BRIEF RESEARCH REPORT article
Front. Psychiatry
Sec. Public Mental Health
Volume 16 - 2025 | doi: 10.3389/fpsyt.2025.1703650
The Hidden Pathways to Internalized Weight Bias: From Insecure Attachment to Depressive Self-Schemas
Provisionally accepted
Emanuela Bianciardi1,2*
Rossella Mattea Quinto3
Ester Longo1Federica De Angelis1
Alberto Siracusano1
Cinzia Niolu1,2
Giorgio Di Lorenzo1,2*- 1Chair of Psychiatry, Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
- 2Psychiatric and Psychological Unit, Fondazione Policlinico Tor Vergata, Rome, Italy
- 3European University of Rome, Rome, Italy
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Background: Internalized weight bias (IWB) is associated with adverse physical and psychopathological outcomes, yet the cognitive and emotional mechanisms underlying its development in non-clinical populations remain insufficiently understood. This study examined whether attachment insecurity, depressive symptoms, and alexithymia were related to IWB in adults with overweight/obesity, and tested a parallel mediation model of depressive symptoms and alexithymia in the link between attachment insecurity and IWB. Methods: 194 Italian adults (75% female; Mage = 37.6, SD = 14.7; BMI ≥ 25) completed an online survey including self-report measures of IWB, attachment style, depression, alexithymia, eating disorder risk, and body dissatisfaction. Hierarchical regression models were conducted to identify predictors of IWB, followed by mediation analyses (PROCESS Model 4) to test indirect effects. Results: The final regression model explained 74% of the variance in IWB. Significant predictors included body dissatisfaction (β = .43, p < .001), cognitive depressive symptoms (β = .22, p < .001), and anxious attachment (β = .30, p < .001). Difficulty describing feelings was unexpectedly inversely associated with IWB (β = –.11, p = .04). Mediation analyses revealed that cognitive depressive symptoms partially mediated the relationship between anxious attachment and IWB, whereas alexithymia dimensions did not. 2 Conclusion: Findings highlighted cognitive depressive symptoms as a central pathway linking insecure attachment to IWB, while suggesting a paradoxical protective role for alexithymic difficulties in emotional expression. We emphasized the importance of considering individual vulnerability factors—particularly relational insecurity and depressive cognitions—in theoretical models of IWB and in the design of targeted interventions.
Keywords: Internalized weight bias, Body image dissatisfaction, Depression, Attachment Style, Eating Disorder, self-stigma, Overweight and obesity
Received: 11 Sep 2025; Accepted: 09 Oct 2025.
Copyright: © 2025 Bianciardi, Quinto, Longo, De Angelis, Siracusano, Niolu and Di Lorenzo. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
Emanuela Bianciardi, emanuelabianciardi@libero.it
Giorgio Di Lorenzo, di.lorenzo@med.uniroma2.it
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