Le Grange, D., Swendsen, J., and Merikangas, K. R. (2011).
with eating disorders. Eur. Psychiatry 64, S32–S38. doi: 10.3109/08039480903265751 Prevalence and correlates of eating disorders in adolescents. Results from the national
comorbidity survey replication adolescent supplement. Arch Gen Psychiatry, 68,
Sepúlveda, A. R., Moreno-Encinas, A., Martínez-Huertas, J. A., Anastasiadou, D., Nova, E., 714–723. doi: 10.1001/archgenpsychiatry.2011.22
Marcos, A., et al. (2021). Toward a biological, psychological and familial approach of eating
disorders at onset: case-control ANOBAS study. Front. Psychol. 12:714414. doi: 10.3389/ Teixeira, M. D., Pereira, A. T., Marques, M. V., Saraiva, J. M., and Macedo, A. F.
(2016). Eating behaviors, body image, perfectionism, and self-esteem in a sample of
fpsyg.2021.714414
Portuguese girls. Rev. Bras. de Psiquiatr. 38, 135–140. doi: 10.1590/1516-4446-2015-1723
Serpell, L., and Troop, N. (2003). “Psychological factors” in The handbook of
Toubøl, A., Koch-Christensen, H., Bruun, P., and Nielsen, D. S. (2019). Parenting
eating disorders. eds. J. Treasure, U. Schmidt and E. V. Furth (Chichester: John
skills after participation in skills-based training inspired by the new Maudsley
Wiley & Sons), 151–168.
method: a qualitative study in an outpatient eating disorder setting. Scand. J. Caring
Sharpe, H., Schober, I., Treasure, J., and Schmidt, U. (2014). The role of high-quality Sci. 33, 959–968. doi: 10.1111/scs.12694
friendships in female adolescents’ eating pathology and body dissatisfaction. Eat. Weight Unikel, C., Martín, V., Juárez, F., González-Fortaleza, C., and Nuño, B. (2013).
Disord. 19, 159–168. doi: 10.1007/s40519-014-0113-8 Disordered eating behavior and body weight and shape relatives’ criticism in
Shomaker, L. B., and Furman, W. (2009). Interpersonal influences on late overweight and obese 15- to 19-year-old females. J. Healht. Pyschol. 18, 75–85. doi:
adolescent girls’ and boys’ disordered eating. Eat. Behav. 10, 97–106. doi: 10.1016/j. 10.1177/1359105311435945
eatbeh2009.02.003 Vall-Roqué, H., Andrés, A., and Saldaña, C. (2021). The impact of COVID-19
Shroff, H., and Thompson, K. (2006). Peer influences body-image dissatisfaction, lockdown on social network sites use, body image disturbances and self-esteem among
eating dysfunction and self-esteem in adolescent girls. J. Health Psychol. 11, 533–551. adolescent and young women. Prog. Neuropsychopaharmacol. Biol. Psychiatry.
doi: 10.1177/1359105306065015 110:110293. doi: 10.1016/j.pnpbp.2021.110293
Smink, F. R., Van Hoeken, D., and Hoek, H. W. (2012). Epidemiology of eating Wade, T. D., Wilksch, S. M., Paxton, S. J., Byrne, S. M., and Austin, S. B. (2015). How
disorders: incidence, prevalence and mortality rates. Curr. Psychiatry Rep. 14, 406–414. perfectionism and ineffectiveness influence growth of eating disorder risk in young
doi: 10.1007/s11920-012-0282-y adolescent girls. Behav. Res. Ther. 66, 56–63. doi: 10.1016/j.brat.2015.01.007
Solmi, M., Radua, J., Stubbs, B., Ricca, V., Moretti, D., Busatta, D., et al. (2020). Risk Zamani, S. H., Fathirezaie, Z., Gerber, M., Pühse, U., Bahamani, D. S., and Bashiri, M.
factors for eating disorders: an umbrella review of published meta-analyses. Braz. J. (2020). Self-esteem and symptoms of eating disordered behavior among female
Psych. 43, 314–323. doi: 10.1590/1516-4446-2020-1099 adolescents. Psychol. Rep. doi: 10.1177/00332948226
Stice, E. (2016). Interactive and mediational etiologic models of eating disorder onset: Zhu, H., Luo, X., Cai, T., He, J., Lu, Y., and Wu, S. (2016). Life event stress and binge
evidence from prospective studies. Annu. Rev. Clin. Psychol. 12, 359–381. doi: 10.1146/ eating among adolescents: the roles of early maladaptive schemas and Impulsity. Stress.
annurev-clinpsy-021815-093317 Health 32, 395–401. doi: 10.1002/smi.2634

An Update On The Underlying Risk Factors of Eating Disorders Onset During Adolescence A Systematic Review

Uploaded by

Copyright:

Available Formats

An Update On The Underlying Risk Factors of Eating Disorders Onset During Adolescence A Systematic Review

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

An Update On The Underlying Risk Factors of Eating Disorders Onset During Adolescence A Systematic Review

Uploaded by

Copyright:

Available Formats

TYPE Systematic Review

PUBLISHED 08 November 2023

An update on the underlying risk

eating disorders, adolescence, prevention, risk factors, protective factors

Frontiers in Psychology 01 frontiersin.org

1. Introduction with eating disorder symptomatology in adolescents (Suarez-Albor

Frontiers in Psychology 02 frontiersin.org

TABLE 1 Eligibility criteria to select studies for the systematic review.

Outcome Presence of ED symptomatology assessed by self-report or standardized/validated tools

Frontiers in Psychology 03 frontiersin.org

Frontiers in Psychology 04 frontiersin.org

Students who substantially increased

BITE Model, the variables presented significant associations were:

Females model 27% variance in binge eating.

Female Model EAT-26. (R2 = 0.236, p < 0.01).

- SPPA Higher scores on anxiety levels and

Female Model. Significant effect of body dissatisfaction on Disordered eating (B = 0.83,

SE = 0.015, 95% CI = 0.012–0.071).

192 53.1 EDE-Q with blocked entry

Full Model. (X2 = 1.02, p < 0.001; CFI = 1; SRMR = 0.009)

Internet use in relation to eating problems (OR = 1.13, 95%CI = 1.08–1.17,

esteem for female. For males, these

depressive symptoms, and covert

The amount of variance in eating disorder explained by psychological inflexibility and

Lifetime prevalence of binge eating was

Body-esteem leads to emotional

p = 0.02) and Ineffectiveness as significant predictors (β = 0.28, p = 0.02).

likely to have disordered eating attitudes

- > Dieting Behaviors

(b = 0.16, p = 0.02) and romantic partners (b = 0.14, p = 0.05) at time 1 predicted

TABLE 3 Level of risk of bias assessment using QUIPS tool.

Study Study Prognostic factor Outcome Statistical analysis

Argydes et al. (2020) Low Low Low Low Low Low

Bachar et al. (2010) Low Low Moderate Low Moderate Moderate

Bacopoulou et al. (2017) Moderate Low Moderate Low Moderate Low

Baylan et al. (2009) Low Low Low Low Low Low

Beckers et al. (2023) Low Low Low Low Low Low

Boone et al. (2014) Moderate Low Moderate Moderate Low Low

Cella et al. (2021) Moderate Low Low Low Low Low

Ćorić et al., 2023 Low Low Low Low Low Low

Costarelli et al. (2011). Moderate Low Low Low Moderate Moderate

Cruz-Sáez et al. (2018) Low Low Low Moderate Moderate Low

Dakanalis et al. (2014) Low Low Low Low Low Low

Evans et al. (2019) Moderate Moderate Low Low Moderate Low

Fortes et al. (2015) Low Low Low Low Moderate Low

Fortes et al. (2016) Low Low Low Low Low Low

Gan et al. (2018) Low Low Low Low Moderate Low

García-Grau et al. (2002) Low Low Low Low Moderate Low

Garrusi et al. (2016) Low Low Moderate Moderate Moderate Moderate

Gomes et al. (2015) Low Low Low Low Low Low

Iannaccone et al. (2016) Low Low Low Low Moderate Low

Jones et al. (2020) Moderate Moderate Low Low Moderate Low

Kaewpradub et al. (2017) Low Low Low Low Moderate Low

Kerremans et al. (2010) Moderate Moderate Low Low Moderate Low

Koushiou et al. (2020) Moderate Low Low Low Moderate Moderate

Lee et al. (2018) Low Low Low Low Low Moderate

Lee-Win et al. (2016) Low Low Low Low Moderate Low

Leung et al. (1995) Moderate Moderate Low Low Moderate Low

Li and Li (2021) Low Low Low Low Moderate Low