{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T06:39:40Z","timestamp":1772087980705,"version":"3.50.1"},"reference-count":61,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,2,22]],"date-time":"2026-02-22T00:00:00Z","timestamp":1771718400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Behavioral Sciences"],"abstract":"<jats:p>Eating disorders among adolescents have emerged as a significant global public health concern, with attachment anxiety identified as a critical risk factor for anorexia nervosa (AN) symptoms. Individuals with attachment anxiety often exhibit heightened sensitivity to others\u2019 perceptions and an intense fear of rejection, which may exacerbate their vulnerability to body image concerns. This study investigates the mediating role of appearance-based rejection sensitivity (ARS) and the moderating effect of sex in the relationship between attachment anxiety and AN symptoms among Chinese college students. A total of 826 participants aged 16\u201325 (M = 18.95, SD = 1.08, 60% females) completed online surveys using three validated scales: the Revised Adult Attachment Scale (RAAS) to assess attachment anxiety, the Appearance-based Rejection Sensitivity Scale (ARSS) to measure sensitivity to rejection related to physical appearance, and the Eating Disorders Inventory (EDI) to evaluate AN symptoms. The results reveal that there was no significant difference in attachment anxiety between males and females, while females experienced significantly higher levels of ARS and severity of AN symptoms than males. Attachment anxiety is positively correlated with AN symptoms, with ARS mediating this association. Sex further moderates the relationship between ARS and AN symptoms, with stronger effects observed in females. Current findings suggest that AN symptoms are closely associated with contemporaneous attachment anxiety, with passive sensitivity to potential rejection acting as a mediating factor. This underscores the importance of addressing attachment styles and communication patterns in interventions targeting adolescent AN symptoms, particularly in females.<\/jats:p>","DOI":"10.3390\/bs16020307","type":"journal-article","created":{"date-parts":[[2026,2,23]],"date-time":"2026-02-23T10:00:52Z","timestamp":1771840852000},"page":"307","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["From Interpersonal Insecurity to Disordered Eating: The Mediating Pathway of Appearance-Based Rejection Sensitivity"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6231-8653","authenticated-orcid":false,"given":"Liang","family":"Zhang","sequence":"first","affiliation":[{"name":"College Students\u2019 Mental Health Education Center, Northeast Agricultural University, Harbin 150030, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yang","family":"Zeng","sequence":"additional","affiliation":[{"name":"Faculty of Psychology, Beijing Normal University, Beijing 100875, China"},{"name":"Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education, Beijing 100875, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yanqiang","family":"Tao","sequence":"additional","affiliation":[{"name":"Shanghai Key Laboratory of Mental Health and Psychological Crisis Intervention, School of Psychology and Cognitive Science, East China Normal University, Shanghai 200062, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8764-2038","authenticated-orcid":false,"given":"Xiangping","family":"Liu","sequence":"additional","affiliation":[{"name":"Faculty of Psychology, Beijing Normal University, Beijing 100875, China"},{"name":"Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education, Beijing 100875, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shujian","family":"Wang","sequence":"additional","affiliation":[{"name":"Faculty of Psychology, Beijing Normal University, Beijing 100875, China"},{"name":"Beijing Key Laboratory of Applied Experimental Psychology, National Demonstration Center for Experimental Psychology Education, Beijing 100875, China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,2,22]]},"reference":[{"key":"ref_1","unstructured":"Bandura, A. (1977). Social learning theory, Prentice-Hall."},{"key":"ref_2","first-page":"532","article-title":"Care and caring: An ecological framework","volume":"51","author":"Bowlby","year":"2019","journal-title":"Area (London 1969)"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e2871","DOI":"10.1002\/brb3.2871","article-title":"Gender and sex in eating disorders: A narrative review of the current state of knowledge, research gaps, and recommendations","volume":"13","author":"Breton","year":"2023","journal-title":"Brain and Behavior"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1002\/cpp.2776","article-title":"Overprotective parenting experiences and early maladaptive schemas in adolescence and adulthood: A systematic review and meta-analysis","volume":"30","author":"Bruysters","year":"2023","journal-title":"Clinical Psychology & Psychotherapy"},{"key":"ref_5","doi-asserted-by":"crossref","unstructured":"Byrne, B. M. (2016). Structural equation modeling with AMOS, Routledge. [3rd ed.].","DOI":"10.4324\/9781315757421"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"112044","DOI":"10.1016\/j.paid.2022.112044","article-title":"Applying the self-determination theory to explain the link between perceived parental overprotection and perfectionism dimensions","volume":"204","author":"Casale","year":"2023","journal-title":"Personality and Individual Differences"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"107899","DOI":"10.1016\/j.appet.2025.107899","article-title":"The role of perceived parental overprotection in women\u2019s restrained eating behavior: A moderated mediation model of alexithymia, perfectionism, and asceticism","volume":"207","author":"Casale","year":"2025","journal-title":"Appetite"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1163","DOI":"10.1111\/j.1467-6494.2006.00406.x","article-title":"Adult attachment and the perception of emotional expressions: Probing the hyperactivating strategies underlying anxious attachment","volume":"74","author":"Niedenthal","year":"2006","journal-title":"Journal of Personality"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Collins, N. L. (1996). Revised adult attachment scale, APA PsycTests. Dataset.","DOI":"10.1037\/t19162-000"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"644","DOI":"10.1037\/0022-3514.58.4.644","article-title":"Adult attachment, working models, and relationship quality in dating couples","volume":"58","author":"Collins","year":"1990","journal-title":"Journal of Personality and Social Psychology"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1016\/j.psychres.2013.10.039","article-title":"Attachment insecurities, maladaptive perfectionism, and eating disorder symptoms: A latent mediated and moderated structural equation modeling analysis across diagnostic groups","volume":"215","author":"Dakanalis","year":"2014","journal-title":"Psychiatry Research"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1037\/0033-2909.116.3.387","article-title":"Marital conflict and child adjustment: An emotional security hypothesis","volume":"116","author":"Davies","year":"1994","journal-title":"Psychological Bulletin"},{"key":"ref_13","first-page":"21","article-title":"Reliability and validity test of appearance-based rejection sensitivity scale in chinese college students","volume":"26","author":"Deng","year":"2018","journal-title":"Chinese Journal of Clinical Psychology"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1002\/erv.2537","article-title":"Social rank and rejection sensitivity as mediators of the relationship between insecure attachment and disordered eating","volume":"25","author":"Halliwell","year":"2017a","journal-title":"European Eating Disorders Review: The Journal of the Eating Disorders Association"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1273","DOI":"10.1002\/cpp.2092","article-title":"Insecure attachment and maladaptive schema in disordered eating: The mediating role of rejection sensitivity","volume":"24","author":"Krug","year":"2017b","journal-title":"Clinical Psychology & Psychotherapy"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"184","DOI":"10.1093\/scan\/nsq107","article-title":"Do neural responses to rejection depend on attachment style? An fMRI study","volume":"7","author":"DeWall","year":"2012","journal-title":"Social Cognitive and Affective Neuroscience"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"622","DOI":"10.1007\/s43076-020-00042-2","article-title":"Multidimensional perfectionism predicted by personality traits and parental bonding: An empirical study with a Brazilian sample","volume":"28","author":"Neufeld","year":"2020","journal-title":"Trends in Psychology"},{"key":"ref_18","unstructured":"Dring, G. (2015). Finding a voice: Family therapy for young people with anorexia, Routledge. Available online: https:\/\/search.ebscohost.com\/login.aspx?direct=true&db=e000xww&AN=996710&lang=zh-cn&site=ehost-live."},{"key":"ref_19","unstructured":"Murzina, I. (2020). The culture of clothing and \u201cI\u201d image among adolescents. Humanistic practice in education in a postmodern age: Vol. 93. European proceedings of social and behavioural sciences, European Publisher."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2183","DOI":"10.1007\/s10508-021-02252-w","article-title":"Gender typicality, pressure to conform to gender norms, and anti-fat and appearance stereotypes in girls","volume":"51","author":"Savoy","year":"2022","journal-title":"Archives of Sexual Behavior"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1007\/s40894-022-00179-4","article-title":"How the exposure to beauty ideals on social networking sites influences body image: A systematic review of experimental studies","volume":"7","author":"Fioravanti","year":"2022","journal-title":"Adolescent Research Review"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"15","DOI":"10.1002\/1098-108X(198321)2:2<15::AID-EAT2260020203>3.0.CO;2-6","article-title":"Development and validation of a multidimensional eating disorder inventory for anorexia nervosa and bulimia","volume":"2","author":"Garner","year":"1983","journal-title":"International Journal of Eating Disorders"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"571","DOI":"10.1016\/j.psychres.2017.11.009","article-title":"Self-disturbances, cognitive biases and insecure attachment as mechanisms of the relationship between traumatic life events and psychotic-like experiences in non-clinical adults\u2014A path analysis","volume":"259","author":"Pionke","year":"2018","journal-title":"Psychiatry Research"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1177\/10497315221138066","article-title":"A systematic review of measures of child neglect","volume":"34","author":"Haworth","year":"2024","journal-title":"Research on Social Work Practice"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1146\/annurev-psych-010213-115057","article-title":"Gender similarities and differences","volume":"65","author":"Hyde","year":"2014","journal-title":"Annual Review of Psychology"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e2904","DOI":"10.1002\/cpp.2904","article-title":"What role do early life experiences play in eating disorders? The impact of parenting style, temperament and early maladaptive schemas","volume":"31","author":"Joshua","year":"2024","journal-title":"Clinical Psychology & Psychotherapy"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"110975","DOI":"10.1016\/j.jpsychores.2022.110975","article-title":"Eating disorder psychopathology: The role of attachment anxiety, attachment avoidance, and personality functioning","volume":"160","author":"Klein","year":"2022","journal-title":"Journal of Psychosomatic Research"},{"key":"ref_28","doi-asserted-by":"crossref","unstructured":"La Rosa, V. L., Tortorella, F., and Commodari, E. (2025). A narrative review of the co-occurrence and interaction of childhood emotional neglect and overprotection in developmental pathways to disordered eating. Children, 12, (12).","DOI":"10.3390\/children12121643"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"1496986","DOI":"10.1080\/23311908.2018.1496986","article-title":"Body image and the role of romantic relationships","volume":"5","author":"Laus","year":"2018","journal-title":"Cogent Psychology"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1016\/j.bodyim.2014.06.008","article-title":"Victimization, social anxiety, and body dysmorphic concerns: Appearance-based rejection sensitivity as a mediator","volume":"11","author":"Lavell","year":"2014","journal-title":"Body Image"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"173","DOI":"10.1089\/cyber.2014.0341","article-title":"The role of attachment style in facebook use and social capital: Evidence from university students and a national sample","volume":"18","author":"Lin","year":"2015","journal-title":"Cyberpsychology Behavior and Social Networking"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/j.eatbeh.2017.10.003","article-title":"Appearance-based rejection sensitivity as a mediator of the relationship between symptoms of social anxiety and disordered eating cognitions and behaviors","volume":"27","author":"Linardon","year":"2017","journal-title":"Eating Behaviors"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"363","DOI":"10.2147\/PRBM.S395628","article-title":"Parental stress on children\u2019s appearance, body dissatisfaction, and eating behaviours in chinese children: A pathway analysis","volume":"16","author":"Liu","year":"2023","journal-title":"Psychology Research and Behavior Management"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"363","DOI":"10.1001\/jamapediatrics.2022.5848","article-title":"Global proportion of disordered eating in children and adolescents: A systematic review and meta-analysis","volume":"177","author":"Smith","year":"2023","journal-title":"JAMA Pediatrics"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"516","DOI":"10.1002\/eat.22254","article-title":"Do you \u201clike\u201d my photo? Facebook use maintains eating disorder risk","volume":"47","author":"Mabe","year":"2014","journal-title":"International Journal of Eating Disorders"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Mahon, C., and Hevey, D. (2021). Processing body image on social media: Gender differences in adolescent boys\u2019 and girls\u2019 agency and active coping. Frontiers in Psychology, 12.","DOI":"10.3389\/fpsyg.2021.626763"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1016\/j.jad.2016.12.020","article-title":"A systematic review of adult attachment and social anxiety","volume":"211","author":"Manning","year":"2017","journal-title":"Journal of Affective Disorders"},{"key":"ref_38","unstructured":"Mikulincer, M., and Shaver, P. R. (2007). Attachment in adulthood: Structure, dynamics, and change, The Guilford Press."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"461","DOI":"10.1002\/erv.2536","article-title":"Embodiment mediates the relationship between avoidant attachment and eating disorder psychopathology","volume":"25","author":"Monteleone","year":"2017","journal-title":"European Eating Disorders Review"},{"key":"ref_40","doi-asserted-by":"crossref","unstructured":"Papapanou, T. K., Darviri, C., Kanaka-Gantenbein, C., Tigani, X., Michou, M., Vlachakis, D., Chrousos, G. P., and Bacopoulou, F. (2023). Strong correlations between social appearance anxiety, use of social media, and feelings of loneliness in adolescents and young adults. International Journal of Environmental Research and Public Health, 20, (5).","DOI":"10.3390\/ijerph20054296"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"490","DOI":"10.1177\/0146167206296301","article-title":"Appearance-based rejection sensitivity: Implications for mental and physical health, affect, and motivation","volume":"33","author":"Park","year":"2007","journal-title":"Personality and Social Psychology Bulletin"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"186","DOI":"10.1016\/j.bodyim.2009.02.003","article-title":"Predicting interest in cosmetic surgery: Interactive effects of appearance-based rejection sensitivity and negative appearance comments","volume":"6","author":"Park","year":"2009","journal-title":"Body Image"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"26","DOI":"10.1002\/eat.20065","article-title":"The clinical presentation of Japanese women with anorexia nervosa and bulimia nervosa: A study of the eating disorders inventory-2","volume":"37","author":"Pike","year":"2005","journal-title":"International Journal of Eating Disorders"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1111\/sjop.12973","article-title":"Appearance-based rejection sensitivity mediates the relationship between Instagram addiction and dysmorphic concerns in young adult women","volume":"65","author":"Swami","year":"2024","journal-title":"Scandinavian Journal of Psychology"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"41","DOI":"10.1111\/camh.12051","article-title":"Linking lack of care in childhood to anxiety disorders in emerging adulthood: The role of attachment styles","volume":"20","author":"Schimmenti","year":"2015","journal-title":"Child and Adolescent Mental Health"},{"key":"ref_46","doi-asserted-by":"crossref","unstructured":"Schmidt, J., and Martin, A. (2019). Appearance teasing and mental health: Gender differences and mediation effects of appearance-based rejection sensitivity and dysmorphic concerns. Frontiers in Psychology, 10.","DOI":"10.3389\/fpsyg.2019.00579"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"117","DOI":"10.1016\/j.bodyim.2023.02.006","article-title":"The impact of beauty and self-compassion tiktok videos on young women\u2019s appearance shame and anxiety, self-compassion, mood, and comparison processes","volume":"45","author":"Seekis","year":"2023","journal-title":"Body Image"},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"106802","DOI":"10.1016\/j.chiabu.2024.106802","article-title":"Neglecting the impact of childhood neglect: A scoping review of the relation between child neglect and emotion regulation in adulthood","volume":"153","author":"Simon","year":"2024","journal-title":"Child Abuse & Neglect"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1002\/eat.20625","article-title":"Gender difference in the prevalence of eating disorder symptoms","volume":"42","author":"Rosselli","year":"2009","journal-title":"The International Journal of Eating Disorders"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"309","DOI":"10.1177\/0146167209359702","article-title":"The attractive female body weight and female body dissatisfaction in 26 countries across 10 world regions: Results of the international body project I","volume":"36","author":"Swami","year":"2010","journal-title":"Personality and Social Psychology Bulletin"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"710","DOI":"10.1002\/eat.22302","article-title":"Attachment and eating disorders: A review of current research","volume":"47","author":"Tasca","year":"2014","journal-title":"International Journal of Eating Disorders"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"101331","DOI":"10.1016\/j.copsyc.2022.101331","article-title":"Online dating and psychological wellbeing: A social compensation perspective","volume":"46","author":"Toma","year":"2022","journal-title":"Current Opinion in Psychology"},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1080\/00223981003784032","article-title":"Adaptive and maladaptive perfectionism, adult attachment, and big five personality traits","volume":"144","author":"Ulu","year":"2010","journal-title":"The Journal of Psychology"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"107975","DOI":"10.1016\/j.childyouth.2024.107975","article-title":"Linking early emotional abuse\/neglect with young adolescents\u2019 social (versus general) anxiety symptoms: A developmental cascade through emotion regulation","volume":"166","author":"Wang","year":"2024","journal-title":"Children and Youth Services Review"},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"718","DOI":"10.1111\/jora.12310","article-title":"\u201cPretty Pressure\u201d from peers, parents, and the media: A longitudinal study of appearance-based rejection sensitivity","volume":"27","author":"Webb","year":"2017","journal-title":"Journal of Research on Adolescence"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"602","DOI":"10.1037\/0022-0167.52.4.602","article-title":"Adult attachment, social self-efficacy, self-disclosure, loneliness, and subsequent depression for freshman college students: A longitudinal study","volume":"52","author":"Wei","year":"2005","journal-title":"Journal of Counseling Psychology"},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1002\/eat.23079","article-title":"Differences in risk factors for binge eating by socioeconomic status in a community-based sample of adolescents: Findings from project EAT","volume":"52","author":"West","year":"2019","journal-title":"The International Journal of Eating Disorders"},{"key":"ref_58","first-page":"536","article-title":"The reliability and validity of adult attachment scale (AAS-1996 revised edition): A report on its application in China","volume":"35","author":"Wu","year":"2004","journal-title":"Journal of Sichuan University (Medical Sciences)"},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"6130","DOI":"10.3758\/s13428-024-02342-2","article-title":"Statistical power analysis and sample size planning for moderated mediation models","volume":"56","author":"Xu","year":"2024","journal-title":"Behavior Research Methods"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"1554","DOI":"10.1080\/0144929X.2021.1887353","article-title":"Submitted for your approval: A cross-cultural study of attachment anxiety, contingencies of self-worth and selfie-related behaviour","volume":"41","author":"Yue","year":"2022","journal-title":"Behaviour & Information Technology"},{"key":"ref_61","first-page":"48","article-title":"Applicability of EDI-1 in Beijing","volume":"18","author":"Zhang","year":"2004","journal-title":"Chinese Mental Health Journal"}],"container-title":["Behavioral Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-328X\/16\/2\/307\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,2,26]],"date-time":"2026-02-26T05:32:52Z","timestamp":1772083972000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-328X\/16\/2\/307"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,22]]},"references-count":61,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,2]]}},"alternative-id":["bs16020307"],"URL":"https:\/\/doi.org\/10.3390\/bs16020307","relation":{},"ISSN":["2076-328X"],"issn-type":[{"value":"2076-328X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,22]]}}}