Self-image and eating disorder symptoms in normal and clinical adolescents

•We examine relations between self-image and ED in normal and clinical adolescents.•We look at gender differences regarding such relations.•Self-blame/self-affirmation is strongly related to ED in patients and normal girls.•The relations are qualitatively different in male and female patients.•Relations between self-image and ED have implications for treatment and prevention.

Eating disorders (ED) are psychiatric disorders of multifactorial origin, predominantly appearing in adolescence. Negative self-image is identified as risk factor, but the association between self-image and ED in adolescents or sex differences regarding such associations remains unclear. The study aimed to investigate the relationship between specific self-image aspects and ED symptoms in normal and clinical adolescents, including sex differences. Participants included 855 ED patients (girls = 813, boys = 42) and 482 normal adolescents (girls = 238, boys = 244), 13–15 years. Stepwise regression demonstrated strong associations between self-image and ED in normal adolescents (girls: R2 = .31, boys: R2 = .08), and stronger associations in patients (girls: R2 = .64, boys: R2 = .69). Qualitative sex differences were observed in patients. Connections between specific self-image aspects and ED have implications for clinical management of ED. The strong link between self-image variables and ED symptoms in normal girls, but not boys, is discussed in terms of the continuity–discontinuity hypothesis.