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Article

The Mediating Effect of Coping Strategies and Emotion Regulation in the Relationship between Impulsivity, Metacognition, and Eating Disorders

by
Ana Estévez
1,*,
Janire Momeñe
1,
Laura Macía
1,
Iciar Iruarrizaga
2,
Leticia Olave
2 and
Gema Aonso-Diego
1
1
Department of Psychology, Faculty of Health Sciences, University of Deusto, Avda. de las Universidades 24, 48007 Bilbao, Spain
2
Department of Experimental Psychology, Cognitive Psychology and Speech & Language Therapy, Faculty of Psychology, Complutense University of Madrid, 28040 Madrid, Spain
*
Author to whom correspondence should be addressed.
Nutrients 2024, 16(12), 1884; https://doi.org/10.3390/nu16121884
Submission received: 21 May 2024 / Revised: 10 June 2024 / Accepted: 12 June 2024 / Published: 14 June 2024
(This article belongs to the Special Issue Nutrition and Dietary Patterns: Effects on Brain Function)
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Abstract

:
Background. Risk factors for eating disorders are multifaceted and complex, so it is crucial to elucidate the role of executive functions, including impulsivity and metacognition, and coping strategies in the severity of eating behaviors. The study aims were threefold: (1) to analyze gender differences in impulsivity, metacognition, coping strategies, emotion regulation, and eating disorders; (2) to examine the correlation between the study variables; and (3) to test the mediating role of coping and emotion-regulation strategies in the relationship between metacognition, impulsivity, and eating disorders. Methods. A total of 1076 participants (Mage = 21.78, SD = 5.10; 77.7% women) completed a set of questionnaires. Two mediation analyses were conducted to test the mediating role of coping strategies, including emotion regulation, in the relationship between executive functions (i.e., impulsivity and metacognition) and eating disorders. Results. Women displayed higher coping strategies, specifically emotional expression, wishful thinking, and social support, whereas men presented greater social withdrawal. Mediational analyses showed a significant association between impulsivity, metacognition, and eating disorders, whose relationship was partially mediated by coping strategies and mainly by emotion regulation. Conclusion. Interventions based on coping strategies and emotion regulation could be a feasible and effective option to deal with eating disorders among the young population.

1. Introduction

Eating disorders constitute a spectrum of psychiatric conditions characterized by disturbances in eating behaviors, attitudes toward food, body weight, and shape. These disorders significantly impact individuals’ physical and mental health (e.g., depression, anxiety) [1], including suicide [2], and notably, the mortality rate for eating disorders is strikingly high [3,4,5]. Among the most prevalent eating disorders are anorexia nervosa, bulimia nervosa, and binge eating disorder, each presenting distinct clinical features and diagnostic criteria [6].
The etiology of eating disorders is multifaceted, influenced by a complex interplay of genetic, biological [7], psychological (e.g., stressful life events) [8,9], and sociocultural factors (e.g., cultural norms) [10]. Two variables that have received the most attention are those related to executive function, specifically lack of control or impulsivity, and metacognitive strategies.
Impulsivity, broadly defined as a predisposition towards rapid, unplanned reactions to internal or external stimuli without consideration of potential consequences, has been deeply studied within the realm of eating disorders, showing a different profile of impulsivity for each diagnosis [11,12]. Previous evidence suggests a strong relationship between impulsivity and different eating disorders (i.e., anorexia nervosa, bulimia nervosa, and binge eating disorder) [13,14,15,16,17], as well as the risk of developing an eating disorder [18]. Impulsivity manifests in binge eating episodes, purging behaviors, or excessive exercise, which are undertaken without forethought or control [19,20].
On the other hand, metacognition, the process of thinking about one’s own thinking, beliefs, and cognitive processes, has emerged as a critical factor in understanding eating behaviors and the development and maintenance of eating disorders. This variable has been related to a large number of psychological disorders [21,22], addictive behaviors [23,24], as well as eating disorders and problematic eating behaviors [25,26,27,28,29], both in anorexia and bulimia [30,31,32] and binge eating [33].
Despite the large number of studies confirming the association between impulsivity and metacognitive strategies with eating disorders, the causal mechanism remains unclear. Some studies have pointed to the importance of coping strategies, including emotion regulation, in explaining this relationship [34,35,36,37].
Coping and emotion regulation strategies have been widely studied in relation to eating disorders [38,39,40,41,42]. Nonetheless, to our knowledge, no previous studies have analyzed the mediating role of coping strategies and emotion regulation in the relationship between metacognition or impulsivity and eating disorders. However, it has been studied in other psychological variables, such as anxiety [43,44], attachment [45], excessive worry [46], posttraumatic symptoms [47], Internet addiction [48], and overall mental health [49], which show elevate comorbidity with eating disorders [1,50].
Based on the Self-Regulatory Executive Function model (S-REF) [51,52,53,54], metacognitive beliefs activate a combination of coping strategies. In other words, whereas metacognition refers to the awareness and understanding of one’s own cognitive processes, including thoughts, beliefs, and strategies, coping strategies encompass the behavioral, cognitive, and emotional efforts employed to manage stressors and adapt to adverse circumstances. Positive metacognitive beliefs (e.g., self-efficacy and perceived control over stressors) promote the utilization of proactive coping strategies (e.g., problem-solving, seeking social support, or positive reappraisal). Conversely, negative metacognitive beliefs, such as catastrophic thinking, may predispose individuals to employ maladaptive coping strategies (e.g., avoidance, rumination, social withdrawal), which exacerbate emotional distress and increase vulnerability to engaging in binge eating, purging, or restrictive eating behaviors, as well as maintaining eating disorders over time.
In this line, impulsivity often undermines the effectiveness of coping efforts by leading individuals to employ maladaptive or reactive strategies in response to stressors [55,56,57,58]. Impulsive individuals may resort to impulsive coping mechanisms, such as avoidance or dysfunctional emotion regulation, as a solution to alleviate distress in the short term.
Despite the amount of research on this issue, no study has tested the mediating role of coping strategies and emotion regulation in the relationship between metacognition or impulsivity and eating disorders. Furthermore, previous studies focusing on these variables (i.e., metacognition, impulsivity, coping strategies, and emotion regulation) were conducted with a clinical population [14,25,30,33], and mostly among the adolescent population [26,27,59]. Also, to our knowledge, no previous study has been conducted among the Spanish population in which eating-related characteristics could differ from other countries [60]. Understanding the role of metacognitive beliefs and impulsivity in shaping eating behaviors has important implications for the development of targeted interventions for eating disorders.
Given this background, the study aims were threefold: (1) to analyze gender differences in the study variables (i.e., eating disorders, impulsivity, metacognition, emotion regulation, and some coping strategies); (2) to examine the correlation between the study variables; and (3) to test the mediating role of coping and emotion-regulation strategies in the relationship between metacognition, impulsivity, and eating disorders.

2. Material and Methods

2.1. Participants and Procedure

The study sample included 1076 participants (Mage = 21.78, SD = 5.10, aged between 18 and 61 years). Most participants were women (77.7%, n = 836), 21.7% (n = 233) were men, and the remaining seven participants (0.70%) were trans men. The majority were students (78.6%, n = 845) and single (93.1%, n = 1000). Finally, 34.57% (n = 372) of the participants had received psychological treatment at some point in their lives, of which 5.10% (n = 19) were for eating disorders.
The recruitment was conducted through two channels: online and face-to-face. For online recruitment, surveys were conducted through a SurveyMonkey platform. For the face-to-face channel, participants were recruited at the Complutense University of Madrid. Participants filled out the questionnaires in the classroom during teaching hours through pencil and paper or an online survey in the university classrooms. The only exclusion criterion was being under 18 years of age.
All participants provided written informed consent before study participation, indicating that they had read the study information and agreed to participate voluntarily. The study adhered to the ethical principles of the Declaration of Helsinki and was approved by the university ethics committee (ref. ETK-38/23-24). Participants were assured of the confidentiality and anonymity of their responses, as well as their voluntary participation. The participants did not receive any kind of compensation.

2.2. Instruments

All participants completed a battery in which sociodemographic data (i.e., age, gender, working status, and marital status) were collected. Additionally, participants completed four questionnaires concerning eating disorders, metacognition, impulsivity, coping strategies, and emotion regulation.

2.2.1. Eating Disorders

The Eating Disorder Inventory (EDI-2) [61], validated in Spain by Muro-Sans et al. (2006) [62], is a widely used self-report questionnaire designed to assess various aspects of disordered eating behaviors and attitudes. This inventory included a total of 91 items divided into 11 scales that evaluate central aspects of eating disorders, that is, drive for thinness, bulimia, body dissatisfaction, ineffectiveness, perfectionism, interpersonal distrust, interoceptive awareness, maturity fears, asceticism, impulse regulation, and social insecurity. All items are rated using a Likert-type scale, where individuals rate the extent to which each statement applies to them, ranging from 0 (“never”) to 5 (“always”). The internal consistency measured by Cronbach’s α of the total scale was 0.95.

2.2.2. Metacognitive Strategies

Metacognitive strategies were assessed with the homonymous subscale of the Inventory of Cognitive Activity in Anxiety Disorders, subscale for obsessive-compulsive disorder (Inventario de Actividad Cognitiva en Trastornos de Ansiedad—Trastorno Obsesivo-Compulsivo; IACTA-TOC) [63]. The total inventory consists of 21 items, including the metacognition subscale, which comprises 7 items rated on a Likert-type scale (ranging from 0 “almost never” to 4 “almost always”). The subscale assessed the frequency of certain thoughts in individuals (e.g., “I place great importance on the thoughts that occupy my mind”, “at times, I may mistake my thoughts for reality”, “I am vigilant and attentive to situations related to my thoughts”). In our sample, Cronbach’s alpha was 0.88 for the metacognition subscale.

2.2.3. Impulsivity

The Barratt Impulsiveness Scale (BIS-11) [64], adapted to Spanish by Oquendo et al. (2001) [65], is a self-report questionnaire assessing several aspects of impulsivity. The BIS-11 is a 30-item questionnaire, rated on a 4-point Likert-type scale, ranging from 1 (never/rarely) to 4 (almost always/always). Items are grouped into three subscales: attentional impulsiveness, motor impulsiveness, and non-planning impulsiveness. In the present study, Cronbach’s alpha was 0.76 for the global scale.

2.2.4. Coping Strategies

The Coping Strategies Inventory (CSI) [66], validated in Spanish by Cano-García et al. (2007) [67], is a self-report measure designed to assess coping strategies employed by individuals to manage stress and adversity. The CSI includes 40 items grouped into eight factors: problem-solving, cognitive restructuring, social support, emotional expression, problem avoidance, wishful thinking, social withdrawal, and self-criticism. Among the eight factors, there are four with positive valence, that is, higher scores indicate adaptive coping strategies (i.e., problem-solving, emotional expression, social support, and cognitive restructuring), whereas the four remaining factors have a negative valence, namely, higher scores indicate maladaptive coping strategies (i.e., self-criticism, wishful thinking, problem avoidance, and social withdrawal). All items are rated on a five-point Likert-type scale ranging from 0 (not at all) to 4 (completely). The internal consistency in the present study ranged from 0.69 in the social withdrawal subscale to 0.88 in the self-criticism subscale.

2.2.5. Emotion Regulation

The Difficulties in Emotion Regulation Scale (DERS) [68], adapted to Spanish by Hervás and Jódar (2008) [69], was used to assess difficulties in the awareness, understanding, or modulation of emotion. The Spanish validation comprises a total of 28 items rated on a Likert-type scale (1 = almost never, 5 = almost always) assessing five emotion-regulation deficits: (1) non-acceptance of emotions; (2) daily interference (‘difficulties engaging in goal-directed behavior’ in the original subscale); (3) emotional inattention (‘lack of emotional awareness’ in the original subscale); (4) emotional confusion (‘lack of emotional clarity’ in the original subscale); and (5) lack of emotional control (‘limited access to emotion regulation strategies’ and ‘impulse control difficulties’ in the original subscales). In the present study, the scale has shown adequate psychometric properties (α = 0.93).

2.3. Data Analysis

Descriptive statistics and frequencies were computed to summarize the sociodemographic characteristics and the study variables. Independent samples t-tests were conducted to examine gender differences in the study variables. Effect sizes were calculated using Cohen’s d [70]. Pearson correlation coefficients were computed to assess the relationships between study variables.
Two mediation analyses were performed to test the mediating role of emotion regulation and coping strategies in the relationship between impulsivity and metacognition and eating disorders. Therefore, we considered coping strategies (i.e., problem-solving, cognitive restructuring, social support, emotional expression, problem avoidance, wishful thinking, social withdrawal, and self-criticism) and emotion regulation as mediation variables. Given the high correlation between the subscales of emotion regulation and the total score (ranging between 0.723 and 0.878) and between the subscale of impulsivity and the total score (ranging between 0.728 and 0.788), we deemed the total score in these questionnaires.
This analysis was conducted with Process 4 for SPSS Statistics 28 [71], using 5000 bootstrapping samples. All analyses were performed using the SPSS package, and the confidence levels were set at 95%.

3. Results

The study found significant gender differences in age, body mass index (BMI), weight, and height (all p-values ≤ 0.001), with women being younger and having lower BMI, weight, and height. Additionally, more men were married and employed. Conversely, there were no gender differences in the study variables, including eating disorders, impulsivity, metacognition, emotion regulation, and some coping strategies. However, there were gender differences in emotional expression, wishful thinking, social support, and social withdrawal, where women scored higher (see Table 1).
Bivariate correlation analyses revealed a strong relationship among the study variables. The only non-significant relationships found were between specific coping strategies and eating disorders (r = 0.06), impulsivity (r ≤ −0.055), metacognition (r ≤ 0.042), and emotion regulation (r = 0.059) (see Table 2).
The mediation analyses showed that impulsivity and metacognition have significant indirect effects on eating disorders through the mediator variables (i.e., coping strategies and emotion regulation). Both mediation models achieved similar results with a significant direct effect of impulsivity and metacognition on eating disorders, emotion regulation, and coping strategies (except for cognitive restructuring and problem avoidance). Additionally, all indirect effects through emotion regulation and coping strategies were statistically significant, except for the pathway mediated by problem-solving, emotional expression, cognitive restructuring, and problem avoidance. Overall, these results demonstrated the intricate connections between impulsivity, metacognition, and eating disorders, whose relationship was partially mediated by emotion regulation and coping strategies, as evidenced by the statistically significant direct and total effects (see Table 3 and Table 4). The two mediating models are displayed in Figure 1 and Figure 2, respectively.

4. Discussion

The current study aimed to test the mediating role of coping strategies, including emotion regulation, in the relationship between impulsivity and metacognition, and eating disorders. Two results are underlined: (1) Women displayed higher coping strategies, specifically emotional expression, wishful thinking, and social support, whereas men presented greater social withdrawal; and (2) there was a significant association between impulsivity, metacognition, and eating disorders, whose relationship was partially mediated by coping strategies and mainly by emotion regulation.
The results did not find gender differences in eating disorder severity, impulsivity levels, metacognition, or emotion regulation, although differences between men and women were found in some coping strategies. In contrast to the present findings, previous studies have consistently indicated that women exhibit a higher prevalence of eating disorders and greater severity, both in the general population [72,73] and in young adults [74]; higher emotion regulation [75]; and higher scores on some coping strategies [76], although other studies suggest that men score higher on other coping strategies (e.g., avoidance, distraction, and social diversion) [77].
On the other hand, there was a high correlation between coping strategies, especially emotion regulation, and the severity of eating disorders. Emotion regulation has been widely studied as a transdiagnostic construct and also its relationship with several psychological disorders [78,79,80,81], including eating disorders [82,83,84,85]. Likewise, a strong relationship was also observed between executive functions, specifically impulsivity and metacognition, with eating disorders, coping strategies, and emotion regulation. Theories such as that proposed by Sharp et al. (2013) [86] indicate that women with eating disorders may articulate their mental states extensively and in detail, demonstrating a cognitive understanding of affectivity but with minimal connection to experiential or affective core [87]. In this regard, cognitive strategies characterized by excessive rumination, for instance, tend to focus on issues such as weight, food, and body image, potentially serving as a cognitive-emotional avoidance strategy, thus perpetuating the maintenance of the eating problem [88,89,90,91], as they impede cognitive and emotional insight [92].
Finally, the results regarding the mediation analysis yielded similar outcomes for impulsivity and metacognition as independent variables. In both models, coping strategies and emotion regulation partially mediated the relationship between impulsivity and metacognition and eating disorders, except for the pathway mediated by problem-solving, emotional expression, cognitive restructuring, and problem avoidance. This relationship has been demonstrated in other psychological disorders (e.g., anxiety, addictive disorder, mental health) [43,44,48,49], but, to our knowledge, it had not been confirmed in relation to eating disorders until now.
This finding leads to significant clinical implications for the young adult population, as interventions targeting effective coping strategies for dealing with emotional distress may prevent youth from disordered eating. First, it is worth mentioning that therapists’ vulnerabilities, biases, and difficulties must be taken into account in addressing eating disorders [93]. Also, several studies have shown the effectiveness of treatments focused on emotion regulation, metacognition, and coping strategies. The systematic review by Sloan et al. (2017) [94] found emotion regulation to be an effective transdiagnostic intervention for eating disorders and other psychological disorders (e.g., anxiety, depression, personality disorders, substance use). Balzan et al. (2023) [95] showed promising results of a metacognition-based intervention in adolescents with anorexia nervosa. Other studies have also examined the effect of coping-based intervention on mental health with excellent results [96,97], although to our knowledge, no studies have conducted coping-based intervention targeted at eating disorders.
When drawing conclusions from the study, it is important to consider certain limitations. Firstly, this is a cross-sectional study, thus causal relationships between variables cannot be established. Moreover, the sample is predominantly composed of women. Hence, future studies should strive to balance gender representation. Although the age range is broad, the sample predominantly comprises young student populations, thus limiting the generalizability of the results to a broader population. Additionally, data collection relied on self-reports, potentially introducing biases such as social desirability. Lastly, given that the sample consisted of the general population rather than clinical populations, caution must be exercised in extrapolating the findings to individuals with eating disorders.

5. Conclusions

In conclusion, understanding eating disorders is paramount for early detection, intervention, and successful treatment outcomes. These findings showed that coping and emotion regulation strategies partially mediated the relationship between executive functions (i.e., impulsivity and metacognition) and eating disorders. Therefore, by elucidating the intricate interplay of executive functions and coping strategies contributing to these disorders, clinicians and researchers can advance our knowledge and develop therapeutic strategies to reduce the impact of eating disorders on individuals and society.

Author Contributions

Conceptualization, G.A.-D., L.M., J.M. and A.E.; Methodology, G.A.-D.; Software, G.A.-D.; Validation, L.M.; Formal Analysis, G.A.-D.; Investigation, G.A.-D.; Resources, Data Curation, I.I. and L.O.; Writing—Original Draft Preparation, G.A.-D.; Writing—Review and Editing, L.M., A.E., I.I., J.M. and L.O.; Visualization, L.M., A.E., I.I., J.M. and L.O.; Supervision, L.M., A.E., I.I., J.M. and L.O.; Project Administration, A.E.; Funding Acquisition, A.E. All authors have read and agreed to the published version of the manuscript.

Funding

This research was funded by the Directorate General for the Regulation of Gambling (ref.: SUBV23/00001) and by a Postdoctoral grant from Ministry of Science (MCIN/AEI/10.13039/501100011033) and from European Union NextGenerationEU/PRTR (ref.: JDC2022-048311-I).

Institutional Review Board Statement

The study was conducted in accordance with the Declaration of Helsinki and approved by the ethics committee of University of Deusto (ref. ETK-38/23-24, approval date: 19 December 2023).

Informed Consent Statement

Informed consent was obtained from all subjects involved in the study. Written informed consent has been obtained from the participants to publish this paper.

Data Availability Statement

The data presented in this study are available on request from the corresponding author. The data are not publicly available because they include confidential information of the participants.

Conflicts of Interest

The authors declare no conflicts of interest.

References

  1. Hambleton, A.; Pepin, G.; Le, A.; Maloney, D.; Aouad, P.; Barakat, S.; Boakes, R.; Brennan, L.; Bryant, E.; Byrne, S.; et al. Psychiatric and Medical Comorbidities of Eating Disorders: Findings from a Rapid Review of the Literature. J. Eat. Disord. 2022, 10, 132. [Google Scholar] [CrossRef]
  2. Amiri, S.; Khan, M.A.B. Prevalence of Non-Suicidal Self-Injury, Suicidal Ideation, Suicide Attempts, Suicide Mortality in Eating Disorders: A Systematic Review and Meta-Analysis. Eat. Disord. 2023, 31, 487–525. [Google Scholar] [CrossRef] [PubMed]
  3. Jagielska, G.; Kacperska, I. Outcome, Comorbidity and Prognosis in Anorexia Nervosa. Psychiatr. Pol. 2017, 51, 205–218. [Google Scholar] [CrossRef] [PubMed]
  4. Van Eeden, A.E.; Van Hoeken, D.; Hoek, H.W. Incidence, Prevalence and Mortality of Anorexia Nervosa and Bulimia Nervosa. Curr. Opin. Psychiatry 2021, 34, 515–524. [Google Scholar] [CrossRef]
  5. Van Hoeken, D.; Hoek, H.W. Review of the Burden of Eating Disorders: Mortality, Disability, Costs, Quality of Life, and Family Burden. Curr. Opin. Psychiatry 2020, 33, 521–527. [Google Scholar] [CrossRef] [PubMed]
  6. American Psychiatric Association. Diagnosis and Statistical Manual of Mental Disorders—Fifth Edition Text Revision. DSM-5-TR; American Psychiatric Association: Washington, DC, USA, 2023. [Google Scholar]
  7. Himmerich, H.; Bentley, J.; Kan, C.; Treasure, J. Genetic Risk Factors for Eating Disorders: An Update and Insights into Pathophysiology. Ther. Adv. Psychopharmacol. 2019, 9, 1–20. [Google Scholar] [CrossRef] [PubMed]
  8. Kober, H.; Boswell, R.G. Potential Psychological & Neural Mechanisms in Binge Eating Disorder: Implications for Treatment. Clin. Psychol. Rev. 2018, 60, 32–44. [Google Scholar] [CrossRef]
  9. Alfoukha, M.M.; Hamdan-Mansour, A.M.; Banihani, M.A. Social and Psychological Factors Related to Risk of Eating Disorders Among High School Girls. J. Sch. Nurs. 2017, 35, 169–177. [Google Scholar] [CrossRef]
  10. Weissman, R.S. The Role of Sociocultural Factors in the Etiology of Eating Disorders. Psychiatr. Clin. N. Am. 2019, 42, 121–144. [Google Scholar] [CrossRef]
  11. Ciberti, A.; Cavalletti, M.; Palagini, L.; Mariani, M.G.; Dell’osso, L.; Mauri, M.; Maglio, A.; Mucci, F.; Marazziti, D.; Miniati, M. Decision-Making, Impulsiveness and Temperamental Traits in Eating Disorders. Clin. Neuropsychiatry 2020, 17, 199–208. [Google Scholar] [CrossRef]
  12. Slof-Op’t Landt, M.C.T.; Claes, L.; van Furth, E.F. Classifying Eating Disorders Based on “Healthy” and “Unhealthy” Perfectionism and Impulsivity. Int. J. Eat. Disord. 2016, 49, 673–680. [Google Scholar] [CrossRef] [PubMed]
  13. Boswell, R.G.; Grilo, C.M. General Impulsivity in Binge-Eating Disorder. CNS Spectr. 2021, 26, 538–544. [Google Scholar] [CrossRef] [PubMed]
  14. Goodwin, A.L.; Butler, G.K.L.; Nikčević, A.V. Impulsivity Dimensions and Their Associations with Disinhibited and Actual Eating Behaviour. Eat. Behav. 2023, 49, 101752. [Google Scholar] [CrossRef] [PubMed]
  15. Carr, M.M.; Wiedemann, A.A.; Macdonald-Gagnon, G.; Potenza, M.N. Impulsivity and Compulsivity in Binge Eating Disorder: A Systematic Review of Behavioral Studies. Prog. Neuro-Psychopharmacol. Biol. Psychiatry 2021, 110, 110318. [Google Scholar] [CrossRef] [PubMed]
  16. Shaker, N.M.; Azzam, L.A.B.; Zahran, R.M.; Hashem, R.E. Frequency of Binge Eating Behavior in Patients with Borderline Personality Disorder and Its Relation to Emotional Regulation and Impulsivity. Eat. Weight Disord. 2022, 27, 2497–2506. [Google Scholar] [CrossRef]
  17. Soidla, K.; Akkermann, K. Perfectionism and Impulsivity Based Risk Profiles in Eating Disorders. Int. J. Eat. Disord. 2020, 53, 1108–1119. [Google Scholar] [CrossRef] [PubMed]
  18. Bénard, M.; Bellisle, F.; Kesse-Guyot, E.; Julia, C.; Andreeva, V.A.; Etilé, F.; Reach, G.; Dechelotte, P.; Tavolacci, M.P.; Hercberg, S.; et al. Impulsivity Is Associated with Food Intake, Snacking, and Eating Disorders in a General Population. Am. J. Clin. Nutr. 2019, 109, 117–126. [Google Scholar] [CrossRef]
  19. Testa, G.; Granero, R.; Misiolek, A.; Vintró-Alcaraz, C.; Mallorqui-Bagué, N.; Lozano-Madrid, M.; Heras, M.V.D.L.; Sánchez, I.; Jiménez-Murcia, S.; Fernández-Aranda, F. Impact of Impulsivity and Therapy Response in Eating Disorders from a Neurophysiological, Personality and Cognitive Perspective. Nutrients 2022, 14, 5011. [Google Scholar] [CrossRef]
  20. Lozano-Madrid, M.; Granero, R.; Lucas, I.; Sánchez, I.; Sánchez-González, J.; Gómez-Peña, M.; Moragas, L.; Mallorquí-Bagué, N.; Tapia, J.; Jiménez-Murcia, S.; et al. Impulsivity and Compulsivity in Gambling Disorder and Bulimic Spectrum Eating Disorders: Analysis of Neuropsychological Profiles and Sex Differences. Eur. Psychiatry 2023, 66, e91. [Google Scholar] [CrossRef]
  21. Turiaco, F.; Bruno, A.; Mento, C.; Cedro, C.; Pandolfo, G.; Muscatello, M.R.A. Impulsivity and Metacognition in a Psychiatric Population. Clin. Neuropsychiatry 2022, 19, 97–102. [Google Scholar] [CrossRef]
  22. Sun, X.; Zhu, C.; So, S.H.W. Dysfunctional Metacognition across Psychopathologies: A Meta-Analytic Review. Eur. Psychiatry 2017, 45, 139–153. [Google Scholar] [CrossRef] [PubMed]
  23. Hamonniere, T.; Varescon, I. Metacognitive Beliefs in Addictive Behaviours: A Systematic Review. Addict. Behav. 2018, 85, 51–63. [Google Scholar] [CrossRef] [PubMed]
  24. Jauregui, P.; Urbiola, I.; Estevez, A. Metacognition in Pathological Gambling and Its Relationship with Anxious and Depressive Symptomatology. J. Gambl. Stud. 2016, 32, 675–688. [Google Scholar] [CrossRef]
  25. Palmieri, S.; Mansueto, G.; Ruggiero, G.M.; Caselli, G.; Sassaroli, S.; Spada, M.M. Metacognitive Beliefs across Eating Disorders and Eating Behaviours: A Systematic Review. Clin. Psychol. Psychother. 2021, 28, 1254–1265. [Google Scholar] [CrossRef]
  26. Laghi, F.; Bianchi, D.; Pompili, S.; Lonigro, A.; Baiocco, R. Metacognition, Emotional Functioning and Binge Eating in Adolescence: The Moderation Role of Need to Control Thoughts. Eat. Weight. Disord. Stud. Anorex. Bulim. Obes. 2018, 23, 861–869. [Google Scholar] [CrossRef] [PubMed]
  27. Limbers, C.A.; Greenwood, E.; Shea, K.; Fergus, T.A. Metacognitive Beliefs and Emotional Eating in Adolescents. Eat. Weight Disord. 2021, 26, 2281–2286. [Google Scholar] [CrossRef] [PubMed]
  28. Olstad, S.; Solem, S.; Hjemdal, O.; Hagen, R. Metacognition in Eating Disorders: Comparison of Women with Eating Disorders, Self-Reported History of Eating Disorders or Psychiatric Problems, and Healthy Controls. Eat. Behav. 2015, 16, 17–22. [Google Scholar] [CrossRef]
  29. Gerges, S.; Azzi, V.; Bianchi, D.; Laghi, F.; Pompili, S.; Malaeb, D.; Obeid, S.; Soufia, M.; Hallit, S. Exploring the Relationship between Dysfunctional Metacognitive Processes and Orthorexia Nervosa: The Moderating Role of Emotion Regulation Strategies. BMC Psychiatry 2023, 23, 674. [Google Scholar] [CrossRef]
  30. Davenport, E.; Rushford, N.; Soon, S.; Mcdermott, C. Dysfunctional Metacognition and Drive for Thinness in Typical and Atypical Anorexia Nervosa. J. Eat. Disord. 2015, 3, 1–9. [Google Scholar] [CrossRef]
  31. Georgantopoulos, G.; Konstantakopoulos, G.; Michopoulos, I.; Dikeos, D.; Gonidakis, F. The Relationship between Metacognitive Beliefs and Symptoms in Eating Disorders. Psychiatriki 2020, 31, 225–235. [Google Scholar] [CrossRef]
  32. Sapuppo, W.; Ruggiero, G.M.; Caselli, G.; Sassaroli, S. The Body of Cognitive and Metacognitive Variables in Eating Disorders: Need of Control, Negative Beliefs about Worry Uncontrollability and Danger, Perfectionism, Self-Esteem and Worry. Isr. J. Psychiatry 2018, 55, 55–65. [Google Scholar] [PubMed]
  33. Aloi, M.; Rania, M.; Carbone, E.A.; Caroleo, M.; Calabrò, G.; Zaffino, P.; Nicolò, G.; Carcione, A.; Lo Coco, G.; Cosentino, C.; et al. Metacognition and Emotion Regulation as Treatment Targets in Binge Eating Disorder: A Network Analysis Study. J. Eat. Disord. 2021, 9, 1–9. [Google Scholar] [CrossRef]
  34. Ruscitti, C.; Rufino, K.; Goodwin, N.; Wagner, R. Difficulties in Emotion Regulation in Patients with Eating Disorders. Borderline Personal. Disord. Emot. Dysregulation 2016, 3, 3. [Google Scholar] [CrossRef] [PubMed]
  35. Mallorquí-Bagué, N.; Testa, G.; Lozano-Madrid, M.; Vintró-Alcaraz, C.; Sánchez, I.; Riesco, N.; Granero, R.; Perales, J.C.; Navas, J.F.; Megías-Robles, A.; et al. Emotional and Non-emotional Facets of Impulsivity in Eating Disorders: From Anorexia Nervosa to Bulimic Spectrum Disorders. Eur. Eat. Disord. Rev. 2020, 28, 410–422. [Google Scholar] [CrossRef] [PubMed]
  36. Luca, M. Maladaptive Rumination as a Transdiagnostic Mediator of Vulnerability and Outcome in Psychopathology. J. Clin. Med. 2019, 8, 314. [Google Scholar] [CrossRef]
  37. Tecuta, L.; Gardini, V.; Digiuseppe, R.; Tomba, E. Do Metacognitions Mediate the Relationship between Irrational Beliefs, Eating Disorder Symptoms and Cognitive Reappraisal? Psychother. Res. 2021, 31, 483–492. [Google Scholar] [CrossRef]
  38. Dingemans, A.; Danner, U.; Parks, M. Emotion Regulation in Binge Eating Disorder: A Review. Nutrients 2017, 9, 1274. [Google Scholar] [CrossRef] [PubMed]
  39. Meule, A.; Richard, A.; Schnepper, R.; Reichenberger, J.; Georgii, C.; Naab, S.; Voderholzer, U.; Blechert, J. Emotion Regulation and Emotional Eating in Anorexia Nervosa and Bulimia Nervosa. Eat. Disord. 2019, 29, 175–191. [Google Scholar] [CrossRef] [PubMed]
  40. Mikhail, M.E.; Kring, A.M. Emotion Regulation Strategy Use and Eating Disorder Symptoms in Daily Life. Eat. Behav. 2019, 34, 101315. [Google Scholar] [CrossRef]
  41. Dworschak, C.; Polack, R.G.; Winschel, J.; Joormann, J.; Kober, H. Emotion Regulation and Disordered Eating Behaviour in Youths: Two Daily-Diary Studies. Eur. Eat. Disord. Rev. J. Eat. Disord. Assoc. 2023, 31, 655–669. [Google Scholar] [CrossRef]
  42. Tragantzopoulou, P.; Giannouli, V. Unveiling Anxiety Factors in Orthorexia Nervosa: A Qualitative Exploration of Fears and Coping Strategies. Healthcare 2024, 12, 925. [Google Scholar] [CrossRef]
  43. Gargabi, Z.H.; Nouri, R.; Moradi, A.; Sarami, G. Evaluation of Coping Styles, Metacognition and Their Relationship with Test Anxiety. J. Mazand. Univ. Med. Sci. 2014, 24, 144–155. [Google Scholar]
  44. Yousefi, M.; Barzegar, M.; Kouroshnia, M.; Khayyer, M. Investigating The Mediating Role of Cognitive Emotion Regulation Strategies in The Relationship Between Meta-Cognitive Beliefs and Learning Anxiety. Iran. Evol. Educ. Psychol. J. 2021, 3, 256–267. [Google Scholar] [CrossRef]
  45. Mohammadkhani, S.; Hasani, J.; Akbari, M.; Panah, N.Y. Mediating Role of Emotion Regulation in the Relationship of Metacognitive Beliefs and Attachment Styles with Risky Behaviors in Children of Iran-Iraq War Veterans with Psychiatric Disorders. Iran. J. Psychiatry Clin. Psychol. 2019, 25, 396–411. [Google Scholar] [CrossRef]
  46. Ceren Yıldırım, J.; Bahtiyar, B. The Association between Metacognitions and Worry: The Mediator Role of Experiential Avoidance Strategies. J. Psychol. 2022, 156, 552–567. [Google Scholar] [CrossRef]
  47. Mazloom, M.; Yaghubi, H.; Mohammadkhani, S. Post-Traumatic Stress Symptom, Metacognition, Emotional Schema and Emotion Regulation: A Structural Equation Model. Personal. Individ. Differ. 2016, 88, 94–98. [Google Scholar] [CrossRef]
  48. Li, Q.; Dai, W.; Zhong, Y.; Wang, L.; Dai, B.; Liu, X. The Mediating Role of Coping Styles on Impulsivity, Behavioral Inhibition/Approach System, and Internet Addiction in Adolescents From a Gender Perspective. Front. Psychol. 2019, 10, 2402. [Google Scholar] [CrossRef] [PubMed]
  49. Bacadini França, A.; Samra, R.; Magalhães Vitorino, L.; Waltz Schelini, P. The Relationship Between Mental Health, Metacognition, and Emotion Regulation in Older People. Clin. Gerontol. 2024, 47, 298–306. [Google Scholar] [CrossRef]
  50. Udo, T.; Grilo, C.M. Psychiatric and Medical Correlates of DSM-5 Eating Disorders in a Nationally Representative Sample of Adults in the United States. Int. J. Eat. Disord. 2019, 52, 42–50. [Google Scholar] [CrossRef] [PubMed]
  51. Wells, A.; Matthews, G. Modelling Cognition in Emotional Disorder: The S-REF Model. Behav. Res. Ther. 1996, 34, 881–888. [Google Scholar] [CrossRef] [PubMed]
  52. Sharma, V.; Sagar, R.; Kaloiya, G.; Mehta, M. The Scope of Metacognitive Therapy in the Treatment of Psychiatric Disorders. Cureus 2022, 14, e23424. [Google Scholar] [CrossRef]
  53. Kraft, B.; Jonassen, R.; Stiles, T.C.; Landrø, N.I. Dysfunctional Metacognitive Beliefs Are Associated with Decreased Executive Control. Front. Psychol. 2017, 8, 259977. [Google Scholar] [CrossRef]
  54. Wells, A. Breaking the Cybernetic Code: Understanding and Treating the Human Metacognitive Control System to Enhance Mental Health. Front. Psychol. 2019, 10, 2621. [Google Scholar] [CrossRef] [PubMed]
  55. Miller, A.E.; Racine, S.E. Emotion Regulation Difficulties as Common and Unique Predictors of Impulsive Behaviors in University Students. J. Am. Coll. Health 2022, 70, 1387–1395. [Google Scholar] [CrossRef]
  56. Lazuras, L.; Ypsilanti, A.; Powell, P.; Overton, P. The Roles of Impulsivity, Self-Regulation, and Emotion Regulation in the Experience of Self-Disgust. Motiv. Emot. 2019, 43, 145–158. [Google Scholar] [CrossRef]
  57. Altan-Atalay, A.; Zeytun, D. The Association of Negative Urgency with Psychological Distress: Moderating Role of Proactive Coping Strategies. J. Psychol. 2020, 154, 487–498. [Google Scholar] [CrossRef] [PubMed]
  58. Maier, M.J.; Schiel, J.E.; Rosenbaum, D.; Hautzinger, M.; Fallgatter, A.J.; Ehlis, A.C. To Regulate or Not to Regulate: Emotion Regulation in Participants With Low and High Impulsivity. Front. Behav. Neurosci. 2021, 15, 645052. [Google Scholar] [CrossRef]
  59. Laghi, F.; Pompili, S.; Bianchi, D.; Lonigro, A.; Baiocco, R. Dysfunctional Metacognition Processes as Risk Factors for Drunkorexia during Adolescence. J. Addict. Dis. 2020, 38, 291–300. [Google Scholar] [CrossRef]
  60. Strodl, E.; Markey, C.; Aimé, A.; Rodgers, R.F.; Dion, J.; Coco, G.L.; Gullo, S.; McCabe, M.; Mellor, D.; Granero-Gallegos, A.; et al. A Cross-Country Examination of Emotional Eating, Restrained Eating and Intuitive Eating: Measurement Invariance across Eight Countries. Body Image 2020, 35, 245–254. [Google Scholar] [CrossRef]
  61. Garner, D.M. Eating Disorder Inventory—2; Psychological Assessment Resources: Lake Magdalene, FL, USA, 1991. [Google Scholar]
  62. Muro-Sans, P.; Amador-Campos, J.A.; Peró-Cebollero, M. Factor Structure of Eating Disorders Inventory-2 in a Spanish Sample. Eat. Weight Disord. Stud. Anorex. Bulim. Obes. 2006, 11, e42–e52. [Google Scholar] [CrossRef]
  63. Leal-Carcedo, L. Validación del Inventrio de Actividad Cognitiva en Los Trastornos de Nasiedad, Subescala Para el Trastorno Obsesivo-Compulsivo (IACTA-TOC); Universidad Complutense de Madrid: Madrid, Spain, 2012. [Google Scholar]
  64. Barratt, E.S. Impulsiveness and Anxiety: Information Processing and Electroencephalograph Topography. J. Res. Pers. 1987, 21, 453–463. [Google Scholar] [CrossRef]
  65. Oquendo, M.A.; Baca-García, E.; Graver, R.; Morales, M.; Montalvan, V.; Mann, J.J. Spanish Adaptation of the Barratt Impulsiveness Scale (BIS-11). Eur. J. Psychiatry 2001, 15, 147–155. [Google Scholar]
  66. Tobin, D.L.; Holroyd, K.A.; Reynolds, R.V.; Wigal, J.K. The Hierarchical Factor Structure of the Coping Strategies Inventory. Cognit. Ther. Res. 1989, 13, 343–361. [Google Scholar] [CrossRef]
  67. Cano-García, F.J.; Rodríguez-Franco, L.; García-Martínez, J. Adaptación Española Del Inventario de Estrategias de Afrontamiento. Actas Españolas Psiquiatr. 2007, 35, 29–39. [Google Scholar]
  68. Gratz, K.L.; Roemer, L. Multidimensional Assessment of Emotion Regulation and Dysregulation: Development, Factor Structure, and Initial Validation of the Difficulties in Emotion Regulation Scale. J. Psychopathol. Behav. Assess. 2004, 26, 41–54. [Google Scholar] [CrossRef]
  69. Hervás, G.; Jódar, R. Adaptación Al Castellano de La Escala de Dificultades En La Regulación Emocional. Clínica Salud 2008, 19, 139–156. [Google Scholar]
  70. Cohen, J. Statistical Power Analysis for the Behavioral Sciences; Hillsdate: Hillsdale, MI, USA, 1988. [Google Scholar]
  71. Hayes, A.F. An Introduction to Mediation, Moderation, and Conditional Process Analysis: A Regression-Based Approach; Guilford Press: New York, NY, USA, 2013. [Google Scholar]
  72. Lindvall-Dahlgren, C.; Wisting, L.; Rø, Ø. Feeding and Eating Disorders in the DSM-5 Era: A Systematic Review of Prevalence Rates in Non-Clinical Male and Female Samples. J. Eat. Disord. 2017, 5, 56. [Google Scholar] [CrossRef]
  73. Qian, J.; Wu, Y.; Liu, F.; Zhu, Y.; Jin, H.; Zhang, H.; Wan, Y.; Li, C.; Yu, D. An Update on the Prevalence of Eating Disorders in the General Population: A Systematic Review and Meta-Analysis. Eat. Weight Disord. 2022, 27, 415–428. [Google Scholar] [CrossRef] [PubMed]
  74. Cheah, W.L.; Shin, E.C.V.; Hazmi, H. Examining Gender Difference in Disordered Eating Behaviour and Its Associated Factors among College and University Students in Sarawak. Nutr. Health, 2022; Advance online publication. [Google Scholar] [CrossRef]
  75. Nolen-Hoeksema, S. Emotion Regulation and Psychopathology: The Role of Gender. Annu. Rev. Clin. Psychol. 2012, 8, 161–187. [Google Scholar] [CrossRef]
  76. Graves, B.S.; Hall, M.E.; Dias-Karch, C.; Haischer, M.H.; Apter, C. Gender Differences in Perceived Stress and Coping among College Students. PLoS ONE 2021, 16, e0255634. [Google Scholar] [CrossRef] [PubMed]
  77. Cabras, C.; Mondo, M. Coping Strategies, Optimism, and Life Satisfaction among First-Year University Students in Italy: Gender and Age Differences. Int. J. Educ. Res. 2018, 75, 643–654. [Google Scholar] [CrossRef]
  78. Sakiris, N.; Berle, D. A Systematic Review and Meta-Analysis of the Unified Protocol as a Transdiagnostic Emotion Regulation Based Intervention. Clin. Psychol. Rev. 2019, 72, 101751. [Google Scholar] [CrossRef]
  79. Cludius, B.; Mennin, D.; Ehring, T. Emotion Regulation as a Transdiagnostic Process. Emotion 2020, 20, 37–42. [Google Scholar] [CrossRef] [PubMed]
  80. Hu, T.; Zhang, D.; Wang, J.; Mistry, R.; Ran, G.; Wang, X. Relation between Emotion Regulation and Mental Health: A Meta-Analysis Review. Psychol. Rep. 2014, 114, 341–362. [Google Scholar] [CrossRef] [PubMed]
  81. Igra, L.; Shilon, S.; Kivity, Y.; Atzil-Slonim, D.; Lavi-Rotenberg, A.; Hasson-Ohayon, I. Examining the Associations between Difficulties in Emotion Regulation and Symptomatic Outcome Measures among Individuals with Different Mental Disorders. Front. Psychol. 2023, 14, 944457. [Google Scholar] [CrossRef] [PubMed]
  82. Mallorquí-Bagué, N.; Vintró-Alcaraz, C.; Sánchez, I.; Riesco, N.; Agüera, Z.; Granero, R.; Jiménez-Múrcia, S.; Menchón, J.M.; Treasure, J.; Fernández-Aranda, F. Emotion Regulation as a Transdiagnostic Feature Among Eating Disorders: Cross-Sectional and Longitudinal Approach. Eur. Eat. Disord. Rev. 2018, 26, 53–61. [Google Scholar] [CrossRef] [PubMed]
  83. Prefit, A.B.; Cândea, D.M.; Szentagotai-Tătar, A. Emotion Regulation across Eating Pathology: A Meta-Analysis. Appetite 2019, 143, 104438. [Google Scholar] [CrossRef] [PubMed]
  84. Leppanen, J.; Brown, D.; McLinden, H.; Williams, S.; Tchanturia, K. The Role of Emotion Regulation in Eating Disorders: A Network Meta-Analysis Approach. Front. Psychiatry 2022, 13, 793094. [Google Scholar] [CrossRef]
  85. Brockmeyer, T.; Skunde, M.; Wu, M.; Bresslein, E.; Rudofsky, G.; Herzog, W.; Friederich, H.C. Difficulties in Emotion Regulation across the Spectrum of Eating Disorders. Compr. Psychiatry 2014, 55, 565–571. [Google Scholar] [CrossRef]
  86. Sharp, C.; Ha, C.; Carbone, C.; Kim, S.; Perry, K.; Williams, L.; Fonagy, P. Hypermentalizing in Adolescent Inpatients: Treatment Effects and Association With Borderline Traits. J. Personal. Disord. 2013, 27, 3–18. [Google Scholar] [CrossRef] [PubMed]
  87. Blatt, S.J.; Auerbach, J.S.; Behrends, R.S. Changes in the Representation of Self and Significant Others in the Treatment Process: Links between Representation, Internalization, and Mentalization. In Mind to Mind: Infant Research, Neuroscience, and Psychoanalysis; Jurist, E.L., Slade, A., Bergner, S., Eds.; Other Press: New York, NY, USA, 2008; pp. 225–263. [Google Scholar]
  88. Rawal, A.; Park, R.J.; Williams, J.M.G. Rumination, Experiential Avoidance, and Dysfunctional Thinking in Eating Disorders. Behav. Res. Ther. 2010, 48, 851–859. [Google Scholar] [CrossRef]
  89. Cowdrey, F.A.; Park, R.J. The Role of Experiential Avoidance, Rumination and Mindfulness in Eating Disorders. Eat. Behav. 2012, 13, 100–105. [Google Scholar] [CrossRef] [PubMed]
  90. Litwin, R.; Goldbacher, E.M.; Cardaciotto, L.A.; Gambrel, L.E. Negative Emotions and Emotional Eating: The Mediating Role of Experiential Avoidance. Eat. Weight Disord. 2017, 22, 97–104. [Google Scholar] [CrossRef] [PubMed]
  91. Espel-Huynh, H.M.; Muratore, A.F.; Virzi, N.; Brooks, G.; Zandberg, L.J. Mediating Role of Experiential Avoidance in the Relationship between Anxiety Sensitivity and Eating Disorder Psychopathology: A Clinical Replication. Eat. Behav. 2019, 34, 101308. [Google Scholar] [CrossRef] [PubMed]
  92. Park, R.J.; Dunn, B.D.; Barnard, P.J. Schematic Models and Modes of Mind in Anorexia Nervosa I: A Novel Process Account. Int. J. Cogn. Ther. 2011, 4, 415–437. [Google Scholar] [CrossRef]
  93. Tragantzopoulou, P.; Giannouli, V. “You Feel That You Are Stepping into a Different World”: Vulnerability and Biases in the Treatment of Anorexia Nervosa. Eur. J. Psychother. Couns. 2023, 25, 351–368. [Google Scholar] [CrossRef]
  94. Sloan, E.; Hall, K.; Moulding, R.; Bryce, S.; Mildred, H.; Staiger, P.K. Emotion Regulation as a Transdiagnostic Treatment Construct across Anxiety, Depression, Substance, Eating and Borderline Personality Disorders: A Systematic Review. Clin. Psychol. Rev. 2017, 57, 141–163. [Google Scholar] [CrossRef] [PubMed]
  95. Balzan, R.P.; Gilder, M.; Thompson, M.; Wade, T.D. A Randomized Controlled Feasibility Trial of Metacognitive Training with Adolescents Receiving Treatment for Anorexia Nervosa. Int. J. Eat. Disord. 2023, 56, 1820–1825. [Google Scholar] [CrossRef]
  96. Tharaldsen, K.B.; Bru, E. Evaluating the Mindfulness-Based Coping Program: An Effectiveness Study Using a Mixed Model Approach. Ment. Illn. 2012, 4, 43–51. [Google Scholar] [CrossRef]
  97. Herrero, R.; Mira, A.; Cormo, G.; Etchemendy, E.; Baños, R.; García-Palacios, A.; Ebert, D.D.; Franke, M.; Berger, T.; Schaub, M.P.; et al. An Internet Based Intervention for Improving Resilience and Coping Strategies in University Students: Study Protocol for a Randomized Controlled Trial. Internet Interv. 2019, 16, 43–51. [Google Scholar] [CrossRef] [PubMed]
Nutrients 16 01884 g001
Figure 1. The mediating role of coping strategies and emotion regulation in the relationship between impulsivity and eating disorders. Note: Solid lines indicate significant indirect effects at a 95% confidence interval. Dashed lines indicate non-significant indirect effects at a 95% confidence interval.
Figure 1. The mediating role of coping strategies and emotion regulation in the relationship between impulsivity and eating disorders. Note: Solid lines indicate significant indirect effects at a 95% confidence interval. Dashed lines indicate non-significant indirect effects at a 95% confidence interval.
Nutrients 16 01884 g001
Nutrients 16 01884 g002
Figure 2. The mediating role of coping strategies and emotion regulation in the relationship between metacognition and eating disorders. Note: Solid lines indicate significant indirect effects at a 95% confidence interval. Dashed lines indicate non-significant indirect effects at a 95% confidence interval.
Figure 2. The mediating role of coping strategies and emotion regulation in the relationship between metacognition and eating disorders. Note: Solid lines indicate significant indirect effects at a 95% confidence interval. Dashed lines indicate non-significant indirect effects at a 95% confidence interval.
Nutrients 16 01884 g002
Table 1. Descriptive statistics of the sociodemographic characteristics and the study variables.
Table 1. Descriptive statistics of the sociodemographic characteristics and the study variables.
Total Sample
(N = 1076)		Male
(n = 233)		Female
(n = 834)		p-ValueEffect Size
M (SD)M (SD)M (SD)
Age21.78 (5.10)25.19 (6.91)20.84 (4.00)<0.0010.768
Weight (kg)61.98 (11.78)73.24 (10.50)58.84 (10.12)<0.0011.396
High (m)1.66 (0.09)1.77 (0.07)1.63 (0.06)<0.0012.145
BMI22.25 (3.24)23.25 (2.78)21.97 (3.32)<0.0010.419
BMI categories <0.0010.142
 Underweight (<18.5) a89 (8.44%)5 (2.16%)84 (10.19%)
 Normal weight (18.5–24.9) a792 (75.07%)176 (75.19%)616 (74.76%)
 Overweight (25–29.9) a145 (13.74%)45 (19.48%)100 (12.14%)
 Obesity (>30) a29 (2.75%)5 (2.16%)24 (2.91%)
Marital status a <0.0010.152
 Single993 (93.06%)209 (89.70%)784 (94.00%)
 Married21 (1.97%)14 (6.01%)7 (0.84%)
 Other53 (4.97%)10 (4.29%)43 (5.16%)
Working status a <0.0010.350
 Student839 (78.56%)120 (51.50%)719 (86.11%)
 Worker218 (20.41%)106 (45.49%)112 (13.41%)
 Other11 (1.03%)7 (3.00%)4 (0.48%)
Eating disorder157.88 (55.36)154.71 (51.05)158.65 (56.65)0.3550.073
Impulsivity66.72 (9.41)67.25 (9.28)66.52 (9.39)0.3070.078
Metacognition9.61 (6.30)10.21 (6.26)9.43 (6.29)0.0920.124
Coping strategies
 Problem-solving12.44 (4.57)12.61 (4.49)12.41 (4.58)0.5600.044
 Self-criticism7.14 (5.25)7.59 (5.09)7.04 (5.29)0.1600.106
 Emotional expression10.94 (4.81)10.00 (4.66)11.23 (4.80)0.0010.260
 Wishful thinking13.03 (5.23)12.23 (5.31)13.27 (5.20)0.0070.198
 Social support14.04 (5.09)13.07 (4.92)14.31 (5.11)0.0010.247
 Cognitive restructuring10.83 (4.74)11.06 (4.90)10.78 (4.68)0.4140.058
 Problem avoidance6.98 (4.10)7.27 (4.08)6.89 (4.09)0.2000.093
 Social withdrawal5.98 (4.23)6.48 (4.24)5.82 (4.21)0.0370.156
Emotion regulation63.16 (19.28)61.53 (16.97)63.59 (19.85)0.1200.112
Note: a frequency (percentage). M = mean; SD = standard deviation; BMI = body mass index.
Table 2. Correlations of the study variables.
Table 2. Correlations of the study variables.
1234567891011
  • Eating disorder
2.
Impulsivity
0.347 **
3.
Metacognition
0.595 **0.255 **
4.
Problem-solving
−0.291 **−0.169 **−0.167 **
5.
Self-criticism
0.426 **0.164 **0.396 **−0.076 *
6.
Emotional expression
−0.163 **−0.0590.0280.389 **0.043
7.
Wishful thinking
0.328 **0.079 *0.299 **−0.0140.378 **0.129 **
8.
Social support
−0.284 **−0.091 **−0.159 **0.356 **−0.153 **0.437 **0.055
9.
Cognitive restructuring
−0.241 **−0.055−0.115 **0.451 **−0.0250.254 **−0.088 **0.382 **
10.
Problem avoidance
0.0600.105 **0.042−0.0560.077 *−0.066 *0.103 **0.0170.358 **
11.
Social withdrawal
0.436 **0.136 **0.337 **−0.237 **0.407 **−0.252 **0.278 **−0.394 **−0.139 **0.254 **
12.
Emotion regulation
0.714 **0.393 **0.595 **−0.259 **0.417 **−0.068 *0.323 **−0.197 **−0.190 **0.0590.391 **
Note: * p ≤ 0.05; ** p ≤ 0.01.
Table 3. Standardized direct and indirect effects of impulsivity on eating disorders.
Table 3. Standardized direct and indirect effects of impulsivity on eating disorders.
βp-ValueLLCIULCI
Direct effects
 Impulsivity → Eating disorders0.0750.0020.1690.714
 Impulsivity → Emotion regulation0.402<0.0010.6880.925
 Impulsivity → Problem-solving−0.163<0.001−0.107−0.047
 Impulsivity → Self-criticism0.169<0.0010.0580.128
 Impulsivity → Emotion expression−0.0770.020−0.069−0.006
 Impulsivity → Wishful thinking0.0870.0080.0120.083
 Impulsivity → Social support−0.1090.001−0.093−0.024
 Impulsivity → Cognitive restructuring−0.0670.042−0.064−0.001
 Impulsivity → Social withdrawal0.131<0.0010.0300.086
 Impulsivity → Problem avoidance0.0990.0030.0150.071
 Emotional regulation → Eating disorders0.535<0.0011.4051.719
 Problem-solving → Eating disorders−0.0480.075−1.2580.06
 Self-criticism → Eating disorders0.111<0.0010.6361.741
 Emotional expression → Eating disorders−0.0430.100−1.1160.098
 Wishful thinking → Eating disorders0.0800.0010.3331.376
 Social support → Eating disorders−0.0700.011−1.347−0.173
 Cognitive restructuring → Eating disorders−0.0240.419−0.9640.401
 Social withdrawal → Eating disorders0.104<0.0010.6562.112
 Problem avoidance → Eating disorders−0.0100.686−0.8140.536
Indirect effects
 Emotion regulation0.215 1.0361.499
 Problem-solving0.008 −0.0050.107
 Self-criticism0.019 0.0480.185
 Emotional expression0.003 −0.0030.053
 Wishful thinking0.007 0.0070.089
 Social support0.008 0.0070.095
 Cognitive restructuring0.002 −0.0130.043
 Social withdrawal0.014 0.0250.152
 Problem avoidance−0.001 −0.0390.025
Total effects
(Impulsivity → mediating variables → Eating disorders)		0.3490.0011.6912.400
Note: LLCI = lower-limit confidence intervals; ULCI = upper-limit confidence interval.
Table 4. Standardized direct and indirect effects of metacognition on eating disorders.
Table 4. Standardized direct and indirect effects of metacognition on eating disorders.
βp-ValueLLCIULCI
Direct effects
 Impulsivity → Eating disorders0.233<0.0011.6062.539
 Metacognition → Emotion regulation0.596<0.0011.6791.996
 Metacognition → Problem-solving−0.181<0.001−0.175−0.085
 Metacognition → Self-criticism0.410<0.0010.2920.389
 Metacognition → Emotion expression0.0150.656−0.0370.059
 Metacognition → Wishful thinking0.287<0.0010.1880.291
 Metacognition → Social support−0.179<0.001−0.195−0.093
 Metacognition → Cognitive restructuring−0.134<0.001−0.147−0.052
 Metacognition → Social withdrawal0.339<0.0010.1870.268
 Metacognition → Problem avoidance0.0190.565−0.0300.055
 Emotional regulation → Eating disorders0.453<0.0011.1491.464
 Problem-solving → Eating disorders−0.0380.149−1.0990.167
 Self-criticism → Eating disorders0.0840.0010.3651.435
 Emotional expression → Eating disorders−0.0720.005−1.44−0.264
 Wishful thinking → Eating disorders0.0660.0060.21.206
 Social support → Eating disorders−0.0570.03−1.196−0.062
 Cognitive restructuring → Eating disorders−0.0360.198−1.0860.225
 Social withdrawal → Eating disorders0.0710.0090.2381.632
 Problem avoidance → Eating disorders0.0090.715−0.5270.767
Indirect effects
 Emotion regulation0.27 2.012.799
 Problem-solving0.007 −0.0270.155
 Self-criticism0.035 0.1170.515
 Emotional expression−0.001 −0.0590.037
 Wishful thinking0.019 0.0520.295
 Social support0.01 0.0070.187
 Cognitive restructuring0.005 −0.0240.123
 Social withdrawal0.024 0.0320.4
 Problem avoidance0 −0.0160.022
Total effects
(Metacognition → mediating variables → Eating disorders)		0.602<0.0014.8925.801
Note: LLCI = lower-limit confidence intervals; ULCI = upper-limit confidence interval.
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MDPI and ACS Style

Estévez, A.; Momeñe, J.; Macía, L.; Iruarrizaga, I.; Olave, L.; Aonso-Diego, G. The Mediating Effect of Coping Strategies and Emotion Regulation in the Relationship between Impulsivity, Metacognition, and Eating Disorders. Nutrients 2024, 16, 1884. https://doi.org/10.3390/nu16121884

AMA Style

Estévez A, Momeñe J, Macía L, Iruarrizaga I, Olave L, Aonso-Diego G. The Mediating Effect of Coping Strategies and Emotion Regulation in the Relationship between Impulsivity, Metacognition, and Eating Disorders. Nutrients. 2024; 16(12):1884. https://doi.org/10.3390/nu16121884

Chicago/Turabian Style

Estévez, Ana, Janire Momeñe, Laura Macía, Iciar Iruarrizaga, Leticia Olave, and Gema Aonso-Diego. 2024. "The Mediating Effect of Coping Strategies and Emotion Regulation in the Relationship between Impulsivity, Metacognition, and Eating Disorders" Nutrients 16, no. 12: 1884. https://doi.org/10.3390/nu16121884

APA Style

Estévez, A., Momeñe, J., Macía, L., Iruarrizaga, I., Olave, L., & Aonso-Diego, G. (2024). The Mediating Effect of Coping Strategies and Emotion Regulation in the Relationship between Impulsivity, Metacognition, and Eating Disorders. Nutrients, 16(12), 1884. https://doi.org/10.3390/nu16121884

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