BODY-SIZE PERCEPTION, BODY-ESTEEM, AND ...

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Perceptual and Motor Skills, 2006,102,485-497.

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BODY-SIZE PERCEPTION, BODY-ESTEEM, AND PARENTING HISTORY I N COLLEGE WOMEN REPORTING A HISTORY OF CHILD ABUSE '.' JESSICA R. EUBANKS, MICHAELA Y. KENKEL, AND RICK M. GARDNER University of Colorado-Denver Summary.-This study investigated the relations among physical, emotional, and sexual abuse up to adolescence and subsequent perception of body size, detection of changes in body size, and body-esteem. The role of parenting history in abused participants was also examined. 38 college undergraduate women, half of whom had been abused, reported instances of abuse, childhood parenting history, and current bodyesteem. A recently developed software program of Gardner and Boice was used to present a series of distorted frontal profiles of each participant's own body for the women to rate as being too wide or too thin. A psychophysical procedure called adaptive probit estimation was used to measure the amount of over- and underestimation of these ratings and whether these changes were statistically significant. Analysis showed abused participants had distorted perceptions of body size, although the direction of the distortion was not consistent. There was no difference in detection of changes in body size. Abused and nonabused participants differed on measures of body-esteem and on ratings of most parenting experiences, including experiences with both mothers and fathers.

Body-image is the subjective picture of one's body, typically including its form, size, integrity, strength, and attractiveness (Popplestone & White, 1988). This complex construct has several distinct parts, including two major components known as the perceptual and the attitudinal components of body-image. Body perception is defined as the accuracy of individuals' judgment of their size, shape, and weight relative to their actual proportions (Cash, Wood, Phelps, & Boyd, 1991). The attitudinal or emotional aspect of body-size estimation involves how the individual feels about the size, shape, and appearance of the body. No significant correlation between accuracy of body-size perception and body satisfaction has been found, suggesting that these are largely independent (Altabe & Thompson, 1990). Both the perceptual and attitudinal components of body-image have been related to various emotional problems, including depression and schizophrenia, and to eating disorders. Adame, Radell, Johnson, and Cole (2003) found that depression in college age men and women was associated with

'This research was supported by a grant to Jessica Eubanks and Michaela Kenkel from the Psychology Department Fund for Undergraduate Research at the University of Colorado-Denver. 'Address correspondence to Rick M. Gardner, Department of Psychology, University of Colorado-Denver , Denver, C O 802 17 or e-mail ([email protected]).

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unhappiness about body appearance, feeling overweight, and preoccupation with being overweight. In addition, adult women with body-image disturbance presented more frequent schizotypic thought disorder (Coleman, Levy, Lenzenweger , & Holzman , 1996). Eating disorders represent a special class of emotional disturbance often related to body-image disturbance. In particular, contemporary theories most often assume that body dissatisfaction is the most immediate antecedent in the development of anorexia nervosa (Garner, 2002). In fact, body-image disturbance and fear of gaining weight are specifically noted as diagnostic criteria for anorexia nervosa in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 1994). In addition to their predictive association with anorexia nervosa, body-image disturbances have also been identified as important risk factors for the development of bulimia nervosa (Stice. 2002a) and eating disorders in general (Connors, 2001; Stice, 2002b). The occurrence of physical or sexual abuse in childhood has been identified as a general risk factor for several psychological disturbances in adult women, including significant associations with depression, anxiety, anger, substance abuse, revictimization, suicidality, self-mutilation, impaired selfconcept, dissociation, somatization, interpersonal difficulties, and obsessional behavior (Neumann, Housekamp, Pollock, & Briere, 1996) as well as disordered eating behaviors (Connors, 2001). In addition, a history of chronic physical and/or sexual abuse can also hinder treatment of eating disordered behavior (Hesse-Biber, Marino, & Watts-Roy, 1999). Little research has been conducted on the effects of abuse on body-image disturbance, and the research is inconsistent. Gardner, Gardner, and Morrell (1990) found that 41 physically or sexually abused children ages 6 to 10 had an accurate view of their body size. Schaaf and McCanne (1994) also found no association between childhood sexual abuse and body-size distortion in 90 female college students. However, Molinari (2001) found that adults reporting child sexual abuse did have a distorted body-image. Both Molinari (2001) and Kenardy and Ball (1998) showed sexually abused women had higher weight dissatisfaction although other studies have indicated no significant relationship (Wonderlich, Brewerton, Jocic, Dansky, & Abbot, 1997). One potential source of the inconsistencies in findings is that a variety of methods have been used to measure perceptual body-image. The perceptual component of body-size estimation has been assessed using distorted images presented as photographs (Glucksman & Hirsch, 1969; Garner & Garfinkel, 1981))distorting mirrors (Traub & Orbach, 1964), and a video distortion procedure (Allebeck, Hallberg, & Epsmark, 1976; Freeman, Thomas, Solyom, & Hunter, 1984; Gardner, Martinez, & Sandoval, 1987). In each procedure, the subject is asked to adjust the distorted image until it be-

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comes their actual or ideal size. While these procedures typically present the whole body-image, Gardner, Martinez, Espinoza, and Gallegos (1988) used the video-distortion procedure to present individual body sites. More commonly, however, procedures to estimate the size of different body sites use light beam projections to represent individual body sites (Thompson & Thompson, 1986). The psychophysical method of adjustment has typically been used with these measurement techniques. In this procedure, the participant adjusts an initially distorted figure representing body size either smaller or larger until it matches their own perceived size. One disadvantage of this psychophysical method is that it does not distinguish between perceptual sensitivity of the subjects performing in the studies and any response bias they show given nonsensory influences (Fonagy, Benster , & Higgitt , 1990; Gardner , 1996). In judging body size, people must first recognize whether the stimulus presented is different from their own actual body size and then make a subjective decision about how much adjustment is necessary. Recently, Gardner and his colleagues have utilized a procedure known as adaptive probit estimation, which is capable of distinguishing between these two independent components of body-image perception. This psychophysical technique estimates a complete psychometric function with maximum statistical efficiency while using minimal subject labor. A detailed description of the technique is beyond the scope of this paper and can be found in Gardner (1996). Briefly, the procedure allows separate and independent measurements of the amount of perceptual distortion as well as the subjects' detection of changes in own body size. The advantage of adaptive probit estimation over all other techniques of body-image estimation lies in its unique ability to separate these two aspects of perceptual body-image. Although some researchers have examined the relationship between child abuse and either eating disorders or body-image, there is no research on the relationship of abuse to the perceptual and attitudinal components of body-image. The current research had three primary goals. The first goal was to investigate any differences in body-esteem of abused and nonabused participants. Previous research has yielded mixed findings, including findings that sexual abuse does negatively affect body-esteem in those with a history of abuse (Eigner, 1995; Wenninger & Heiman, 1998), while others report no effect (Kulkoski & Kilian, 1997). It was hypothesized the abused participants would have significantly less body-esteem than the nonabused participants. The second goal was to investigate differences in parenting behaviors of the mothers and fathers of abused and nonabused participants, including factors of emotional, physical, and sexual abuse. Other parenting factors examined include amount of love and support, promotion of independence, and positive modeling and fairness. Previous studies have shown inconsistent re-

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sults including differences in parenting behaviors between the two groups (Gold, Hyman, & Andres-Hyman, 2004)) while others indicated no differences (Kallstrom-Fuqua, 2005). Significant differences in parenting behaviors are hypothesized for the present two groups of participants. The third goal was to assess the separate relationship of abuse on bodysize distortion and detection of changes in body size. Abused subjects were hypothesized to show greater perceptual size distortion than nonabused subjects, indicating less accuracy in judging their actual body size. In addition, it is hypothesized that one consequence of abuse may be a poorer detection of changes in their body size by abused participants.

METHOD The research protocol was approved by the university's internal review board prior to the beginning of data collection. Participants Participants were 38 female undergraduates enrolled at a regional university and college. They were recruited through advertisements in campus newspapers and flyers placed around the campuses, stating that research was being conducted regarding previous childhood abuse and body-image. The researcher's names were given along with contact information. These notices also stated that $10.00 would be given to research participants and ensured participants that the information gathered from the study would remain confidential. There were 19 participants in each of the abused and nonabused groups. All participants in the abused group had a self-reported history of physical or sexual abuse. Sexual abuse was defined by any instances of inappropriate touching, fondling, kissing, or penetration by a person at least five years older than the victim when the victim was less than 13 years of age. Physical abuse was defined by more than five instances of infliction of bruises, welts, cuts, scratches, burns, fractures, or dislocations by family members or people living in the home, who were at least seven years older than the victim and that occurred regardless of the victim's age. Materials Demographic survey.-All participants completed a demographic survey asking for height, weight, date of birth, college or university attended, and year in school. Davis (1990) cited research in which self-reported height and weight were strongly correlated with actual measured height and weight, indicating such self-assessments of physical characteristics to be valid. Childhood History Questionnaire.-To measure detail and severity of the participants' history of abuse, the Childhood History Questionnaire (Milner, Robertson, & Rogers, 1990) was employed. It asks questions regarding the nature of physical and sexual abuse before and after the age of 13. Re-

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sponses to the questions were scored on a 5-point Likert scale anchored by 0: Never and 4: Very Often. The participants were asked to respond according to the type of abuse they had experienced. There were nine categories for physical abuse and five categories for sexual abuse. Examples of abuse categories included whipping, bruises/welts, cuts/scratches, sexual fondling, and inappropriate touching. In addition, participants answered three questions regarding emotional abuse. The relationship of the abuser to the child was also recorded for each type of abuse. Body-esteem Scak for adolescents and adzrZts.-The Mendelson Body-esteem Scale (Mendelson & White, 1982) measured body-esteem. It has three different subscales to assess components of body-esteem-. These are how satisfied the person is with own weight, appearance or feelings about how the participant looks, and attribution, which is how the person thinks others view them. Participants responded to questions such as, "I am satisfied with my weight," on a 5-point Likert scale anchored by 0: Never and 4: Always. The test-retest reliability is based on coefficients of the three subscales ranging between .83 and .95 (Mendelson & White, 1982). Exposure to Abusive and Supportive Environments-Parenting Inventory. -This measure (Nicholas & Bieber, 1997) is a 70-item inventory designed to assess how the mother and father were perceived to treat the respondent as a child. Reported test-retest reliability of items ranged from .78 to .91, and the inventory was shown to be valid in comparison with other similar inventories. Participants responded to each question on a 5-point Likert scale anchored by 1: Very Often and 5 : Never. It has six subscales. Included were scales for emotional abusiveness ("made you feel stupid when you didn't understand something"), physical abusiveness ("hit you" and "pushed, grabbed or shoved you"), sexual abusiveness ("touched you sexually"), and love/support ("told you that she (he) loved you"). An additional scale measured promotion of independence ("let you feel you were in control of your own life"), while a final positive modeling/fairness scale ("provided a good example") assessed whether the respondents viewed their parents as good role models. Body-image computer program.-The Body-image Distortion Computer Program (Gardner & Boice, 2004) employs the psychophysical procedure Adaptive Probit Estimation, which calculates a participant's body-size distortion as well as the detection of changes in body size. For a detailed explanation of Adaptive Probit Estimation the reader is referred to Gardner and Boice (2004). O n a given trial, a static video image of the frontal profile of a participant is distorted as wider or thinner than their actual size. The participant is asked to judge if the image is too wide or too thin. Initially, two blocks of 40 trials were presented with four images distorted f 3.27%

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and k 9.81%. Distortions are adjusted for the next six blocks of 40 trials each by the formulas suggested by Watt and Andrew (1981). These adjustments are taken to present four new distortion levels in each block, which are centered about the calculated size of their bodies by participants. Following data collection, the computer program calculates an average value for point of subjective equality and just noticeable difference (JND) values. Here, the point of subjective equality measures the amount of body-size distortion and represents the amount of distortion whereby a participant would respond that the image was distorted ('too wide" 50% of the time and "too thin" 50% of the time. Thus, it is the amount of distortion necessary before a respondent reported that the body size presented was subjectively equal to their perceived size. The JND is the amount of change in body size the participant would require to detect a change in body size 50% of the time. The JND is dependent upon the participant's processing sensory information and as such is a measure of the participant's sensory detection of changes in body size (Gardner, 1996). The adaptive probit estimation procedure has been demonstrated to be both reliable and valid (Gardner, Jones, & Bokenkamp, 1995).

Procedure Volunteers who called or e-mailed the researchers were provided additional information about the study. The potential participants were informed that they would be using a computer program to assess body-image as well as completing three surveys which would require 30 to 40 minutes of their time. Potential participants were then queried regarding their history of abuse and informed that if questions made them feel uncomfortable they could stop at any time. If there was no history of abuse, they were asked to participate in the control group. If there was a history of abuse, questions were asked regarding the age at which the abuse occurred and whether it was physical and/or sexual abuse. Participants signed a consent form informing them about the details of the study and noted that parts of the surveys involved questions concerning their past experiences of abuse. They were told they could withdraw from participation at any time if they felt uncomfortable. A static digital image was taken of each fully clothed participant standing against a white wall. Full body, frontal images of each participant were used. They were asked to stand with the feet shoulder-width apart with the arms slightly away from the body, and if they were wearing a coat or heavy sweater over another article of clothing, they were asked to remove it. The digital image was then downloaded into the Body-image Distortion Computer Program. Researchers read the directions to participants on how to use the computer program from a script. Participants were informed that

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once the program started, a picture of them would appear on the screen. They were to make a judgment on whether they thought the picture was wider or thinner than their actual body size and to press the right button or the left button on the mouse, respectively. After completing the program, each participant was asked to fill out the demographic survey, the Childhood History Questionnaire, the Body-esteem Scale for adolescents and adults, and the Exposure to Abusive and Supportive Environments-Parenting Inventory. Each participant was paid $10.00. RESULTS There was a significant difference between the mean ages of the nonabused (M=22.7, SD =5.0) and abused groups (M = 34.1, SD= 12.9; t,, = -3.59, p < .O01, Cohen d = 1.17, power at a .O1= .80). There was also a significant difference between the mean Body Mass Index of the two groups (nonabused M=21.6, S=5.0, abused M=26.2, S = 12.9; t,,= -3.31, p < .004, Cohen d = .47, power at a .O1 = .74). The original intent of this study was to examine separately participants who reported past physical and sexual abuse. However, there was a great deal of overlap in these two groups. For example, 100% of the abused participants were physically abused under the age of 13, while 73.7% were also sexually abused. The two groups were combined, given the overlap, into one group of physically and sexually abused participants. Of the abused participants, one was sexually abused by her mother, six by their fathers, and eight by another adult. Physical abuse was given by the mother for eight participants, by the father for 13, and by other adults for five participants. The first hypothesis stated that abused participants would have lower body-esteem than nonabused participants. Table 1 shows the differences between the abused and nonabused groups on scores for the Body-esteem Scale for Adolescents and Adults. Given the multiple t tests in this analysis, an alpha level of .Ol was adopted. There were significant differences between the groups on the appearance and weight subscales with no difference on attribution. The nonabused group had higher scores on the appearance and weight subscales, indicating that they felt more positive about their appearance and their weight, thus supporting the main tenet of the hypothesis. The effect sizes (Cohen d ) were almost universally large, with only one value falling below 3 0 . The second hypothesis predicted significant differences in the childhood history of parenting behaviors of participants who reported being abused as compared to those who did not. Table 1 also shows the group differences on the six subscales of the Exposure to Abusive and Supportive Environments-Parenting Inventory with relation to the mother and the father. There were significant differences on each of the subscales for both

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J. R. EUBANKS, ET AL. TABLE 1 MEANS AND STANDARD DEVIATIONS ON BODY-ESTEEM SCALE FORADOLESCENTS AND ADULTS (BESAA) AND EXPOSURE TO ABUSIVE AND SUPPORTIVE ENVIRONMENTS-PARENTING AND NONABUSED PARTICIPANTS INVENTORY (EASE-PI) FORABUSED Measure

Abused

M

SD

Nonabused

M

SD

t,,

Effect Size (Cohen d )

BESAA (Overall) Appearance Weight Attribution EASE-PI (Mother) Emotional abuse Physical abuse Sexual abuse Love/Support Promoting independence Positive modeling/fairness EASE-PI (Father) Emotional abuse Physical abuse Sexual abuse Love/Support Promoting independence Positive modeling/fairness

mother and father, with the nonabused group presenting consistently higher scores. As expected, the nonabused group reported significantly less physical and emotional abuse and significantly more love and support and positive modeling than the abused group. The only nonsignificant differences were in the incidence of sexual abuse by the mother or in the promotion of independence by the father. Otherwise, these differences between the abused and nonabused groups were consistent for both mothers and fathers. The effect sizes were again nearly universally large, with only one value falling below .8O. Overall, the hypothesized difference in parenting behaviors was supported. As noted earlier, the participants' point of subjective equality values represented the percentage of distortion in their perceived body size, with scores closer to O representing less distortion. An average point of subjective equality score was calculated for each participant over the eight blocks of the adaptive probit estimation procedure. No point of subjective equality data was obtained for one abused participant given failure to comply with instructions. The third hypothesis predicted greater perceptual size distortion in the abused participants. For the nonabused group, the mean point of subjective

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equality was -2.63 (SD=4.57) while for the abused group, the mean was -.003 (SD=9.30). This indicates that the abused participants were extremely accurate in estimating their body size while the nonabused slightly underestimated their body size by 2.6%. These point of subjective equality values of the abused and nonabused groups were not significantly different (t,, = 1.10, p = .28, Cohen d = -36, power at a .01= .06). In addition, neither group's estimate size distortion was significantly different from zero (abused t,,= -1.20, p = .25, power at a .01= .07; nonabused t,, = .00, p = .99, power at a .O1= .O1). The hypothesis of greater perceptual distortion for abused subjects was therefore not supported. However, further examination of the point of subjective equality values indicated that the variance of point of subjective equality scores was significantly greater for participants in the abused condition (Fmax,, =4.14, p < .01), indicating that participants with a history of abuse were much more variable in their judgments of their body size. In light of this, raw point of subjective equality scores were converted into absolute values, indicating the amount of distortion in each participant's bodysize judgment, irrespective of whether that distortion represented under- or overestimation. An independent groups t test on absolute value point of subjective equality scores between the abused and nonabused groups was significant (t,, = -2.56, p = .O2, Cohen d = 24, power at a .O1= .44) with the abused group presenting significantly greater body-size distortion ( M = 7.4, SD = 6.0) than the nonabused group (M = 3.5, SD = 2 3). This indicates that, while both groups significantly distorted their body-image sizes, there was a greater magnitude of body-image distortion in the abused group, although the direction of that distortion was not consistent. The hypothesis of greater perceptual distortion for abused participants was therefore supported when absolute values of distortion were used. In addition, significantly greater variability was noted for the absolute body-size distortion values of the abused participants (Fmax,, =4.48, p < .01). In the present experiment, the participants' JND scores showed their detection of changes or differences in their body size. Included in the third hypothesis was a prediction that abused participants might be poorer at detecting changes in their body size. The average JND score for the abused group was 2.72 (SD=3.79), while the nonabused group average was 2.03 (SD = 1.44). This indicates that on the average the abused participants had to see a change of 2.7% in their body size to detect the difference reliably (50% of the time) and nonabused participants 2.0%. The difference in JND values was not significant (t,, = .74, p= .47, Cohen d = .24, power for a .Ol = .O3), indicating no significant difference between the two groups in terms of accuracy in detecting changes in body size and no support for the hypothesized differences between the groups. In summary, abused subjects were significantly more variable in their body-size estimations. The absolute amount

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of body-size distortion was also greater for the abused participants. There was no difference between the two groups with respect to detection of changes in their body size. DISCUSSION Hypothesis 1 that abused participants would have lower body-esteem was supported. This supports previous studies showing various aspects of esteem are negatively related to an abusive family environment (Eigner, 1995; Wenninger & Heiman, 1998). Previous studies have found that adults reporting abuse do not show greater body dissatisfaction (Tobin & Griffing, 1996; Zlotnick, Hohlstein, Shea, Pearlstein, Recupero, & Bidadi, 1996), suggesting there may be an important distinction between how dissatisfied such persons are and with their body-esteem. Since these two are seemingly closely interrelated, possible distinctions must await further study. The hypothesis that there are differences in parenting history between abused and nonabused participants was also supported. Differences appeared on nearly every subscale of the parenting inventory, including parenting experiences of the mother and father. In a majority of the cases, these differences were significant at the .O01 level. As expected, abused participants reported more emotional and physical abuse. They also perceived their parents as being less loving and supportive and as being a more negative model. Of course, it is impossible to know for certain if the abuse they suffered was the only factor responsible for these discrepancies, as there may be other familial factors responsible. Nevertheless, a picture emerges wherein the abused participants clearly perceived large differences in negative familial experiences compared to the nonabused participants. The hypothesis that participants with a history of abuse would have greater body-size distortion was only partially supported by the data. The direction of the size distortion was not consistent, with both abused and nonabused participants equally likely to make over- or underestimates of their body size. Only the nonabused groups slightly underestimated their body size, while abused participants were almost precisely accurate. Significant differences between abused and nonabused were found only when examining the amount of distortion regardless of direction. College age women reporting a history of sexual or physical abuse were also more variable in their body-size judgments. Researchers examining body-size distortion should examine the absolute magnitude of distortion judgments, in addition to the more commonly used amount and direction of distortion. In cases where there is both over- and underestimation, the amounts can serve to cancel each other out if one looks only at the average values. Although individuals with eating disorders typically overestimate their body size (Gardner & Bokenkamp, 1996), the direction of body-size distortion in other populations

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may not be as consistent. Examination of both the absolute amount of distortion as well as the variability between groups may identify significant body-size distortions in populations where it has not been previously found. The inconsistency of these findings with previous studies using both children and adults (Warner, 1977; Kelly, 1984; Molinari, 2001) might be accounted for by several factors. Previous studies did not examine the absolute amount of body-size distortion independent of direction. Previous researchers did not use psychophysical techniques examining body-size judgments separately from and independent of detection of changes in body size. Gardner (1996) argued for the importance of measuring these factors separately in any measurement of body-size distortion. Limitations of the present study include an inability to locate independent groups of participants who had received sexual and physical abuse. In addition, nearly all reported instances of sexual abuse were by the father or other adults and not the mother. The sample may not be representative of persons reporting abuse, since all the participants were functioning college or university students. Calam and Slade (1989) noted that experiences with sexual abuse often are negativeIy related to academic performance. This may also be a reason that the abused group were significantly older than the nonabused group. Finally, it should be noted that retrospective self-reports about emotionally laden topics such as abuse should always be interpreted with caution. The present study adds to the small base of knowledge about the relationship of abuse to the perception of body size. For the first time, it also measures the ability of abused participants to detect changes in their body size. The computerized body-image distortion program appears to be a viable and useful way for investigators to measure both the attitudinal and perceptual aspects of body-image perception. It also adds to our knowledge of the role of parenting factors in college age women reporting sexual abuse as well as the relationships of childhood sexual abuse to body-esteem. REFERENCES ADAME,D. D., RADELL, S. A., JOHNSON, T. C., &COLE,S. P. (2003) Relations of physical fitness, body image, locus of control, depression, and self-reported exercise in college women and men. Research Quarterly for Exercise and Sport, 74, 1-13. P., HALLBERG, D., &EPSMARK, S. (1976) Bod image: an apparatus for measuring disALLEBECK, Research, 20, 583-589. turbances in estimation of sire and shape. lournaJof ~s~chosomatic ALTABE,M., &THOMPSON, J. K. (1990) Size estimation versus figural ratings of body image disturbance: relation to body dissatisfaction and eating dysfunction. International Journal of Eating Disorders, 11, 397-403. AMERICAN PSYCHIATRIC ASSOCIATION. (1994) Diagnostic and statistical manual of mental disorders. (4th ed.) Washington, DC: American Psychiatric Association. CALAM,R. M., &SLADE,l? D. (1989) Sexual experience and eating problems in female undergraduates. InternationalJournal of Eating Disorders, 8, 391-397. CASH,T. F., WOOD,K. C., PHELPS,K. D., &BOYD,K. (1991) New assessment of weight-related body image derived from extant instruments. Perceptual and Motor Skzlls, 73, 235-241.

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Accepted March 20, 2006