Predicting Body Dysmorphic Disorder Based on Perceived Emotional Invalidation with the Mediating Role of Fear of Negative Evaluation in Women with a Body Mass Index of 30 or Higher

Abstract

Introduction and Aim: Body dysmorphic disorder is one of the major psychological disorders associated with body image and is more prevalent among women with high body mass index, negatively affecting their mental health, social functioning, and quality of life. The present study aimed to predict body dysmorphic disorder based on perceived emotional invalidation with the mediating role of fear of negative evaluation in women with a body mass index of 30 or higher.

Methodology: This applied study employed a descriptive-correlational design using structural equation modeling. The statistical population consisted of all women with a body mass index of 30 or higher who referred to diet therapy centers and health houses in Tehran during 2023–2024, from whom 391 participants were selected through multistage cluster sampling. Data collection instruments included the modified Yale-Brown Obsessive-Compulsive Scale for Body Dysmorphic Disorder, Zelinsky’s Perceived Emotional Invalidation Questionnaire, and Leary’s Brief Fear of Negative Evaluation Scale. Data were analyzed using Pearson correlation coefficient and structural equation modeling in SPSS-27 and SmartPLS-3.3 software.

Findings: The findings indicated that perceived emotional invalidation had a significant direct effect on fear of negative evaluation (β=0.724, t=21.317). Fear of negative evaluation also had a significant direct effect on body dysmorphic disorder (β=0.723, t=21.296). Path analysis further demonstrated that perceived emotional invalidation exerted a significant indirect effect on body dysmorphic disorder through fear of negative evaluation, with a total effect size of 1.251. Moreover, the model fit indices, including GOF=0.527 and NFI=0.989, confirmed the desirable fit of the proposed model.

Conclusion: The results demonstrated that perceived emotional invalidation can intensify body dysmorphic disorder in women with high body mass index through increasing fear of negative evaluation. Therefore, interventions focused on emotion regulation skills, reducing sensitivity to social evaluation, and enhancing psychological support may help decrease body dysmorphic symptoms and improve mental health in this population.