Causal Modeling of Bulimia Nervosa Based on Obsessive Beliefs with the Mediating Role of Relationships in Fear of Negative Evaluation in Individuals with Symptoms of Bulimia Nervosa
Keywords:
Bulimia nervosa, obsessive beliefs, fear of negative evaluation, symptoms of bulimia nervosa disorderAbstract
Objective: The present study aimed to model the causal relationships between bulimia nervosa and obsessive beliefs by examining the mediating role of fear of negative evaluation among individuals with symptoms of bulimia nervosa.
Methods and Materials: This descriptive–correlational study employed structural equation modeling to examine the proposed relationships. The statistical population consisted of individuals with symptoms of bulimia nervosa who were members of Overeaters Anonymous associations in Iran in 2025, from whom 163 participants were selected using purposive sampling. Research instruments included the Gormally Binge Eating Scale, the Obsessive Beliefs Questionnaire (OBQ-44), and the Fear of Negative Evaluation Scale. Data analysis was conducted using SPSS version 27 and SmartPLS version 4.
Findings: Structural model results indicated that fear of negative evaluation had a significant positive direct effect on bulimia nervosa (β = 0.329, p = 0.001). The general factor of obsessive beliefs had a significant positive effect on fear of negative evaluation (β = 0.492, p < 0.001), but its direct effect on bulimia nervosa was not significant (β = −0.034, p = 0.800). Perfectionism and certainty also showed a significant positive effect on fear of negative evaluation (β = 0.197, p = 0.025), but their direct effect on bulimia nervosa was not supported (β = 0.139, p = 0.223). The only significant indirect effect was observed for the general obsessive belief factor on bulimia nervosa through fear of negative evaluation (β = 0.162, p = 0.006). The coefficient of determination showed that the model explained 38.8% of the variance in fear of negative evaluation and 20.8% of the variance in bulimia nervosa.
Conclusion: The findings demonstrated that fear of negative evaluation plays a central role in predicting bulimia nervosa and serves as a key mediating mechanism linking obsessive beliefs to binge eating behavior. The results also indicated that obsessive beliefs do not exert direct effects on binge eating unless mediated by emotional–social processes.
Downloads
References
Ahmadi Golsfidi, E., Asadi, J., Khajvand Khooshli, A., & Abdollahzadeh, H. (2021). Modeling body image concern based on obsessive-compulsive disorder, perfectionism, and eating attitudes with the mediation of basic psychological needs in girls. Rooyesh-e Ravanshenasi Journal, 10(8). https://frooyesh.ir/browse.php?a_id=2889&slc_lang=en&sid=1&printcase=1&hbnr=1&hmb=1
American Psychiatric, A. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). American Psychiatric Publishing. https://doi.org/10.1176/appi.books.9780890425596
Amianto, F., Secci, I., Arletti, L., Davico, C., Abbate Daga, G., & Vitiello, B. (2021). Obsessive-compulsive symptoms in young women affected with anorexia nervosa, and their relationship with personality, psychopathology, and attachment style. Eating and Weight Disorders-Studies on Anorexia, Bulimia and Obesity, 1-15. https://doi.org/10.21203/rs.3.rs-383271/v1
Arghavani Hadi, S., Afshari, A., & Tavoli, A. (2023). The role of rumination and grief emotion management skills in predicting emotional eating behavior in overweight and obese children aged 9 to 12. Journal of Cognition and Psychiatry Psychology, 2(10). https://doi.org/10.32598/shenakht.10.2.118
Babakhanlou, A., & Babakhanlou, Z. (2023). Presenting a structural model of emotional eating in obese individuals based on self-regulation with the mediation of emotional processing. Journal of Psychological Dynamics in Mood Disorders, 2(2). https://doi.org/10.61838/kman.pdmd.2.2.4
Beckers, D., Burk, W. J., Larsen, J. K., & Cillessen, A. H. (2025). Friends' influence on Adolescents' loss of control eating: The moderating role of self‐esteem, fear of negative evaluation, and body dissatisfaction. Journal of Research on Adolescence, 35(1), e70005. https://doi.org/10.1111/jora.70005
Beirami, M., Bakhshipour Roudsari, A., Fakhari, A., & Khakpour, Z. (2012). Comparison of impulsivity and its subscales in patients with eating disorders, obsession, and the normal group. Journal of Behavioral Sciences Research, 9(5). https://rbs.mui.ac.ir/article-1-222-en.html
Bodaghi, E., Hassani, J., & Moradi, A. (2016). Activity of behavioral-brain systems in patients with binge eating disorder, addiction, and normal individuals. Journal of Neuropsychology, 2(3). https://www.sid.ir/paper/266850/en
Chew, H. S. J., Soong, R. Y., Ang, W. H. D., Ngooi, J. W., Park, J., Yong, J. Q. Y. O., & Goh, Y. S. S. (2025). The global prevalence of emotional eating in overweight and obese populations: A systematic review and meta‐analysis. British Journal of Psychology. https://doi.org/10.1111/bjop.12768
Côté, M., Roy, M. P., Rodrigue, C., & Bégin, C. (2025). Binge eating disorder recognition and stigma among an adult community sample. Journal of eating disorders, 13(1), 5. https://doi.org/10.1186/s40337-024-01162-1
Daneshjoo, F., Barzegar Bofrouei, K., & Hassani, H. (2023). Investigating the role of negative perfectionism and experiential avoidance in academic stress with the mediation of fear of negative evaluation in Yazd University students. Research in School and Virtual Learning, 10(4). https://etl.journals.pnu.ac.ir/article_9785.html?lang=en
Dar, S., Baloch, R., & Usman, M. (2023). Mediating role of Depression between Fear of Negative Evaluation and Suicidal Ideation among University Students. Pakistan Journal of Humanities and Social Sciences, 11(3), 3311-3316. https://doi.org/10.52131/pjhss.2023.1103.0614
Demiray, M. (2025). Duygu Odaklı Psikoterapi Ekolünün Bulimia Nervoza Olgularında Etkililiğine Dair Sistematik Bir Gözden Geçirme. Türkiye Bütüncül Psikoterapi Dergisi, 8(15), 103-113. https://doi.org/10.56955/bpd.1500061
Di Luzio, M., Bellantoni, D., Bellantoni, A. L., Villani, V., Di Vincenzo, C., Zanna, V., Vicari, S., & Pontillo, M. (2024). Similarities and differences between eating disorders and obsessive-compulsive disorder in childhood and adolescence: a systematic review. Frontiers in Psychiatry, 15, 1407872. https://doi.org/10.3389/fpsyt.2024.1407872
Eichholz, A., Schwartz, C., Meule, A., Heese, J., Neumüller, J., & Voderholzer, U. (2020). Self‐compassion and emotion regulation difficulties in obsessive-compulsive disorder. Clinical Psychology & Psychotherapy, 27(5), 630-639. https://doi.org/10.1002/cpp.2451
Farhadi Khoozani, M. (2021). The relationship between attachment styles and mentalization with symptoms of eating disorders with the mediation of interpersonal emotion regulation strategies
Fekih-Romdhane, F., Pardini, S., Hallit, S., Novara, C., & Brytek-Matera, A. (2024). A multi-country examination of the relationship between perfectionism and disordered eating: the indirect effect of obsessive beliefs and obsessive-compulsive symptoms. Journal of eating disorders, 12(1), 69. https://doi.org/10.1186/s40337-024-01030-y
Ghalandari, S., Borjali, A., & Bagheri, F. (2020). Modeling the prediction of eating behavior based on anxiety with the mediation of self-esteem in adolescent girls. Journal of Education and Training, 38(4). https://qjoe.ir/article-1-2073-en.html
Ghazi Hassan, F. (2021). Comparison of Obsessive Beliefs, Perceived Social Support, and Quality of Life in University Students With and Without Corona Anxiety
Gholami Keneshti, S., & Firouzi, M. (2023). Predicting mental health based on fear of negative evaluation, shyness, and body esteem. Journal of Family and Health, 13(3). https://sanad.iau.ir/en/Article/1186988
Khanjani, Z., Hashemi, T., & Jaliz, R. (2024). The mediating role of emotion regulation in the relationship between attachment and children's eating behaviors. Rooyesh-e Ravanshenasi Journal, 13(1). https://frooyesh.ir/browse.php?a_id=4973&slc_lang=en&sid=1&printcase=1&hbnr=1&hmb=1
Khodabandeh Loui, M., Asgharnezhade Farid, A. A., & Maddahi, M. E. (2024). Structural relationships between obsessive-compulsive cognitive beliefs and symptoms of obsessive-compulsive disorder. Journal of New Psychological Research, 19(75). https://en.civilica.com/doc/2109794/
Khoramaee, F., & Azadi Dehbidi, F. (2017). Explaining academic procrastination of students based on the religious-ethical construct of patience (Presenting a structural equation model). Journal of Culture in Islamic University, 7(22). https://ciu.nahad.ir/article_409.html?lang=en
Leary, R. M. (1983). A brief version of the Fear of Negative Evaluation Scale. Personality and Social Psychology Bulletin, 9, 371-375. https://doi.org/10.1177/0146167283093007
Liu, S., Hu, W., Yang, Y., & Yang, F. (2023). Body dissatisfaction and smartphone addiction: The mediation role of intrusive imagery and fear of negative evaluation. Frontiers in psychology, 14, 1217220. https://doi.org/10.3389/fpsyg.2023.1217220
Megiani, I. N., Forte, A. H. R., de Moraes Ferreira, L. P., Chagas, K. F., de Oliveira, B. M. P., Mendes, A. D. F., de Melo Gonçalves Pinto, A., & da Silva Fernandes, J. M. D. (2025). Medical and psychoanalytical epidemiological analysis of bodily and emotional impact between overeating and restrictive eating during adolescence. Brazilian Journal of Health Review, 8(1), e76814-e76814. https://doi.org/10.34119/bjhrv8n1-187
Najjar Kakhaki, I., Kalhornia Galkar, M., Nejad Mohammad Nameghi, A., Mohammadi Shirmahalheh, F., & Valizadeh, M. (2024). Comparing the effectiveness of acceptance and commitment therapy and schema therapy on avoidance coping style and body mass index in obese individuals with emotional eating. Journal of Applied Psychological Research, 15(2). https://japr.ut.ac.ir/article_95258.html?lang=en
Niafar, G. H., Moghtader, L., Asadi Majareh, S., & Mehrgan, B. (2024). The mediating role of self-criticism in the relationship between mindfulness and body image concern in students with symptoms of nervous overeating. Rooyesh-e Ravanshenasi Journal, 13(2). https://frooyesh.ir/browse.php?a_id=4989&slc_lang=en&sid=1&printcase=1&hbnr=1&hmb=1
Okati, M., & Arab, A. (2022). Comparison of emotion dysregulation difficulty, fear of negative social evaluation, and suicidal ideation in women with addicted and non-addicted husbands. Journal of Islamic Lifestyle with a Focus on Health, 6(1). https://www.sid.ir/paper/992957/en
Ren, M. (2024). A review on psychological factors of eating disorders. Proceedings of the 3rd International Conference on Interdisciplinary Humanities and Communication Studies, https://doi.org/10.54254/2753-7064/50/20242516
Rocha, L. C. (2024). Desregulação emocional como fator de risco para o desenvolvimento de transtornos alimentares: uma revisão de literatura. https://repositorio.pucgoias.edu.br/jspui/handle/123456789/8534
Roithmeier, L., Fuchshuber, J., Prandstätter, T., Andres, D., Schmautz, B., Schwerdtfeger, A., & Unterrainer, H. F. (2024). Does adult attachment mediate the relationship between primary emotion traits and eating disorder symptoms? Frontiers in psychology, 15, 1372756. https://doi.org/10.3389/fpsyg.2024.1372756
Sabani, H., & Baki, E. (2024). Anorexia Nervosa And Bulimia Nervosa. International Scientific Journal Vision, 27-46. https://doi.org/10.55843/ivisum241027sh
Sawma, T., El Khoury-Malhame, M., Hayek, T., Mourad, J., Bou Malhab, S., & Rizk, R. (2025). The association between maternal parenting styles and eating disorders among Lebanese university students: The mediating role of the self-assessment dimension of self-esteem. medRxiv. https://doi.org/10.1101/2025.02.06.25321782
Shams, G., Karam Ghadiri, N., Esmaeili Torkanbori, Y., & Ebrahim Khani, N. (2004). Validity and reliability of the Persian version of the Obsessive Beliefs Questionnaire-44 (OBQ-44). New Advances in Cognition, 1(6). https://icssjournal.ir/article-1-29-en.html
Soleimani, M., & Izadi, F. (2024). Effectiveness of emotion-focused therapy on emotional self-awareness, objectification, and symptom reduction in female students with symptoms of nervous overeating. Rooyesh-e Ravanshenasi Journal, 13(7). https://frooyesh.ir/browse.php?a_id=4943&slc_lang=en&sid=1&printcase=1&hbnr=1&hmb=1
Trompeter, N., Bussey, K., Hay, P., Griffiths, S., Murray, S. B., Mond, J., Lonergan, A., Pike, K. M., & Mitchison, D. (2019). Fear of negative evaluation among eating disorders: Examining the association with weight/shape concerns in adolescence. International Journal of Eating Disorders, 52(3), 261-269. https://doi.org/10.1002/eat.23018
Vafaee Moghaddam, M., Haji Alizadeh, K., Zarei, E., & Amir Fakhraei, A. (2023). Structural relationships of rumination with the mediation of body image on anxiety in individuals with bulimic nervosa. Journal of Psychological Dynamics in Mood Disorders, 2(4). https://doi.org/10.61838/kman.pdmd.2.4.2
Vatan Khah, S., Bakhshipour Roudsari, A., Hashemi Nosratabad, T., & Shalchi, B. (2025). Effectiveness of Emotionally Focused Therapy (EFT) on body image dissatisfaction, cognitive emotion regulation, and impulsivity in women with bulimic nervosa: A single-subject experimental study. Journal of Clinical Psychology, 17(1). https://en.civilica.com/doc/2290188/
Zare, H., Biglari, S., Alizadeh Fard, S., & Savari, K. (2023). Structural modeling of obsessive beliefs and executive functions with the mediation of emotion regulation: Evaluating the Gross emotion regulation process model. Journal of Social Cognition, 12(24). https://journals.pnu.ac.ir/article_10543.html?lang=en
Downloads
Publication Timeline
Issue
Section
License
Copyright (c) 2025 Raana Peighamy (Author); Davood Hosseini-Nasab; Marziyeh Alivandi Vafa (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
