Latent Structure of Body Dysmorphia, Eating Disorder Symptoms, and Self Esteem Problems in Heterosexual Women, and Their Association with Cluster B Personality Traits

Latent Structure of Body Dysmorphia, Eating Disorder Symptoms, and Self Esteem Problems in Heterosexual Women, and Their Association with Cluster B Personality Traits

Eating disorders (specifically ones that involve weight loss) and body dysmorphia are debilitating mental disorders involving extreme difficulties with self-esteem, relationship problems, self harm, and many physical health problems due to the effects of weight loss and body mutilation. These disorders are far more prevalent in females than they are in males (Raevuori et al. 2014), and subclinical behaviors & thoughts characteristic of these disorders are common for females to experience in adolescence (Micali et al. 2014). 

I developed a list of items that reflect common ideations, behaviors in body dysmorphia and eating disorders, as well as items related to self esteem, sexuality, and mating, and created a survey (n=68) to investigate the latent structure of these ideations and behaviors, and how they relate to pathological narcissism, borderline personality traits, and histrionic personality traits. 66% of participants reported a diagnosis or suspected eating disorder or body dysmorphia.

Factor analysis was used on the created list of items, and parallel analysis suggested the extraction of three factors. Based on content, these were named: body dysmorphia (BD), drive for thinness (DT), and sexual status seeking (ST) [Table 1] (only items loading >0.5 onto each factor are included).

Table 1

	BD	DT	ST
I lack physical features that would make me attractive	0.86
It angers me that people feel the need to lie to me about my looks	0.83
Most girls are prettier than me	0.80
Many of my body parts and/or facial features are unattractive and abnormal	0.80
My body and/or face look weird	0.80
I will never find someone who really loves me and finds me beautiful because I lost the genetic lottery, I have nothing that makes me worthy or attractive	0.79
When people reject me, it is because I am ugly	0.73
I have felt guilty for being in a relationship because they shouldn't have to date someone ugly like me	0.73
I know my partner will always find other girls far more attractive than me	0.72
Many of my experiences with rejection or being made fun of were because I'm ugly	0.60
I do not let my partner see me without makeup or without clothes on because they will not find me attractive otherwise	0.59
I avoid having sex in relationships because I know my partner will not enjoy it	0.56
Attractive women don't understand how privileged they are	0.56
I am jealous of other women's looks	0.55
It sickens me when attractive women dishonestly complain that they're unattractive	0.51
I have considered plastic surgery to fix my face or body	0.50
I restrict how much I eat with the goal of having a thinner body		0.85
I try to eat less than other women		0.84
I research weight loss methods frequently		0.83
I exercise to counteract the calories gained from eating		0.72
I want to be thinner than other women		0.69
Seeing other women trying to lose weight makes me want to also lose weight		0.68
I throw up after eating too much so I do not become fatter		0.66
I enjoy when many men are attracted to me			0.64
I want other women to be jealous of me			0.56
I am motivated to make myself good enough to date men I find attractive			0.53
I have a high sex drive			0.51

Table 2

	Body Dysmorphia	Thinness
Body Dysmorphia	1
Thinness	0.32	1
Sexual Dominance	0.13	0.29

These factors were moderately correlated with each other, body dysmorphia & thinness having the strongest (r=0.32), followed by thinness & sexual status seeking (r=0.29), and lastly body dysmorphia & sexual status seeking (r=0.13)  [Table 2]. 

Items loading on the body dysmorphia factor were analyzed again separately, and two lower level factors reflecting different aspects emerged, which were labeled competitiveness and low self esteem [Table 3] (only items loading >0.5 shown). These factors correlated (r=0.85, r=0.83) respectively with the body dysmorphia factor.

Table 3

	Competitiveness	Low self esteem
It sickens me when attractive women dishonestly complain that they're unattractive	0.86
Attractive women don't understand how privileged they are	0.85
I am jealous of other women's looks	0.84
It angers me that people feel the need to lie to me about my looks	0.68	0.34
I want to be thinner than other women	0.65
Most girls are prettier than me	0.64
I lack physical features that would make me attractive	0.64	0.39
Many of my body parts and/or facial features are unattractive and abnormal	0.63	0.38
My body and/or face look weird	0.60	0.39
Seeing other women trying to lose weight makes me want to also lose weight	0.56
When people reject me, it is because I am ugly	0.53	0.36
I do not let my partner see me without makeup or without clothes on because they will not find me attractive otherwise		0.88
I avoid having sex in relationships because I know my partner will not enjoy it		0.79
I know my partner will always find other girls far more attractive than me		0.69
I have felt guilty for being in a relationship because they shouldn't have to date someone ugly like me	0.31	0.61
I will never find someone who really loves me and finds me beautiful because I have “lost the genetic lottery”, I have nothing that makes me worthy or attractive	0.43	0.54

Table 4

	Competitiveness	Low self esteem	Thinness
Competitiveness	1
Low self esteem	0.47	1
Thinness	0.50	0.33	1
Sexual Dominance	0.45	-0.13	0.299

These factors were moderately correlated with each other (r=0.47) [Table 4]. The competitiveness factor was strongly correlated with thinness (r=0.50), and sexual status seeking (r=0.45). The low self esteem factor was moderately correlated with thinness (r=0.33) and was insignificantly negatively correlated with sexual status seeking.

The items making up the thinness factor were also analyzed separately, however items relating to the construct (e.g., “I try to eat less than other women”) did not load on the second factor, suggesting there are no lower level factors beneath it.

The so far obtained factors were then tested for correlations with with grandiose & vulnerable narcissism (SB-PNI, Schoenleber et al. 2016), borderline personality traits (MSI, Zanarini et al. 2003), and histrionic personality traits (BHPS, Ferguson & Negy 2014) [Table 5]. Vulnerable narcissism was the strongest correlate of all of the obtained factors, most strongly predicting the competitiveness aspect of body dysmorphia and most weakly predicting sexual status seeking. Grandiose narcissism correlated most strongly with sexual status seeking and drive for thinness. Histrionic personality traits correlated with sexual status seeking and thinness. Borderline personality traits correlated with all variables but to a lesser extent than vulnerable narcissism.

Table 5

	Vulnerable Narcissism	Grandiose Narcissism	HPD	BPD	Sexual Status Seeking
Competitiveness	0.60	0.17	-0.13	0.34	0.46
Low self esteem	0.40	0.09	-0.26	0.24	-0.13
Thinness	0.53	0.24	0.21	0.30	0.29
Sexual Status Seeking	0.51	0.37	0.45	0.38	1.00

The competitive and defeat aspects of body dysmorphia are highly correlated, so they were correlated with other variables when controlling for each other [Table 6]. Competitiveness was strongly predicted by vulnerable narcissism and sexual status seeking, whereas low self esteem was predicted by low sexual status seeking and low histrionic personality traits.

Table 6

	Competitiveness	Low self esteem
Vulnerable Narcissism	0.47	0.14
Grandiose Narcissism	0.14	0.01
Histrionic	0.01	-0.23
Borderline	0.26	0.09
Sexual Status Seeking	0.59	-0.39

1. Raevuori et al. (2014) A review of eating disorders in males

2. Micali et al. (2014) Frequency and patterns of eating disorder symptoms in early adolescence

3. Schoenleber et al. (2016) Development of a Brief Version of the Pathological Narcissism Inventory

4. Zanarini et al. (2003) A screening measure for BPD: The McLean screening instrument for borderline personality disorder (MSI-BPD)

5. Ferguson & Negy (2014) Development of a brief screening questionnaire for histrionic personality symptoms

Appendix

Table 7 (Correlations between measured cluster B traits)

	Grandiose narcissism	Histrionic personality	Borderline personality
Vulnerable narcissism	0.57	0.21	0.62
Grandiose narcissism		0.25	0.41
Histrionic personality			0.17