Body dissatisfaction, ethnic identity, and disordered eating among African American women

Initial research suggested that only European American women developed eating disorders (Garner, 1993), yet recent studies have shown that African American women do experience them (e.g., Lester & Petrie, 1998b; Mulholland & Mintz, 2001) and also may be negatively affected by similar sociocultural variables. In this study, we examined a sociocultural model of eating disorders for African American women but included the influences of ethnic identity (e.g., Hall, 1995; Helms, 1990). Participants (N = 322) were drawn from 5 different universities. They completed measures representing ethnic identity, societal pressures regarding thinness, internalization of societal beauty ideals, body image concerns, and disordered eating. Structural equation modeling revealed that ethnic identity was inversely, and societal pressures regarding thinness directly, related to internalization of societal beauty ideals. Societal pressures regarding thinness was also related to greater body image concerns. Both internalization of societal beauty ideals and body image concerns were positively associated with disordered eating (R2 = .79). Overall, the final model fit the data well, supporting its generalizability and the importance of ethnic identity in determining risk.     

Gender identity and bulimic eating behavior

From a social-psychological perspective, the disproportionate number of women compared to men affected by bulimia nervosa implies that gender (i.e., the social construction of sex) plays an important part in the etiology of this disorder. From this perspective it was hypothesized that the risk of developing bulimia depends, in part, on the composition of a woman's gender identity. Three questionnaire studies conducted in the United States and former West Germany tested competing hypotheses on the relationship between gender identity and bulimia. Respondents were predominantly middle class and Caucasian. Study 1 was conducted in West Germany and tested the hypothesis that bulimia is related to a hyperfeminine gender identity [M. Boskind-Lodahl (1976) Cinderella's stepsisters: A feminist perspective on anorexia nervosa and bulimia, Signs, Vol. 2, pp. 342–356]. Twenty-six bulimic women were compared to 26 nonbulimic women. Results from Study 1 indicated that bulimic women typically had a gender-typed identity, whereas nonbulimic controls tended to be androgynous. However, between-group differences were based on hypomasculinity rather than hyperfemininity on part of bulimic women. Study 2 and Study 3 explored the idea that masculinity positively contributes to general esteem and reduces the risk of bulimia nervosa. In Study 2, three competing theories of the optimal relationship between mental health and gender identity (congruence, androgyny, and masculinity) were related to bulimia and tested with structural equation modeling in a sample of 301 North American undergraduates. In Study 3, the findings of Study 2 were cross-validated in a sample of 464 West German high school students. The results indicate that masculinity had significant positive effects on eating behavior via esteem, whereas the effects of femininity were negligible.The research and preparation of this article were supported in part by a Fulbright scholarship, a predoctoral stipend from the University of Heidelberg, and a postdoctoral stipend from the Max Planck Institute for Human Development and Education.I thank the women who volunteered to participate in this research project as subjects. I gratefully acknowledge the support of the principals, especially Frau Ute Vater, and teachers of the Bunsen-, Feudenheim-, and Lessing-Gymnasium, who enabled Study 3.Thanks to Michael Marsiske, Ulrich Mayr, John R. Nesselroade, Kai Schnabel, Anna Stetsenko, and two anonymous reviewers for their comments on an earlier draft of this paper, and to Bettina Franzke for technical support. I also extend my thanks to Frank Faulbaum and Norbert Schwarz, without whom this research could not have been completed.     

Mothers, daughters, and disordered eating

We examined features of 77 mothers' attitudes and behavior that relate to disordered eating among their adolescent daughters. Mothers whose daughters reported a level of disordered eating comparable with clinical samples of bulimic patients were compared with mothers whose daughters reported a low level of eating disturbances. As hypothesized, mothers of daughters with disordered eating were more dissatisfied with the general functioning of the family system. Also, mothers whose daughters were eating disordered were themselves more eating disordered and differed in their dieting history compared with mothers of the girls who were not eating disordered. Furthermore, mothers of girls with disordered eating thought their daughters should lose more weight than mothers of girls who were not eating disordered. They also thought that their daughters were less attractive than the girls judged themselves.     

Nontraditional sex role aspirations,gender identity conflict,and disordered eating among college women

Many studies point directly to the role played by sex roles and indirectly to the role played by gender identity in the onset of disordered eating. In this study, women who report adhering to nontraditional sex role aspirations are almost twice as likely as other women to report purging or frequent bingeing. Women who exhibit gender identity conflict by drawing a male or androgynous figure on the Draw-A-Person Test or by reporting a pattern of wishing they had been born a male are more likely than other women to report purging or frequent bingeing. The results are consonant with a hypothesis regarding the etiology of disordered eating that implicates gender identity conflicts among women, particularly women who exhibit nontraditional sex role aspirations.     

Gender,sexual orientation,and disordered eating

Abstract

While most patients with bulimia nervosa are heterosexual women, a significant number of men with bulimia nervosa are gay males, suggesting that gay men, more than heterosexual men, may be at risk for developing eating disorders. This study compared the food-related attitudes and behaviors of heterosexual men and women in contrast with those of lesbians and gay men, attempting to find whether one's sexual orientation may contribute to differential risk. Two thousand employees were randomly selected from a large health care corporation, of whom 805 returned a completed questionnaire including Stunkard and Messick's (1985) Dietary Restraint and Disinhibition Scales. A stratified random sample was drawn to include demographically comparable groups of 25 lesbians, 50 gay men, 75 heterosexual women, and 75 heterosexual men. Women were less satisfied with their appearance at their present weight and expressed more restraint and more negative feelings after bingeing than did men. Heterosexual women were most dissatisfied with their weight, although heterosexual men were more objectively overweight. Gay men and heterosexual women were similar in disordered eating patterns and disinhibition, contrasting with lesbians and heterosexual men.     

Perfectionism, perceived weight status, and self-esteem interact to predict bulimic symptoms: a model of bulimic symptom development

An interactive model of perfectionism, perceived weight status, and self-esteem was tested on 342 female undergraduates to predict bulimic symptoms. Using a longitudinal design, the authors tested the model on data collected at 2 points: the spring of participants' senior year of high school and during participants' first year of college. The authors hypothesized and found that self-esteem moderates the interaction between perfectionism and perceived weight status in predicting bulimic symptoms. Women who are high in perfectionism and who consider themselves overweight exhibit bulimic symptoms only if they have low self-esteem (i.e., if they doubt they can attain their high body standards). High self-esteem women with the same diathesis-stress conditions are less likely to exhibit bulimic symptoms. These findings clarify the role of perfectionism in bulimic symptomatology.     

The relationships between socially prescribed perfectionism,in‐group affect,negative urgency,and disordered eating in women

Socially prescribed perfectionism (SPP) is often considered as a key risk factor for disordered eating (DE). However, current conceptualizations of SPP largely assume that this perfectionism pressure is non‐specific (i.e., a global pressure), despite research indicating that for females experiencing DE, female‐dominated groups impose this pressure (as a perceived norm). Furthermore, this relationship may be mediated by a negative reaction to this pressure, in the form of impulsivity (or negative urgency). To date, no research has investigated whether the relationship between SPP and DE is mediated by negative urgency, nor has there been research clarifying how in‐group identification relates to DE, independent of SPP and negative urgency. To address these gaps, we assessed these variables in 147 female dieters (M_age = 25.12 years, SD = 3.08) using a cross‐sectional design. Consistent with our hypotheses, negative urgency fully mediated the link between female‐based SPP and disordered eating, while female‐based in‐group affect (identification) was predictive of disordered eating (although the latter relationship was not sustained in a multiple regression model). These findings suggest that the SPP from other women may relate to DE through increasing negative urgency, and that the link between in‐group (female) affect and DE may be better explained by SPP's link to DE.     

The hijab as a protective factor for body image and disordered eating: a replication in French Muslim women

We examined differences in body image and disordered eating between Muslim women who do and do not wear the hijab in France, a nation marked by religious-based sartorial censorship. In an online survey, 450 French Muslim women completed measures of hijab use, weight discrepancy, disordered eating, body image-related constructs, religiosity, perceived support from Allah, and perceived discrimination. Controlling for religiosity and support from Allah, women who wore the hijab reported significantly lower weight discrepancy, body dissatisfaction, drive for thinness, social physique anxiety, internalisation of the thin and muscular ideals, and pressure to attain ideals from peers and the media, though they also reported significantly higher perceived discrimination than those who did not wear the hijab. Further analyses showed that use of the hijab was significantly associated with weight discrepancy and disordered eating. Our results suggest that use of the hijab may offer a protective element for French Muslim women.     

Perceptions and metaperceptions of same-sex social interactions in college women with disordered eating patterns

This study compared perceptions and metaperceptions after a social interaction between a woman with disordered eating (subclinical bulimia nervosa) and a female interaction partner. Hypotheses were: women with disordered eating would have more negative metaperceptions of social interactions than women without disordered eating, and women with disordered eating would show a greater discrepancy between metaperceptions and perceptions than women without disordered eating. All participants completed questionnaires about their perceptions and metaperceptions post-interaction. Results showed women with disordered eating thought that they had made a negative impression; findings addressing the relationships among social desirability, loneliness, social support utilization, and fear of negative evaluation are also discussed.     

Organization of needs in anorectic, bulimic, and obese college women

Central -peripheral organization of needs in women with eating disorders was investigated. Subjects included three clinical groups, totalling 50 female university students, identified as anorectic, bulimic and obese, and two nonclinical control groups, totalling 70 female students. The revised Picture Identification Test (PIT), which measures motivational aspects of Murray-based needs, was administered to all subjects. A new PIT measure, Cenper Index, showed significant differences in central-peripheral organization of needs between clinical and control groups, and among clinical eating disorder groups. The anorectic group differed most from groups on aggression and succorance needs; the bulimic group differed on abasement and defendance needs; and the obese group differed on dominance, exhibition, and gratitude needs.     

The influence of trait anger,trait anxiety and negative urgency on disordered eating

Negative affectivity and impulsivity are potential risk factors for eating pathology. Both are heterogeneous constructs, yielding varied effect sizes in the prediction of pathology. The use of a specific construct, negative urgency, the tendency to act impulsively while distressed, improves the predictive utility of ‘impulsivity’ in eating pathology. The use of specifically defined affectivity constructs may similarly improve theories of risk. Anger and anxiety both represent high arousal, negatively valenced emotions, but promote different interactions with the environment; approach vs. avoidance. Undergraduate women completed measures of negative urgency, trait anger, trait anxiety, and eating pathology 3 months apart. Negative urgency and trait anxiety prospectively accounted for unique variance in increases in global eating pathology, while negative urgency prospectively accounted for unique variance in binge eating. Anger was not a significant predictor. Results suggest that the use of both specifically defined impulsivity and affectivity constructs improves predictive utility of traits in eating pathology.     

Predicting bulimic symptoms: an interactive model of self-efficacy, perfectionism, and perceived weight status

An interactive model of perfectionism, perceived weight status, and self-efficacy was tested on 406 women to predict the bulimic symptoms of binge eating and inappropriate compensatory behaviors separately. This longitudinal study assessed hypothesized vulnerabilities of high perfectionism and low self-efficacy and the stressor of feeling overweight at Time 1 and then gathered weekly assessments of binge eating, vomiting, laxative use, fasting, and diet pill use for 11 weeks. As predicted, results showed that perfectionism, weight perception, and self-efficacy interacted to prospectively predict binge eating. In particular, women high in perfectionism who felt they were overweight and who had low self-efficacy reported the most number of weeks of binge eating. This interactive model did not predict inappropriate compensatory behaviors. Future directions and clinical implications are discussed.     

Weight stigmatization and disordered eating in obese women: The mediating effects of self-esteem and fear of negative appearance evaluation

ObjectiveThe aim of this study is to examine whether self-esteem and fear of negative appearance evaluation are significant mediators in the association between weight-related self-devaluation and disordered eating.MethodA sample of obese Canadian women (N = 111, M age = 40.9, SD = 10.2) completed the Weight Self-Stigma Questionnaire (WSSQ), the Rosenberg Self-Esteem Scale (RSES), the Fear of Negative Appearance Evaluation Scale (FNAES), and the Eating Disorder Examination Questionnaire (EDE-Q).ResultsSelf-esteem mediated the relationship between weight-related self-devaluation and restraint and weight concerns, whereas fear of negative appearance evaluation mediated the relationship with weight, shape and eating concerns.ConclusionSince, for obese women, self-esteem and fear of negative appearance evaluation are likely to maintain disordered eating, they should be more frequently taken into consideration by researchers, health professionals and public policy stakeholders.     

Body dissatisfaction, bulimic symptoms, and clothing practices among college women

Clothing use may be a behavioral avoidance strategy for individuals with body dissatisfaction and eating pathology. The authors administered the Body Image Avoidance Questionnaire (J. C. Rosen, D. Srebnik, E. Saltzberg, & S. Wendt, 1991), the Bulimia Test-Revised (M. Thelen, J. Farmer, S. Wonderlich, & M. Smith, 1991), and the Body dissatisfaction subscale of the Eating Disorder Inventory (D. M. Garner, M. P. Olmstead, & J. Polivy, 1983) to undergraduate college women from two universities (N = 540). Results indicated that women who were more dissatisfied with their bodies (beta = .396) and had greater disordered eating behaviors (beta = .378) were more likely to engage in clothing-related appearance-management behaviors (p < .001), including wearing apparel to camouflage their bodies; avoiding revealing, brightly colored, or tightly fitting clothing; and avoiding shopping for clothing. These findings suggest that the presence of certain clothing-related appearance-management behaviors may be a warning sign that an individual is at risk for developing an eating disorder or may currently have an eating disorder.     

Subtyping eating disordered patients along drive for thinness and depression

Subtyping individuals who binge eat by “diet-DT” and “depression” has yielded two valid and clinically useful subtypes that predict eating severity, comorbid psychopathology and outcome. The present study aimed to find four subtypes based on these dimensions and test their validity. Besides, it explored the distribution of eating disorder (ED) diagnoses across subtypes given their known heterogeneity, crossover and binge-eating fluctuation.Cluster analysis grouped 1005 consecutively admitted ED adult women into four subtypes, those previously described “DT” (22%), “DT-depressive” (29%), and “mild DT” (25%) and “depressive-moderate DT” (24%). Overall “mild DT” presented lower and “DT-depressive” greater eating and comorbid psychopathology than the rest, whereas “pure DT” and “depressive-moderate DT” presented no differences on bulimic symptoms but in psychopathology (p < .01). Finally, while BN-P patients were mostly and similarly distributed in the “DT” and “DT-depressive” subtypes than in the other, AN were in the new “mild DT” and “depressive-moderate DT” (p < .01). However, BN-NP, BED and EDNOS were similarly represented across subtypes.Results are discussed with regard to 1) the newly emerged subtypes that may explain cases in which DT prevents or does not predict binge eating; 2) the confluence of DT-depression that signaled greater eating and comorbid pathology, particularly self-control problems; 3) ED-DSM-diagnostic criteria.     

The thin ideal, depression and eating disorders in women

It is proposed that a cultural ideal of thinness for women causes depression at a higher rate among women than among men. This model accounts for five currently unintegrated trends in the epidemiology of depression. It explains why: (1) twice as many women as men are likely to be depressed; (2) this sex difference emerges at puberty; (3) this sex difference is only found in western countries; (4) there is more depression today; (5) the average age of onset for depression is younger now than in the past. Four parallel trends in eating disorders can also be accounted for by the same factor.     

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.     

The relative contributions of subjective and objective measures of body shape and size to body image and disordered eating in women

This research explored the relative contributions of subjective perceptions of body weight and body shape/proportion, as well as objective measures of body mass index (BMI) and waist-to-hip ratio (WHR) to disordered eating, exercise involvement, and body image. One hundred and fifty-eight female university students completed questionnaires and provided body measurements for this study. Although an interaction between BMI and WHR was found for some measures (i.e., Eating Disorder Examination Questionnaire total and subscale scores), results indicated that BMI was consistently the better objective predictor of disordered eating and body image. Subjective perceptions of body weight and, to a lesser extent, body shape, were found to account for the greatest proportion of variance in the dependent measures (disordered eating, body esteem, and body dissatisfaction). Overall, these results offer more support for sociocultural theories emphasizing the importance of thinness for women, than evolutionary theories emphasizing the role of WHR.