Structural Equation Modeling of Body Image Concern and Psychological Distress with the Mediating Role of Self-Criticism among Students

Subject Areas :

fatemeh nazari ^{1 *} , Samin Afshari ²

1 - Assistant Professor, Department of Psychology, Faculty of Humanities and Arts, Zanjan Branch, Islamic Azad University, Zanjan, Iran (Corresponding Author). Email: [e-mail]
2 - M.A. in General Psychology, Department of Psychology, Faculty of Literature, Humanities and Social Sciences, Science and Research Branch, Islamic Azad University, Tehran, Iran. Email: [e-mail]

Received: 2025-01-02 Accepted : 2025-03-09 Published : 2025-09-27

Keywords: Body image concern, psychological distress, self-criticism, structural equation modeling, students,

Abstract :

This study employed structural equation modeling to investigate the relationships between body image concern, psychological distress, and the mediating role of self-criticism among students at Islamic Azad University, Zanjan Branch. The aim was to examine how body image concern influences psychological distress, both directly and indirectly through self-criticism. The research was applied in purpose, descriptive-correlational in terms of data collection (structural equation modeling), and quantitative in nature. The statistical population included all students of Islamic Azad University, Zanjan Branch, during the 2023–2024 academic year, totaling 12,000 individuals. Using cluster and simple random sampling methods, 384 students were selected as the study sample. The research instruments consisted of the Littleton et al. (2005) Body Image Concern Questionnaire, the Symptom Checklist-25-R (SCL-25-R; Derogatis, 2000), and the Self-Criticism Scale (Thompson & Zuroff, 2000). Data analysis was conducted using SPSS and PLS software. The results indicated that body image concern had a significant effect on psychological distress, and self-criticism played a crucial mediating role in this relationship. Specifically, body image concern affected psychological distress both directly (path coefficient = 0.905, P = 0.000) and indirectly through self-criticism (path coefficient = 0.930, P = 0.000). In conclusion, addressing body image concern and self-criticism may be effective in preventing and reducing psychological distress among students. These findings can assist policymakers and mental health professionals in designing targeted interventions to enhance the mental well-being of university students.

References:

پورآوری، مینو، حبیبی، مجتبی، عابدی پریجا، حسین، و سید علی‌تبار، سید هادی. (۱۳۹۳). روان‌سنجی سیاهه نگرانی درباره‌ی تصویر بدنی در نوجوانان. پژوهنده، ۱۹(۴)، ۱۸۹-۱۹۹. http://pajoohande.sbmu.ac.ir/article-1-1807-fa.html
تنهای رشوانلو، فرهاد و سعادتی شامیر، ابوطالب. (1394). اعتبار و روایی سازه‌ی فهرست 25 سئوالی نشانه‌های روان‌شناختی (SCL-25). مجله اصول بهداشت روانی، 18(1)، 48-56. https://doi.org/10.22038/jfmh.2015.6255
شریعتی، مریم، حمید، نجمه، هاشمی شیخ شبانی، اسماعیل، بشلیده، کیومرث، و مرعشی، علی. (۱۳۹۵). اثربخشی درمان مبتنی بر مهرورزی بر افسردگی و خودانتقادی دانشجویان دختر. دانش و پژوهش در روانشناسی کاربردی، ۱۷(۱)، ۵۰-۴۳. https://journals.iau.ir/article_534001.html?lang=en
صادق‌زاده، مرضیه، عسکری، زهرا و خرمایی، فرهاد. (1401). ‌‌رابطه خودانتقادی و حساسیت به طرد با آشفتگی روان‌شناختی دانشجویان دختر: نقش واسطه‌ای خودخاموشی. مطالعات اجتماعی روان‌شناختی زنان، 20(2)، 127-155. https://doi.org/10.22051/jwsps.2022.36452.2450
محمدی، لیلا و مجتبی‌زاده، محمد. (1402). نقش میانجی‌گری خود-کنترلی در رابطه با صفت‌های شخصیتی، تعهد سازمانی و انگیزش شغلی. پژوهش در نظام‌های آموزشی، 17(62)، 64-82. https://doi.org/10.22034/jiera.2023.412914.3036
موسوی، اشرف السادات و قربانی، نیما. (1385). خودشناسی، خود انتقادی و سلامت روان. مطالعات روان‌شناختی، 2(3)، 75-91. https://doi.org/10.22051/psy.2006.1688
نجاریان، بهمن و داوودی، ایران. (1380). ساخت و اعتباریابی SCL-25 (فرم کوتاه مدت SCL- 90-R). مجله روانشناسی، 5(2 (پیاپی 18))، 136-149. https://sid.ir/paper/54411/fa
نیافر، غلامحسین، مقتدر، لیلا، اسدی مجره، سامره و مهرگان، بتول. (1403). نقش میانجی خودانتقادی در رابطه بین ذهن آگاهی و نگرانی از تصویر بدن در دانشجویان با نشانگان پرخوری عصبی. رویش روان‌شناسی، 13(2)، 141-150. http://frooyesh.ir/article-۱-۴۹۸۹-fa.html
Ahorsu, D. K., Imani, V., Potenza, M. N., Chen, H. P., Lin, C. Y., & Pakpour, A. H. (2023). Mediating roles of psychological distress, insomnia, and body image concerns in the association between exercise addiction and eating disorders. Psychology research and behavior management, 2533-2542. https://doi.org/10.2147/PRBM.S414543
Ashra, H., Barnes, C., Stupple, E. J. N., & Maratos, F. A. (2025). The development and validation of the child self-criticism scale (CSCS). Current Psychology, 1-22. https://doi.org/10.1007/s12144-025-07660-y
Blatt, S. J. (1995). The destructiveness of perfectionism: Implications for the treatment of depression. American psychologist, 50(12), 1003. https://doi.org/10.1037/0003-066X.50.12.1003
Bonfanti, R. C., Melchiori, F., Teti, A., Albano, G., Raffard, S., Rodgers, R., & Coco, G. L. (2025). The association between social comparison in social media, body image concerns and eating disorder symptoms: A systematic review and meta-analysis. Body Image, 52, 101841. https://doi.org/10.1016/j.bodyim.2024.101841
Bourke, M., Wang, H. F. W., McNaughton, S. A., Thomas, G., Firth, J., Trott, M., & Cairney, J. (2025). Clusters of healthy lifestyle behaviours are associated with symptoms of depression, anxiety, and psychological distress: A systematic review and meta-analysis of observational studies. Clinical Psychology Review, 102585. https://doi.org/10.1016/j.cpr.2025.102585
Cash, T. F., & Smolak, L. (Eds.). (2011). Body image: A handbook of science, practice, and prevention. Guilford press. ISBN 9781462509584
Chopra, D., De La Garza, R., & Lacourt, T. E. (2021). Clinical relevance of a Body Image Scale cut point of 10 as an indicator of psychological distress in cancer patients: results from a psychiatric oncology clinic. Supportive Care in Cancer, 29, 231-237. https://doi.org/10.1007/s00520-020-05491-0
Den Heijer, M., Seynaeve, C., Timman, R., Duivenvoorden, H. J., Vanheusden, K., Tilanus-Linthorst, M., & Tibben, A. (2012). Body image and psychological distress after prophylactic mastectomy and breast reconstruction in genetically predisposed women: a prospective long-term follow-up study. European Journal of Cancer, 48(9), 1263-1268. https://doi.org/10.1016/j.ejca.2011.10.020
Derogatis, L. R. (2000). Symptom Checklist-90-Revised. In Handbook of psychiatric measures. American Psychiatric Association. https://doi.org/10.1002/9780470479216.corpsy0970
Derogatis, L. R., & Savitz, K. L. (1999). The SCL-90-R, Brief Symptom Inventory, and Matching Clinical Rating Scales. https://api.semanticscholar.org/CorpusID:147820465
Díaz-Mosquera, E., Merlyn, M. F., Latorre, G., & Orbe, C. (2025). Internalizing and externalizing psychological problems in young adults from Quito, Ecuador. Ciencias Psicológicas, 19(1). https://doi.org/10.22235/cp.v19i1.3857
Duarte, C., & Pinto-Gouveia, J. (2017). Self-defining memories of body image shame and binge eating in men and women: Body image shame and self-criticism in adulthood as mediating mechanisms. Sex Roles, 77(5), 338-351. https://doi.org/10.1007/s11199-016-0728-5
Duarte, C., Pinto-Gouveia, J., & Ferreira, C. (2014). Escaping from body image shame and harsh self-criticism: Exploration of underlying mechanisms of binge eating. Eating behaviors, 15(4), 638-643. https://doi.org/10.1016/j.eatbeh.2014.08.025
Elhabashy, M., Adzrago, D., & Williams, F. (2025). Psychological Distress among US-Born and Non–US-Born Black or African American Adults in the US. JAMA Network Open, 8(4), e256558-e256558. https://doi.org/10.1001/jamanetworkopen.2025.6558
Fang, A., & Hofmann, S. G. (2010). Relationship between social anxiety disorder and body dysmorphic disorder. Clinical psychology review, 30(8), 1040-1048. https://doi.org/10.1016/j.cpr.2010.08.001
Ferreira, C., Dias, B., & Oliveira, S. (2019). Behind women's body image-focused shame: Exploring the role of fears of compassion and self-criticism. Eating behaviors, 32, 12-17. https://doi.org/10.1016/j.eatbeh.2018.11.002
Friedman, K. E., Reichmann, S. K., Costanzo, P. R., & Musante, G. J. (2002). Body image partially mediates the relationship between obesity and psychological distress. Obesity research, 10(1), 33-41. https://doi.org/10.1038/oby.2002.5
Geller, S., Levy, S., Ashkeloni, S., Roeh, B., Sbiet, E., & Avitsur, R. (2021). Predictors of psychological distress in women with endometriosis: The role of multimorbidity, body image, and self-criticism. International Journal of Environmental Research and Public Health, 18(7), 3453. https://doi.org/10.3390/ijerph18073453
Gerada, A. (2020). The longitudinal association between body image dissatisfaction, social anxiety, and fear of negative evaluation in adolescents (Doctoral dissertation, Université d'Ottawa/University of Ottawa). http://dx.doi.org/10.20381/ruor-24566
Gois, A. C., Ferreira, C., & Mendes, A. L. (2018). Steps toward understanding the impact of early emotional experiences on disordered eating: The role of self-criticism, shame, and body image shame. Appetite, 125, 10-17. https://doi.org/10.1016/j.appet.2018.01.025
Khalajipour, H., & Mojtabazadeh, M. (2024). Structural Equation Modeling of Students' Sense of Responsibility and Teachers' Formative Assessment with the Mediating Role of Self-Regulated Learning Strategies. Iranian Journal of Learning and Memory, 7 (26), 71-91. http//doi.org/10.22034/iepa.2024.471505.1495
Khosravi, A., Abyar, F., Merci, Y., Khodakhah Darban, S., Vandshekari, F., & Ebadi, Z. (2022). The effect of compassion-focused therapy on self-compassion and self-criticism in adolescents with body-image disorder. Journal of Research in Psychopathology, 3(9), 8-14. https://doi.org/10.22098/JRP.2022.10363.1067
Kivlighan III, D. M., Goldberg, S. B., Abbas, M., Pace, B. T., Yulish, N. E., Thomas, J. G., & Wampold, B. E. (2015). The enduring effects of psychodynamic treatments vis-à-vis alternative treatments: A multilevel longitudinal meta-analysis. Clinical Psychology Review, 40, 1-14. https://doi.org/10.1016/j.cpr.2015.05.003
Gerada, A. (2020). The longitudinal association between body image dissatisfaction, social anxiety, and fear of negative evaluation in adolescents (Doctoral dissertation, Université d'Ottawa/University of Ottawa). http://dx.doi.org/10.20381/ruor-24566
Gois, A. C., Ferreira, C., & Mendes, A. L. (2018). Steps toward understanding the impact of early emotional experiences on disordered eating: The role of self-criticism, shame, and body image shame. Appetite, 125, 10-17. https://doi.org/10.1016/j.appet.2018.01.025
Khalajipour, H., & Mojtabazadeh, M. (2024). Structural Equation Modeling of Students' Sense of Responsibility and Teachers' Formative Assessment with the Mediating Role of Self-Regulated Learning Strategies. Iranian Journal of Learning and Memory, 7 (26), 71-91. http//doi.org/10.22034/iepa.2024.471505.1495
Khosravi, A., Abyar, F., Merci, Y., Khodakhah Darban, S., Vandshekari, F., & Ebadi, Z. (2022). The effect of compassion-focused therapy on self-compassion and self-criticism in adolescents with body-image disorder. Journal of Research in Psychopathology, 3(9), 8-14. https://doi.org/10.22098/JRP.2022.10363.1067
Kivlighan III, D. M., Goldberg, S. B., Abbas, M., Pace, B. T., Yulish, N. E., Thomas, J. G., & Wampold, B. E. (2015). The enduring effects of psychodynamic treatments vis-à-vis alternative treatments: A multilevel longitudinal meta-analysis. Clinical Psychology Review, 40, 1-14. https://doi.org/10.1016/j.cpr.2015.05.003
Krejcie, R. V., & Morgan, D. W. (1970). Determining Sample Size for Research Activities. Educational and Psychological Measurement, 30(3), 607-610. https://doi.org/10.1177/001316447003000308
Laskowski, N. M., Jürgensen, V. C., Lehe, M. S., Halbeisen, G., & Paslakis, G. (2025). Converging Paths: Autistic Traits, Body Image Concerns, and Disordered Eating Symptoms in Women. Journal of Psychiatric Research. https://doi.org/10.1016/j.jpsychires.2025.02.018
Libosan, J. (2025). From Critique to Care: A New Lexicon for Understanding Self-Compassion and Self-Criticism (Master's thesis, University of Twente). https://purl.utwente.nl/essays/106133
Linardon, J., Moffitt, R., Anderson, C., & Tylka, T. L. (2024). Testing for longitudinal bidirectional associations between self-compassion, self-criticism, and positive body image components. Body Image, 49, 101722. https://doi.org/10.1016/j.bodyim.2024.101722
Littleton, H. L., Axsom, D., & Pury, C. L. (2005). Development of the body image concern inventory. Behaviour Research and therapy, 43(2), 229-241. https://doi.org/10.1016/j.brat.2003.12.006 Mabe, A. G., Forney, K. J., & Keel, P. K. (2014). Do you “like” my photo? Facebook use maintains eating disorder risk. International Journal of Eating Disorders, 47(5), 516-523. https://doi.org/10.1002/eat.22254
McIntyre, R., Smith, P., & Rimes, K. A. (2018). The role of self-criticism in common mental health difficulties in students: A systematic review of prospective studies. Mental Health & Prevention, 10, 13-27. https://doi.org/10.1016/j.mhp.2018.02.003
Mitchison, D., Hay, P., Griffiths, S., Murray, S. B., Bentley, C., Gratwick‐Sarll, K., & Mond, J. (2017). Disentangling body image: The relative associations of overvaluation, dissatisfaction, and preoccupation with psychological distress and eating disorder behaviors in male and female adolescents. International Journal of Eating Disorders, 50(2), 118-126. https://doi.org/10.1002/eat.22592 Niafar, G. H., Moghtader, L., Asadi Majareh, S., & Mehregan, B. (2024). The mediating role of self-criticism in the relationship between mindfulness and concern body image in students with bulimia nervosa symptom. Rooyesh-e-Ravanshenasi Journal (RRJ), 13(2), 141-150.
Norton, D. W., Modesto, O., Bennett, J. M., & Fraser, M. I. (2024). Sleep disturbance mediates the link between both self‐compassion and self‐criticism and psychological distress during prolonged periods of stress. Applied Psychology: Health and Well‐Being, 16(1), 119-137. https://doi.org/10.1111/aphw.12474
Oers, H. V., & Schlebusch, L. (2020). Indicators of psychological distress and body image disorders in female patients with breast cancer. Journal of Mind and Medical Sciences, 7(2), 179-187. https://doi.org/10.22543/7674.72.P179187
Okan, N. (2023). Is Self-Criticism Really a Trigger of Psychological Problems? An Analysis of Self-Criticism in the Context of Turkish University Students. Educational Policy Analysis and Strategic Research, 18(1), 175-195. https://doi.org/10.29329/epasr.2023.525.8
Okur, S., Satıcı, S. A., Erdinç, B., & Akyıl, Y. (2025). Longitudinal serial mediation study after the 2023 earthquake in Türkiye: Associations between difficulties in emotion regulation, psychological distress, resilience and mental well-being. Psychiatric Quarterly, 1-15. https://doi.org/10.1007/s11126-025-10130-0
Özdemir, Y., & Sağkal, A. S. (2019). Recalled parenting practices and psychological distress in Turkish emerging adults: the role of self-criticism. Psychological Reports, 122(5), 1720-1743. https://doi.org/10.1177/0033294118798
Pekin, Z., & Güme, S. (2025). Self-Criticism: Conceptualization, Assessment and Interventions. Psikiyatride Güncel Yaklaşımlar, 17(1), 107-123. https://doi.org/10.18863/pgy.1455185
Piarulli, F. M., Margari, A., Margari, F., Matera, E., Viola, G., Maiorano, C., ... & Petruzzelli, M. G. (2025). Cutting into the Mirror: Association of Body Image Concerns with Non-Suicidal Self-Injury in Adolescents and Young Adults with Eating Disorders. European Journal of Investigation in Health, Psychology and Education, 15(2), 23. https://doi.org/10.3390/ejihpe15020023
Pinto, A., & Phillips, K. A. (2005). Social anxiety in body dysmorphic disorder. Body Image, 2(4), 401-405. https://doi.org/10.1016/j.bodyim.2005.10.003
Puckett, J. A., Levitt, H. M., Horne, S. G., & Hayes-Skelton, S. A. (2015). Internalized heterosexism and psychological distress: The mediating roles of self-criticism and community connectedness. Psychology of Sexual Orientation and Gender Diversity, 2(4), 426. https://doi.org/10.1037/sgd0000123
Salarian Kaleji, Z., Poursharifi, H., Dolatshahi, B., & Momeni, F. (2022). The relationship between body image victimization experiences and binge eating symptoms: the mediating role of body image shame and self-criticism. Iranian Journal of Psychiatry and Clinical Psychology, 28(1), 48-61. http://ijpcp.iums.ac.ir/article-1-3384-en.html
Sanavio, E. (1988). Obsessions and compulsions: the Padua Inventory. Behaviour research and therapy, 26(2), 169-177. https://doi.org/10.1016/0005-7967(88)90116-7
Šoková, B., Greškovičová, K., Halamová, J., & Baránková, M. (2025). Breaking the vicious cycles of self-criticism: a qualitative study on the best practices of overcoming one’s inner critic. BMC psychology, 13(1), 1-12. https://doi.org/10.1186/s40359-024-02250-2
Song, L., Han, X., Zhang, J., & Tang, L. (2020). Body image mediates the effect of stoma status on psychological distress and quality of life in patients with colorectal cancer. Psycho‐Oncology, 29(4), 796-802. https://doi.org/10.1002/pon.5352
Subramaniam, M., Vaingankar, J. A., Tan, B., Abdin, E., Chang, S., Tan, Y. W. B., ... & Verma, S. K. (2025). Examining psychological distress among youth in Singapore: insights from the National youth mental health study. Asian Journal of Psychiatry, 105, 104405. https://doi.org/10.1016/j.ajp.2025.104405
Thompson, R., & Zuroff, D. C. (2000). Levels of Self-Criticism Scale. Personality and Individual Differences. https://doi.org/10.1037/t10954-000
Vendemia, M. A., Goodboy, A. K., Chiasson, R. M., & Dillow, M. R. (2025). Person-specific effects of women’s social media use on body image concerns: an intensive longitudinal study of daily life. Human Communication Research, hqaf001. https://doi.org/10.1093/hcr/hqaf001
Yao, H., Xiong, M., Cheng, Y., Zhang, Q., Luo, Y., Ding, X., & Zhang, C. (2024). The relationship among body image, psychological distress, and quality of life in young breast cancer patients: a cross-sectional study. Frontiers in Psychology, 15, 1411647. https://doi.org/10.3389/fpsyg.2024.1411647