The mediating role of psychological factors in the relationship between body image dissatisfaction and eating disorders: a cross-sectional study in adults.

BACKGROUND/OBJECTIVES: Body image disturbance is a well-established risk factor for eating disorders; however, the psychological mechanisms through which it exerts its influence remain insufficiently understood. This study examined the mediating roles of guilt, shame, anxiety, depression, and distress in the relationship between body image disturbance and eating disorder behaviors in adults. METHODS: This cross-sectional study included 1,576 adults aged 19-64 years from Elazığ province, Turkey. Participants completed the Body Image Disturbance Questionnaire (BIDQ), Eating Disorder Examination Questionnaire short form (EDE-Q-13), Guilt and Shame Proneness Scale (GASP), and Depression Anxiety Stress Scale-21 (DASS-21). Hierarchical regression and path analyses were conducted to identify predictors and mediators of eating disorder symptoms, with gender, location, and BMI as covariates. RESULTS: Body image disturbance was the strongest independent predictor of eating disorder symptoms, explaining 24% of the variance (β = 0.89). Higher symptom scores were significantly associated with elevated depression, anxiety, and distress levels, with moderate-to-large effect sizes. Path analyses demonstrated that guilt oriented toward negative behavioral evaluation (Guilt-NBE), shame-related withdrawal, and depression partially mediated the BIDQ-EDE-Q relationship, with the depression model accounting for 28.3% of total variance. Anxiety similarly mediated this relationship (28.3%), whereas distress explained a slightly lower proportion (27.3%). CONCLUSION: Body image disturbance was statistically associated with eating pathology, with depression, anxiety, and shame-based withdrawal emerging as significant indirect pathways in the mediation model, while behaviorally focused guilt demonstrated a pattern consistent with a self-regulatory function. Interventions targeting maladaptive shame and affective distress, alongside strategies supporting adaptive guilt processing, may constitute meaningful clinical targets in eating disorder prevention and treatment.