Self-concept clarity and eating pathology: a systematic review of associations with disordered eating symptoms

Self-concept clarity (SCC) refers to the degree to which the self-concept is well defined, internally consistent, and temporally stable, and has been theorized as a vulnerability factor in the development and maintenance of eating disorders (EDs). This systematic review examined the association between SCC, related aspects of identity functioning, and ED symptoms. Peer-reviewed quantitative studies in English, conducted in clinical, at-risk, or community samples, that measured SCC/identity and ED symptoms were included (while qualitative studies, theoretical studies, reviews, case reports, and grey literature were excluded). The search was conducted using PubMed, PsycINFO, Scopus, and Web of Science, supplemented by citation tracking and screening of reference lists. The risk of bias was assessed using the AXIS tool, and the results were summarized narratively due to heterogeneity, which precluded a meta-analysis. A total of 23 studies were included. Lower SCC and poorer identity functioning were consistently associated with higher levels of ED symptoms. Moreover, some longitudinal studies provided preliminary support for bidirectional associations between identity functioning and specific ED symptoms (particularly bulimia and body dissatisfaction). The association between SCC and ED symptoms was frequently mediated by thin-ideal internalization, social comparison, perfectionism, and emotional dysregulation. In conclusion, the results supported the hypothesis that SCC deficits and identity disturbances represent vulnerability mechanisms in ED onset and maintenance, highlighting the importance of interventions targeting self and identity functioning.