Digital body image interventions for adult women: A meta-analytic review.

Although many women experience body dissatisfaction, treatment options that prevent the onset of more serious conditions are limited in accessibility. As such, digital interventions may be an appropriate alternative resource to address restricted treatment options. This study provides statistical syntheses of the evidence for digital body image interventions for non-clinical adult women. A systematic literature search identified 19 studies (N = 2424) that tested the effect of a digital body image intervention compared to a control condition. Study results were synthesised using random effects models, and small to medium statistically significant effect sizes indicated that digital interventions were beneficial in increasing overall global satisfaction (g = 0.43) and reducing cognitive body dissatisfaction (g = 0.36). These meta-analytic findings provide evidence for the efficacy of digital body image interventions for non-clinical adult women. Intervention type was not found to be a statistically significant moderator, which may suggest that a range of intervention types can produce similar reductions in body dissatisfaction. Overall, digital body image interventions may be a feasible option to alleviate body dissatisfaction, particularly for women who may be unable to access conventional treatment.

Comparing Social Stigma of Dissociative Identity Disorder, Schizophrenia, and Depressive Disorders.

The aim of the current study was to explore how the social stigmatization of dissociative identity disorder (DID) compared to that of schizophrenia and depressive disorders. Using a between-subjects experimental design, a total of 139 participants (126 usable data [39 men, 84 women, 3 other]) from the general population were randomly assigned to either a DID, schizophrenia, or depressive disorders experimental condition and responded to an adapted version of the Prejudice Toward People With Mental Illness (PPMI) Scale. Results suggested that, overall, depressive disorders were stigmatized against the least, schizophrenia was stigmatized against the most, and DID was intermediate, with its PPMI score being closer to schizophrenia than that of depressive disorders. We also found the same pattern for most of the subscales of the PPMI. At least relative to other well-known disorders, there is negative stigma associated with having DID.

How coming out and community involvement affects body image: An in-depth examination of lesbian women's personal experiences.

Research on body image commonly focuses on the negative aspects of the construct, and the majority of findings related to body image in general arise from quantitative methods of investigation. Furthermore, little is known about the experiences lesbian women go through as they come out, and what consequence this has on their body image. In this study we examined the experiences of 12 lesbian women and explored how coming out affected their body image. Data were collected via face-to-face interviews and analyzed using thematic analysis. Participants' ages ranged from 20 to 33 (M = 25). The analysis revealed that all participants reported experiencing improved body image after coming out. Other changes related to the presentation of sexual identity in terms of how they dressed, i.e., presenting as either more masculine or feminine. Most participants reported feeling that the sexual and gender minority community was more accepting of different body shapes and sizes compared to the heteronormative society in which they resided. Negative feelings and experiences related to family situations, and occasionally from within themselves. The results are important in understanding how gender and sexual orientation are intertwined to create a distinct experience of body image in lesbian women, and also to illustrate the heterogeneity of body image within subgroups of women.

Body image disturbance and sexual orientation: An updated systematic review and meta-analysis.

Negative body image, or body image disturbance (BID) has been associated with depression, low self-esteem, and the development of eating disorders. Furthermore, BID may affect an individual regardless of gender or sexual orientation. To synthesise the current literature, we conducted a meta-analysis of 48 studies to determine if BID differed between lesbian versus heterosexual women, lesbian women versus gay men, and gay versus heterosexual men. Body image measures were grouped according to similarities in constructs measured, resulting in five different categories (global satisfaction, figural-rating scales, cognitive measures, affect measures, and male body image). The results indicated that lesbian women reported experiencing less BID compared to heterosexual women on measures of global satisfaction, but more compared to gay men, and gay men reported experiencing greater BID compared to heterosexual men on three out of five analyses. Moderation analyses indicated that the study quality was not a statistically significant moderator of the effect sizes. Results from this updated meta-analysis indicate that, to some degree, BIDs affect individuals regardless of gender and sexual orientation; however, there is some variability associated with sexual orientation.

Anorexia nervosa and perfectionism: A meta-analysis.

OBJECTIVE: Despite the multitude of research surrounding anorexia nervosa (AN) and perfectionism, there is yet to be a thorough investigation comparing perfectionism in those diagnosed with AN and other eating disorders, and other psychiatric diagnoses. The current meta-analysis aimed to explore these comparisons. METHOD: Following the Preferred Reporting Items or Systematic Reviews Meta Analyses (PRISMA) guidelines, we identified empirical studies that compared maladaptive and/or adaptive perfectionism scores in those diagnosed with AN and either a non-clinical comparison group, people diagnosed with a non-AN ED, or people diagnosed with another psychological disorder (i.e., other DSM diagnoses). In total, we identified 23 studies, comprising 3,561 participants who were all female. Comparison groups extracted from the studies were a non-clinical group, bulimia nervosa (BN) diagnosis group, and another psychological diagnostic group. RESULTS: When AN maladaptive perfectionism levels were compared against the comparison groups, the results showed that those diagnosed with AN were more perfectionistic compared to the non-clinical group (g = 1.00), and the other psychiatric diagnosis group (g = 0.41). People diagnosed with AN also had higher levels of adaptive perfectionism levels compared to the non-clinical group (g = 1.24). Comparisons between those diagnosed with AN and BN were statistically non-significant for maladaptive perfectionism. DISCUSSION: Although publication bias potentially affected the psychological diagnosis group comparisons, findings suggest that maladaptive perfectionism is a factor associated with both AN and BN.

Treatment outcome research of enhanced cognitive behaviour therapy for eating disorders: a systematic review with narrative and meta-analytic synthesis.

Enhanced cognitive behaviour therapy (CBT-E) has recently generated interest as a potentially useful treatment for eating disorders (ED). In the current study, we conducted a systematic review of the outcome literature on CBT-E, with both narrative and meta-analytic synthesis. We included single-group uncontrolled pre-post design studies and randomised control trials (RCTs) of CBT-E, which allowed us to include a larger number of studies, and also compare the two methodologies in terms of effect size. The primary analysis included 15 CBT-E studies with a total of 948 participants. Narrative synthesis examined bingeing and purging episodes, BMI change, and follow-up results. A large, statistically significant effect supported CBT-E as a treatment for all EDs (g = 1.06). When comparing methodologies, both pre-post design studies (g = 1.26) and RCTs (g = 0.82) yielded large effects. Narrative synthesis outlined reductions in ED behaviours and increases in BMI which were maintained at follow-up. Limitations include that further RCTs of CBT-E are needed to establish clinical effectiveness of this treatment approach for all EDs; however, results from narrative exploration indicate this endeavour would be worthwhile. Despite the limitations, this study provides additional support for CBT-E as a successful treatment across the range of EDs.

An examination of risk factors that moderate the body dissatisfaction-eating pathology relationship among New Zealand adolescent girls.

BACKGROUND: Eating disorders (EDs) and their subclinical variants are important health concerns for adolescent girls, and body dissatisfaction is a more common yet often debilitating experience that typically precedes the development of an ED. Despite this fact, little is known about what makes girls who are dissatisfied with their bodies more likely to engage in pathological eating behaviors. The present study explored eating pathology among a sample of adolescent girls from New Zealand and examined a variety of established risk factors that may moderate the relationship between body dissatisfaction (BD) and eating pathology. METHODS: Adolescent girls aged between 14 and 18 (N = 231) completed questionnaires assessing eating pathology, BD, negative affect, perfectionism, self-esteem, teasing and sociocultural pressure. Regression analyses tested for moderator effects to examine which variables moderated the relationship between BD and eating pathology. RESULTS: The analyses indicated that high levels of socially prescribed and self-oriented perfectionism, negative affect, perceived pressure from the media, and low levels of self-esteem all strengthened the relationship between BD and eating pathology. CONCLUSIONS: The results highlight potential factors that may make adolescent girls who are dissatisfied with their bodies more susceptible to eating pathology.

Psychopathology Factors That Affect the Relationship Between Body Size and Body Dissatisfaction and the Relationship Between Body Dissatisfaction and Eating Pathology.

Although high body mass index (BMI) alone does not invariably lead to body dissatisfaction (BD) and BD alone does not invariably lead to eating pathology (EP), research has suggested that there are clear relationships between each predictor and its respective criterion. We have a limited understanding of the factors that explain why some women at higher risk for BD (because of their BMI) do not report being dissatisfied with their bodies and why some women who are highly dissatisfied, do not engage in pathological eating behaviors. The present study examined such factors. A university sample of New Zealand women (N = 166) completed the Personality Assessment Inventory (Morey, 1991) and questionnaires measuring BD and EP. The tendency to report lower BD than would be predicted by one's BMI, and the tendency to report lower EP than would be expected based on one's BD, were characterized by lower overall distress (i.e., lower levels of anxiety and depression) and greater mood stability compared to those who followed the predicted outcome. Greater understanding of the factors that protect high-risk women from BD and EP may contribute to prevention and intervention strategies.

The Relationship between Social Networking Site Use and the Internalization of a Thin Ideal in Females: A Meta-Analytic Review.

Previous research has indicated that exposure to traditional media (i.e., television, film, and print) predicts the likelihood of internalization of a thin ideal; however, the relationship between exposure to internet-based social media on internalization of this ideal remains less understood. Social media differ from traditional forms of media by allowing users to create and upload their own content that is then subject to feedback from other users. This meta-analysis examined the association linking the use of social networking sites (SNSs) and the internalization of a thin ideal in females. Systematic searches were performed in the databases: PsychINFO, PubMed, Web of Science, Communication and Mass Media Complete, and ProQuest Dissertations and Theses Global. Six studies were included in the meta-analysis that yielded 10 independent effect sizes and a total of 1,829 female participants ranging in age from 10 to 46 years. We found a positive association between extent of use of SNSs and extent of internalization of a thin ideal with a small to moderate effect size (r = 0.18). The positive effect indicated that more use of SNSs was associated with significantly higher internalization of a thin ideal. A comparison was also made between study outcomes measuring broad use of SNSs and outcomes measuring SNS use solely as a function of specific appearance-related features (e.g., posting or viewing photographs). The use of appearance-related features had a stronger relationship with the internalization of a thin ideal than broad use of SNSs. The finding suggests that the ability to interact with appearance-related features online and be an active participant in media creation is associated with body image disturbance. Future research should aim to explore the way SNS users interact with the media posted online and the relationship linking the use of specific appearance features and body image disturbance.

Use of social networking sites and associations with skin tone dissatisfaction, sun exposure, and sun protection in a sample of Australian adolescents.

OBJECTIVE: Previous research has indicated that greater exposure to traditional media (i.e. television, film, and print) predicted skin cancer risk factors in adolescents; however, the relationship between social media usage and these outcomes remains unexplored. We examined whether social networking site (SNS) usage, and the particular manner of this use, was associated with skin tone dissatisfaction, sun exposure and sun protection among Australian adolescents. We also explored sex differences in SNS usage related to tanning. METHOD: A total of 1856 South Australian secondary school students completed the Australian School Students Alcohol and Drug 2014 survey. SNS usage related to tanning comprised posting pictures, posting text, viewing pictures, viewing text and liking or sharing posts. RESULTS: Adolescents spent 214.56 minutes, on average, per day using SNSs. Behaviours related to tanning that involved pictures (i.e. viewing pictures, posting pictures, and liking or sharing content) were significantly associated with more skin tone dissatisfaction, more sun exposure and less sun protection. Females performed all SNS-linked behaviours more frequently than did males, with the exception of posting text. CONCLUSION: Australian adolescents spend a considerable amount of time using SNSs, and their behaviours related to tanning on these SNSs are significantly associated with skin cancer risk factors.

Measuring Dietary Restraint Status: Comparisons between the Dietary Intent Scale and the Restraint Scale.

The measurement of young women's self-reported dietary restraint status is complex. Compared to Herman and Polivy's commonly utilized Restraint Scale (RS), Stice's Dietary Intent Scale (DIS) is less understood. Because the DIS is becoming a popular research tool, it is important to understand how this scale compares to more traditional measures of restraint. We conducted two correlational studies (Study 1 N = 110; Study 2 N = 216) to ascertain the similarities and the differences between the DIS and - as a comparison measure - the well-researched RS. We explored how the two scales were related to several body image variables (e.g., thin-ideal internalization); with a range of self-regulatory variables (e.g., dispositional self-control); with observed food intake during a taste test; and with 18-month weight change (Study 2 only). Participants were female University students and were not selected for dieting or disordered eating. Unlike RS scores, DIS scores were not significantly correlated with the majority of variables tapping into unsuccessful self-regulation. However, our data also highlighted similarities between the two restraint scales (e.g., association with 18-month weight-loss) and demonstrated that not only were participants' DIS scores un-related to unsuccessful self-regulatory variables, neither were they related to the variables tapping into successful self-regulation.

Translation and validation of a Spanish version of the Sociocultural Attitudes Towards Appearance Questionnaire-4 (SATAQ-4).

OBJECTIVE: The goal of this study was to create a Spanish version of the Sociocultural Attitudes Towards Appearance Questionnaire-4 (SATAQ-4) and examine its factorial validity, reliability, and convergent validity in a sample of women from Spain. METHOD: Two hundred and sixty female college students from Spain completed the Spanish version of the SATAQ-4 and measures for eating pathology. RESULTS: Internal consistency was high; data from EFA and CFA supported the original five-factor structure; and results showed good convergent validity with measures of body-image and eating problems. DISCUSSION: Results strongly support the psychometric properties of the Spanish version of SATAQ-4 and its use to examine perceived pressure for thinness from parents, peers and the media; and thin- and muscular/athletic-ideal internalization in Spanish-speaking adult women.

Reality versus fantasy: reply to Lynn et al. (2014).

We respond to Lynn et al.'s (2014) comments on our review (Dalenberg et al., 2012) demonstrating the superiority of the trauma model (TM) over the fantasy model (FM) in explaining the trauma-dissociation relationship. Lynn et al. conceded that our meta-analytic results support the TM hypothesis that trauma exposure is a causal risk factor for the development of dissociation. Although Lynn et al. suggested that our meta-analyses were selective, we respond that each omitted study failed to meet inclusion criteria; our meta-analyses thus reflect a balanced view of the predominant trauma-dissociation findings. In contrast, Lynn et al. were hypercritical of studies that supported the TM while ignoring methodological problems in studies presented as supportive of the FM. We clarify Lynn et al.'s misunderstandings of the TM and demonstrate consistent superiority in prediction of time course of dissociative symptoms, response to psychotherapy of dissociative patients, and pattern of relationships of trauma to dissociation. We defend our decision not to include studies using the Dissociative Experiences Scale-Comparison, a rarely used revision of the Dissociative Experiences Scale that shares less than 10% of the variance with the original scale. We highlight several areas of agreement: (a) Trauma plays a complex role in dissociation, involving indirect and direct paths; (b) dissociation-suggestibility relationships are small; and (c) controls and measurement issues should be addressed in future suggestibility and dissociation research. Considering the lack of evidence that dissociative individuals simply fantasize trauma, future researchers should examine more complex models of trauma and valid measures of dissociation.

Measuring eating disorder attitudes and behaviors: a reliability generalization study.

BACKGROUND: Although score reliability is a sample-dependent characteristic, researchers often only report reliability estimates from previous studies as justification for employing particular questionnaires in their research. The present study followed reliability generalization procedures to determine the mean score reliability of the Eating Disorder Inventory and its most commonly employed subscales (Drive for Thinness, Bulimia, and Body Dissatisfaction) and the Eating Attitudes Test as a way to better identify those characteristics that might impact score reliability. METHODS: Published studies that used these measures were coded based on their reporting of reliability information and additional study characteristics that might influence score reliability. RESULTS: Score reliability estimates were included in 26.15% of studies using the EDI and 36.28% of studies using the EAT. Mean Cronbach's alphas for the EDI (total score = .91; subscales = .75 to .89), EAT-40 (total score = .81) and EAT-26 (total score = .86; subscales = .56 to .80) suggested variability in estimated internal consistency. Whereas some EDI subscales exhibited higher score reliability in clinical eating disorder samples than in nonclinical samples, other subscales did not exhibit these differences. Score reliability information for the EAT was primarily reported for nonclinical samples, making it difficult to characterize the effect of type of sample on these measures. However, there was a tendency for mean score reliability to be higher in the adult (vs. adolescent) samples and in female (vs. male) samples. CONCLUSIONS: Overall, this study highlights the importance of assessing and reporting internal consistency during every test administration because reliability is affected by characteristics of the participants being examined.

Positive fantasies or negative contrasts: the effect of media body ideals on restrained eaters' mood, weight satisfaction, and food intake.

Although viewing media body ideals promotes body dissatisfaction and problematic eating among women (e.g., extreme restraint/overeating), some argue that women only report such negative effects because they think that they are meant to (i.e., demand characteristics). Because restrained eaters are trying to lose weight, they might be vulnerable to such media exposure. However, because of demand characteristics, evidence is mixed. Therefore, we minimized demand characteristics and explored whether media body ideals would trigger restrained eaters to report negative (negative mood, weight dissatisfaction) or positive (positive mood, weight satisfaction) effects. We also hypothesized that this change (negative or positive) would encourage food intake. Restrained and unrestrained eaters (n=107) memorized media or control images. Restrained eaters exposed to media images reported decreased weight satisfaction and increased negative mood, but their food intake was not significantly affected. Perhaps paying advertent attention to the images caused goal-related negative affect, which triggered restraint.

Quality of life impairment and the attitudinal and behavioral features of eating disorders.

We examined the relative contribution of different forms of eating disorder (ED) pathology to impairment in mental and physical health-related quality of life (QOL) in women with a wide range of ED symptoms. Female participants from an outpatient ED clinic (n = 53) and the local community (n = 214) completed measures of ED features and mental and physical health-related QOL. Across the sample, ED features were significantly associated with most mental and physical domains of QOL. In multiple regression analyses controlling for age and body mass index, ED features significantly predicted impairment in mental and physical QOL. Extreme shape and weight concern significantly and independently predicted most QOL subscales (ß range = 0.19-0.44). The prominent contribution of shape and weight concern to both mental and physical QOL impairment underlines the importance of addressing body dissatisfaction in the treatment and prevention of EDs.

A Spanish version of the Sociocultural Attitudes Towards Appearance Questionnaire-3 (SATAQ-3): translation and psychometric evaluation.

OBJECTIVE: The goal of this study was to translate the Sociocultural Attitudes Towards Appearance Questionnaire-3 (SATAQ-3; Thompson, van den Berg, Roehrig, Guarda, & Heinberg, 2004) into Spanish and psychometrically evaluate the comparability of the Spanish translation to the original English version. METHOD: 638 female college students from Spain and the United States completed the SATAQ-3 in Spanish and English, respectively. RESULTS: Internal consistency was high in both languages. Tests of factor equivalence suggested that the four pre-established factors of the SATAQ-3 (i.e., knowledge, perceived pressure, thin-ideal internalization, athletic-ideal internalization) were relatively similar between the two groups. Differences that emerged between groups (on items 6 and 20) were in the expected direction and appeared to be influenced by reverse-scoring or item wording. CONCLUSIONS: Results support the psychometric properties of this Spanish translation of the SATAQ-3 and support its use to measure endorsement of Western values and ideals of appearance in adult women.

Score reliability and factor similarity of the Sociocultural Attitudes Towards Appearance Questionnaire-3 (SATAQ-3) among four ethnic groups.

BACKGROUND: This study evaluated the score reliability and equivalence of factor structure of the Sociocultural Attitudes towards Appearance Questionnaire-3 (SATAQ-3) [1] in a sample of female college students from the four largest ethnic groups in the USA. METHODS: Participants were 1245 women who self-identified as European American/White (n = 543), African American/Black (n = 137), Asian American (n = 317), or Latina/Hispanic (n = 248). All completed the SATAQ-3 and a demographic questionnaire. To test the factor similarity and score reliability across groups, we used exploratory factor analysis and calculated Cronbach's alphas (respectively). RESULTS: Score reliability was high for all groups. Tests of factor equivalence suggested that the four pre-established factors of the SATAQ-3 (i.e., knowledge, perceived pressure, thin-ideal internalization, athletic-ideal internalization) were similar for women of all ethnic groups. Only two items (20 and 27) did not consistently load on the previously identified scale across all four groups. When scored, African Americans reported significantly less perceived pressure and internalization than all other groups. CONCLUSIONS: Results support the use of the SATAQ-3 in female college students of these four ethnicities.

Body checking and avoidance in women: associations with mental and physical health-related quality of life.

Body checking and body avoidance have demonstrated clinical significance in a number of populations. However, the associations between these behaviors and mental and physical health-related quality of life have not been examined. This study investigated the associations between body checking and avoidance and quality of life in 214 community women. Body checking and body avoidance were significantly correlated with mental and physical quality of life, as well as with eating disturbances. Frequency of body checking significantly predicted impairment in mental quality of life, and frequency of body avoidance significantly predicted impairment in physical quality of life, over and above the contributions of depressive symptoms and related demographic characteristics. Targeting checking and avoidance in prevention and treatment programs may improve quality of life and reduce health-related functional impairment.