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Family dysfunction and self-esteem play an important role in the development of eating disorders (EDs), but this role has not been sufficiently examined regarding eating pathology and psychosocial quality of life (QoL), which often remains unchanged even after ED symptoms reduce. The purpose of this study was to therefore assess the mediating role of self-esteem between family dysfunction and both eating pathology and psychosocial QoL in ED patients and controls. One hundred and fifty four female adult ED patients and 154 female healthy adult controls were recruited from Athens, Greece, and self-reported measures were used to assess family dysfunction, eating pathology, self-esteem, and psychosocial QoL. Structural equation modelling (SEM) was employed to test the mediation hypotheses. For both the ED and control groups, family dysfunction levels did impact eating pathology, but only through self-esteem. Family dysfunction, self-esteem, and eating pathology had a direct effect on both groups' psychosocial QoL. Self-esteem's important role in EDs was confirmed in both groups, along with its sensitivity to family dysfunction. We propose a parsimonious yet comprehensive theoretical model of the role of family dysfunction and self-esteem in EDs which future studies should further investigate longitudinally and in other population groups. © 2022 Eating Disorders Association and John Wiley & Sons Ltd.


Olga Theodoropoulou, Kathryn Jane Gardner, Noreen Caswell, Lynda Holyoak, Fragiskos Gonidakis. Effects of family functioning on eating pathology and psychosocial quality of life: The mediating role of self-esteem. European eating disorders review : the journal of the Eating Disorders Association. 2023 Jan;31(1):121-134

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PMID: 35951630

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