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.     

Is intensive measurement of body image reactive? A two-study evaluation using Ecological Momentary Assessment suggests not

Intensive assessment methods (e.g., Ecological Momentary Assessment [EMA]) are increasingly used to capture body image experiences in daily life. One concern with EMA is multiple assessments may increase reactivity to internal or external cues, potentially biasing measurement. Reactivity to EMA was evaluated in two studies (Study 1: N = 63 female undergraduates, Study 2: N = 131 women with high body dissatisfaction/disordered eating). Participants completed five daily surveys on handheld computers for 1–2 weeks and body image-related questionnaires at the start and end of each study. Results showed no systematic changes in pre- and post-EMA measures or momentary EMA reports, suggesting women were not reactive to the EMA protocols. Completing 1–2 weeks of EMA does not appear to affect body dissatisfaction, mood, or attitudes in non-clinical or at-risk samples of women. These studies provide evidence that EMA methods can be used to assess real-world body image experiences without undue concern about measurement reactivity.     

Evaluating the Effectiveness of ACT for Anxiety Disorders in a Self-Help Context: Outcomes From a Randomized Wait-List Controlled Trial

Rigorous evaluations of cognitive behavioral self-help books for anxiety in pure self-help contexts are lacking. The present study evaluated the effectiveness of an Acceptance and Commitment Therapy (ACT) self-help workbook for anxiety-related concerns, with no therapist contact, in an international sample. Participants (N = 503; 94% mental health diagnosis) were randomized to an immediate workbook (n = 256) or wait-list condition (n = 247). Assessments at pretreatment, 12 weeks, 6 months, and 9 months evaluated anxiety and related symptoms, quality of life, and ACT treatment processes (e.g., psychological flexibility). Participants in the wait-list arm crossed over to the workbook following the 12-week assessment. The workbook condition yielded significant improvements on all assessments from pre- to posttreatment relative to wait-list, and these gains were maintained at follow-ups. The pattern observed in the wait-list condition was virtually identical to the active treatment arm after receiving the workbook, but not before. Attrition was notable, but supplemental analyses suggested dropout did not influence treatment effects for all but one measure. Overall, findings provide preliminary support for the effectiveness of this self-help workbook and suggest ACT-based self-help bibliotherapy might be a promising low-cost intervention for people experiencing significant anxiety-related concerns.     

The Caregiver Eating Messages Scale: Development and psychometric investigation

Certain caregiver eating messages – restriction of food intake and pressures to eat – are associated with body dissatisfaction and eating disturbances among young girls. This study explored whether these messages are also associated with body attitudes and eating behaviors of young adult women and men. The Caregiver Eating Messages Scale was developed to measure this construct. Two studies (Ns = 238, 288) indicated that it contained two factors (restrictive/critical messages and pressure to eat messages) and yielded internally consistent, stable, and valid scores. Both factors were positively related to women's BMI, and restrictive/critical messages were positively related to men's BMI. Restrictive/critical messages predicted lower perceived familial body acceptance and intuitive eating and higher perceived familial pressure to be lean and disordered eating. Restrictive/critical messages predicted participants’ body attitudes indirectly via their perceptions of their family's attitude toward their body, with one exception: restrictive/critical messages uniquely predicted men's body appreciation.     

Empowerment,feminism, and self-efficacy: Relationships to body image and disordered eating

Sociocultural norms pertaining to an ideal of thinness for women likely play a role in the development and maintenance of disturbance in body image, and by extension, disordered eating. However, competing norms associated with feminism may buffer women from pressures associated with achieving the thin ideal. The present study explored the relationship between feminist ideology, empowerment, and self-efficacy relative to body image and eating behavior with a sample of U.S. undergraduate women (N = 318) attending a southeastern U.S. mid-sized university. In planned hierarchical multiple regression analyses, endorsement of feminist ideology predicted perceptions of positive body image, but did not appear to predict disordered eating. Self-efficacy emerged as a robust predictor of positive body image and lower disordered eating even after controlling for perceptions of personal empowerment and feminism. Results, although limited by correlational data, suggest that self-efficacy may protect college-aged women from disordered eating and negative body image.     

Appearance commentary from romantic partners: Evaluation of an adapted measure

The purpose of this study was to evaluate the psychometric properties of the Verbal Commentary on Physical Appearance Scale (VCOPAS; Herbozo & Thompson, 2006b) after modifying it to capture appearance feedback given by romantic partners (VCOPAS-P). Women participants (N = 248) completed the VCOPAS-P, as well as measures of disordered eating, body image dissatisfaction, relationship quality, and socially desirable responding. Exploratory factor analysis identified the best factor structure for the VCOPAS-P, which contained three factors similar to the VCOPAS. Correlations between the VCOPAS-P subscales and measures of disordered eating, body image dissatisfaction, relationship quality, and social desirability responding demonstrated convergent and discriminant validity of the VCOPAS-P. There was a significant positive correlation between the negative comments subscale of the VCOPAS-P and the measures of body dissatisfaction and weight concern (measured by the EDE-Q). Additionally, VCOPAS-P subscales reflecting positive comments about appearance and weight were associated with greater relationship satisfaction.     

Étude de validation de la version française de l’Échelle d’Estime Corporelle (Body Esteem Scale) chez les adolescentes et les jeunes adultes

IntroductionThe literature of body image suggests that many women and young women suffer from body dissatisfaction and this dissatisfaction is an important risk factor for the development of eating disorders.ObjectiveThe aim of the study was to validate the French female version of the Body Esteem Scale (BES; Mendelson et al., 2001).MethodThis self-administered questionnaire assesses body esteem and includes three subscales: “Weight”, “Appearance” and “Attribution”. The questionnaire was given to a sample of 835 adolescent girls and young adults (mean age = 16.62 ± 1.50).ResultsExploratory factorial analysis yielded three factors “Weight”, “Appearance” and “Desire to modify and negative affect associated with the general appearance”, somewhat similar to those of the original validation study. The goodness-of-fit of the three factors model was satisfactory. Correlations were found between the three subscales of the BES, BMI and general self-esteem.ConclusionThe French version of the BES shows satisfactory psychometric properties and provides a useful tool for better understanding the psychological aspects of attitudes towards one's body. In France, very few questionnaires are available to measure body attitudes, despite the fact that the body dissatisfaction affects many adolescent girls and represents a risk factor for the development of eating disorders.     

Effects of an Internet-based intervention for subthreshold eating disorders: a randomized controlled trial

BackgroundWomen reporting initial eating disorder (ED) symptoms are at highest risk for the development of an eating disorder. Preventive interventions should, therefore, be specifically tailored for this subgroup.AimsTo adapt and evaluate the effects of the Internet-based prevention program “Student Bodies?” for women with symptoms of disordered eating and/or subthreshold eating disorder (ED) syndromes.Method126 women, reporting subthreshold ED symptoms (high weight and shape concerns and below threshold bingeing, purging, chronic dieting or several of these symptoms) were randomly assigned to a Student Bodies?+ (SB+) intervention or a wait-list control group and assessed at pre-intervention, post-intervention, and 6-month follow-up. “Student Bodies?” was adapted to be suitable for subthreshold EDs. Main outcome measures were attitudes and symptoms of disordered eating. Pre-follow-up data were analyzed by ANCOVAS with mixed effects.ResultsAt 6-month follow-up, compared to participants in the control group, participants in the intervention group showed significantly greater improvements on ED-related attitudes. Intervention participants also showed 67% (95% CI = 20–87%) greater reductions in combined rates of subjective and objective binges, and 86% (95% CI = 63–95%) greater reduction in purging episodes. Also, the rates of participants abstinent from all symptoms of disordered eating (restrictive eating, binge eating and any compensatory behavior) were significantly higher in the intervention group (45.1% vs. 26.9%). Post-hoc subgroup analyses revealed that for participants with binge eating the effect on EDE-Q scores was larger than in the pure restricting subgroup.ConclusionThe adapted “SB+” program represents an effective intervention for women with subthreshold EDs of the binge eating subtype.     

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.     

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.     

The effects of fat talk on body dissatisfaction and eating behavior: The moderating role of dietary restraint

Although research suggests that fat talk, the normalized conversations that involve degrading one's body shape/weight and size, can increase body dissatisfaction and disordered eating behavior, the extent to which dietary restraint may moderate these relationships remains uncertain. A pilot study (N = 30) comparing online videos with researcher-developed vignettes as prospective manipulations for fat talk exposure suggested use of the vignettes as potent yet subtle stimuli. In the main study, women undergraduates (N = 116) were randomized to read a fat talk or neutral vignette and then completed standardized measures of body dissatisfaction and dietary restraint while being concurrently presented with food stimuli. Results suggest significant moderation effects for dietary restraint: whereas fat talk exposure was associated with increased body dissatisfaction among low dietary restrainers, it appeared to reduce food consumption among high dietary restrainers. Findings highlight the importance of individual differences in shaping responses to fat talk.     

Body talk and body-related co-rumination: Associations with body image,eating attitudes,and psychological adjustment

Talk about physical appearance and body image is common among young women. We investigated how body talk (negative, positive/self-accepting, and co-ruminative) is related to body image, body-related cognitive distortions, disordered eating, psychological adjustment, and friendship quality via hierarchical regression analyses (controlling for social desirability and body mass index). In a sample of young adult women (N = 203), negative body talk was, as predicted, negatively related to body satisfaction and self-esteem and positively related to appearance investment, body-related cognitive distortions, disordered eating, and depression, but not friendship quality. Self-accepting/positive body talk was negatively related to body-related cognitive distortions and positively related to body satisfaction, self-esteem, and friendship quality. Body-related co-rumination demonstrated adjustment trade-offs, being related to body-related cognitive distortions, disordered eating, and higher friendship quality. Results indicated no advantage to negative body talk, both individual and relationship benefits from positive/self-accepting body talk, and mixed outcomes for body-related co-rumination     

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.     

Exploring the integration of thin-ideal internalization and self-objectification in the prevention of eating disorders

Analyses of thin-ideal internalization and self-objectification were conducted within the context of a cognitive dissonance based eating disorder prevention program implemented in an undergraduate sorority. Participants completed self-report assessments at baseline (n = 177), post-intervention (n = 169), 5-month (n = 159), and 1-year follow-up (n = 105). Cross-sectional path analysis indicated that thin-ideal internalization and self-objectification predict each other and both predict body dissatisfaction, which in turn, predicts eating disorder symptoms. A longitudinal examination conducted using hierarchical linear modeling indicated that participants showed significant reductions in thin-ideal internalization, self-objectification, body dissatisfaction, and eating disorder symptoms after participating in the prevention program. Reductions of symptoms were maintained 1-year post-intervention, with the exception of self-objectification, which was significantly reduced up to 5-months post-intervention. Collectively, results suggest that targeting both thin-ideal internalization and self-objectification simultaneously within eating disorder prevention programs could increase the reduction of eating disorder symptoms.     

More than just body weight: The role of body image in psychological and physical functioning

The current study examined BMI and body image dissatisfaction as predictors of physical and mental health-related quality of life (HRQL) and psychosocial functioning in a sample of 414 undergraduate students (mean age = 21.5, SD = 4.9; mean BMI = 23.6, SD = 5.2). In men and women, higher BMI was correlated with body image dissatisfaction and physical HRQL, but not with any measures of psychosocial functioning, whereas higher body image dissatisfaction was associated with poorer physical HRQL and psychosocial functioning. Furthermore, body image dissatisfaction was observed to mediate the relationship between BMI and physical HRQL in men and women. Interestingly, in this model, higher BMI predicted increased self-esteem. These findings suggest that body image dissatisfaction may be an important target for health interventions.     

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.     

Do lesbian women have a better body image? Comparisons with heterosexual women and model of lesbian-specific factors

Body dissatisfaction is prevalent among women but may be less common among lesbian women. Although research trends toward this conclusion when samples are well-matched and body mass index (BMI) is controlled for, many studies do not exhibit these characteristics. Furthermore, few studies have examined sociocultural contributors to group differences. I addressed limitations of past research with a large community sample of lesbian (n = 479) and heterosexual (n = 400) women. I contrasted the two sexual identity groups on several body dissatisfaction measures, and tested theoretically derived relationships between lesbian-specific cultural factors and body dissatisfaction. As predicted, lesbian women reported lower body dissatisfaction than did heterosexual women on three of four measures, and expressed a larger ideal body size. A structural equation model of lesbian-specific risk and protective factors for body dissatisfaction did not reveal significant relationships. This study represents a first attempt to model culturally specific influences on lesbian body image.     

The influence of social anxiety on the body checking behaviors of female college students

Social anxiety and eating pathology frequently co-occur. However, there is limited research examining the relationship between anxiety and body checking, aside from one study in which social physique anxiety partially mediated the relationship between body checking cognitions and body checking behavior (Haase, Mountford, & Waller, 2007). In an independent sample of 567 college women, we tested the fit of Haase and colleagues’ foundational model but did not find evidence of mediation. Thus we tested the fit of an expanded path model that included eating pathology and clinical impairment. In the best-fitting path model (CFI = .991; RMSEA = .083) eating pathology and social physique anxiety positively predicted body checking, and body checking positively predicted clinical impairment. Therefore, women who endorse social physique anxiety may be more likely to engage in body checking behaviors and experience impaired psychosocial functioning.     

Gender-based differential item functioning in common measures of body dissatisfaction

Many widely used measures of body image were developed using all-female samples and thus may not adequately capture the male experience of body dissatisfaction. The current study examined differential item functioning (DIF) in three commonly-used measures of body image: The Body Shape Questionnaire (N = 590, 39.7% male), the Body Dissatisfaction subscale of the Eating Disorders Inventory (N = 529, 44.6% male), and the Shape and Weight Concern subscales of the Eating Disorders Examination Questionnaire (N = 1116, 43.5% male). Participants completed a series of measures evaluating body image and eating pathology. Results evidenced statistically significant DIF in several of the items; one item met criteria for clinically significant DIF. While most items did not evidence clinically elevated levels of DIF, additional evaluation is necessary in order to determine overall quality of the measures in terms of capturing the experience of male body image concerns.     

Acceptance and Commitment Therapy Group Treatment for Symptoms of Borderline Personality Disorder: A Public Sector Pilot Study

A pilot study of a brief group-based Acceptance and Commitment Therapy (ACT) intervention (12 two-hour sessions) was conducted with clients of public mental health services meeting four or more criteria for borderline personality disorder (BPD). Participants were randomly assigned to receive the ACT group intervention in addition to their current treatment (ACT + TAU; N = 21) or to continue with treatment as usual alone (TAU; N = 20). There was significantly more improvement from baseline for the ACT + TAU condition than the TAU condition on the primary outcome variable—self-rated BPD symptoms. The ACT + TAU gain was both clinically and statistically significant. The ACT + TAU condition also had significantly more positive change on anxiety and hopelessness, and on the following ACT consistent process variables: psychological flexibility, emotion regulation skills, mindfulness, and fear of emotions. For all but anxiety, the improvements for the ACT + TAU condition were significant, while the TAU condition had no significant changes on any measure. Follow-up was possible for only a small number of participants. The improvements gained by the ACT + TAU participants were maintained except for fear of emotions. Anxiety continued to improve, becoming significantly different from baseline at follow-up. Examination of mediators found that psychological flexibility, emotion regulation skills and mindfulness, but not less fear of emotions, mediated BPD symptoms. Psychological flexibility and emotion regulation skills also mediated hopelessness. There is a need for a larger trial, for comparison with other established treatments for BPD, and for conducting a trial of a longer intervention. Nonetheless, this pilot study suggests that a brief group-based ACT intervention may be a valuable addition to TAU for people with BPD symptoms in the public sector.