The role of actual-ideal weight discrepancy in the relationships between perfectionism, self-esteem, self-compassion and eating pathology in adolescents with eating disorders

Understanding factors associated with adolescent eating disorders is important for improving treatment outcomes. Actual-ideal weight discrepancy refers to the discrepancy between actual weight and the ideal weight an individual wants to achieve. Actual-ideal weight discrepancy is associated with poorer treatment outcome in eating disorders. It is important to understand factors associated with weight discrepancy to identify targets for treatment to improve outcomes. The aim of this study was to examine self-related constructs associated with actual-ideal weight discrepancy. The specific aim was to determine if perfectionism, self-esteem, and self-compassion contribute to eating disorder symptoms in adolescents, both independently, and through the mediating pathway of actual-ideal weight discrepancy. Participants comprised 114 female adolescents, aged 12–17 years with an eating disorder (40% anorexia nervosa, 33% atypical anorexia nervosa, 16% bulimia nervosa, 5% other specified and 5% unspecified feeding and eating disorders). Higher actual-ideal weight discrepancy, higher perfectionism, lower self-esteem, and lower self-compassion were associated with greater eating disorder symptoms. When the predictors of perfectionism, self-esteem, and self-compassion were included together in a path model predicting eating disorder symptoms, the model explained 59% of variance, and self-esteem and actual-ideal weight discrepancy were the only significant predictors of eating disorder symptoms. Lower self-esteem predicted greater eating disorder symptoms directly and through the mediator of actual-ideal weight discrepancy.