Revista multidisciplinaria

investigación Contemporánea

ISSN-e: 2960-8015Vol. 3 -No. 207 - 2025

Deteriorated Mental Health, Expressive Suppression, and Stress as

Predictors of Eating Disorders

DOI: https://doi.org/10.58995/redlic.rmic.v3.n2.a109

492-515

Deteriorated Mental Health,

Expressive Suppression, and Stress as

Predictors of Eating Disorders

Salud mental deteriorada, supresión expresiva

y estrés como predictores de los desórdenes

alimenticios

Miguel Ángel Rodríguez García

, Geovanny Genaro Reivan Ortiz

National University of Chimborazo; miguela.rodriguez@unach.edu.ec. Riobamba, Ecuador.

Catholic University of Cuenca; greivano@ucacue.edu.ec. Cuenca, Ecuador.

How to cite:

Rodríguez García, M. A., & Reivan Ortiz, G. G. (2025). Impaired mental health, expressive suppression, and

stress as predictors of eating disorders. Multidisciplinary Journal of Contemporary Research, 3(2). 492–515.

https://doi.org/10.58995/redlic.rmic.v3.n2.a109

Article Information

Received: 12-02-2025

Accepted: 22-04-2025

Published: 01-07-2025

Editor’s Note

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claims in published messages and institutional

afliations.

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Research (REDLIC

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Funding Sources

The research was conducted using the authors’

own resources.

Conicts of Interest

No conicts of interest are declared.

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Leucemia de células dendríticas plasmocitoides

- estudio y diagnóstico de un caso

49 -49

González González Camila Raquel, Matute Aguiar Joselyn Nayeli, Rodríguez Ver-

dugo Alejandra Valentina.

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Resumen de licencia - Texto completo de la licencia

Original article. Revista Multidisciplinaria Investigación Contemporánea.

Vol. 3 - No. 2, pp. 492 - 515. July-December, 2025. e-ISSN: 2960-8015

DOI: https://doi.org/10.58995/redlic.rmic.v3.n2.a109

Revista multidisciplinaria

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Vol. 3 - No. 2 ISSN-e: 2960-8015

DOI: https://doi.org/10.58995/redlic.rmic.v3.n2.a90

Leucemia de células dendríticas plasmocitoides

- estudio y diagnóstico de un caso

32 -49

Artículo Caso clínico. Revista multidisciplinaria investigación Contemporánea.

Vol. 3 - No. 2, pp. 32 - 49. julio-diciembre, 2025. e-ISSN: 2960-8015

Leucemia de células dendríticas

plasmocitoides - estudio y diagnóstico

de un caso

Leucemia de células dendríticas plasmocitoides - estudio y

diagnóstico de un caso

Información del artículo:

Recibido: 05-12-2024

Aceptado: 21-02-2025

Publicado: 01-07-2025

Nota del editor:

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reclamos jurisdiccionales en mensajes publi-

cados y aliaciones institucionales.

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Conictos de interés:

No presentan conicto de intereses.

Este texto está protegido por una licencia Creative Commons 4.0.

Usted es libre para Compartir —copiar y redistribuir el material en cual-

quier medio o formato— y Adaptar el documento —remezclar, transformar

y crear a partir del material— para cualquier propósito, incluso para nes

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Puede hacerlo en cualquier forma razonable, pero no de forma tal que sugie-

ra que tiene el apoyo del licenciante o lo recibe por el uso que hace de la obra

Docente Investigador; pedro.faican@ucacue.edu.ec. Azogues, Ecuador.

Estudiante; ibelice.dutan.44@est.ucacue.edu.ec. Azogues, Ecuador.

Estudiante; camila.gonzalez.66@est.ucacue.edu.ec. Azogues, Ecuador.

Estudiante; joselyn.matute.44@est.ucacue.edu.ec. Azogues, Ecuador.

Estudiante; alejandra.rodriguez.60@est.ucacue.edu.ec. Azogues, Ecuador.

Faicán Rocano Pedro Fernando

, Dután Pérez Ibelice Salomé

, González González Camila

Raquel

, Matute Aguiar Joselyn Nayeli

, Rodríguez Verdugo Alejandra Valentina

DOI: https://doi.org/10.58995/redlic.rmic.v3.n2.a90

Cómo citar:

Faican Rocano, P. . F., Dután Pérez, I. S. ., González González, C. R. ., Rodríguez Verdugo, A. V. ., & Matute Aguiar, J.

N. . (2025). Leucemia de células dendríticas plasmocitoides - estudio y diagnóstico de un caso.

Revista Multidisci-

plinaria Investigación Contemporánea

, 3(2), 32-49. https://doi.org/10.58995/redlic.rmic.v3.n2.a90

Revista multidisciplinaria

investigación Contemporánea

ISSN-e: 2960-8015Vol. 3 -No. 207 - 2025

Deteriorated Mental Health, Expressive Suppression, and Stress as

Predictors of Eating Disorders

DOI: https://doi.org/10.58995/redlic.rmic.v3.n2.a109

493-515

Summary

This study analyzes the relationship between impaired mental

health, expressive suppression, and stress as predictors of eating disorders

(EDs), with a particular emphasis on anorexia nervosa (AN) and bulimia

nervosa (BN). Eating disorders, characterized by severe disturbances in

eating patterns and compensatory behaviors such as binge eating, binge

eating, and self-induced vomiting, represent a growing problem in mental

and physical health. Previous studies indicate that impaired mental

health, expressive suppression, and stress may be highly inuential risk

factors for the development of these disorders. Using a non-experimental,

cross-sectional , correlational design, 116 patients diagnosed with AN

and BN from the Ecuadorian Mental Health Citizen Care Program were

evaluated. The results revealed a signicant positive relationship between

impaired mental health and AN, while expressive suppression showed

an unexpected negative relationship with this disorder. Stress, on the

other hand, did not show a signicant association with AN. None of these

variables were signicant in relation to BN. Furthermore, women had a

higher prevalence of eating disorders, especially AN, although the gender

difference was not signicant in the case of BN.

This study highlights the importance of mental health in the

prevention of eating disorders, emphasizing the need to include variables

such as body dissatisfaction, social pressure, and traumatic history in

future research, as well as longitudinal approaches that allow exploring

causal dynamics in the development of these disorders. This study, within

the practical approaches, is consolidated as an important theoretical line

for the creation of promotion, prevention, and future intervention plans.

Keywords: Mental health, expressive suppression, stress, eating

disorders, anorexia nervosa, bulimia nervosa.

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investigación Contemporánea

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Abstract

This study analyzes the relationship between deteriorated mental

health, expressive suppression, and stress as predictors of eating

disorders (EDs), with a strong emphasis on anorexia nervosa (AN) and

bulimia nervosa (BN). EDs, characterized by severe disruptions in eating

patterns and compensatory behaviors such as food restriction, binge

eating, and self-induced vomiting, represent a growing concern for both

mental and physical health. Previous studies indicate that deteriorated

mental health, expressive suppression, and stress may be inuential risk

factors in the development of these disorders. Using a non-experimental,

cross-sectional, and correlational design, 116 patients diagnosed with AN

and BN from the Citizen Care Program “Ecuadorian Mental Health” were

evaluated. The results revealed a signicant positive relationship between

deteriorated mental health and AN, while expressive suppression showed

an unexpected negative association with this disorder. On the other

hand, stress did not present a notable association with AN. None of these

variables were signicant in relation to BN. Additionally, women showed

a higher prevalence of EDs, especially AN, although the sex difference was

not signicant in the case of BN.

This study highlights the importance of mental health in the

prevention of EDs, emphasizing the need to include variables such as

body dissatisfaction, social pressure, and traumatic history in future

research. Furthermore, longitudinal approaches are recommended to

explore causal dynamics in the development of these disorders, within the

practical approaches of the same study, it is consolidated as an important

theoretical framework for the creation of promotion, prevention, and

future intervention plans.

Keywords: Mental health, expressive suppression, stress, eating

disorders, anorexia nervosa, bulimia nervosa.

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1. Introduction

Eating disorders (ED) are an increasingly prevalent health problem

in society, characterized by serious alterations in eating behavior that

can cause problems in both the physical and psychological well-being of

the individual (Ortiz, et al., 2017). Eating disorders are a group of negative

statements that the individual makes about their own body image, which

leads them to adopt restrictive behaviors such as: dietary restrictions,

binge eating, excessive exercise, self-induced vomiting , and the use of

some kind of laxatives (Arija, et al., 2022).

Knowing the factors that inuence the development of eating

disorders is of great importance because it could lead to actions related

to these factors that reduce them to levels that do not inuence people

(Ayuzo & Covarrubias, 2019). For this study, the factors considered are:

impaired mental health, expressive suppression, and stress.

The relationship between mental health and eating disorders has

been documented by various authors. Méndez et al. (2018) were among

the rst to highlight that people with compromised mental health may

be more vulnerable to developing eating disorders. Mebarak et al. (2009)

subsequently noted that the main problems associated with deteriorating

mental health include alterations in psycho-affective development, sexual

and eating habits. Esteban et al. (2012) later highlighted how social and

personal factors limit access to optimal mental health. Miranda (2018) and

Casañan & Lalucat (2018) reinforced this idea, emphasizing the protective

role of optimal mental health at both the social and personal levels.

Thus, deteriorating mental health has gone from being seen as a simple

coexisting symptom to a possible predictor variable in the development

of eating disorders.

Regarding emotions, these are psychophysiological responses to

specic situations, whose adaptive function has been widely recognized

(Piqueras et al., 2009). Expressive suppression, understood as the conscious

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inhibition of emotional expression, has been linked to psychological

discomfort (Pagano & Vizioli, 2021). Sánchez & Reivan (2024) point out

that this emotional regulation strategy can hinder adequate emotional

expression, interfering with the individual’s adaptation. The emotional

regulation model proposed by Gross (2003) and highlighted by Arrieta &

Moreno (2023), identies ve stages in the regulation process: selection

and modication of the situation, attentional orientation, cognitive

restructuring, and response modulation.

Gross and John (2003) also developed the Emotion Regulation

Questionnaire (ERQ), which primarily assesses two strategies:

expressive suppression and cognitive reappraisal (Navarro et al., 2018).

Recent literature has found links between expressive suppression and

dysfunctional eating behaviors. Palomino (2020) highlights that sustained

emotional inhibition could trigger irregular eating behavior patterns.

On the other hand, stress has been considered a prominent risk

factor in eating disorders. Leal (2006) denes it as a physical and emotional

reaction to stimuli perceived as threatening. Over the years, it has been

shown that sustained stress can generate signicant physiological and

psychological alterations. Herrera et al. (2017) point to a direct correlation

between stress and the onset of mental disorders, including eating

disorders. Although stress is a frequent variable in the daily environment,

its clinical and preventive approach has gained importance due to its

ability to trigger disorders when not properly regulated.

In this context, and considering the theoretical and empirical

background that links impaired mental health, expressive suppression,

and stress with the presence of eating disorders, the objective of this study

is to evaluate a predictive model that allows identifying the probability

of developing an eating disorder based on these three psychological

variables.

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2. Materiales y métodos

Diseño

Alcance correlacional explicativo de diseño no experimental, transversal tipo

correlacional-causal.

Participantes

Se incluyó en el estudio una muestra de pacientes con diagnóstico de AN (n =

52) y BN (n = 64) correspondientes al área ambulatoria psiquiátrica del Pro-

grama de Atención Ciudadana “Salud Mental Ecuatoriana” del Ministerio de

Salud Pública del Ecuador. El diagnóstico de los pacientes fue realizado por

los psiquiatras a cargo del programa. Los criterios de inclusión para este es-

tudio fueron una edad de 17 a 40 años, la presencia de diagnóstico de AN y

BN según criterios DSM-V, para el diagnóstico de la severidad de la anore-

xia nerviosa se consideró el bajo peso corporal denido como un IMC ≥17.

No se consideraron los subtipos de: anorexia nerviosa (tipo restrictivo y tipo

atracones/purgas) y bulimia nerviosa (severidad: leve, moderada, severa y

extrema). Los criterios de exclusión fueron dependencia de sustancias psi-

coactivas, enfermedad médica o neurológica mayor y deterioro cognitivo. Los

pacientes incluidos cumplieron con los criterios establecidos por el DSM-5

para el diagnóstico de TCA, al menos 2 meses antes de ingresar al estudio, así

mismo no reportaron estar bajo el efecto de algún medicamento o psicotrópi-

co, en el desarrollo de las pruebas. La distribución de los participantes según

sus variantes sociodemográcas, enfermedades médicas y psicopatología se

reporta en la Tabla 1.

Instrumentos

Salud mental deteriorada - GHQ-12 (General Health Questionnaire-12).

El test GHQ desarrollado por Goldberg, 1972, la versión más usada en el con-

texto latinoamericano es la GHQ-12, la cual es una versión reducida que

2. Materials and methods

Design

Explanatory correlational scope of non-experimental, transversal

correlational-causal design.

Participants

Se incluyó en el estudio una muestra de pacientes con diagnóstico

de AN (n = 52) y BN (n = 64) correspondientes al área ambulatoria

psiquiátrica del Programa de Atención Ciudadana “Salud Mental

Ecuatoriana” del Ministerio de Salud Pública del Ecuador. El diagnóstico

de los pacientes fue realizado por los psiquiatras a cargo del programa.

Los criterios de inclusión para este estudio fueron una edad de 17 a 40

años, la presencia de diagnóstico de AN y BN según criterios DSM-V,

para el diagnóstico de la severidad de la anorexia nerviosa se consideró

el bajo peso corporal denido como un IMC ≥17. No se consideraron los

subtipos de: anorexia nerviosa (tipo restrictivo y tipo atracones/purgas)

y bulimia nerviosa (severidad: leve, moderada, severa y extrema). criteria

were substance dependence, major medical or neurological illness , and

cognitive impairment. Included patients met the DSM-5 criteria for the

diagnosis of eating disorders at least 2 months prior to entering the study.

They also did not report being under the inuence of any medication or

psychotropic drug during the testing. The distribution of participants

according to sociodemographic characteristics, medical illnesses, and

psychopathology is reported in Table 1.

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consta de 12 ítems esta escala está compuesta por un factor que valora

la depresión y otro que analiza la disfunción social, para la calicación

de la misma se usa una escala de Likert que va de 0 a 3. Como resultado

en el contexto ecuatoriano se presentó con α = .83 (Moreta, et, al 2018).

Supresión expresiva – EQR (Escala de Supresión Expresiva).

El test de “Emotion Regulation Questionnaire” desarrollado por Gross y Jhon

en el año 2003 el cual evalúa los dos tipos de estrategias de la regulación

emocional los cuales son: la reevaluación cognitiva y la supresión emo-

cional, el cuestionario consta de 10 ítems entre los cuales 6 responden

al factor reevaluación cognitiva y 4 al factor de supresión, los cuales se-

rán evaluados mediante una escala de Likert de 1 a 5. Como resultado

en el contexto ecuatoriano se presentó α= .80 (Moreta, et, al, 2018).

Estrés - DASS-21 (Depression, Anxiety, and Stress Scale - 21 items)

El test Depression, Anxiety, and Stress Scale, desarrollado por Lovibond y Lo-

vibond en 1995, es un test que mide la depresión, ansiedad y estrés en

una persona. Este test cuenta con 21 ítems para esta calicación se apli-

ca una escala de Likert de 0 a 3. Como resultado se ha obtenido un pro-

medio de α= .89 en un contexto latinoamericano Contreras, et al. (2021).

El presente cuestionario sociodemográco. Se trata de un cuestionario

corto, estructurado y con respuestas cerradas, diseñado para la reco-

lección de información sociodemográca, incluyendo variables como

el sexo, estado civil, y la edad expresa en años (Román, et, al, 2018).

Todos los instrumentos usados en esta investigación han presentado validez

de criterio y de contenido, además de que todos cumplen con el supues-

to de normalidad, homoestacidad y de colinealidad.

Procedimiento

El estudio se realizará de acuerdo con la última versión de la Declaración de

Helsinki. El Comité de Ética en Investigación Clínica del Ministerio de

Tools

Impaired mental health - GHQ-12 (General Health Questionnaire-12).

The GHQ test developed by Goldberg, 1972, the most used version in the

Latin American context is the GHQ-12, which is a reduced version

consisting of 12 items. This scale is composed of a factor that assesses

depression and another that analyzes social dysfunction, for its

qualication a Likert scale is used that goes from 0 to 3. As a result,

in the Ecuadorian context it was presented with α = .83 (Moreta, et,

al 2018).

Expressive Suppression – EQR (Expressive Suppression Scale).

The “Emotion Regulation Questionnaire” test developed by Gross and

Jhon in 2003, which evaluates the two types of emotional regulation

strategies, which are: cognitive reappraisal and emotional

suppression, the questionnaire consists of 10 items, among which 6

respond to the cognitive reappraisal factor and 4 to the suppression

factor, which will be evaluated using a Likert scale from 1 to 5. As a

result, in the Ecuadorian context, α = .80 was presented (Moreta, et,

al, 2018).

Stress - DASS-21 (Depression, Anxiety, and Stress Scale - 21 items)

The Depression, Anxiety, and Stress Scale, developed by Lovibond and

Lovibond in 1995, is a test that measures depression, anxiety, and

stress in a person. This test has 21 items, and a Likert scale of 0

to 3 is used for this assessment. As a result, an average of α = .89

was obtained in a Latin American context Contreras, et al. (2021).

This sociodemographic questionnaire is a short, structured,

closed-ended questionnaire designed to collect sociodemographic

information, including variables such as sex, marital status, and age

expressed in years (Román, et al, 2018).

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All instruments used in this research have presented criterion and content

validity, in addition to all of them complying with the assumption of

normality and homostaticity. and collinearity.

Procedure

The study will be conducted in accordance with the latest version of the

Declaration of Helsinki. The Clinical Research Ethics Committee of

the Ministry of Public Health (project approved by CEISH:036-2023,

MSP Catholic University of Cuenca, Ecuador) will approve the

study, and signed informed consent will be obtained from the

volunteer participants in the psychiatric outpatient department of

the “Ecuadorian Mental Health” Citizen Care Program.

Outpatient physicians and psychiatrists Patients will be invited to

participate in the study during the consultation process, informing

them that their attitudes toward mental health issues were being

assessed. Data collection lasted two months. Those who gave their

written consent to participate were included in the study. Once this

process was completed, patients were scheduled with the patients to

complete the tests during their regular consultations and follow-up

visits. Data collection was conducted by the on-staff psychologist in

conjunction with the attending physician. Patients who completed

the measures were thanked for their time.

Data analysis

All data were processed using Ro-Statistics for Windows. First, descriptive

statistics were calculated, including frequencies, means, and

standard deviations. Pearson’s correlations (r) were then applied to

analyze bivariate associations between the study variables. Multiple

regression analysis was also performed to explore the relationship

between inhibition, depression, and food addiction. To do this, the

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coefcients (R²) and standardized coefcients (β) were determined,

along with the semipartial compensation coefcient (sr²), which

indicates the percentage of variance explained by each predictor

variable after controlling for the effects of the others (Harrell, 2015).

3. Results

In cases of anorexia, single women represent 26.7% of the total

sample, while single men account for 14.7%. No cases of married or

cohabiting men with anorexia were observed; however, in the case of

bulimia, women represent 28.4% and single men 19.8%. These data

suggest that anorexia and bulimia are present in single individuals, with

women being particularly prevalent in that group.

In terms of gender, a female predominance can be seen, as women

represent 67.3% of cases of anorexia and 56.3% of cases of bulimia.

However, it should be noted that men are more prevalent in bulimia, at

43.8%, and in anorexia, at 32.7%. However, the predominance of women is

still notable.

Descriptive data

Diagnosis Marital status Sex Frequencies % of Total

Anorexia Single Women 31 26.7%

  Man 17 14.7%

 Married Women 3 2.6%

  Man 0 0.0 %



Common-Law

Union

Women 0 0.0 %

  Man 0 0.0 %

 Separated Women 0 0.0 %

  Man 0 0.0 %

 Divorced Women 1 0.9%

  Man 0 0.0 %

Bulimia Single Women 33 28.4%

  Man 23 19.8%

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Diagnosis Marital status Sex Frequencies % of Total

 Married Women 3 2.6%

  Man 2 1.7%



Common-Law

Union

Women 0 0.0 %

  Man 1 0.9%

 Separated Women 0 0.0 %

  Man 1 0.9%

 Divorced Women 0 0.0 %

  Man 1 0.9%

Di󰂎erence between groups by type of diagnosis and variables (age, stress,

expressive suppression, and impaired mental health)

No signicant statistical differences could be observed between the

diagnostic groups, so these variables do not present notable differences

between those suffering from bulimia and anorexia.

Relationship between type of diagnosis and sex

The Chi-square test does not show a signicant relationship between

the type of diagnosis (AN and BN) and sex, which shows us that despite the

difference between sexes in the sample group, it is not so great as to be

considered signicant.

Correlation between impaired mental health and expressive

suppression Pearson’s P = 0.246: Positive-moderate correlation between

variables. Therefore, as expressive suppression increases, so does mental

health deterioration, although not strongly. P = 0.008 This relationship is

signicant given that the “p” value is less than 0.05.

Correlation between impaired mental health and stress Pearson’s

P = 0.517: Moderate to strong positive correlation between variables.

Therefore, as stress increases, so does the deterioration in mental health. P

= < 0.001, this relationship is highly signicant, reinforcing a considerable

association between variables.

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Correlation between expressive suppression and stress Pearson’s P

= 0.343: Moderate positive correlation between variables. Therefore, the

greater the emotional suppression, the greater the stress. P = < 0.001 , this

relationship is signicant between variables.

Correlation Matrix

 

Deteriorated

mental health

Expressive

suppression

Stress

Deteriorated Mental

Health

Pearson’s R —  

 gl —  

 p-value —  

Expressive

Suppression

Pearson’s R 0.246 — 

 gl 114 — 

 p-value 0.008 — 

Stress Pearson’s R 0.517 0.343 —

 gl 114 114 —

 p-value < .001 < .001 —

Linear Regression Dependent Variable Bulimia

Analysis for Bulimia:

Model t measures:

R = 0.111: The correlation between the independent variables and

bulimia is very weak.

R² = 0.0123: Only 1.23%* of the variability in bulimia is explained

by the independent variables, indicating that the model is not useful for

predicting this variable.

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Coeﬁcientes del Modelo – Anorexia

Supresión expresiva:

Estimador = -0.2297, p = 0.004: Hay una relación signicativa y negativa. A

medida que aumenta la supresión expresiva, la anorexia tiende a disminuir.

Dado que el valor p es menor a 0.05, la relación es estadísticamente signica-

tiva.

Salud mental deteriorada:

Estimador = 0.4978, p = 0.013: Existe una **relación signicativa y positiva*

entre la salud mental deteriorada y la anorexia. A medida que la salud mental

empeora, la anorexia aumenta. Esta variable tiene un impacto relevante en la

anorexia.

Estrés:

Estimador = 0.0289, p = 0.882: No hay una relación signicativa entre el estrés

y la anorexia (valor p alto, no signicativo).

Predictor Estimador EE t p

Constante 11.7082 1.3449 8.706 < .001

Supresión Expresiva -0.2297 0.0778 -2.954 0.004

Salud Mental Deteriora-

0.4978 0.1972 2.524 0.013

Estrés 0.0289 0.1945 0.148 0.882

Predictor Estimator EE t p

Constant 13.2743 1.5319 8.666 < .001

Expressive Suppression 0.0203 0.0886 0.230 0.819

Deteriorated Mental Health 0.0514 0.2246 0.229 0.819

Stress 0.1666 0.2215 0.752 0.454

Model Coefcients – Bulimia

Model coefcients:

Expressive suppression:

Estimator = 0.0203, p = 0.819: There is no signicant relationship

with bulimia (high p-value, not signicant).

Deteriorated mental health:

Estimator = 0.0514, p = 0.819: It also does not show a signicant

relationship with bulimia.

Stress:

Estimator = 0.1666, p = 0.454: No signicant relationship was

observed between stress and bulimia.

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Linear Regression Dependent Variable Bulimia

Analysis for Bulimia:

Model t measures:

R = 0.111: The correlation between the independent variables and

bulimia is very weak.

R² = 0.0123: Only 1.23%* of the variability in bulimia is explained by

the independent variables, indicating that the model is not useful

for predicting this variable.

Model Coe󰂐cients – Bulimia

Model coefcients:

Expressive suppression:

Estimator = 0.0203, p = 0.819: There is no signicant relationship

with bulimia (high p-value, not signicant).

Deteriorated mental health:

Estimator = 0.0514, p = 0.819: It also does not show a signicant

relationship with bulimia.

Stress:

Estimator = 0.1666, p = 0.454: No signicant relationship was

observed between stress and bulimia.

Predictor Estimator EE t p

Constant 13.2743 1.5319 8.666 < .001

Expressive Suppression 0.0203 0.0886 0.230 0.819

Deteriorated Mental Health 0.0514 0.2246 0.229 0.819

Stress 0.1666 0.2215 0.752 0.454

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4. Discussion

The present study aimed to analyze the relationship between poor

mental health, expressive suppression, and stress with eating disorders

(EDs), focusing on anorexia and bulimia, using linear regression analysis.

The results obtained offer interesting results and reveal signicant

differences in the inuence of independent variables on the two types of

EDs focused on in this study.

The results obtained indicate that impaired mental health and

expressive suppression have a signicant relationship with anorexia.

Impaired mental health showed a positive and signicant relationship

with anorexia, which conrms the hypothesis raised by previous studies

Irarrázaval, Prieto & Armijo (2016), which indicate that the lack of adequate

resources to manage the deterioration of mental health can inuence the

appearance of TCA, as well as studies by Ruiz, et, al, (2022), David García

(2020) and Muñoz, et, al, (2023) which in their research refer to the fact

that people with characteristics of impaired mental health are the most

vulnerable to suffering from TCA, specically anorexia, these ideas are

reafrmed by Mendieta et al, (2025), determining that there were factors

associated with deteriorated mental health before the emergence of TCA.

As the mental health of individuals worsens, the likelihood of developing

anorexia increases. This nding underscores the importance of addressing

mental health as a key component in the treatment and prevention of

eating disorders. Furthermore, this nding reinforces the preventive

approach from a clinical perspective, which involves not only intervening

when symptoms appear, but also acting early to promote psychological

well-being.

Expressive suppression presented a signicant negative relationship

with anorexia, indicating that the greater the tendency to suppress

emotions, the lower the likelihood of manifesting anorexia symptoms.

This nding differs from what was expected, given that previous research

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such as that of Palomino (2020) indicated that emotional suppression can

trigger disordered eating behaviors. Studies proposed by Díaz & Beltrán

(2021), Gómez, et al, (2022) and Nicolás Vizioli (2022) show a mutual

agreement that emotional suppression can lead to mental disorders in the

future, among which anorexia is mentioned. One possible interpretation

is that some individuals with anorexia could resort to emotional

regulation strategies other than suppression, such as cognitive avoidance

or perfectionism, which could make invisible the direct role of emotional

suppression in the development of this pathology. A possible explanation

could be that people with anorexia do not necessarily suppress their

emotions, but rather channel them differently, which requires further

exploration in future research. However, it has also been shown that

eating disorders are not specically linked to issues related to emotions,

as stated by Riveros, Garrido & Reyes (2025).

Stress, however, did not show a signicant relationship with anorexia,

so it can be understood that, despite being a factor that has traditionally

been associated with psychological and eating disorders , in this study

sample it was not considered a relevant predictor. As García, et al, (2023)

points out, stress alone is not a determining factor for anorexia nervosa,

however, this associated with other factors can be a great determinant

for it. It is possible that other additional factors, such as individual or

contextual characteristics, mediate this present relationship, authors

such as Acosta, et, al (2023), Elena Gismero (2020), Escandón & Garrido

(2020) mention that long-term stress can become a determining factor for

the appearance of TCA. This result invites reection on the role of chronic

stressors versus acute stressors, since it may be that only sustained stress

without a signicant emotional support network has an effect on the

development of eating disorders.

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In the case of bulimia nervosa, the results obtained were different

from the previous ones. None of the variables taken into account for this

study (deteriorated mental health, expressive suppression and stress)

showed a signicant relationship with this disorder, authors such as

Castro, et, al (2023), Diana Pacheco (2021) & Villamar & Baile (2023) mention

that in their studies psychological factors that inuence the emergence

of bulimia nervosa have been determined, however, the variables taken

into account in this study are not considered by these authors. These data

suggest that bulimia nervosa could be inuenced by other factors not

contemplated in this study, such as social pressure, body dissatisfaction or

a history of emotional trauma, as has been suggested in previous research

as referred to by Doncel (2022), as well as the intensity and inuence that

they had since the person’s childhood as mentioned by Orellana & Reivan

(2025). Another option to consider is the fact that bulimia, when including

behaviors such as binge eating, is more closely related to impulsive

emotional dysregulation than to emotional suppression or psychological

impairment, which leads us to suggest including other variables such as

impulsivity in future studies. Furthermore, the low predictability value

indicates that the model is inappropriate for predicting the variability of

bulimia with these variables.

It is important to highlight the possible inuence of sex on the

results, since the data show a higher prevalence of anorexia in women

compared to men, which coincides with the literature, which has pointed

out the greater vulnerability of women to developing eating disorders,

as mentioned in their research by Arija et al (2022), Fernández & Pedrón

(2022), Restrepo & Castañeda (2020) and Quiñonez et, al (2022). It should be

noted that this pattern could be partly explained by the greater social and

media pressure exerted on the female gender related to a social standard

of ideal body, as well as by cultural factors that promote unattainable

beauty standards for women. However, in the case of bulimia, the sex

difference was not signicant, as mentioned by authors such as Antonia

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Rodríguez (2024) and Bautista et, al (2020), which suggests that eating

disorders can affect both sexes equally. However, when mentioning TCA

together, we can conclude that there is a higher prevalence in women than

men, as mentioned by Hoyos et al. (2025).

The limitations of this research were related to the limited sample

size, which could reduce the ability to generalize results. Variables not

considered in this case included body dissatisfaction, personal history,

social pressure, among others, which could provide a new database on

risk factors for eating disorders. The non-experimental, cross-sectional

design chosen for this study prevents causal inferences, limiting it to

identifying correlations, not whether one variable can cause changes

in another. It should be taken into account that the results obtained

may be affected by external events, which do not necessarily reect the

longitudinal dynamics of eating disorders. To address these limitations,

it is recommended to increase the sample size to obtain a greater amount

of data, in addition to including other psychological factors that may be

related to the case, as well as changing the design to a longitudinal one in

order to study the development and progression of eating disorders along

with their determining factors.

5. Conclusions

Despite its limitations, this study provides a solid theoretical

framework for the relationship between poor mental health and anorexia

nervosa, highlighting the importance of mental health in preventing future

eating disorders. On a practical level , the results obtained may be useful

for designing future programs focused on psychological interventions

to improve people’s mental health and thus prevent the onset of eating

disorders. Among the benets of this research is the understanding of

how poor mental health can lead to future eating disorders, which is why

addressing this issue through individual or group interventions must be

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a key focus in our practice. Similarly, the impact of poor mental health,

expressive suppression, and stress on eating disorders was identied,

enabling future research to provide baseline information from which to

build new goals.

6. Contribution of the authors

MARG – Analysis of results

GGRO – Data collection

7. Ethics committee approval and consent to

participate in the study

The Clinical Research Ethics Committee of the Ministry of Public

Health, approved by CEISH:036-2023, MSP Catholic University of Cuenca,

Ecuador, will approve the study, and signed informed consent will be

obtained from the volunteer participants in the psychiatric outpatient

department of the Citizen Care Program “Ecuadorian Mental Health.”

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Revista multidisciplinaria

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Leucemia de células dendríticas plasmocitoides

- estudio y diagnóstico de un caso

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González González Camila Raquel, Matute Aguiar Joselyn Nayeli, Rodríguez Ver-

dugo Alejandra Valentina.

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