The role of psychological flexibility in the relationship between self-concealment and disordered eating symptoms

Abstract

The present cross-sectional study investigated whether psychological flexibility mediates the association between self-concealment and disordered eating (DE) symptoms among non-clinical college students. Data of 209 male and female participants (nfemale = 165), aged 18–22 years old, were used for analyses. Self-concealment was found to be positively associated with DE symptoms (i.e., general eating disorder symptoms and eating disorder-related cognitions) and negatively associated with psychological flexibility. Psychological flexibility was inversely associated with DE symptoms. Finally, psychological flexibility was found to mediate the association between self-concealment and DE symptoms after accounting for gender, ethnic background, and body mass index (BMI).

Introduction

Disordered eating (DE) symptoms, defined as general eating disorder pathology and eating disorder-related cognition, is increasingly common among adolescents and younger adults (e.g., Grabe et al., 2008, Striegel-Moore and Bulik, 2007), including college students (Vohs, Heatherton, & Herrin, 2001). While only a small number of college students meet the clinical criteria for an eating disorder (Hudson, Hiripi, Pope, & Kessler, 2007), many of them, especially women, experience some constellation of DE symptoms, such as negative body image, dieting, exercise, and compensatory behaviors (e.g., Mintz & Betz, 1988). Although historically European American women have been the primary target of college programming to reduce disordered eating and body dissatisfaction, recent evidence indicates that male students (Cooper, 2006, Lavender and Anderson, 2010, Timko et al., 2010) and ethnic minority college females (e.g., Mintz and Kashubeck, 1999, Rogers and Petrie, 2010) endorse DE symptoms as well.

Many factors are theorized to contribute to the development and maintenance of DE symptoms (Fairburn, 2008, Fairburn et al., 2003, Striegel-Moore and Bulik, 2007). One factor that has not been fully investigated is a dispositional tendency to keep personal information from others. Literature has suggested that individuals diagnosed with an eating disorder tend to distort or withhold information about their eating, amount of exercise, purging, drive for thinness, and negative body image (Pryor, Johnson, Wiederman, & Boswell, 1995), and employ a variety of strategies to do so (Vandereycken & Van Humbeeck, 2008).

Self-concealment, a general and stable behavioral tendency to keep distressing and potentially embarrassing personal information from others (Larson & Chastain, 1990), is a construct that is particularly relevant to this area of research. According to Larson and Chastain (1990), self-concealment involves multiple processes, including possessing a troubling and negatively evaluated secret, keeping it from others, and avoiding or feeling apprehensive about self-disclosure. Research has shown that self-concealment is positively associated with various negative behavioral and health outcomes, including negative affect (e.g., Kahn and Hessling, 2001, Larson and Chastain, 1990), psychological distress (Cramer, 1999, Kelly and Yip, 2006, Masuda, Anderson and Sheehan, 2009), pain and headaches (Larson & Chastain, 1990), and many others (e.g., Kawamura & Frost, 2004).

Although the evidence is limited, there is likely a relationship between self-concealment and DE symptoms. One study revealed that self-disclosure, which by definition is antithetical to self-concealment, was inversely related to eating disorder symptoms and associated factors, such as body dissatisfaction, dieting, and perceived social pressure to be thin (Basile, 2004). Another study reported that women with more DE symptoms were less willing to self-disclose certain personal details (e.g., relationships, DE symptoms, daily activities) than women with fewer DE symptoms (Evans & Wertheim, 2002).

While these findings are informative, it is still unclear why self-concealment relates to DE symptoms. Given the existing evidence (Lavender and Anderson, 2010, Masuda, Anderson and Sheehan, 2009, Masuda, Wendell, et al., 2010, Wismeijer et al., 2009), it may be that self-concealment and DE symptoms are linked by a shared feature: maladaptive avoidance-based coping strategies. Self-concealing individuals often inhibit and suppress potentially embarrassing personal information and painful psychological experiences as a means of down-regulating negative affect (e.g., Farber, Berano, & Capobianco, 2004). However, such attempts can paradoxically amplify negative affect (Wegner, 1994), which in turn further strengthens the maladaptive coping strategies (Hayes, Wilson, Gifford, Follette, & Strosahl, 1996). For example, one study showed that women with eating disorders who role-played not having an eating disorder (i.e., suppressed) experienced more intrusive thoughts and required greater effort to suppress than other women when answering questions about body image, eating habits, and weight (Smart & Wegner, 1999). Similarly, literature on affect regulation models posits that DE symptoms such as binging, purging, and restriction function as maladaptive efforts to modulate or escape from aversive emotional states (Christiano and Mizes, 1997, Ghaderi, 2003, Lavender and Anderson, 2010, Stice et al., 1996). These behaviors inevitably generate further aversive emotional states, which precipitate further disordered behavior.

This explanation parallels the model of psychological flexibility, a contemporary behavioral account of psychological wellbeing (Hayes, Luoma, Bond, Masuda, & Lillis, 2006). According to Hayes et al. (2006), psychological flexibility is “the ability to contact the present moment fully as a conscious human being, and to change or persist in behavior when doing so serves valued ends” (p. 7). It is an overarching behavioral process of experiencing whatever one is experiencing as it is fully and non-judgmentally without defense or judgment in addition to engaging in value-directed activities. The model also states that diminished psychological flexibility, which is characterized by maladaptive self-rules, avoidance, and suppression, is at the core of various forms of psychopathology.

Evidence indicates that diminished psychological flexibility is a generalized diathesis (Kashdan, Barrios, Forsyth, & Steger, 2006) associated with a wide range of negative psychological outcomes, including depressive symptoms (e.g., Bond & Bunce, 2000), anxiety (e.g., Kashdan et al., 2006), general psychological ill-health (e.g., Bond and Bunce, 2003, Masuda, Anderson and Sheehan, 2009), and emotional distress in stressful interpersonal contexts (Masuda, Price, Anderson, Schmertz, & Calamaras, 2009). Although the evidence is still limited, psychological flexibility is found to be inversely related to self-concealment (Masuda, Anderson and Sheehan, 2009, Masuda et al., 2011), cognitive aspects of DE symptoms (Masuda, Price, et al., 2010, Masuda and Wendell, 2010), and general eating disorder pathology (Rawal, Park, & Williams, 2010).

Though this literature suggests a relationship between self-concealment and DE symptoms, one which might explained in part by diminished psychological flexibility, no study has yet clearly established this link. The purpose of the present study was to examine whether self-concealment was related to DE symptoms and, if so, whether the relationship was mediated in part by psychological flexibility. Based on prior findings (e.g., Basile, 2004, Masuda, Price, et al., 2010), it was hypothesized that self-concealment would be positively related to DE symptoms (i.e., general eating disorder pathology and eating disorder-related cognitions) and inversely related to psychological flexibility. Conversely, psychological flexibility was hypothesized to be inversely associated with DE symptoms. Finally, it was hypothesized that diminished psychological flexibility would at least partially mediate the associations between self-concealment and ED symptoms after accounting for gender, ethnicity, and body mass index (BMI), factors found to be strongly associated with DE symptoms (Striegel-Moore & Bulik, 2007).