Body image, social comparison, and eating disturbance

Body Image, Social Comparison, and Eating Disturbance: A Covariance Structure Modeling Investigation

J. Kevin Thompson,* Michael D. Coovert, Susan M. Stormer Department of Psychology, University of South Florida, Tampa, Florida Accepted 9 February 1998

Abstract: Objective: To evaluate the role of appearance-based social comparison processes as a possible mediational link between developmental factors (negative social feedback, i.e., teasing about appearance; biological status, i.e.,early physical maturation) and levels of body dissatisfaction, eating disturbance, and global psychological functioning. Method: In this study of 173 female undergraduates, covariance structure modeling (CSM) was used to examine direct and mediational relationships among these variables. Results: Appearancebased social comparison mediated the effect of appearance-related teasing on body image and eating disturbance; body image mediated the effect of teasing on eating disturbance; eating disturbance had a direct effect on overall psychological functioning. Discussion: Implications for devising and testing other theoretical models are discussed. © 1999 by John Wiley & Sons, Inc. Int J Eat Disord 26: 43–51, 1999. Key words: body image; teasing; eating disturbance; social comparison; covariance structure modeling

INTRODUCTION Recent prospective and covariance structure modeling (CSM) investigations have begun to elucidate the role of specific factors in the development of eating disturbances (Thompson, 1996). Body image dissatisfaction has received the greatest empirical support as a precursor to eating disturbances (Thompson et al., 1999). However, other developmental, social, and sociocultural factors may also play an important etiological role (Heinberg, 1996). For instance, media-related factors such as exposure and internalization of idealized images may contribute to body dissatisfaction and eating-related pathology (Levine, Smolak, & Hayden, 1994; Stice, Schupak-Neuberg, Shaw, & Stein, 1994; Heinberg, Thompson, & Stormer, 1995). In addition, negative social feedback, in the form of teasing regarding one’s appearance, is indicated from both prospective and CSM analyses as a

*Correspondence to: J. Kevin Thompson, Ph.D., Department of Psychology, University of South Florida, Tampa, FL 33620-8200. E-mail: [email protected] © 1999 by John Wiley & Sons, Inc.

Prod. #1418

CCC 0276-3478/99/010043-09

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Thompson, Coovert, and Stormer

possible etiological factor in the development of body image-related dysfunction and eating disturbances (Cattarin & Thompson, 1994; Thompson, Coovert, Richards, Johnson, & Cattarin, 1995). Interestingly, the potentially important mediational role of appearance-related social comparison has not been evaluated in conjunction with the above factors in prospective and CSM studies. Festinger (1954) suggested that individuals engage in the comparison process to judge their standing on a variety of dimensions. With reference to body image issues, individuals in our society, particularly women, are bombarded on a regular basis with images which may serve as comparison targets. Importantly, the goal of many of the sources of these stimuli (e.g., magazines, TV) is to produce such a comparison, in the hopes of stimulating a financial outlay by the individual to obtain materials for the amelioration of her (by comparison) appearance shortcomings. Support for the role of appearance-related comparisons is tentative, based largely on correlational studies, but suggestive of the possibility of an important mediational role in the onset of body image and eating-related disorders. Heinberg and Thompson (1992) found that women’s rating of the importance of others as appearance-related comparison targets was significantly associated with overall body dissatisfaction and eating disturbance. Thompson and Heinberg (1993) found that the overall frequency of appearance comparisons significantly correlated with these same variables. Stormer and Thompson (1996), using regression analyses, found that appearance comparison levels predicted variance associated with eating disturbance beyond that accounted for by teasing and internalization of societal pressures to be attractive. Clearly, the role of appearance-related social comparison deserves further analysis. In this study, CSM analyses were used to evaluate the possibility that appearance comparisons mediate the connection among developmental issues (early maturational timing, teasing), body image, and eating disturbance. Furthermore, one goal was to replicate earlier work with adolescents by testing for a directional influence from teasing to body image and from body image to eating disturbance (Thompson, Coovert, et al., 1995). It was hoped that the findings would further elucidate possible causal sequences for the development of body dissatisfaction and eating disturbance.

METHOD Participants The participants were 173 female college students (ages 18–30) who participated for extra course credit as part of an introductory psychology course at the University of South Florida. Approximately 85% of the sample consisted of Caucasian women and the rest of the participant pool comprised primarily African-American or Hispanic-American women. Measures Maturational Timing Maturational Timing—Age (MTA). This measure attempts to pinpoint the participants’ exact age of menarche through several detailed questions. Participants were asked the age at which they began their period, noting the time of year, grade, month, and year. They

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also made a “certainty” rating, using a 5-point scale ranging from not at all certain (1) to absolutely certain (5). Participants who did not note a 4 or 5 on this item were eliminated from analyses. Maturational Timing—Subjective Rating (MTSR). This question indexes participants’ view of their physical development in relation to peers. A 5-point scale, ranging from much ahead to much behind, was used to answer the following question: When you were going through puberty, in relation to other girls of the same age, how would you rate your level of physical development? Maturational Timing—Peer Menarche (MTPM). This question asked women to rate their timing of menarche with reference to that of peers by responding to the following question: In relation to other girls your age, when did you have your first period? Response choices ranged from much before (1) to much after (5). Teasing Three measures that formed the basis for the later development of the Perception of Teasing Scale (Thompson, Cattarin, Fowler, & Fisher, 1995) were used in this study. Thompson and Cattarin (1992) found psychometrically sound measures of three aspects of appearance-related teasing in an earlier study. These subscales are used in the current investigation because of the benefits of multiple indicators of latent variables for use with CSM. Perception of Teasing Scale—Weight (POTSWT). This subscale contains seven items that measure a global type of weight-related teasing (i.e., overall weight/size) (internal consistency = .94). Perception of Teasing Scale—Site-Specific Teasing (POTSST). This four-item subscale measures teasing directed at specific body sites that are weight related (i.e., thighs) (internal consistency = .90). Perception of Teasing Scale—General Appearance (POTSGA). This three-item subscale measures teasing directed at non–weight-related features (i.e., the face) (internal consistency = .64). Comparison The Physical Appearance Comparison Scale (PACS). This five-item measure reflects the degree of overall appearance comparison to other individuals (Thompson, Heinberg, & Tantleff, 1991). It was used as the basis for the formation of three new scales for the current study, in order to arrive at measures that provided an index of different aspects of appearance-related social comparison. Comparison—Weight (CW). This 11-item scale uses a 5-point frequency scale (never to always) for the assessment of a weight-related comparison dimension. Sample items include waist, hips, and thighs. Internal consistency (Chronbach’s alpha) is .95. Comparison—Muscular (CM). This five-item scale measures the frequency of comparison of muscle-related body sites, such as shoulders, upper arms, and back. Chronbach’s alpha is .87. Comparison—General Appearance (CGA). This nine-item scale reflects the degree of comparison of non–weight, non–muscle-related sites, such as the shape of the face, nose, and lips. Chronbach’s alpha is .82. Body Image Two widely used measures were included to assess body image satisfaction (Thompson, 1990). The Eating Disorder Inventory—Body Dissatisfaction scale (EDI-BD) is a

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seven-item Likert-scaled self-report instrument which measures participants’ subjective feelings of dissatisfaction with their bodies. It’s internal consistency is above .80 for a wide range of samples, ranging from children to adults (Garner, 1991). The Body Image Automatic Thoughts Questionnaire (BIATQ) is a widely used measure of a more cognitive aspect of body image (Cash, 1996; Cash, Lewis, & Keeton, 1987; Thompson, 1990). It contains a 37-item Negative Thoughts subscale and a 15-item Positive Thoughts subscale. Only the Positive Thoughts subscale was used in this study (Chronbach’s alpha = .90). Eating Disturbance Two widely used subscales of the EDI, the Bulima and Drive for Thinness subscales, were used to obtain a global measure of eating disturbance (Garner, 1991). The Bulimia subscale measures the tendency to purge, binge, and engage in bulimic behaviors whereas the Drive for Thinness scale is an index of restrictive symptoms consistent with anorexia nervosa. Both measures have excellent psychometric characteristics (e.g., Garner, 1991) with a wide range of clinical and nonclinical samples. The Rosenberg Self-Esteem Inventory. The Rosenberg Self-Esteem Inventory is a 10item index of global self-esteem (Rosenberg, 1965). It is perhaps the most widely used measure of self-esteem with norms, good to excellent reliabilities, and validity studies in a wide range of samples (Alfonso, 1995). Manipulation Check. To ensure that the participants attended to the various questionnaires, two items were embedded which asked the participants to either write a certain number in the space or circle a particular answer to a question. (No participants were eliminated because of random responding.) Procedure Participants were given the questionnaire packet in a large classroom setting and asked to complete it as accurately as possible. They were informed that it would take approximately 20 min to complete the packet and that questionnaires would not be collected by the experimenter until this time period had passed. Overview of Design The three competing models are different statements about the interrelationships among and between the model’s latent variables. The base model specifies that Maturational Timing and Teasing are exogenous latent variables which directly influence the process of Comparison. The Comparison latent variable has a direct influence on Eating Disturbance and Body Image. Body Image subsequently influences Eating Disturbance. Finally, Self-Esteem is directly affected by eating disturbance. Figure 1 provides a graphic illustration of these structural relationships and the two modifications to the model which we now describe. In the base model, Comparison serves a key mediational role, controlling the impact of Maturational Timing on Eating Disturbance and Teasing on Body Image. As we outlined earlier, the hypothetical mediational role of Comparison fits well with previous research and theoretical perspectives. Alternative theoretical perspectives argue for two minor, but plausible, modifications as a priori competing alternative models. The first modification, which we refer to as competing model 1, has all the parameters of the base model. Additionally, it specifies a direct influence of Maturational Timing on Eating Disturbance (Figure 1). Maturational Timing, therefore, influences Eating Distur-

Body Image

Figure 1.

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Overall relationships specified in base and competing models.

bance indirectly (mediated by Comparison) and directly. The basis for this competing model is evidence that eating disorders frequently begin during the pubertal years (Thompson, 1990) and that age at menarche is associated with the severity of eating disturbance in adolescents (Graber, Brooks-Gunn, Paikoff, & Warren, 1994. Killen and colleagues (1992) have also found that puberty may be a risk factor for the development of eating disturbance. Similarly, competing model 2 incorporates all of the parameters as competing model 1, but also specifies a direct influence of Teasing on Body Image. As such, Teasing is hypothesized to have both a direct and an indirect (through Comparison) influence on Body Image (Figure 1). As noted in the Introduction, this competing model is included to test the replicability of our earlier research (e.g., Thompson, Coovert, et al., 1995).

RESULTS The base and competing alternative models were estimated with LISREL. The overall model fit indices for these are provided in Table 1. Structural parameter estimates and factor loadings are provided in Figure 2. As expected, the obtained chi-square test for an exact fit of the models to the data reveals that none of the models are plausible. Given the ease with which the chi-square test of exact fit is rejected, we also employed the chi square for close fit as a less biased point estimator (Browne & Mels, 1990, pp. 16–17; MacCallum & Browne, 1993; MacCallum, Browne, & Sugawara, 1996; Steiger, Shapiro, & Browne, 1985). The close fit chi square reveals that, of the three a priori models, only competing model 2 is statistically plausible. Other fit indices also support competing model 2. For all three models, root mean square error of approximation (RMSEA) is below its critical value of .08 (Browne & Mels, 1990) for describing a modest fitting model, but it is substantially lower in the case of

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Table 1.


Overall fit measures for the three competing models

Obtained chi square Probability to exact fit Probability of close fit RMSEA NNFI CFI ECVI

Base Model

Competing Model 1 (added path from Maturational Timing to Eating Disturbance)

Competing Model 2 (added path from Teasing to Body Image)

␹271 = 141 p < .00001 p < .013 .076 .91 .93 1.21

␹270 = 130 p < .00001 p < .039 .071 .92 .94 1.16

␹269 = 118 p < .00001 p < .11 .064 .94 .95 1.11

Note: RMSEA = root mean square error of approximation; NNFI = nonnormed fit index; CFI = comparative fit index; ECVI = expected cross-validation index.

competing model 2. Similarly, the nonnormed fit index (NNFI; Tucker & Lewis, 1973) and the comparative fit index (CFI; Bentler, 1990) also favor competing model 2. A final assessment of the models can be made in terms of the extent to which the present model would generalize. This can be assessed via the expected cross-validation index (ECVI; Cudeck & Browne, 1993) which reflects the discrepancy between the fitted covariance matrix in the sample and the expected covariance matrix that would be obtained in another sample. There are no recommended values associated with the ECVl, but as a measure of discrepancy, we prefer a model with the smaller value. As with the other measures of fit, the ECVI prefers competing model 2.

Figure 2. Covariance structure modeling analysis of hypothesized relationships among variables. (All paths significant, with exception of .16 from Maturational Timing to Comparison.)

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Nested Model Comparisons An advantage of the way the models are specified is that the base model is nested within the two competing models and competing model 1 is nested within competing model 2. This allows for a chi-square difference test to be employed to determine if statistically the addition of parameters leads to a significant improvement in the overall model fit. The addition of the path in competing model 1 (from Maturational Timing to Eating Disturbance) significantly improved from the base model (difference ␹21 = 10, p < .005). This is seen as a significant reduction in the overall chi square, as well as the other measures of overall fit. Similarly, competing model 2 (path added from Teasing to Body Image) is also a significant improvement in overall fit from the base model (difference ␹22 = 22, p < .001) and competing model 1 (difference ␹21 = 12, p < .001).

DISCUSSION Previous research uncovered the relationship among social comparison, body dissatisfaction, and eating disturbance (Heinberg, 1996; Heinberg & Thompson, 1992). This study extends these correlational findings via the use of CSM and supports the central role of appearance-based comparisons as a mediational link between social feedback (teasing), body image, and eating disturbance. Also, in a replication of our earlier work (Thompson, Coovert, et al., 1995), body image was found to mediate the effects of teasing on eating disturbance. Maturational timing was not a significant predictor of comparison. The competing model with the added path from maturational timing to eating disturbance did not fit the data as well as the second competing model (teasing to body image), although the path was significant. These results add to the list of conflicting findings in this area (Thompson, 1990). However, one must use caution before eliminating this variable as an important risk factor. In the current study, adults recalled developmental milestones related to menarche and pubertal timing in comparison to peers. However, many of the supportive studies have been conducted on adolescents who rated levels of physical development or noted age at menarche in a time frame much closer to the actual experience of puberty (Graber et al., 1994; Killen et al., 1992). However, the limited role played by maturational timing in the current study replicates our earlier finding with adolescents, also using CSM (Thompson, Coovert, et al., 1995). Clearly, maturational timing is an important conceptual variable and further investigation is warranted before any final statement can be made regarding its utility in explaining body image and eating disturbance. The current model is limited in several ways that should be addressed in future research. First, the measurement of self-esteem needs to be broadened to include other indicators. At first glance, it may seem odd that the BIATQ—an indicator of body image— is also an indicator of self-esteem. However, a wealth of research has documented the strong connection between body satisfaction and overall self-esteem (Thompson, 1990). An examination of two of the items on this scale reveals how this measure may have also tapped into an overall self-evaluative component (e.g., “My appearance helps me to be more confident. I still think I’m attractive even when I’m with people more attractive than me”). Second, certainly we have not modeled all of the influential factors that lead to body image dysphoria and eating disturbance. As Stice and colleagues (1994) have noted in

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previous work, media exposure and internalization of media-related pressures also have a clear effect on body satisfaction and eating dysregulation. Levine and Smolak (1996) have also noted the contextual role that media images play in the possible onset of dysfunctional eating. Heinberg et al. (1995) developed the Sociocultural Attitudes Towards Appearance Questionnaire (SATAQ) which contains scales that assess an awareness of societal pressures presented via the media and one’s internalization of these messages. Recent studies with this measure have replicated Stice et al. (1994) in documenting the importance of internalization as a factor in women’s weight and shaperelated problems (Heinberg & Thompson, 1995; Cusumano & Thompson, 1997). The current findings support the use of clinical techniques for the treatment of body image dysphoria that have recently received empirical validation. For instance, Cash (1995, 1996) and Rosen (1996) have developed body image treatment programs which address multiple aspects of body dissatisfaction via a variety of treatment strategies, including psychoeducational information, in vivo exposure, and cognitive restructuring. Importantly, both of their programs deal with the often pernicious effects of social comparison on one’s own appearance to other individuals (typically an “upward” comparison to someone more attractive). Because of its implications for such interventions for body image dysphoria, future prospective and structural modeling investigations need to further evaluate the mediational role of social processes such as appearance-based comparison and internalization of societally-based images of beauty and attractiveness.

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