Cited by 1,251Eating Disorders and BehaviorsNutrition, Health and Food BehaviorBody Image and Dysmorphia Studies

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A prospective test of the dual pathway model of bulimic pathology: mediating effects of dieting and negative affect

Stice, Eric·2001·Journal of Abnormal Psychology

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Abstract

Because there have been few longitudinal investigations of integrative etiological theories of bulimia nervosa, this study prospectively tested the dual-pathway model using random regression growth curve models and data from a 3-wave community sample of adolescent girls (N = 231). Initial pressure to be thin and thin-ideal internalization predicted subsequent growth in body dissatisfaction, initial body dissatisfaction predicted growth in dieting and negative affect, and initial dieting and negative affect predicted growth in bulimic symptoms. There was prospective evidence for most of the hypothesized mediational effects. Results are consistent with the assertion that pressure to be thin, thin-ideal internalization, body dissatisfaction, dieting, and negative affect are risk factors for bulimic pathology and provide support for the dual-pathway model.

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Gender Differences in Risk Factors for Stice’s Bulimia in a Non-Clinical Sample
Ruisoto, P., Cacho, R., López-Goñi, J. J., Deus, J. E. R., Vaca, S., & Mayoral, P. (2015) · The Spanish Journal of Psychology · doi:10.1017/sjp.2015.58 · Cited by 6
“According to this model, social pressure and thin body internalization promotes body dissatisfaction, which increases negative emotions and dieting behaviors that trigger bulimic pathology (Ouwens, van Strien, van Leeuwe, & van der Staak, 2009; Stice, 2001).”
BackgroundInfluential
Sociocultural Attitudes Towards Appearance Questionnaire-4-Revised in Asian Americans
Lim, D. W. (2018) · The Scholars Repository - LLU (Loma Linda University) · Cited by 6
A Biopsychosocial Model of Body Image in New Mothers
Welsh, A. C. (2009) · University Libraries (University of Maryland) · Cited by 5
Body image dissatisfaction of college women : potential risk and protective factors
Cheng, H. (2006) · MOspace Institutional Repository (University of Missouri) · doi:10.32469/10355/4493 · Cited by 7
Responses to bright light exposure in individuals with binge-spectrum eating disorders characterized by high dietary restraint and negative affect
Kambanis, P., Bottera, A., & Young, K. D. D. (2023) · International Journal of Eating Disorders · doi:10.1002/eat.24054 · Cited by 5
Instagram Use and Endorsement of a Voluptuous Body Ideal: A Serial Mediation Model
Belmonte, A., Hopper, K. M., & Aubrey, J. S. (2024) · Sex Roles · doi:10.1007/s11199-024-01442-9 · Cited by 9
“R; Stice, 2001) assesses the degree to which women endorse an ideal two and three hours on Instagram daily; 24 (12.8”
Influential
The pressure to be ‘Fair and Lovely’: Exploring the contributing factors to body dissatisfaction and disordered eating among South Asian women and girls in the UK
Lewis, H. K., Vora, D., Craddock, N., Foye, U., Cini, E., & Freestone, M. C. (2025) · Body Image · doi:10.1016/j.bodyim.2025.101971 · Cited by 6
Effect of food cues on time perception: influence of calories and diet control
Hallez, Q., Filippone, L., & Shankland, R. (2022) · Scientific Reports · doi:10.1038/s41598-022-24848-5 · Cited by 5
Is Body Surveillance Trivial? A Model of Body Dissatisfaction in Women based on the Sociocultural Model, Self-Determination Theory and Objectification Theory
Paulisova, E., & Orosová, O. (2023) · Polish Psychological Bulletin · doi:10.24425/ppb.2023.144885 · Cited by 5
“The sociocultural model of eating disorders has been well supported (e. g. Austin & Smith, 2008; Fitzsimmons-Craft et al., 2014; Stice, 2001; Stice & Agras, 1998; Vander Wal et al., 2008).”
Background
Relationship Between Intense Personal Celebrity Worship and Cosmetic Surgery Consideration Among Chinese Young Women: The Serial Mediating Effects of Body Dissatisfaction and Body Shame
Shen, X., Zheng, P., & Lyu, Z. (2025) · The Journal of Genetic Psychology · doi:10.1080/00221325.2025.2453711 · Cited by 5
“Body dissatisfaction was assessed by the 9-item scale Satisfaction and Dissatisfaction with Body Parts Scale (Stice, 2001).”
Measurement in sociocultural research on body image: Issues and solutions
Jarman, H. K., McLean, S. A., Rodgers, R. F., & Fuller‐Tyszkiewicz, M. (2025) · Body Image · doi:10.1016/j.bodyim.2025.101922 · Cited by 7
The effects of sociocultural influences of appearance on body dissatisfaction and appearance enhancement behavior of female college students
Park, E.-J., & Chung, M.-S. (2013) · The Research Journal of the Costume Culture · doi:10.7741/rjcc.2013.21.3.361 · Cited by 5
Relationships between nonappearance self-discrepancy, weight discrepancy, and binge eating disorder symptoms
Lantz, E. L., Smith, K. E., Strauman, T. J., Crosby, R. D., Engel, S. G., Crow, S. J., Peterson, C. B., & Wonderlich, S. A. (2020) · Eating and Weight Disorders - Studies on Anorexia Bulimia and Obesity · doi:10.1007/s40519-020-00975-8 · Cited by 5
Psychological Constructs and Dysfunctional Eating in Pakistani University Students
Hussain, M. (2021) · Journal of Muslim Mental Health · doi:10.3998/jmmh.238 · Cited by 6
Body Image, Anxiety, and Bulimic Behavior during Confinement Due to COVID-19 in Mexico
Pineda-García, G., Serrano‐Medina, A., Ochoa-Ruiz, E., & Martínez, A. L. (2021) · Healthcare · doi:10.3390/healthcare9111435 · Cited by 5
“At the beginning of the century, body image dissatisfaction was identified as a normative characteristic of women in the United States [23], presenting as a risk factor for disorderly eating behavior [24].”
Background
A study protocol for a preliminary randomised controlled trial assessing the acceptability and effectiveness of two eating disorders prevention interventions in Switzerland: The HEIDI BP-HW project
Carrard, I., & Torre, S. B. D. (2021) · PLoS ONE · doi:10.1371/journal.pone.0259796 · Cited by 5
“The prevention interventions built on the Dual Pathway Model [15] as theoretical foundations are among the most effective [16,17].”
Sexual Assault
Koss, M. P., Hansen, M., Anderson, E. J., Bach, M. H., & Bramsen, R. H. (2020) · Cambridge University Press eBooks · doi:10.1017/9781108561716.035 · Cited by 5
Body image dissatisfaction and academic buoyancy in adolescents: The mediating roles of social anxiety and basic psychological needs satisfaction
Zhao, D., Bai, B., & Bai, C. (2024) · Psychology in the Schools · doi:10.1002/pits.23085 · Cited by 5
Trajectories of therapeutic skills use and their dynamic relations to symptom change during cognitive‐behavioral therapy for bulimia nervosa
D’Adamo, L., Linardon, J., Manasse, S. M., & Juarascio, A. S. (2023) · International Journal of Eating Disorders · doi:10.1002/eat.24099 · Cited by 5
Psychosocial outcomes of a non-dieting based positive body image community program for overweight adults: a pilot study
Bloom, L., Shelton, B., Bengough, M., & Brennan, L. (2013) · Journal of Eating Disorders · doi:10.1186/2050-2974-1-44 · Cited by 6
“Dietary restraint has also been associated with psychological distress, including anxiety, food and weight preoccupation, disordered eating and eating disorders, particularly binge eating [16-18].”
Obsesividad e intrusiones alimentarias en pacientes con trastornos alimentarios y en lapoblación general
Roncero, M., Tordera, C. P., & Belloch, A. (2010) · Revista de Psicopatología y Psicología Clínica · doi:10.5944/rppc.vol.15.num.2.2010.4089 · Cited by 5
“En cuanto a los síntomas depresivos y ansiosos, hay bastantes estudios que evidencian asociaciones entre la patología alimentaria y el afecto negativo (Stice, 2001; Whiteside et al., 2007).”
Background
The Effect of Sociocultural Influence, Body Dissatisfaction, Coping and Dichotomous Thinking on Restriction and Bulimia
Kim, I., & Lee, Y.-H. (2014) · The Korean Journal of Clinical Psychology · doi:10.15842/kjcp.2014.33.2.006 · Cited by 5
The effects of sociocultural pressure for body thinness on eating behavior in female college students : Mediating effect of body dissatisfaction and moderating effect of BAS
임숙희, & Heon, K. K. (2009) · Korean Journal of Health Psychology · doi:10.17315/kjhp.2009.14.4.010 · Cited by 5
Behavioral Risk Factors for Overweight and Obesity
Seburg, E. M., Crane, M. M., & Sherwood, N. E. (2017) · Elsevier eBooks · doi:10.1016/b978-0-12-802928-2.00024-2 · Cited by 5
Development of Loss of Control Eating
Byrne, M. E., & Tanofsky‐Kraff, M. (2018) · Elsevier eBooks · doi:10.1016/b978-0-12-811716-3.00012-9 · Cited by 5
Men Making Meaning of Eating Disorders: A Qualitative Study
Leichtman, R., & And, S. T. (2017) · Gestalt Review · doi:10.5325/gestaltreview.21.1.0023 · Cited by 5
“…(Cafri et al., 2005b; Cusumano & Thompson, 1997; Groesz, Levine, & Murnen, 2002; Moriarty & Harrison, 2008; Morrison, Kalin, & Morrison, 2004; Stice, 2001; Stormer & Thompson, 1996; Tiggemann & Slater, 2004); family influences in which attachment styles and family dynamics were related…”
Background
Predicting body mass index in women: The value of the psychological components of depression, anxiety, dietary restraint, and nutritional habits
Esfahani, B. N., Kolahdouzan, M., Aflakseir, A., & Gharipour, M. (2017) · Journal of Education and Health Promotion · doi:10.4103/jehp.jehp_247_13 · Cited by 5
“The scores of this tool varied from 0 (without response) to 4 or 5 (with the highest response).[21] The reliability of this questionnaire in our study population was evaluated, and a Cronbach’s coefficient of 0.”
Method
Understanding the body image of adolescents: A psychological perspective
Yadav, V. P. (2017) · International journal of applied research · Cited by 5

Authors: Stice, E.
Affiliations: The University of Texas at Austin (US)
Corresponding author: Stice, Eric
ORCID: Stice, Eric
Venue: Journal of Abnormal Psychology
Publisher: American Psychological Association (APA)
Published: 2001-02
Volume: 110
Issue: 1
Pages: 124-135
ISSN: 0021-843X (ISSN-L)
1939-1846
DOI: 10.1037/0021-843x.110.1.124
OpenAlex: W2097312669
Cited by: 1,251
References: 87
Citations by year: 2026: 33 · 2025: 38 · 2024: 44 · 2023: 57 · 2022: 54 · 2021: 48 · 2020: 88 · 2019: 46 · 2018: 47 · 2017: 58 · 2016: 47 · 2015: 87 · 2014: 80 · 2013: 67 · 2012: 76
FWCI: 23.64
Type: journal article
Language: en
Open access: closed
Locations: Journal of Abnormal Psychology (publishedVersion)
PubMed (publishedVersion)
Funders: National Institute of Mental Health (MH-19908, MH 01708, K01MH001708, T32MH019908)
Topics: Social Sciences › Psychology › Clinical Psychology › Eating Disorders and Behaviors
Health Sciences › Nursing › Nutrition and Dietetics › Nutrition, Health and Food Behavior
Social Sciences › Psychology › Clinical Psychology › Body Image and Dysmorphia Studies
Keywords: bulimia nervosa, dual-pathway model, dieting, negative affect, body dissatisfaction, thin-ideal internalization, adolescent girls, bulimic symptoms, mediation
MeSH terms: Adolescent, Affect, Body Image, Bulimia, Feeding Behavior, Female, Humans, Internal-External Control, Models, Psychological, Prospective Studies, Psychiatric Status Rating Scales, Regression Analysis, Social Conformity, Body Mass Index

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A prospective test of the dual pathway model of bulimic pathology: mediating effects of dieting and negative affect

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