From Interpersonal Insecurity to Disordered Eating: The Mediating Pathway of Appearance-Based Rejection Sensitivity

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' 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 16-25 (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.