Relationship between body dissatisfaction and disordered eating: Mediating role of self-esteem and depression Inge Brechan ⁎, Ingela Lundin Kvalem Department of Psychology, University of Oslo, P.O. Box 1094 Blindern, NO-0317 Oslo, Norway abstract article info Article history: Received 22 August 2013 Received in revised form 6 October 2014 Accepted 3 December 2014 Available online 11 December 2014 Keywords: Self-esteem Depression Body image Eating behavior Binge eating The purpose of this study was to investigate the hypothesis that the effect of body dissatisfaction on disordered eating behavior is mediated through self-esteem and depression. If the effect of body dissatisfaction on disor- dered eating can be explained by self-esteem and depression, treatment may benefit from focusing more on self-esteem and depression than body dissatisfaction. We also hypothesized body image importance to be asso- ciated with lower self-esteem, stronger symptoms of depression, and more disordered eating. The results showed that the effect of body dissatisfaction on disorder eating was completely mediated, whereas the effect of body image importance was partly mediated. Both self-esteem and depression were significant mediators. Body image importance and self-esteem had a direct effect on restrained eating and compensatory behavior. Depres- sion had a direct effect on binge eating. This effect was significantly stronger among women. Depression also had a direct effect on restrained eating. This effect was positive among women, but negative among men. The results support emotion regulation and cognitive behavioral theories of eating disorders, indicating that self-esteem and depression are the most proximal factors, whereas the effect of body dissatisfaction is indirect. The results point out the importance of distinguishing between different symptoms of bulimia. Depression may cause binge eating, but compensatory behavior depends on self-esteem and body image importance. The results suggest that women may turn to both binge eating and restrained eating to escape awareness of negative emotions, whereas men focus on eating to a lesser extent than women. Existing treatment focuses on eating behavior first and mecha- nisms such as self-esteem and depression second. The results from this study suggest that an earlier focus on self-esteem and depression may be warranted in the treatment of disordered eating. © 2015 Elsevier Ltd. All rights reserved. 1. Introduction Body dissatisfaction predicts development of disordered eating (e.g., Wertheim, Koerner, & Paxton, 2001), but why body dissatisfaction may lead to disordered eating remains an unanswered question. Self- esteem and negative emotions (e.g., depression) have been proposed as mediators in the relationship between body dissatisfaction and disor- dered eating (Fairburn, Shafran, & Cooper, 1999; Vitousek & Hollon, 1990), but with mixed results (e.g., Heywood & McCabe, 2006; Van den Berg, Wertheim, Thompson, & Paxton, 2002). Clinically, this propo- sition means that body dissatisfaction has an indirect impact on disor- dered eating, and that self-esteem and negative emotions are the intermediate agents or mechanisms through which the effect on disor- dered eating is transferred. We believe the mixed results may be ex- plained by different aspects of body dissatisfaction (i.e., body dissatisfaction vs. body image importance) having different relations to different types of disordered eating (i.e., restrained eating, binge eating, and compensatory behavior). Studies including men (Heywood & McCabe, 2006; Ricciardelli & McCabe, 2001) have been less successful in identifying the proposed mediation, than studies exclusively made up of women, thus the mixed results may also be due to gender differences. Negative emotions have been identified as a mediator in the rela- tionship between body dissatisfaction and bulimic symptoms (Heywood & McCabe, 2006; Ricciardelli & McCabe, 2001; Stice, 2001), but the concept of negative emotions has been operationalized as a composite of different types of negative emotions. Most often, it in- cludes depression and anxiety, but mixed with other types of negative emotions, and sometimes also self-esteem. The problem is that we do not know if the results apply to all or just some of the different negative emotions. There is a need for research to investigate the mediating role of self-esteem and depression, distinctively, in the relationship between body dissatisfaction and disordered eating. If the relationship between body dissatisfaction and disordered eating can be explained by self- esteem and depression, acting as intermediate agents, clinical interven- tions against disordered eating may benefit from targeting self-esteem and depression. Such interventions may focus on improving self- esteem and solving emotional problems in general, by other means than body satisfaction, as well as reducing the importance of physical Eating Behaviors 17 (2015) 49–58 ⁎ Corresponding author at: Lillehammer University College, P.O. Box 952, NO-2604 Lillehammer, Norway. Tel.: +47 61 28 81 69. E-mail address: inge.brechan@hil.no (I. Brechan). http://dx.doi.org/10.1016/j.eatbeh.2014.12.008 1471-0153/© 2015 Elsevier Ltd. All rights reserved. Contents lists available at ScienceDirect Eating Behaviors