Athletic-ideal and thin-ideal internalization as prospective predictors of body dissatisfaction,dieting, and compulsive exercise

Although internalization of the thin ideal has been extensively researched and is now regarded as a risk factor for eating disturbance, endorsement of the firm, athletic body ideal has received only minimal attention. This short-term longitudinal study explored whether internalization of two aspects of the current cultural ideal (thinness and athleticism) prospectively predicted three potentially deleterious outcomes: body dissatisfaction, dieting, and compulsive exercise. Undergraduate women (N = 231) completed self-report measures at the beginning of the academic year and again 7 months later (N = 156 at Time 2). Athletic-ideal internalization predicted change in compulsive exercise over the 7-month study period but not body dissatisfaction or dieting; thin-ideal internalization predicted change in all three outcomes. When both internalization measures were tested simultaneously, neither contributed unique variance. Results suggest that athletic-ideal internalization is not as detrimental as thin-ideal internalization.     

Mediators in the dissonance eating disorder prevention program

Previous research has supported thin-ideal internalization as a partial mediator of the effects of the dissonance eating disorder prevention program. The current study replicated previous findings and examined an additional mediator, body dissatisfaction, hypothesized to account for partial intervention effects. As a secondary goal, we developed a more rigorous and accurate test of mediation that accounted for the temporal, causal interplay between mediator and outcome, and controlled for “reverse mediation”. Results from a sample of 71 high-risk females (M age = 19.8, SD = 1.3) who participated in a four-week dissonance intervention supported thin-ideal internalization as a partial mediator of the effects of the dissonance intervention on bulimic symptoms, even after controlling for body dissatisfaction as a second mediator. Furthermore, results supported body dissatisfaction as a partial mediator for bulimic symptoms after controlling for thin-ideal internalization. Significant “reverse mediation” effects suggested the reciprocal influence of some risk factors for bulimia nervosa and bulimic symptoms. These results contribute to our understanding of the mediators in the dissonance intervention, which can help refine eating disorder prevention programs.     

Peer-facilitated cognitive dissonance versus healthy weight eating disorders prevention: A randomized comparison

Research supports the efficacy of both cognitive dissonance (CD) and healthy weight (HW) eating disorders prevention, and indicates that CD can be delivered by peer-facilitators, which facilitates dissemination. This study investigated if peer-facilitators can deliver HW when it is modified for their use and extended follow-up of peer-facilitated CD as compared to previous trials. Based on pilot data, we modified HW (MHW) to facilitate peer delivery, elaborate benefits of the healthy-ideal, and place greater emphasis on consuming nutrient dense foods. Female sorority members (N = 106) were randomized to either two 2-h sessions of CD or MHW. Participants completed assessment pre- and post-intervention, and at 8-week, 8-month, and 14-month follow-up. Consistent with hypotheses, CD decreased negative affect, thin-ideal internalization, and bulimic pathology to a greater degree post-intervention. Both CD and MHW reduced negative affect, internalization, body dissatisfaction, dietary restraint, and bulimic pathology at 14 months.     

Self-concept clarity,thin-ideal internalization,and appearance-related social comparison as predictors of body dissatisfaction

This study examined the associations among self-concept clarity, thin-ideal internalization, appearance-related social comparison tendencies, and body dissatisfaction. Female university students (N = 278) completed self-report measures of these constructs. Structural equation modeling revealed several key findings: (a) thin-ideal internalization mediated the link between appearance-related social comparison tendencies and body dissatisfaction; (b) self-concept clarity was negatively associated with both thin-ideal internalization and appearance-related social comparison tendencies; and (c) thin-ideal internalization mediated the link between self-concept clarity and body dissatisfaction. These findings suggest that low self-concept clarity might contribute to body image problems because it increases women's vulnerability to thin-ideal internalization and appearance-related social comparison tendencies.     

Body dissatisfaction and disordered eating attitudes in 7- to 11-year-old girls: Testing a sociocultural model

We examined the sociocultural model of body dissatisfaction and disordered eating attitude development in young girls for the first time. According to the model, internalizing an unrealistically thin ideal body increases the risk of disordered eating via body dissatisfaction, dietary restraint, and depression. Girls aged 7–11 years (N = 127) completed measures of thin-ideal internalization, body dissatisfaction, dieting, depression, and disordered eating attitudes. Participants’ height and weight were measured and their body mass index calculated. Thin-ideal internalization predicted disordered eating attitudes indirectly via body dissatisfaction, dietary restraint, and depression; it also predicted disordered eating attitudes directly. Path analyses showed that a revised sociocultural model fit well with the data. These data show that a sociocultural framework for understanding disordered eating and body dissatisfaction in adults is useful, with minor modifications, in understanding the development of related attitudes in young girls.     

Body checking and avoidance in ethnically diverse female college students

Although body checking and avoidance behaviors are common in women with eating disorders, minimal research has examined the nature or correlates of these behaviors in ethnically diverse female college students without eating disorders. Self-identified European American (n = 268), Asian American (n = 163), Latina (n = 146), and African American (n = 73) women completed self-report measures of body checking and avoidance, thin-ideal internalization, eating pathology, and clinical impairment. Results indicated that European and Asian American women reported significantly more body checking and avoidance than African American and Latina women. Generally, correlates of body checking and avoidance were consistent across ethnic groups: Regression analyses indicated that type of ethnicity predicted body checking and avoidance; and ethnicity, body checking, and body avoidance predicted eating pathology and clinical impairment. These associations suggest that body checking and avoidance are not benign behaviors in diverse nonclinical women.     

Moderators of the association between exercise identity and obligatory exercise among participants of an athletic event

Previous research has connected exercise identity with obligatory exercise, yet to date no empirical studies have identified moderator variables of this association. The current study included participants of an athletic event (full marathon, n = 582; half marathon, n = 1,106; shorter distance, n = 733) who completed questionnaires about exercise behaviors, obligatory exercise, and internalization of both the thin-ideal and athletic-ideal body shapes. General linear model analyses were conducted to examine the exercise identity–obligatory exercise relationship; moderator variables included gender, internalization of the thin-ideal body shape, and internalization of the athletic-ideal body shape. After controlling for the effects of body mass index, age, and distance group, the three-way interaction of exercise identity, gender, and internalization of the athletic-ideal body shape predicted obligatory exercise. Findings suggest that women who report high identification with exercise and high value on having an athletic physique may be vulnerable to obligatory exercise.     

Testing the Tripartite Influence Model of body image and eating disturbance among Hungarian adolescents

We tested the Tripartite Influence Model of body image and eating disturbance on two separate samples of Hungarian boys (n = 145) and girls (n = 225), aged 10–16 years. Our results supported the model among Hungarian adolescents; however we found notable gender differences. The associations were stronger in girls compared to boys; moreover, internalization and body dissatisfaction mediated the relationship between appearance-related sociocultural influences and self-esteem only in girls. BMI and weight perception were also involved in the model, and we could present evidence that the sociocultural influence and the weight perception predict independently body dissatisfaction. Our data are in line with previous results; however, further exploration of gender, age, and culture-related differences in the pattern of associations may contribute to the refinement of intervention programs.     

Sociocultural pressures,thin-ideal internalization,self-objectification,and body dissatisfaction: Could feminist beliefs be a moderating factor?

Theory and research suggest that sociocultural pressures, thin-ideal internalization, and self-objectification are associated with body dissatisfaction, while feminist beliefs may serve a protective function. This research examined thin-ideal internalization and self-objectification as mediators and feminist beliefs as a moderator in the relationship between sociocultural pressures to meet the thin-ideal and body dissatisfaction. Female undergraduate volunteers (N = 195) completed self-report measures assessing sociocultural influences, feminist beliefs, thin-ideal internalization, self-objectification, and body dissatisfaction. Multisample structural equation modeling showed that feminist beliefs moderate the relationship between media awareness and thin-ideal internalization, but not the relationship between social influence and thin-ideal internalization. Research and clinical implications of these findings are discussed.     

An effectiveness trial of a new enhanced dissonance eating disorder prevention program among female college students

Objective

Efficacy trials indicate that a dissonance-based prevention program in which female high school and college students with body image concerns critique the thin-ideal reduced risk factors, eating disorder symptoms, and future eating disorder onset, but weaker effects emerged from an effectiveness trial wherein high school clinicians recruited students and delivered the program under real-world conditions. The present effectiveness trial tested whether a new enhanced dissonance version of this program produced larger effects when college clinicians recruited students and delivered the intervention using improved procedures to select, train, and supervise clinicians.

Method

Young women recruited from seven universities across the US (N = 408, M age = 21.6, SD = 5.64) were randomized to the dissonance intervention or an educational brochure control condition.

Results

Dissonance participants showed significantly greater decreases in risk factors (thin-ideal internalization, body dissatisfaction, dieting, negative affect) and eating disorder symptoms versus controls at posttest and 1-year follow-up, resulting in medium average effect size (d = .60). Dissonance participants also reported significant improvements in psychosocial functioning, but not reduced health care utilization or unhealthy weight gain.

Conclusions

This novel multisite effectiveness trial with college clinicians found that the enhanced dissonance version of this program and the improved facilitator selection/training procedures produced average effects that were 83% larger than effects observed in the high school effectiveness trial.     

Social connectedness,conformity, and internalization of societal standards of attractiveness

Internalization of societal standards of attractiveness is known to play a role in the development of body dissatisfaction and disordered eating, and researchers are now working toward identifying factors that influence the internalization of those societal standards. The present study examined to what extent social connectedness and conformity were related to internalization. Female college students (n = 300) completed measures of social connectedness, conformity, and internalization, as well as measures of body image concerns, dietary restraint, and bulimic symptoms. Path analysis showed that social connectedness was negatively related to conformity, and that conformity was positively related to internalization. Consistent with past research, internalization predicted body image concerns and dietary restraint, which in turn predicted bulimic symptoms. Conformity appears to be a risk factor for the internalization of societal standards of attractiveness, and could be targeted in efforts to reduce internalization, negative body image, and disordered eating.     

Ethnic identity,thin-ideal internalization,and eating pathology in ethnically diverse college women

Although much research suggests that ethnic identity is positively correlated with psychological health for ethnic minority women, research examining ethnic identity's relationships to thin-ideal internalization, weight concerns, and eating concerns is sparse. Consequently, this study examined these relationships in European American, African American, Latina, and Asian American college women (N = 816). As expected, univariate analyses of variance indicated that European American women scored lowest on ethnic identity and highest on eating and weight concerns, whereas African American women scored lowest on thin-ideal internalization. Hierarchical regression analyses indicated that ethnic identity was negatively associated with eating and weight concerns, while body mass index and thin-ideal internalization were positively associated. Ethnic identity moderated the relationship between thin-ideal internalization and eating concerns such that the relationship was stronger for participants with lower ethnic identity. These results suggest ethnic identity may be a direct or interactive protective factor against eating concerns in ethnically diverse college women.     

Feeling body dissatisfied after viewing thin-ideal pictures is mediated by self-activation

The present study sought to investigate the influence of self-activation on body and weight satisfaction in restrained and unrestrained eaters, after exposure to thin-ideal images. Restrained eaters (n = 39) and unrestrained eaters (n = 40) were randomly assigned to a self-activation manipulation versus a control manipulation. After the manipulation, all participants were exposed to eight thin-ideal images. Measures of state body and weight satisfaction and of social comparison tendencies were assessed throughout the experiment. Self-activated restrained eaters showed a significant decrease in body and weight satisfaction after exposure to thin-ideal images, compared to restrained eaters who were not self-activated. In unrestrained eaters, the self-activation manipulation did not have any effect on body or weight dissatisfaction. In conclusion, exposure to fashion models only had a negative influence on women's self-evaluations when two conditions were met: (1) the participant was ‘self-activated’ and (2) the participant classified as a restrained eater.     

Differential association between food craving,food addiction and eating-related characteristics in persons at risk for eating disorders

IntroductionFood craving is a key feature of eating disorders, but its association with medical and psychological outcome might depend on the type of eating disorder.ObjectivesThis study investigated the factors associated with food craving in individuals at risk for DSM-5 eating disorder.MethodSeventy-six women were recruited from a non-clinical population (n = 372) based on their positive screening (EDDS, QEWP-R) for binge eating disorder (BED; n = 29), anorexia nervosa (AN; n = 28) or bulimia nervosa (BN; n = 19). They completed self-administered questionnaires assessing food craving (FCQ- T-r), Body Mass Index (BMI), eating behaviour (DEBQ), food addiction (YFAS 2.0), and anxiety and depressive symptoms (HADS).ResultsIndividuals at risk for BED or BN had higher food craving than those at risk for AN. Food craving was associated with BMI only in the BED group. Food craving was positively correlated with external eating in all groups, and with emotional eating in the AN and BED groups and correlated with anxiety only in BN. Food addiction prevalence was higher in the BN group than in the AN or BED groups (respectively 94.7%, 46.4% and 65.5%; p < 0.01). In this non-clinical population, we demonstrated that food craving was differentially associated with BMI and eating-related characteristics according to the type of eating disorder.ConclusionThis suggests that food craving is a transdiagnostic dimension that should be differentially targeted depending on the type of eating disorder; future studies should test this hypothesis in clinical populations.     

Multidimensional body image comparisons among patients with eating disorders,body dysmorphic disorder,and clinical controls: A multisite study

Body image disturbance is considered a core characteristic of eating disorders and body dysmorphic disorder (BDD), however its definition has been unclear within the literature. This study examined the multidimensional nature of body image functioning among individuals with either anorexia nervosa (AN; n = 35), bulimia nervosa (BN; n = 26), or BDD (n = 56), relative to female (n = 34) and male (n = 36) psychiatric controls. Participants were recruited from 10 treatment centers in the United States and England and completed psychometrically validated and standardized self-report measures of body image. Overall, the AN, BN, and BDD groups were characterized by significantly elevated disturbances in most body image dimensions relative to their gender-matched clinical controls. There was variability, however, in the comparisons among the three groups of interest, including foci of body dissatisfaction and body image coping patterns. On omnibus indices of body image disturbance and body image quality of life, patients with BDD reported more body image impairment than those with eating disorders. Although AN, BN, and BDD are characterized by body image disturbances, similar and partially distinctive cognitive, behavioral, and emotional elements of body image functioning exist among these groups. The study's empirical and clinical implications are considered.     

Appearance-related teasing,body dissatisfaction,and disordered eating: A meta-analysis

A meta-analysis was conducted to determine the relationship between appearance and weight-based teasing and three outcome measures: body dissatisfaction, restrictive eating, and bulimic behaviors. Four meta-analyses were conducted. Fifty effect sizes (N = 10,618) resulted in a moderate effect size of .39 for the relationship between weight teasing and body dissatisfaction; 24 effect sizes (N = 7190) resulted in an effect size of .32 for the relationship between appearance teasing and body dissatisfaction; 20 effect sizes (N = 4792) resulted in an effect size of .35 for the relationship between weight teasing and dietary restraint; and 22 effect sizes (N = 5091) resulted in an effect size of .36 for the relationship between weight teasing and bulimic behaviors. Significant moderators that emerged were teasing measure type, publication type, study type, age group, and gender. The findings offer further support for the inclusion of strategies in body image and eating disorders’ prevention and intervention programs that focus on handling negative, appearance-related commentary.     

Mediators of the relationship between media literacy and body dissatisfaction in early adolescent girls: Implications for prevention

This study examined in young adolescent girls the fit of a theoretical model of the contribution of media literacy to body dissatisfaction via the mediating influences of internalisation of media ideals and appearance comparisons. Female Grade 7 students (N = 469) completed self-report assessments of media literacy, internalisation, appearance comparisons, body dissatisfaction, and media exposure. Strong, significant inverse associations between media literacy and body dissatisfaction, internalisation, and appearance comparisons were observed. Path analysis revealed that a slightly modified revision of the model provided a good fit to the data. Specifically, body dissatisfaction was influenced directly by appearance comparisons, internalisation, and body mass index, and indirectly by media literacy and media exposure. Indirect pathways were mediated by appearance comparisons and internalisation. Thus, a relationship between media literacy and eating disorder risk factors was observed. Findings may explain positive outcomes of media literacy interventions in eating disorder prevention.     

Randomized Controlled Trial of an Internet-Based Cognitive-Behavioral Treatment Program for Binge-Eating Disorder

Binge-eating disorder (BED) is a prevalent health condition associated with obesity. Few people with BED receive appropriate treatment. Personal barriers include shame, fear of stigma, geographic distance to mental health services, and long wait-lists. The aims of this study were to examine the efficacy of an Internet-based cognitive-behavioral intervention for adults with threshold BED (DSM-IV) and to examine the stability of treatment effects over 12 months. Participants were randomly assigned to a 16-week Internet-based cognitive-behavioral intervention (n = 69) or a wait-list condition (n = 70). Binge-eating frequency and eating disorder psychopathology were measured with the Eating Disorder Examination–Questionnaire and the Eating Disorder Examination administered over the telephone. Additionally, body weight and body mass index, depression, and anxiety were assessed before and immediately after treatment. Three-, 6-, and 12-month follow-up data were recorded in the treatment group. Immediately after the treatment the number of binge-eating episodes showed significant improvement (d = 1.02, between group) in the treatment group relative to the wait-list condition. The treatment group had also significantly reduced symptoms of all eating psychopathology outcomes relative to the wait-list condition (0.82 ≤ d ≤ 1.11). In the treatment group significant improvement was still observed for all measures 1 year after the intervention relative to pretreatment levels. The Internet-based intervention proved to be efficacious, significantly reducing the number of binge-eating episodes and eating disorder pathology long term. Low-threshold e-health interventions should be further evaluated to improve treatment access for patients suffering from BED.     

Parenting to prevent body dissatisfaction and unhealthy eating patterns in preschool children: A Delphi consensus study

Interventions to prevent body dissatisfaction and unhealthy eating patterns are needed in early childhood. Identifying effective parenting strategies would be useful for parents and prevention researchers. To develop expert consensus, an online Delphi study was conducted with experts (N = 28, M_age = 44.34) who rated statements describing potential parenting strategies gleaned from a systematic literature search. If 90–100% rated a statement as either Essential or Important, it was endorsed as a guideline. From a total of 335 statements 153 were endorsed. Despite some areas of disagreement, including whether parents should weigh their child or discourage weighing, experts were able to reach consensus on a wide range of issues, such as how to discuss healthy eating with children. The developed guidelines provide a novel and required resource for parents, and a framework for researchers developing interventions to prevent the onset of body dissatisfaction and unhealthy eating patterns in early childhood.     

Body image in social anxiety disorder,obsessive–compulsive disorder,and panic disorder

Body dysmorphic disorder falls under the category of obsessive–compulsive and related disorders, yet research has suggested it may also be highly associated with social anxiety disorder. The current study examined body image variables among 68 outpatients with primary obsessive–compulsive disorder (OCD; n = 22), social anxiety disorder (SAD; n = 25), and panic disorder (PD; n = 21). Participants filled out self-report measures of body image disturbance, attitudes toward one's appearance, and anxiety. Body image disturbance and attitudes toward appearance did not significantly differ between the groups. However, SAD symptoms predicted body image disturbance, Appearance Evaluation and Body Areas Satisfaction, and OCD symptoms predicted Appearance Orientation. These findings suggest that SAD and OCD may be associated with different facets of body image. Implications for the treatment of anxiety disorders and for future research are discussed.