Self-esteem trajectories over three decades predict opposition to social equality in midlife.

Although life trajectories are frequently theorized to explain people's attitudes toward different social groups, few studies have been able to directly assess their importance with suitable data. Addressing this gap and focusing on the development of general and domain-specific self-esteem, we report results from a population-based sample of Norwegians (N = 2,215) followed over 28 years and five time points from adolescence to midlife. Growth curve models demonstrated that irrespective of self-esteem domain, low levels of self-esteem in adolescence as well as a depressed self-esteem development over the next three decades were related to more overall opposition to social equality as well as more opposition to gender equality and immigration in midlife. The results held when controlling for participants' baseline political orientations and other key covariates in adolescence. Our findings indicate that low self-esteem and a lack of positive self-esteem development can be detrimental to harmonious intergroup relations in ever-diversifying societies. We discuss how future psychological interventions aimed at enhancing self-esteem may promote support for a more inclusive society.

The influence of self-esteem on interpersonal and competence evaluations: electrophysiological evidence from an ERP study.

Using event-related potentials, this study examined how self-esteem affects neural responses to competence (interpersonal) feedback when the need for relatedness (competence) is thwarted or met. Participants with low and high self-esteem acted as advisors who selected one of two options for a putative advisee. Subsequently, they passively observed the advisee, accepted, or rejected their advice (i.e. interpersonal feedback) and received correct or incorrect outcomes (i.e. competence feedback). When interpersonal feedback was followed by competence feedback, high self-esteem participants showed a smaller P3 following incorrect than correct outcomes, irrespective of whether the advice had been accepted or rejected. However, low self-esteem participants showed this P3 effect only when the advice was rejected, and the P3 difference disappeared when the advice was accepted. When competence feedback was followed by interpersonal feedback, both low self-esteem and high self-esteem individuals showed a larger P2 for rejection than for acceptance and a larger late potential component for incorrect than correct outcomes. These findings suggest that when interpersonal feedback is followed by competence feedback, low self-esteem and high self-esteem individuals have a desire for self-positivity. When competence feedback is followed by interpersonal feedback, they may have motives for self-change. Our findings shed light on the motivational mechanisms for self-esteem and feedback.

Changing adolescent activity patterns and the correlation of self-esteem and externalizing mental health symptoms across time: results from the USA from 1991 through 2020.

BACKGROUND: Common adolescent psychiatric symptoms cluster into two dominant domains: internalizing and externalizing. Both domains are linked to self-esteem, which serves as a protective factor against a wide range of internalizing and externalizing problems. This study examined trends in US adolescents' self-esteem and externalizing symptoms, and their correlation, by sex and patterns of time use. METHODS: Using Monitoring the Future data (N = 338 896 adolescents, grades:8/10/12, years:1991-2020), we generated six patterns of time use using latent profile analysis with 17 behavior items (e.g. sports participation, parties, paid work). Groups were differentiated by high/low engagement in sports and either paid work or high/low peer socialization. Within each group, we mapped annual, sex-stratified means of (and correlation between) self-esteem and externalizing factors. We also examined past-decade rates of change for factor means using linear regression and mapped proportions with top-quartile levels of poor self-esteem, externalizing symptoms, or both. RESULTS: We found consistent increases in poor self-esteem, decreases in externalizing symptoms, and a positive correlation between the two across nearly all activity groups. We also identified a relatively constant proportion of those with high levels of both in every group. Increases in poor self-esteem were most pronounced for female adolescents with low levels of socializing, among whom externalizing symptoms also increased. CONCLUSIONS: Rising trends in poor self-esteem are consistent across time use groups, as is the existence of a group facing poor self-esteem and externalizing symptoms. Effective interventions for adolescents' poor self-esteem/co-occurring symptoms are needed broadly, but especially among female adolescents with low peer socialization.

Associations between weight self-stigma and healthy diet and physical activity among adults with type 2 diabetes: Cross-sectional results from the second Diabetes MILES - Australia (MILES-2) study.

AIMS: To examine associations between weight self-stigma and healthy diet or physical activity, and potential moderating effects of self-esteem, diabetes self-efficacy, and diabetes social support, among adults with type 2 diabetes. METHODS: Diabetes MILES-2 data were used, an Australian cross-sectional online survey. Participants with type 2 diabetes who considered themselves overweight, and reported concern about weight management (N = 726; 48% insulin-treated), completed the Weight Self-Stigma Questionnaire (WSSQ; total score and subscales: self-devaluation, fear of enacted stigma), measures of diabetes self-care (diet, exercise), and hypothesised psychosocial moderators (self-esteem, diabetes self-efficacy, and diabetes social support). Adjusted linear regression tested associations and interaction effects, separately by insulin treatment status. RESULTS: Greater weight self-stigma (WSSQ total) was associated with less optimal dietary self-care (both groups: ß = -0.3), and with a lower level of exercise (non-insulin only: ß = -0.2; all p < 0.001). All hypothesised moderators were negatively associated with weight self-stigma (range r = -0.2 to r = -0.5). Positive associations were identified between the hypothesised moderators and self-care behaviours (strongest between diet and diabetes self-efficacy, r = > 0.5). No significant interaction effects were observed. CONCLUSIONS: This study provides novel evidence of negative associations between weight self-stigma and self-care behaviours among adults with type 2 diabetes. Weight self-stigma is a demonstrated barrier to self-care behaviours in type 2 diabetes cohorts. Acknowledgement and strategies to address weight self-stigma are needed in clinical care and health programmes.

When sexual distress shares the bed: the role of sexual self-esteem in the relationship between dispositional mindfulness and sexual distress in sex therapy patients.

BACKGROUND: Sexual distress (eg, feeling distressed, unhappy, frustrated, stressed, dissatisfied, or bothered about their sexuality) is a central concern reported by patients seeking sex therapy, and might be related to sexual self-esteem and mindfulness disposition, yet research is needed to examine the links among those variables within the specific population of patients seeking therapy. AIM: This study aimed to examine the indirect role of sexual self-esteem in the relationship between dispositional mindfulness and sexual distress. METHODS: The study was conducted among 696 patients undergoing sexual therapy (mean age 34.19 ± 11.21 years, age range 18-78 years). Participants identified as women (57.3%), men (38.5%), or nonbinary (4.2%). They completed self-report questionnaires assessing dispositional mindfulness (Five Facet Mindfulness Questionnaire), sexual self-esteem (Multidimensional Sexuality Questionnaire), and sexual distress (Sexual Distress Scale-Revised), during their first few sessions (ie, first to third sessions [the assessment phase]). OUTCOMES: Sexual distress was the main outcome, as measured with the Sexual Distress Scale-Revised. RESULTS: Results indicated that 54% (n = 376) of patients reported elevated sexual distress based on the questionnaire threshold score. Path analyses indicated an indirect effect in which higher dispositional mindfulness was associated with higher levels of sexual self-esteem, which in turn was associated with lower sexual distress. Results also highlighted that specific facets of mindfulness were related to higher sexual self-esteem (ie, describing, and nonreacting) and lower sexual distress (ie, nonjudgment and acting with awareness). The integrative model explained 23% of the variance of sexual distress scores. CLINICAL IMPLICATION: Findings suggest that addressing specifically sexual self-esteem and mindfulness may represent relevant clinical avenues to reduce sexual distress among sex therapy patients. STRENGTHS AND LIMITATIONS: Strengths of this study include the novel examination of the role of sexual self-esteem in the link between mindfulness disposition and sexual distress in a large clinical sample of patients seeking sex therapy. Limitations includes reliance on patient self-report and a cross-sectional design that limit conclusion regarding causality. CONCLUSION: This study makes a valuable contribution to the existing body of research highlighting the pivotal roles of sexual self-esteem in the link between dispositional mindfulness and reduced sexual distress among adults undergoing sex therapy, allowing us to identify potential targets of intervention.

Examining the impact of androgen deprivation therapy, masculine self-esteem, and psychological flexibility on distress and quality of life in men with prostate cancer.

OBJECTIVE: Studies suggest that androgen deprivation therapy (ADT) exacerbates psychological and quality of life (QoL) issues associated with prostate cancer (PCa). However, quantitative research examining underlying psychosocial mechanisms for this is limited. We examined the association of PCa symptoms with distress and QoL in ADT-treated and ADT-naïve patients, and the influence of masculine self-esteem and psychological flexibility (PF) on these relationships. METHODS: Secondary analysis of a quantitative, cross-sectional survey of 286 PCa patients. Independent samples t-tests, moderation, and conditional process analysis were used to assess relationships between predictor, mediator, moderator, and outcome variables. RESULTS: ADT was associated with greater PCa symptomology, lower masculine self-esteem, and lower QoL. Moderation analysis showed that ADT potentiated adverse impacts of PCa symptomology on distress and QoL. High PF attenuated these relationships, though less so for ADT-treated participants. Conditional process analysis showed that masculine self-esteem mediated the predictive effect of symptoms on distress across treatments. However, ADT did not moderate this indirect effect, nor was moderation conditional on PF. CONCLUSION: PF appears to: (1) attenuate psychological distress in ADT patients; and (2) improve distress, QoL, and masculine self-esteem in ADT-naïve patients. Interventions targeting PF may thus be a viable adjunct to established approaches. However, their effects may be comparatively limited in ADT patients, who may benefit from more intensive and tailored treatment.

Risk and Protective Factors of Psychosocial Functioning in Survivors of Childhood Cancer: Results of the DCCSS-LATER Study.

OBJECTIVE: This study examines the association between psychosocial risk and protective factors and a wide range of psychosocial outcomes including emotional, social, cognitive, and physical domains in childhood cancer survivors (CCS). METHODS: CCS from the Dutch Childhood Cancer Survivor Study (DCCSS)-LATER cohort (diagnosed 1963-2001) part 2 (age ≥ 18 years, diagnosed < 18 years, ≥ 5 years since diagnosis) completed questionnaires on psychosocial risk and protective factors (Benefit and Burden Scale, Illness Cognition Questionnaire, Rosenberg Self-Esteem Scale, and Impact of Cancer Scale), and psychosocial outcomes (Hospital Anxiety and Depression Scale, Self-Rating Scale for Post-Traumatic Stress Disorder, TNO-AZL Questionnaire for Adult Health-Related Quality of Life, and Short Form-36). Associations were assessed with regression analysis, adjusting for attained age, sex, number of health conditions, and time since diagnosis, while correcting for multiple testing (p < 0.004). RESULTS: A total of 1382 CCS participated, all diagnosed ≥ 15 years ago. The mean age of participating CCS was 36 years, and 51% were female. Perceived benefit and burden, acceptance, and helplessness, self-esteem and social support were associated with the psychosocial outcomes. In the models including all psychosocial factors, most associations with psychosocial outcomes were seen for self-esteem (10×), and perceived burden (9×). Self-esteem (all ß ≤ 0.47) and perceived burden (all ß ≤ 0.38) demonstrated strongest associations of medium/large size. CONCLUSIONS: Perceptions of childhood cancer, illness cognitions, self-esteem, and social support play a role in explaining psychosocial functioning in CCS, outweighing the influence of socio-demographic and medical variables. Addressing negative perceptions and reducing feelings of helplessness, while promoting acceptance, self-esteem, and social support, could provide intervention targets for CCS who encounter psychosocial challenges.

Personal Resources and Total Pain: Exploring the Multiple Mediation of Fear of Recurrence, Meaning-Making, and Coping in Posttreatment Cancer Patients.

BACKGROUND: People with cancer who have completed treatment still experience negative effects, such as an increased risk of experiencing cancer-related pain. Psychological factors tend to influence cancer patients' ability to cope with pain in various dimensions. Although personal resources are an important factor in buffering total pain, still little is known about the intervening variables and underlying mechanisms. PURPOSE: The current study examined the relationship between psychological flexibility, self-esteem, and total pain, while considering fear of recurrence, meaning-making, and coping as potential mediating factors. METHODS: Adults (N = 304) who completed medical treatment (radiotherapy, chemotherapy, and combined therapy) participated in this study. They completed questionnaires measuring the aforementioned variables. Structural equation models were used to examine mediation effects. RESULTS: Psychological flexibility, and partly self-esteem, were negatively related to the dimensions of total pain. However, to a large extent, these relationships were serially and parallelly mediated by fear of recurrence, meaning-making, and emotion-oriented coping. CONCLUSIONS: Consistent with the meaning-making model, cognitive (meaning-making), and affective (fear of recurrence and emotional coping) factors may be potential mechanisms underlying the association between psychological flexibility, self-esteem, and total pain in posttreatment cancer patients. In this study, they tended to interact in the area of physiological and psychosocial experiences of cancer-related pain.

A significant number of cancer patients who undergo medical treatment tend to experience pain as a consequence of medical and psychological factors. Personal resources such as psychological flexibility and self-esteem can play important roles in the pain experiences of cancer patients, including their physical, psychological, social, and spiritual symptoms. However, other factors related to anxiety and coping can also affect the relationships mentioned above. Therefore, we examined whether fear of recurrence, meaning-making, and coping serially mediated the relationships between psychological flexibility, self-esteem, and total pain in posttreatment cancer patients. A total of 304 cancer patients (159 women, 145 men) who had completed medical treatment participated in our study. Patients with higher psychological flexibility experienced lower physical, psychological, social, and spiritual pain, whereas patients with higher self-esteem felt only lower physical pain. Furthermore, posttreatment cancer patients characterized by well-defined goals and self-worth experienced lower fear of recurrence and were able to find meaning and emotionally cope with their daily predicament. As a consequence, they felt less total pain in physical, psychological, social, and spiritual dimensions. Experiencing lower fear of cancer recurrence combined with finding meaning and goals predisposes patients to more effectively deal with pain symptoms.

Psychological Mechanisms of Internalized HIV Stigma Affect Sleep Impairment among People Living with HIV in China: A follow-up Study.

Prior studies have demonstrated that HIV-related stigma (e.g., internalized HIV stigma) is detrimental to the physical and mental health (e.g., sleep impairment and depressive symptoms) of people living with HIV (PLWH). However, follow-up data are limited regarding the longitudinal relationships between internalized HIV stigma, future orientation, self-esteem, depressive symptoms, and sleep impairment. The present study attempted to examine a mediation model involving these variables among Chinese PLWH. A two-wave follow-up design (6 months intervals) was employed in a final sample of 1,140 Chinese PLWH (Mage = 41.63, SD = 9.29, age range: 21-67 years; 64.6% men). Participants completed Internalized HIV Stigma Scale, Optimism About the Future Scale, Rosenberg Self-Esteem Scale, Center of Epidemiological Studies Depression Scale, and an adapted version of Pittsburgh Sleep Quality Index. Results revealed that internalized HIV stigma at baseline had a significant direct relationship with sleep impairment over time, and a significant indirect relationship with increased sleep impairment over time via future orientation and depressive symptoms. Furthermore, the linkage between internalized HIV stigma and sleep impairment was serially mediated via self-esteem and depressive symptoms. This study highlights the deleterious effects of internalized HIV stigma on the physical and psychological health of PLWH. The findings suggest that interventions targeting internalized HIV stigma and related factors such as future orientation, self-esteem, and depressive symptoms may facilitate improvements in sleep quality and overall well-being among PLWH.

Assessment of stigmatization and self-esteem in patients with epilepsy.

AIM: This study was conducted to examine the relationship between stigmatization and self-esteem of patients with epilepsy. METHODS: This cross-sectional study was conducted with 216 patients at a university hospital in Van, a province in eastern Turkey. The researcher prepared the data collection tools, including a personal information form, Jacoby Stigma Scale and the Rosenberg self-esteem scale, in line with the literature. The Jacoby stigma scale was applied to assess stigma. Data analysis was performed using t-test, one-way analysis of variance (ANOVA), and Tukey, LSD coefficient. RESULTS: The mean total stigmatization score of patients with epilepsy was 21.11 ± 10.00, while the mean total self-esteem score was 20.26 ± 5.16. The study found a significant negative correlation between stigmatization and self-esteem scores (r = -0.411; p < 0.05). CONCLUSION: The research study revealed that patient with epilepsy have a high perception of stigma and low selfesteem levels.

Medication adherence and its relationship with self-esteem among patients with epilepsy in Isfahan, Iran.

Medication adherence is of utmost importance in achieving the desired therapeutic outcome and effectively managing seizures in patients with epilepsy (PWE). It is imperative to recognize self-esteem as a psychological determinant that potentially influences the optimal compliance with anti-seizure medications (ASMs) among PWE. The objective of this study was to explore medication adherence and its relationship with self-esteem among individuals diagnosed with epilepsy in Isfahan, Iran. METHODS: This descriptive-analytical study was conducted in the year 2021, encompassing a cohort of 250 PWE who were referred to designated medical facilities in Isfahan, Iran, and were selected by the consecutive sampling technique. A 3-part instrument including demographic components, the Rosenberg Self-Esteem Scale, and the Morissky Drug Adherence Questionnaire employed for data collection. RESULTS: The mean and standard deviation of adherence to the medicinal regimen in the participants were 6.9 ± 2.02, and 46.4 % had a low level of adherence to the medication regimen (total score 0-6). At the same time, the mean and standard deviation of self-esteem in these patients was 5.11 ± 2.11. There was a statistically significant and direct correlation between adherence to the prescribed drug regimen and self-esteem (rs = 0.464, p = 0.00). CONCLUSION: Based on the findings of the study that showed a statistically significant and positive correlation between self-esteem and adherence to the medication regimen, it is advisable to enhance and advocate for these factors in PWE.

Initiative apathy trait underlies individual differences in the ability to anticipate and expend cognitive effort in cost-benefit decision-making tasks.

Initiative apathy is the most disabling form of apathy, prevalent both in neuropsychiatric pathologies and in the healthy population. This apathy has been specifically associated with functional abnormalities of the anterior cingulate cortex, a key structure underlying Effort-based Decision-Making (EDM). The main aim of the present study was to explore, for the first time, the cognitive and neural effort mechanisms of initiative apathy, by distinguishing the steps of effort anticipation and effort expenditure and the potential modulating effect of motivation. We conducted an EEG study in 23 subjects with specific subclinical initiative apathy and 24 healthy subjects with no apathy. The subjects had to complete two effort tasks. The analysis of behavioral choices, CNV, and mPFC theta power highlighted that initiative apathy is associated with effort avoidance and impairments of effort anticipation and effort expenditure that suggest EDM deficits. Better knowledge of these impairments should aid the development of new, more targeted therapeutic interventions necessary for reducing the debilitating consequences of initiative apathy.

Exercise interventions for self-perceived body image, self-esteem and self-efficacy in women diagnosed with breast cancer: a systematic review with meta-analysis and meta-regressions.

PURPOSE: To synthesise the effectiveness of exercise interventions on self-perceived body image, self-esteem and self-efficacy in women diagnosed with breast cancer who are undergoing or have completed primary adjuvant treatments. METHODS: A systematic review was conducted with meta-analysis and meta-regressions. Five electronic databases were searched from inception to June 2023, and hand searches were performed to explore the reference lists of similar systematic reviews. The established selection criteria were randomised clinical trials that evaluated any type of physical exercise intervention with self-perceived body image, self-esteem and self-efficacy as outcomes. No restrictions were imposed with respect to the control group. Main characteristics were extracted for each study. Meta-analyses, meta-regressions and sensitivity analyses were performed. The certainty of evidence for each outcome was graded using the GRADE approach. The risk of bias was evaluated using the RoB2 Cochrane tool. RESULTS: Twenty studies, comprising 19 different samples (n = 2030), were included. In general, meta-analysis indicated that physical exercise interventions were not superior to controls for improving self-esteem and body image in women diagnosed with breast cancer. However, subgroup meta-analysis showed a significant difference in self-esteem improvement for resistance exercise (SMD = 0.31; 95% CI = 0.07, 0.55; p = 0.01; I2 = 0%) and supervised exercise (SMD = 0.25; 95% CI = 0.08, 0.42; p = 0.0004; I2 = 0%) compared with controls. Self-efficacy results were scarce and controversial. In addition, serious concerns were mainly detected in terms of the risk of bias and indirectness of the evidence, which caused the certainty of evidence to be very low for all outcomes. CONCLUSION: Supervised exercise and resistance training appear to be effective exercise modalities for improving self-esteem in women diagnosed with breast cancer. In contrast, exercise interventions are not significantly associated with improvements in body image, while results on self-efficacy are controversial. However, due to the study's limitations, further research is needed.

Stigma and related influencing factors in brain cancer patients: a cross-sectional study and parallel mediation analysis.

PURPOSE: Patients with brain cancer and painful symptoms of the disease experience heavy pressure and negative inner experiences, leading to a sense of stigma. Therefore, this study assessed the level of stigma in patients with brain cancer and analyzed the risk factors for stigma to analyze the underlying relationships among depression, social support, low self-esteem, and stigma. METHODS: Patients completed the Social Impact Scale, Self-rating Depression Scale, Rosenberg Self-Esteem Scale, Herth Hope Index, Social Support Rating Scale, and Self-Perceived Burden Scale. Multiple linear regression analysis was used to identify factors independently associated with stigma. Parallel mediation analysis was used to evaluate the mediating role of the relationship between psychoemotional factors and stigma. RESULTS: A multivariate linear regression analysis demonstrated significant associations between age (ß = - 0.189, P = 0.002), treatment (ß = 0.184, P = 0.003), self-esteem (ß = - 0.128, P = 0.046), depression (ß = 0.273, P < 0.001), hope (ß = - 0.217, P = 0.003), and self-perceived burden (ß = 0.260, P < 0.001) with brain cancer. It was observed that the social support received by brain cancer patients directly impacted their stigma (total effect, - 0.851, P = 0.001). Additionally, this relationship was influenced by depression and self-esteem through two distinct pathways. CONCLUSION: Increased stigma among brain cancer patients was found to be associated with severe depression, feelings of inferiority, diminished hope, and a heavy perceived burden. The structural equation modeling (SEM) revealed that social support negatively influenced stigma through depression and self-esteem. It is imperative to grasp patients' inner needs, implement psychological interventions, and cultivate a cancer-friendly social environment to prevent stigmatization and discrimination based on their patient status.

The bidirectional associations between self-esteem and problematic eating behaviors in adolescents.

OBJECTIVE: Theories propose that low self-esteem and problematic eating behaviors (PEBs) negatively impact each other. While previous studies suggested bidirectional associations between self-esteem and PEBs, they did not separate within-person from between-person associations. Therefore, this prospective study investigated the within-person bidirectional associations between self-esteem and four PEBs in adolescence, while accounting for between-person differences. METHOD: We used two independent longitudinal samples of Dutch adolescents, each including three annually collected waves of data. Sample 1 consisted of 1856 adolescents (Baseline: 50.4% males; Mage = 13.79 years, SDage = 0.72), with measures of self-esteem, emotional eating, restrained eating, and loss of control (LOC) while overeating. Sample 2 consisted of 555 adolescents (Baseline: 49.7% males; Mage = 13.13 years, SDage = 0.68), with measures of self-esteem and LOC eating. The data were analyzed using random intercept cross-lagged panel models (CLPMs). RESULTS: Within persons, lower self-esteem was associated with higher emotional and restrained eating (both Sample 1) one year later, and vice versa. Self-esteem did not predict, nor was predicted by, LOC while overeating (Sample 1) or LOC eating (Sample 2). Between persons, self-esteem was negatively correlated with all PEBs (Samples 1 and 2). DISCUSSION: We found within-person bidirectional associations between low self-esteem and emotional and restrained eating (but not LOC while overeating/LOC eating), and between-person correlations between low self-esteem and all PEBs. These results have theoretical and practical implications. Within-person processes clarify underlying mechanisms that explain the occurrence of PEBs; between-person associations are important to identify adolescents at risk of PEBs. PUBLIC SIGNIFICANCE: While theories indicate that low self-esteem and PEBs are inversely associated within individuals, empirical studies have not disentangled within-person processes from between-person differences. This study addressed this disparity, finding that lower self-esteem was bidirectionally associated with higher emotional and restrained eating (but not LOC eating) within persons. These findings suggest that enhancing self-esteem is a viable option for prevention and intervention.

Self-referential processing in anorexia nervosa.

OBJECTIVE: Anorexia nervosa (AN) is a serious psychiatric illness associated with significant medical and psychiatric comorbidity and impairment. Theoretical models of AN and self-report studies suggest that negative self-evaluation (i.e., low self-esteem) is related to the development and maintenance of AN. The goal of this study was to extend findings from self-report methodology using a neurocognitive task that probes self-evaluation implicitly and explicitly. METHOD: We compared female adolescent and adult patients with AN (n = 35) and healthy controls (HC, n = 38) on explicit (i.e., endorsement of words as self-relevant), implicit (recall, recognition, reaction time), and composite (i.e., valence index, bias score, drift rates) indices of self-evaluation. We applied a drift-diffusion model to compute the drift rates, reflecting participants' decision-making process as to whether words were self-relevant. The association between self-evaluation indices and eating disorder severity was examined. RESULTS: There were significant Group × Condition interaction effects for all explicit and implicit measures (all p's ≤ .01), where the AN group endorsed, recalled, and recognized more negative relative to positive words than HC. The AN group had more negative valence index and bias scores, and slower drift rate away from negative words, reflecting more negative self-evaluation. The finding for recall was attenuated when individuals with depression were excluded. Measures of self-evaluation bias were not related to eating disorder severity. DISCUSSION: Using a neurocognitive approach that includes explicit and implicit indices of bias, results suggest that patients with AN have more negative self-evaluation. Due to the cross-sectional design, additional studies are needed to further evaluate directionality. PUBLIC SIGNIFICANCE: Negative self-evaluation/low self-esteem is thought to contribute to eating disorder symptoms. Findings of this study using a neurocognitive task to probe self-evaluation suggested that individuals with anorexia nervosa have more negative self-evaluation, reflected by endorsing and remembering more negative (than positive) words compared to healthy controls, and doing so faster. Targeting the construct of negative self-evaluation in treatment of AN may be warranted.

Moderating effect of self-esteem between perfectionism and avoidant restrictive food intake disorder among Lebanese adults.

BACKGROUND: Avoidant Restrictive Food Intake Disorder (ARFID) is a new diagnosis added to the DSM-5 characterized by pathological eating habits without body image disturbances. Previous findings demonstrated a general association between high levels of perfectionism and low levels of self-esteem in association with general eating disorders. However, research is scant when it comes to ARFID specifically. Subsequently, although self-esteem is seen to moderate the association between perfectionism and general eating disorders, this research study aims to explore the same moderation but with ARFID specifically. METHODS: For this study, 515 Lebanese adults from the general Lebanese population were recruited from all over Lebanon, 60.1% of which were females. The Arabic version of the Big Three Perfectionism Scale- Short Form (BTPS-SF) was used to measure self-critical, rigid and narcissistic perfectionism; the Avoidant/Restrictive Food Intake Disorder screen (NIAS) was used to score the ARFID variable; the Arabic-Single Item Self-Esteem (A-SISE) was the scale used to measure self-esteem. RESULTS: Across the different perfectionism types, self-esteem was seen to moderate the association between narcissistic perfectionism and ARFID (Beta = - 0.22; p =.006). At low (Beta = 0.77; p <.001), moderate (Beta = 0.56; p <.001) and high (Beta = 0.36; p =.001) levels of self-esteem, higher narcissistic perfectionism was significantly associated with higher ARFID scores. CONCLUSION: This study brought to light some crucial clinical implications that highlight the need for interventions that help in the enhancement of self-esteem in patients with high perfectionism and ARFID. This study suggests that clinicians and healthcare professionals should focus more on risk factors influencing the development and maintenance of ARFID-like symptoms.

The association between expressive suppression and anxiety in Chinese left-behind children in middle school: serial mediation roles of psychological resilience and self-esteem.

BACKGROUND: Left-behind children (LBC) have become a special population to be concerned due to the negative consequences of parental absence during their physical and psychological development in China. Expressive suppression (ES) is a response-focused emotion regulation and may be frequently used by LBC to suppress their emotions resulting in different forms of internalizing problems. The objective of the present study was to investigate the role of ES as an emotion regulation strategy on anxiety in Chinese left-behind children in middle school (LBC-MS) by considering the mediating role(s) of psychological resilience and self-esteem. METHODS: 820 middle school students aged between 12 and 17 years from a middle school in Xiangtan, Hunan Province, participated in the study. Screen for Child Anxiety Related Emotional Disorders (SCARED), Emotion Regulation Questionnaire (ERQ), Resilience Scale for Chinese Adolescents (RSCA), and Rosenberg Self-Esteem Scale (SES) were administered. Variables measured using the above scales in left-behind children in middle school (LBC-MS) and non-left-behind children in middle school (non-LBC-MS) were compared, and descriptive statistics were used to present the overall characteristics. Then the PROCESS macro of SPSS was used to conduct regression-based statistical mediation for the data of 211 left-behind children. RESULTS: This study revealed that LBC-MS had higher anxiety and ES scores and lower psychological resilience and self-esteem scores than non-LBC-MS (Ps < 0.01). ES was found positively associated with anxiety in LBC-MS and negatively associated with psychological resilience and self-esteem (Ps < 0.05 - 0.01). Specifically, both psychological resilience and self-esteem significantly mediated the association between ES and anxiety, accounting for 7.50% and 10.68%, respectively, of the total associations. Moreover, psychological resilience and self-esteem had a chain mediating effect between ES and anxiety in LBC-MS. CONCLUSION: The findings indicated that LBC-MS in China may frequently engage in the use of ES which correlated with higher level of anxiety. Psychological interventions should be dedicated to this underserved group. Intervention approaches that improve emotion regulation strategies (i.e., decrease the use of ES) and increase psychological resilience and self-esteem may help to alleviate anxiety in LBC-MS.

Profiles of intuitive eating in adults: the role of self-esteem, interoceptive awareness, and motivation for healthy eating.

OBJECTIVE: Intuitive eating is an eating behavior that has recently come to use mainly in the young population. Knowing that the Lebanese cultural diet differs from other countries, the purpose of this study was to investigate if there is a relationship between self-esteem, interoceptive awareness, and motivation for healthy eating in a sample of Lebanese adults using a Latent Profile Analysis approach. DESIGN: Cross-sectional study. SETTING: Lebanese governorates. PARTICIPANTS: 359 Lebanese participants enrolled in this study (mean age: 22.75 ± 7.04 years, 40.1% males), through convenience sampling in several Lebanese governorates. Participants were asked to fill anonymously the following scales: The Intuitive Eating Scale (IES-2), the Rosenberg Self-Esteem Scale, the Multidimensional Assessment of Interoceptive Awareness Scale (MAIA), and the Motivation for Healthy Eating Scale (MHES). RESULTS: Our findings revealed four profiles: profile 1 (n = 67; 18.66%) characterized by high SE and intermediate interoceptive awareness and motivation for healthy eating; profile 2 (n = 86; 23.97%) presented high SE, interoceptive awareness, and motivation for healthy eating; profile 3 (n = 86; 23.96%) characterized by high SE, interoceptive awareness, and motivation for healthy eating; class 4 (n = 108; 30.08) described by low SE, intermediate interoceptive awareness, and motivation for healthy eating One-way analysis of variance did not observe a significant difference between the four profiles based on intuitive eating (F = 1.810; p = 0.145; ɳp2 = 0.015). CONCLUSIONS: Among a sample of Lebanese people, four profiles of interoceptive awareness, motivation for healthy eating, and self-esteem were observed, with no difference concerning intuitive eating.

The effects of self-esteem and parental phubbing on adolescent internet addiction and the moderating role of the classroom environment: a hierarchical linear model analysis.

BACKGROUND: With the advent of the new media era, the understanding of adolescent internet addiction needs to be enriched. It is also necessary to distinguish the related factors of adolescent internet addiction at different levels to clarify the mechanisms of this phenomenon. METHODS: This study used hierarchical linear model analysis to explore the effects of student-level factors and school-level factors on adolescent internet addiction, along with cross-level moderating effects. A total of 1,912 students between the 4th and 8th grades in China participated in the study. Participants completed the Self-Esteem Scale, Parents Phubbing Scale, Classroom Environment Scale, and the Diagnostic Questionnaire of Internet Addiction. RESULTS: Correlational analyses revealed that internet addiction was found to be negatively correlated with both self-esteem and the teacher-student relationship (p < 0.01), while father phubbing, mother phubbing, and learning burden were shown to positively correlate with internet addiction (p < 0.01). Hierarchical linear model analysis suggested that student-level variables, including self-esteem, and mother phubbing, were significant predictors of internet addiction (ß = -0.077, p < 0.001 and ß = 0.028, p < 0.01, respectively). At the school level, learning burden significantly and negatively predicted internet addiction (ß = 0.073, p < 0.05). Furthermore, the relationship between self-esteem and internet addiction was significantly moderated by learning burden (ß = -0.007, p < 0.05). Meanwhile, the teacher-student relationship also had a significant moderating effect on the association between mother phubbing and internet addiction (ß = -0.005, p < 0.01). CONCLUSIONS: This study revealed the relationships between self-esteem, parental phubbing, and classroom environment with adolescent internet addiction, and these findings could provide insights into reducing adolescent internet addiction from the perspective of individuals, families, and schools.