Relationships Between Eating Behaviors and Psychological Distress Among Female High School Students: A Social Network Analysis Perspective

Abstract

Objective The purpose of this study is to examine the relationship between body image distress and disordered eating behaviors (DEBs) using peer-based social network characteristics during adolescence. Methods Data were drawn from the Korean Study of Adolescent Health, a longitudinal cohort investigating mental and behavioral health in Korean youth. The analytic sample comprised 315 female high school students from two cohorts. Eating behaviors, body image distress, depressive and anxiety symptoms, perceived stress, personality traits, and social network centrality were assessed using self-report questionnaires. Ordinal and binary logistic regression analyses were conducted. Results Students in Cohort 23 reported lower body image distress and binge eating compared with those in Cohort 22 (p<0.05). Underweight status (body mass index [BMI] <18.5) was associated with lower body image distress and reduced binge eating, whereas obesity was linked to body image distress but not dieting behaviors. Depressive symptoms predicted both binge eating and dieting (p<0.01). Social network indices indicated that higher in-degree centrality was protective against body image distress, while higher out-degree centrality was associated with body image distress but reduced dieting behaviors. Conclusion In addition to BMI and depressive symptoms, social network centrality emerged as a correlate of DEBs among adolescent girls. These findings highlight the importance of integrating emotional regulation and supportive peer network structures into interventions aimed at promoting healthy body image and eating behaviors. Psychiatry Investig 2026;23(6):818-828