Internalising symptoms and body dissatisfaction: untangling temporal precedence using cross-lagged models in two cohorts

Background: Cross-sectional studies demonstrate that body dissatisfaction and internalising symptoms are correlated and are both overrepresented in girls compared to boys. However, it is not clear whether body dissatisfaction typically precedes internalising symptoms or vice versa. Existing literature provides theoretical and empirical support for both possibilities, but is limited in two ways: (a) no study has simultaneously tested the two temporal hypotheses within the same model, and (b) the studies focus almost exclusively on early adolescents resulting in little being known about development from preadolescence and across puberty.

Methods: This study used data from 5485 primary school students (49.1% girls, aged 8-9 years at baseline) and 5981 secondary school students (53.9% girls, aged 11-12 years at baseline). Self-reports of internalising symptoms and body dissatisfaction were collected over three consecutive years at 1-year intervals. Cross-lagged models were estimated in the two cohorts, for boys and girls separately, to examine the temporal associations between these two domains across the three measurement points.

Results: In the younger cohort, internalising symptoms predicted body dissatisfaction 1-year later for both boys and girls, whereas there was no evidence for the reverse being true. In the older cohort, internalising symptoms predicted later body dissatisfaction for boys. However, in girls, body dissatisfaction predicted later internalising symptoms.

Conclusions: In preadolescents, internalising symptoms drive later body dissatisfaction regardless of gender, suggesting body dissatisfaction is a specific manifestation of a tendency towards negative affect. From age 11, girls develop a distinct risk profile whereby body dissatisfaction drives later internalising symptoms. Preventative interventions in this field would benefit from adopting a developmentally sensitive approach that takes into account gender differences in risk pathways.