Title: Self-concealment, Psychological Flexibility, and Severity of Eating Disorders
Description: The primary aim of this study was to investigate the relationship between psychological flexibility, self-concealment, and eating disorder severity. This study also sought to explore the relationship between these variables in a clinical sample. Existing literature has demonstrated that diminished psychological flexibility is likely to play a key role in eating pathology. Additionally, self-concealment has been found to be a common and treatment-interfering aspect of the clinical presentation of eating-disordered individuals. Preliminary evidence has been found linking these variables to severity of eating-disorder pathology. However, this relationship needs further clarification to understand fully the implications for treatment and relapse prevention, for these often treatment-resistant disorders. Participants were 182 respondents to an online survey including demographic information, the Eating Disorder Examination Questionnaire (EDE-Q), the Acceptance and Action Questionnaire (AAQ-16), and the Self-Concealment Scale (SCS).

Data were collected via Qualtrics software and analyzed in SPSS using Hayes PROCESS models. Findings included the following. Among a sample of eating-disordered individuals, the less (more diminished) psychological flexibility they reported, the more severe the reported eating-disorder symptoms; in other words, an inverse relationship was found. Additionally, the greater self-concealment participants reported, the more severe were their reported eating-disorder symptoms. These findings held up for overall severity of reported symptoms and also for subscale severity for eating restraint, eating concern, weight concern, and shape concern. Additionally, a moderated mediation model found that greater self-concealment, diminished psychological flexibility, and no treatment were all significantly related to increases in eating-disorder severity. This model also found a significant interaction between psychological flexibility and eating-disorder severity moderated by treatment condition. That is, the extent to which someone self-conceals helps to explain the relationship between psychological flexibility and severity.

Furthermore, whether a patient has been in treatment significantly relates to the relationship between psychological flexibility and severity. Implications of these findings are discussed, including a focus on emotion-regulation models of eating disorders and the rationale for adopting a transdiagnostic understanding of eating pathology. Recommendations are proposed for clinical practice, including expanding the utilization of therapies such as Acceptance and Commitment Therapy (ACT) and Dialectical Behavioral Therapy (DBT) for eating disorders, which specifically target psychological flexibility and self-concealment in the hope of preventing future relapse.