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International Journal of Adolescent Medicine and Health

Editor-in-Chief: Merrick, Joav

Editorial Board: Birch, Diana ML / Blum, Robert W. / Greydanus, MD, Dr. HC (Athens), Donald E. / Hardoff, Daniel / Kerr, Mike / Levy, Howard B / Morad, Mohammed / Omar, Hatim A. / de Paul, Joaquin / Rydelius, Per-Anders / Shek, Daniel T.L. / Sher, Leo / Silber, Tomas J. / Towns, Susan / Urkin, Jacob / Verhofstadt-Deneve, Leni / Zeltzer, Lonnie / Tenenbaum, Ariel

CiteScore 2018: 0.79

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Anxiety and depression mediate the role of low self-esteem and low self-directedness in the development of eating disorders

Matteo Aloi
  • Ambulatory for Clinical Research and Treatment of Eating Disorders, Mater Domini University Hospital, Catanzaro, Italy
  • Department of Health Sciences, University Magna Graecia, Catanzaro, Italy
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Cristina Segura-García
  • Corresponding author
  • Ambulatory for Clinical Research and Treatment of Eating Disorders, Mater Domini University Hospital, Catanzaro, Italy
  • Department of Health Sciences, University Magna Graecia, Catanzaro, Italy
  • Email
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
Published Online: 2016-10-14 | DOI: https://doi.org/10.1515/ijamh-2016-0084



Low self-esteem and low self-directedness (SD) are considered a risk factor for the development of eating disorders (EDs). The aim of this study was to test the hypothesis that low self-esteem and low SD lead to a higher risk for EDs through the mediation of anxiety and depression.


Seventy-seven female teenagers answered the Eating Disorder Inventory 3 (EDI-3), the Intolerance of Uncertainty Scale (IUS), the Temperament and Character Inventory-Revised (TCI-R), the Rosenberg Self-Esteem Scale (RSES), and the State and Trait Anxiety Inventory (STAI), and the Symptom Checklist-90-Revised (SCL-90-R). To test the hypothesis, a structural equation model (SEM) was used.


According to the EDI3-EDRC scores, 23/77 (29.9%) participants demonstrated positive results in the screening. Participants who had positive results in the screening had significantly higher scores on trait and state anxiety, depression, and IU, and lower means of self-esteem and SD. The SEM demonstrated good fit indices and all paths were significant in the predicted directions, confirming the hypothesized model.


The current results confirm the role of self-esteem and SD in the development of an ED among adolescent females through the mediating action of IU, anxiety, and depression.

Keywords: anxiety; eating disorder; intolerance of uncertainty; self-directedness; self-esteem


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About the article

Corresponding author: Cristina Segura-García, MD, PhD, Department of Health Sciences, University Magna Graecia, Viale Europa, 88100-Catanzaro, Italy, Phone: +39 0961 712408/3316718232, Fax: +39 0961 712393

Received: 2016-07-24

Accepted: 2016-09-01

Published Online: 2016-10-14

Citation Information: International Journal of Adolescent Medicine and Health, 20160084, ISSN (Online) 2191-0278, ISSN (Print) 0334-0139, DOI: https://doi.org/10.1515/ijamh-2016-0084.

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