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The Role of Sisters in Body Image Dissatisfaction
and Disordered Eating
Kerri Coomber &Ross M. King
#Springer Science + Business Media, LLC 2008
Abstract The Tripartite Influence Model (TIM) argues
sociocultural agents affect body image dissatisfaction (BID)
via the mediators of social comparison and internalization.
BID subsequently influences disordered eating. Forty-seven
Australian sister pairs (18–25 years) provided self-reports
of perceived familial modeling and pressure by the
sociocultural agents of mother, father and sister, social
comparison, internalization, BID, bulimic behaviors, and
dietary restriction. Sisters were correlated on internaliza-
tion, BID, disordered eating, and parental modeling and
pressure. Mothers and sisters were equally important
modeling agents. Sisters were an equivalent social compar-
ison target to peers. Consistent with the TIM, internaliza-
tion and social comparison mediated familial pressure on
BID. Contrary to the model, sister modeling directly
affected bulimic behaviors and dietary restriction.
Keywords Sisters .Body image .Disordered eating .
Familial influence .Tripartite influence model
Two key areas in the development of body image dissatisfac-
tion (BID) and disordered eating within an Australian, young
adult female sample have been investigated within the current
study. These are: how sisters impact each other in regard to
body image dissatisfaction (BID) and disordered eating, and
the degree of similarity between sister pairs on their
perception of their mother, father and sister as influential
communicators of body image and eating attitudes and
behaviors. Employing a quantitative self-report questionnaire
methodology, these questions will be addressed using current
dominant theories of BID and disordered eating.
Body image dissatisfaction (BID) is the negative subjective
evaluation of one’s own physical appearance (Groesz et al.
2002; Stice 1998). BID is a complex, multidimensional
construct encompassing factors such as body esteem and
body size distortion, and an individual’s attitude towards
their own body weight, size, and appearance (Pruzinsky and
Cash 2002). Furthermore, both structural equation modeling
and prospective research evidence indicates that BID is a risk
factor for development of disordered eating (Ricciardelli
et al. 1997;SticeandAgras1998; Stice and Shaw 2002;
Thompson et al. 1999a).
Considerable research evidence indicates that in Western
countries such as the USA and UK the current societal
standard of attractiveness for females is a thin ideal body
type (Thompson et al. 1999b). This ideal is so pervasive that
body image concerns and dieting behaviors are widespread
among both adolescent and young adult females (Thompson
et al. 1999b). Extensive research indicates that exposure to
media representations of this ideal (Groesz et al. 2002)as
well as pressure and modeling by sociocultural agents such
as peers and family (e.g., Cafri et al. 2005;Levineetal.
1994; Keery et al. 2004;vandenBergetal.2002)are
predictive of the development of BID. Furthermore, inter-
nalization of this thin-ideal is consistently demonstrated to be
a significant predictor of BID (Cafri et al. 2005).
Australian research mirrors that found in other Western
countries; between 60 and 90% of Australian adolescent
and young adult females report desiring a thinner body size
(Maude et al. 1993; Nowak et al. 2001), including nearly
70% of young adult females in the healthy BMI range
(Kenardy et al. 2001). Similar to overseas research,
Australian studies indicate that family, peers, and the media
are significant influences on BID (Dunkley et al. 2001;McCabe
and Ricciardelli 2001; Schutz et al. 2002;Tiggemannand
Slater 2004). Furthermore, prospective research on Australian
K. Coomber (*):R. M. King
School of Psychology, Deakin University,
Geelong, Victoria 3217, Australia
female adolescents shows that exposure to appearance-
related magazines predicts internalization of the thin-ideal
Sociocultural theories propose that social ideals for body
weight and shape emphasize a thin-ideal (Thompson et al.
1999b). Research within both USA (e.g., Stice 1994)and
Australia (e.g., Wertheim et al. 1997) has shown that
sociocultural agents, including family, the media and peers,
can reinforce this ideal within the social environment. A
recent model within the domain of sociocultural theories that
has shown promise is the Tripartite Influence Model (TIM;
Thompson et al. 1999b), which integrates a number of
theoretical perspectives on BID and disordered eating. In line
with sociocultural theories, the TIM proposes that family
members, peers and the media are important contributors to
the development of BID, with their influence being mediated
by the mechanisms of social comparison and internalization
of the thin-ideal (Thompson and Stice 2001). Subsequently,
BID directly impacts upon the disordered eating patterns of
dietary restraint and bulimic behaviors. When utilized to
examine familial influences, the TIM provides a useful
theoretical framework to understanding the development of
BID and disordered eating within young women.
Path analytic studies have provided support for the TIM
as a functional framework for understanding BID and
disordered eating in young women and female adolescents
(Keery et al. 2004; van den Berg et al. 2002). van den Berg
and colleagues (2002) utilized covariance structure model-
ing to examined the utility of the TIM with a sample of
American college females. Consistent with the proposed
relationship within the TIM, the effect of family members
and media on BID was found to be mediated by social
comparison, but not so for peer influences. Within this
study peer influences directly impacted upon dietary
restriction, as opposed to the proposed relationship (van
den Berg et al. 2002). As such, the TIM did not receive full
support. However, van den Berg et al.’s(2002) study was
limited by their focus on only social comparison as a
mediator. Keery and colleagues (2004) found both social
comparison and internalization either fully or partially
mediated the relationship between parental, peer and media
influence on BID in American young adolescent females.
Therefore, examinations of the TIM indicate that the media,
peers and family are influential agents on BID and
disordered eating. However, while some BID studies have
disaggregated the effect of family members (e.g., Levine et
al. 1994; Vincent and McCabe 2000), those using the TIM
typically have not disaggregated family influence into
individual agents, namely, mother, father and siblings.
Consequently, the potential differential influence of specific
family members has not been determined. Such an
examination is warranted given the existing evidence
supporting the differential impact of maternal and paternal
influences (Keel et al. 1997; Levine et al. 1994)
Sociocultural theories proposes that the family environment
provides salient, proximal reinforcement of the Western societal
thin-ideal via both modeling and direct pressure (Dunkley et al.
2001; McCabe and Ricciardelli 2005; Wertheim et al. 1997,
2004). Modeling of the thin-ideal consists of an individual
displaying negative attitudes about their own weight and body
image concerns in conjunction with associated behaviors such
as attempts to lose weight (Wertheim et al. 2004). Conversely,
a young female may hear directly from family members that
her body shape or weight is not desirable and that she should
lose weight. This may be accompanied by criticism from
family members directed to eating habits, body shape and
appearance (Wertheim et al. 2004).
The effect of maternal modeling of body image
concerns, dieting and weight loss behaviors on the
development of BID within young females has received
inconsistent support (Pike and Rodin 1991; Stice 1998;
Thelen and Cormier 1995), suggesting that indirect com-
munication of the thin-ideal may be an unreliable predictor
of BID. Attempts to elucidate these discrepant findings
suggest that adolescents whose mothers utilize more
extreme weight loss behaviors, such as extreme dietary
restriction or purging, may be more susceptible to the
influence of maternal modeling (Benedikt et al. 1998;
Sanftner et al. 1996). There is currently limited research
assessing the impact of paternal modeling of such concerns
and behaviors on BID, with indications that it is less
influential than maternal modeling (Keel et al. 1997).
Parental pressure to be thin via direct encouragement to
diet or suggestions to lose weight can be determined through
either parents’self-report of their comments, or participants’
self-report of perceived parental encouragement to be thin
(Moreno and Thelen 1993; Stice et al. 1998;Thelenand
Cormier 1995). Further, parental pressure to be thin, rather
than parental modeling of weight and shape concerns, is a
more powerful predictor of a daughter’s BID and disordered
eating patterns (Wertheim et al. 2004). Stice and colleagues
(1998) found that within an American adolescent sample
pressure to be thin predicted disordered eating after a nine
month period. Further, many cross-sectional studies show
that pressure to be thin is moderately correlated with
disordered eating within American children (Thelen and
Cormier 1995), Australian adolescents (Benedikt et al. 1998;
Wertheim et al. 2002) and American undergraduate females
(Moreno and Thelen 1993). Therefore, a significant relation-
ship exists between parental pressure to be thin and
daughter’s BID and consequent weight loss attempts
(Benedikt et al. 1998; Moreno and Thelen 1993;Thelen
and Cormier 1995; Wertheim et al. 2002). Maternal pressure
is more influential than paternal pressure to be thin, with
daughters perceiving lower levels of encouragement to be
thin from their fathers for American children (Thelen and
Cormier 1995), Australian and New Zealand adolescents
(Dixon et al. 2003; Wertheim et al. 2002) and American
undergraduate female samples (Moreno and Thelen 1993).
However, simple exposure to familial modeling and pressure
are insufficient predictors of BID (Heinberg and Thompson
1995;Thompsonetal.1999b). Internalization of the thin-
ideal and social comparison are cognitive processes identi-
fied as contributing to individual differences in BID
(Thompson et al. 1999b).
Internalization of the thin-ideal occurs when an individual
holds the Western societal thin-ideal as a personal standard to
achieve (Low et al. 2003; Thompson and Stice 2001). Pursuit
of an unattainable thin-ideal can lead to BID and disordered
eating (Stice and Shaw 2002; Stormer and Thompson 1996).
In examining the relationship between parental influence and
internalization structural equation modeling studies have
indicated that a combined measure of modeling and pressure
from parents predicts internalization (Keery et al. 2004;
Shroff and Thompson 2006). Further, correlational studies
consistently show that internalization is associated with
increased BID (Low et al. 2003; Stormer and Thompson
1996), with longitudinal studies indicating that higher levels
of internalization may be predictive of BID (Stice and Agras
1998; Stice et al. 1998;SticeandWhitenton2002). Lastly,
experimental studies which provide participants with cogni-
tive tools to tackle media representations of the thin-ideal
decrease internalization, as well as increase positive body
image and healthy eating in young women (Stice et al. 2000,
2001). Therefore, internalization contributes to BID and
disordered eating patterns (Cafri et al. 2005; Stice et al. 2000,
2001; Thompson and Stice 2001), however, it has been
argued that the relationship between internalization and BID
may be reciprocal in nature (Stice and Tristan 2005).
Social comparison of physical appearance has been identi-
fied as a further influential factor in BID (Thompson et al.
1999a). The negative impact of social comparison increases if
the comparison target is perceived as more attractive (Wood
1989), important to the individual (Thompson et al. 1999a),
and when a size/weight comparison is made salient (Stormer
and Thompson 1996). Experimental manipulation of social
comparison to targets conforming to the thin-ideal within
music videos (Tiggemann and Slater 2004), commercials
(Cattarin et al. 2000) and in-vivo with peers (Krones et al.
2005) has been shown to increase BID. Longitudinally, social
comparison predicts BID in adolescent girls (Jones 2004).
The relationship between internalization and social
comparison appears to be reciprocal in nature. Those high
in internalization compare their appearance to others more
readily (Tiggemann and McGill 2004), while frequent
social comparison can also intensify internalization
(Dittmar and Howard 2004; Krones et al. 2005). As targets
of repeated social comparison, images of models and
celebrities can increase BID and disordered eating among
young women (Garner 1997; Thompson et al. 1999b), with
a greater effect for women who have internalized the thin-
ideal, and/or have initial high levels of BID and shape
concerns (Groesz et al. 2002).
The Role of Sisters
Currently, there is limited body image and disordered eating
research involving the sister relationship. Within the family
environment, Australian adolescent females perceive similar
levels of parental modeling of weight concerns and dieting,
and parental pressure to be thin (Bliss 2000). Preliminary
findings indicate that within the family environment adoles-
cent sisters may be the most potent modeling agents of
weight concerns (Bliss 2000). However, sisters were
perceived to communicate equivalent pressures to be thin
as both parents (Bliss 2000). As sisters may perceive more
modeling cues from each other than either parent, it could be
speculated that they are important social comparison targets.
Both during adolescence (Bliss 2000) and young
adulthood (Tsiantas and King 2001), Australian sisters have
been found to be influential targets of social comparison.
This comparison may be more negative when they are
perceived as more attractive (Rieves and Cash 1996).
However, preliminary evidence suggests that outside the
family environment, female peers are more influential
targets of comparison than sisters for Australian young
adolescent females (Schutz et al. 2002). Nonetheless, social
comparisons with peers and sisters have yet to be examined
within one study for young adult women.
Finally, sisters also report similar levels of internalization
of the thin-ideal and BID (Bliss 2000; Tsiantas and King
2001). Therefore, sisters wish to attain a similar ideal body
shape and weight. Taken together, previous findings (Bliss
2000; Rieves and Cash 1996; Tsiantas and King 2001) may
lead to the speculation of the existence of a familial
subculture of thinness. Such a subculture is similar to
Levine and colleagues’(1994) definition of a subculture of
dieting, where girls are exposed to the thin-ideal via the
media, peers and parents. A familial subculture would
comprise family members’endorsement of the thin-ideal,
thereby placing adolescents and young women at a greater
risk for BID and disordered eating.
To date only one study utilizing the TIM has disaggregated
family influence into mother, father and sister to investigate
their impact on both BID and disordered eating. Bliss (2005)
utilized structural equation modeling to examine the TIM as
an explanatory model within Australian adolescent sister
pairs. Within this study, all components of the TIM were
tested; that is, the impact of the media, peers and family as
mediated by social comparison and internalization; however,
there was an additional specific focus on the impact of sisters.
While the study is limited by cross-sectional, retrospective
self-report data, there were some important preliminary
findings. Although perceived mother and father influence on
BID were mediated by social comparison and internalization
as predicted within the TIM, the effect of sister modeling of
dietary behaviors and body shape and weight concerns
directly impacted on dietary restriction and sister pressure,
in the form of direct communication that their sister needs to
be thin or lose weight, directly affected bulimic behaviors
(Bliss 2005). This suggests that sisters may be a powerful
influence on both BID and disordered eating.
Summary and Hypotheses
In summary, the TIM provides a functional framework for
the development of BID and disordered eating, indicating
that sociocultural agents exert their influence on BID via
the mediating variables of social comparison and internal-
ization (Keery et al. 2004; van den Berg et al. 2002).
Further, within Australia family members are important
sociocultural agents in the development of BID and
disordered eating (e.g. Benedikt et al. 1998; Bliss 2005;
Wertheim et al. 2002). To date, sisters have typically been
neglected as sociocultural agents within BID and disordered
eating research, despite preliminary evidence suggesting
they are exposed to similar familial messages of the thin-
ideal and they are influential sociocultural agents for each
other. Further, preliminary evidence suggests that sisters
bypass the proposed mediators of social comparison,
internalization and BID to exert a direct influence upon
disordered eating (Bliss 2005). The finding that sisters
impact BID and disordered eating requires replication to
further delineate the exact nature of their influence.
The present study aims to build upon preliminary evidence
of the role sisters have in BID and disordered eating. Using the
TIM as a theoretical framework to ascertain variables relevant
to the development of BID and disordered eating, a
quantitative self-report methodology will examine various
aspects of the sister relationship in terms of BID and
disordered eating. The first broad aim is to examine how
similar or different young adult sisters are, with regard to BID,
disordered eating, and perceptions of mother, father and sister
modeling and pressure. Specifically, it was hypothesized that
sisters are a significantly greater source of modeling and
pressure than either parent (H1). Further, it was hypothesized
that sisters and peers are significantly more important targets
for social comparison than mothers and fathers (H2). In terms
of similarities between sister pairs, it was hypothesized that
they would be significantly correlated on measures of social
comparison, internalization, BID, dietary restraint and bulimic
behaviors (H3), and that sister pairs would be significantly
correlated on perceptions of mother, father and sister
modeling and pressure (H4).
The second broad aim concerned the examination of the
mediating role of social comparison and internalization
between father, mother and sister modeling and pressure on
BID as proposed within the TIM. As such, it was
hypothesized that social comparison and internalization will
act as independent mediators on the relationship between
perceived modeling and pressure from mothers, fathers and
sisters and BID (H5). The final aim of the current study is to
examine whether the influence of perceived modeling and
pressure from sisters has a direct effect upon disordered
eating. Specifically, it was hypothesized that contrary to the
TIM, sister influence will have a significant direct relation-
ship to both dietary restraint and bulimic behaviors (H6).
Participants were recruited from Australian undergraduate
students and personal contacts of the researchers. Partic-
ipants were either informed in person about the study, or sat
though short presentations given at lectures in which
information about the study was conveyed. Interested
participants received a pair of questionnaires. In the
majority of cases only one participant in each pair was
initially recruited. The recruited participants were asked to
provide a copy of the plain language statement and
questionnaire to their sister. The plain language statement
invited the second sister to participate but stressed that their
involvement was voluntary and independent of their sisters’
involvement. Therefore, confidentiality and anonymity of
both sisters within a pair was achieved.
One hundred and twenty-eight pairs of questionnaires
were distributed to sister pairs meeting two criteria. Firstly,
they were both aged between 18–25 years; and secondly,
they had regular contact with their mother, father and each
other. An examples of regular contact include, “I live with
my mother, but see my father regularly.’A total of 47 pairs
of questionnaires were returned, yielding a 37% response
rate. Of the pairs of questionnaires not returned, six
younger sisters and six older sisters were unpaired.
Examination of the unpaired data revealed no systematic
biases in between the paired and unpaired responses, aside
from a non-significant higher perceived level of familial
modeling from the unpaired younger sisters.
The mean age of younger and older sisters was
19.55 years (SD=1.30) and 21.81 years (SD=1.78), respec-
tively, with a mean age difference of 2.26 years (SD=1.42).
Current BMI was in the healthy range for both younger (M=
22.98, SD=4.44) and older sisters (M=22.02, SD=3.13).
Average ideal BMI was 21.03 (SD=2.50) for younger and
20.53 (SD=2.40) for older sisters. Sister pairs perceived
themselves as very close (M=3.88, SD=.90) on a five-point
Likert scale (1=not at all close, 5= extremely close).
General Information Sheet
The general information sheet obtained demographic
information regarding participant’s age, their sister’s age,
amount of contact with their sister, perceived closeness of
their relationship, whether they live at or away from home,
and the participant’s current height, current weight, and
Eating Disorders Inventory-2 (EDI-2)
Participants completed three subscales of the EDI-2 (Garner
1991): drive for thinness (EDI-DT), bulimia (EDI-B), and
body dissatisfaction (EDI-BD). The EDI-BD contains nine
items measuring dissatisfactionwithoverallshapeandsizeof
body areas of concern for those with eating disorders. The
EDI-B contains seven items measuring tendencies to think
about and engage in uncontrolled overeating (binging). The
EDI-DT contains seven items measuring excessive concern
with dieting, preoccupation with weight, and relentless drive
to be thin. All subscales are rated on a six-point Likert scale
(1=Never, 6= Always). Following the recommendation for
non-clinical samples, the untransformed six point scores were
summed (Shoemaker et al. 1994). Each subscale has good
convergent validity with other measures of BID and disor-
consistency for non-clinical samples (EDI-BD α=.91–.94;
EDI-B α=.69–.83; EDI-DT α=.81–.91; Shoemaker et al.
1994). Cronbach’s alphas for the current study indicated
acceptable internal consistency (EDI-BD α=.91; EDI-B
α=.86; EDI-DT α=.91).
Sociocultural Attitudes Towards Appearance Questionnaire
III—Internalization Subscale (SATAQ-I)
The SATAQ-I (Thompson et al. 2004) subscale measures
internalization of the thin-ideal. Nine items assess the
extent to which participants accept and internalize media
portrayals of the thin-ideal using a five-point Likert scale (1
=Completely Disagree, 5 = Completely Agree). However,
due to a typographical error, item nine from the SATAQ-I
was removed prior to analyses. An example item is “I wish
I looked like the models in music videos”. Item scores are
summed with high scores indicating increased internaliza-
tion of the thin-ideal. There is good convergence between
the SATAQ-I and BID and eating disturbance (r= .32–.57),
and high reliability (Cronbach’sα=.92; Thompson et al.
2004), with a Cronbach’s alpha of .94 in the current study.
Social Comparison Questionnaire (SCQ)
The original SCQ (Schutz et al. 2002) assesses both the
frequency and effect of comparison with specific targets.
Five revised items such as “If you do compare your body
with others, who do you compare your body with?”were
each rated on a five-point Likert scale (1=Never, 5=Very
often) for sister, mother, father and female friends. High
scores indicate increased influence of comparison. The
original SCQ demonstrates high internal consistency with
Cronbach’s alphas ranging from .80 to .87 (Schutz et al.
2002). The SCQ has been successfully used in body image
and disordered eating studies within adolescent females
(Durkin et al. 2007; Keery et al. 2004; Shroff and Thompson
2006). Further, the SCQ demonstrates convergent validity
with body image and disordered eating measures (Keery et
al. 2004;Schutzetal.2002). The Cronbach’salphaforthe
current study was .76.
Family, Peers and Media Influence Scale—Family Subscale
The FPMIS-f assesses perception of modeling of body
weight and shape concerns, and dieting behavior as
displayed by parents and sisters, and was adapted by Bliss
(2005) from an original scale by Levine et al. (1994). Using
a five-point Likert scale (1= Never, 5=Always), three items
assess whether the participant’s mother, father or sister diet,
while six items assess the perceived importance of weight
and appearance for family members (1 = Not at all impor-
tant, 5=Very important). A “Not Applicable”option was
also provided, which was scored as 0 for consistency with
Bliss (2005). Separate scores for mother, father and sister
were calculated with higher scores indicating greater
modeling. Currently, little evaluation of the validity of the
FPMIS has been conducted. However, the scale has been
used successfully within adolescent (Keery et al. 2004) and
young adult female samples (van den Berg et al. 2002). The
FPMIS has good internal consistency (Cronbach’sα=.84;
Bliss 2005) with a Cronbach’s alpha of .73 for the FPMIS-f
in the current study.
Family and Peers Involvement Scale—Family Subscale
The FPIS-f assesses participants perceptions of the degree of
importance that the participant be thin as communicated by
their parents, sisters and peers, as adapted by Bliss (2005)
from an original scale by Levine et al. (1994). Six items
measuring parental and sister pressure were used in the
current study. An example is, “How important is it to your
mother that you be thin?”are rated on a five-point Likert
scale (1= Not at all important to 5=Very important). A “Not
Applicable”option was also provided, which was scored as
0 for consistency with Bliss (2005). Separate scores for
mother, father, and sister were summated, with higher scores
indicating greater pressure. The validity of the FPIS has yet
to be evaluated; however it has been effectively utilized
within previous research (Bliss 2005; Keery et al. 2004). The
revised FPIS has good internal consistency (Cronbach’s
α=.83; Bliss 2005), with a Cronbach’s alpha of .77 for the
FPIS-f in the present study.
Approval for the study was obtained from the Deakin
University Human Research Ethics Committee. Participants
were recruited by three primary means: brief presentations
during undergraduate lectures, advertising in the university’s
electronic newsletter, and via personal contacts. Question-
naires were distributed to interested participants at the end of
lectures, via mail, or in person.
Sister pairs were instructed to independently complete
anonymous, self-report questionnaires in their own time,
and return them via reply-paid post. Questionnaires had
corresponding numbers (e.g., 48A and 48B) to enable
matching upon return.
Examination of Individual Sociocultural Agents
The first set of statistical analyses were conducted
separately for each sister group, that is, younger and older
sisters. These analyses examined within each group family
modeling and pressure, and their role as a target of social
comparison. For this purpose, a series of repeated-measures
ANOVAs were conducted. Further, pairwise contrasts were
conducted to assess the relative perceived influence of
sisters as compared to other measured sociocultural agents.
The alpha levels for these contrasts were adjusted using the
Bonferrroni correction (α/number of contrasts). Power
analyses showed that the sample sizes obtained in the
current study provided adequate power (>.08) for repeated-
measures ANOVAs (Faul et al. 2007).
Table 1presents the means and standard deviations for
the FPMIS-f and indicates a moderate degree of perceived
modeling from mothers and sisters, and low perceived
modeling from fathers. Given that parents and peers both
directly and indirectly influence BID and disordered eating,
and that previous findings indicate sisters may be an
important sociocultural agents (Bliss 2000,2005; Tsiantas
and King 2001), it could be speculated that sisters will exert
a direct and indirect influence.
To examine the hypothesis that sisters are a significantly
greater source of modeling than either parent (H1), a one-way
repeated-measures ANOVA (Hyunh-Feldt adjustment) was
Table 1 Means and standard deviations for modeling, pressure, comparisons, BID and disordered eating measures within younger and older
Younger sisters Older sisters
7.68 2.56 7.55 2.77
4.98 2.07 5.30 2.13
8.28 3.00 8.43 2.76
3.53 1.54 3.21 1.44
3.09 1.54 3.06 1.86
3.60 1.36 2.89 1.00
5.74 1.33 6.30 1.56
6.49 1.55 5.36 .82
8.51 2.83 8.13 2.27
9.47 2.93 8.57 2.66
31.77 9.87 32.15 9.82
14.45 6.32 12.23 3.98
Drive for thinness
19.13 7.85 19.21 7.99
Family, Peers and Media Influence Scale—Family Subscale, scale range is 3–15
Family and Peers Involvement Scale—Family subscale, scale range is 2–10
SCQ, scale range is 5–15
EDI-Body Dissatisfaction, scale range is 9–54
EDI-Bulimia, scale range is 7–42
EDI-Drive for Thinness, scale range is 7–42
conducted. This hypothesis was partially supported. A
significant difference existed between family members for
younger (F(2,82)=27.61, p<.001) and older sisters (F(2,90) =
26.41, p<.001). Pairwise comparisons revealed that contrary
to the hypothesis, participants perceived equal modeling cues
from mothers and sisters for both younger and older sisters.
Lastly, their sister was a significantly stronger modeling agent
than fathers for both younger (F(1,46)=35.64, p<.001) and
older sisters (F(1,46)=47.08, p<.001).
With respect to pressure to be thin as assessed by the
FPIS-f, both sisters perceived little pressure from family
members (see Table 1). The hypothesis that sisters are a
significantly greater source of pressure than either parent
(H1) was tested by conducting a one-way repeated-
measures ANOVA for each sister age group. This hypoth-
esis was not supported. The difference in perceived
pressure from family members approached significance
(Huynh-Feldt adjustment) for younger sisters, F(2,92) =
3.06, p=.052, with fathers the least influential pressure
agent. Older sisters (Greenhouse-Geisser adjustment) per-
ceived family members to exert equivalent pressure.
With respect to social comparison, means and standard
deviations for both groups of sisters are shown in Table 1.
Both sister groups reported a moderate degree of appearance
comparisons with sisters and female peers, but low tendency
to compare their appearance with either parent. The
hypothesis that sisters and peers are significantly more
important targets for social comparison than either parent
(H2) was tested using a one-way repeated-measures ANOVA
for each sister age group. The hypothesis was supported.
Specifically, there was a significant difference for comparison
targets for younger sisters (Greenhouse-Geisser adjustment;
F(2,101)=38.19, p<.001) and older sisters (Huynh-Feldt
adjustment; F(3,120)= 40.37, p<.001). Pairwise compar-
isons revealed that for younger sisters, their sister was a more
influential comparison target than their mother (F(1,46)=
40.50, p<.001) and their father (F(1,46)=22.83, p<.001).
Similarly, for older sisters, their sister was a more influential
comparison target than their mother (F(1,46) = 36.44,
p<.001) and father (F(1,46)= 67.67, p<.001). Importantly,
female peers and sisters were perceived as being of equal
importance within each sister group.
Similarities Between Sister Pairs
Pearson’s correlations were chosen for the second set of
analyses which examined similarities between younger and
older sisters with respect to social comparison, internaliza-
tion, BID, disordered eating and perceptions of family
influence. On the basis of the TIM it would be predicted
that sisters would display similar levels of these variables
due to the similarity of familial environment and social
cognitive learning throughout much of their lives. Further,
it would be predicted that a high level of internalization
and/or social comparison would be associated with a higher
level of perceived modeling and pressure from family
members due to the possible bi-directionality of the
relationship between these variables. Power analyses for
correlations, utilizing past research (Bliss 2000; Tsiantas
and King 2001) to estimate effect sizes, revealed that there
was marginal power (power=.80) for this sample size (Faul
et al. 2007; Howell 2007). Therefore, interpretation of the
following correlations must remain tentative.
Pearson’s correlations tested the hypothesis that sisters
are significantly correlated on self-report measures of social
comparison and internalization (H3). The hypothesis was
found to be partially supported. Sisters were moderately
correlated on internalization (r= .39, p< .01; Younger, M=
24.43, SD=7.92; Older, M=23.79, SD=8.03), but, contrary
to the hypothesis, were not correlated on measures of social
comparison (Younger, M=35.50, SD = 6.79; Older, M=
34.32, SD=7.12). The lack of correlation between sister
pairs for the variable of social comparison may be due to
the small sample size, lack of power, or possible issues
relating to restriction of range.
Means and standard deviations for BID and disordered
eating are presented in Table 1. Sisters were very similar on
measures of BID and drive for thinness, while younger
sisters displayed non-significantly higher bulimic behaviors.
In testing the hypothesis that sisters are significantly
correlated on self-report measures of BID and disordered
eating (H3), Pearson’s correlations revealed that sisters were
moderately correlated on measures of BID (r=.30, p<.05),
dietary restriction (r=.45, p<.01) and bulimic behaviors
(r=.43, p<.01). Thus, the hypothesis was supported.
To test the hypothesis that sisters are significantly
correlated on self-report measures of family modeling and
pressure (H4), Pearson’s correlations were conducted. The
hypothesis was partially supported. In regard to familial
pressure, sisters were moderately correlated on perceptions
of mother (r=.64, p<.001) and father (r= .56, p< .001)
pressure, but, contrary to the hypothesis, not correlated on
perceived sister pressure. Similarly, sisters were moderately
correlated on perceptions of mother (r= .30, p< .05) and
father (r=.33, p<.05) modeling, but, contrary to the
hypothesis, not correlated on perceived sister modeling.
Examination of Theoretical Mediators
For these set of analyses, the younger and older sisters were
combined to form one group of 94 participants. Utilizing
the Baron and Kenny (1986) method for testing mediation,
the hypothesis that internalization and social comparison
will act as independent mediators on the relationship
between perceived family modeling and pressure and BID
(H5) was tested. Separate regression equations were
conducted for each form of communication of the thin-ideal
(pressure and modeling) by each family member (sister,
mother and father). Similarly, mediation analysis tested the
hypothesis that the influence of sisters will directly impact
upon dietary restraint and bulimic behaviors (H6). Media-
tion requires three conditions to be met: family influence
must predict social comparison/internalization; social com-
parison/internalization must predict BID; and finally,
familial influence must predict BID (see Fig. 1). Full
mediation occurs when the addition of the mediator reduces
the final path to non-significance. Partial mediation occurs
when the final path is reduced in significance. Preliminary
examination of the predictor variables revealed no multi-
collinearity between these variables. Power analyses,
utilizing past research (Bliss 2005) to estimate effect sizes,
revealed that there was adequate power for this sample size
(Faul et al. 2007).
Tab le 2presents R
values of mediation analyses
examining the mediation of social comparison and inter-
nalization between familial modeling and pressure and
BID, as hypothesized in H5. This hypothesis was received
partial support. Contrary to the hypothesis, familial model-
ing did not significantly predict BID; therefore further
testing was suspended. As hypothesized, the relationship of
father and sister pressure on BID was found to be partially
mediated by internalization, while the relationship between
mother pressure and BID was fully mediated by internal-
ization of the thin-ideal. The relationship of father and sister
pressure with BID was partially mediated by social
comparison, while the relationship of mother pressure to
BID was fully mediated by social comparison.
As previous research (Bliss 2005) failed to find a direct
relationship between mother and father influence to
disordered eating, no hypotheses were made in relation to
this influence. Additionally, the focus of the current
research is to examine the impact sisters have on disordered
eating patterns. The zero-order correlations between mother
and father pressure and modeling and disordered eating
variables were low (range r= .15 to r= .25). Therefore,
analyses were limited to the direct impact of sister
modeling and pressure. Table 3presents R
examining the effect of sister modeling and pressure on
dietary restriction and bulimic behaviors as mediated by
BID. Findings revealed that the hypothesis that sister
influence directly impacts upon disordered eating was
partially supported. Contrary to the hypothesis, the rela-
tionship between sister pressure and bulimic behaviors and
dietary restriction were partially and fully mediated by BID,
respectively. However, as hypothesized sister modeling had
a direct effect on both dietary restriction and bulimic
behaviors, bypassing the proposed mediator of BID.
The results of the current study give partial support to
specific components of the TIM, specifically the role of
social comparison and internalization as independent
mediators between familial modeling and pressure and
BID. Similarly, the results support the theorized relation-
ship between sister pressure and disordered eating as
mediated by BID. However, data from this study demon-
strates that modeling from sisters has the potential to
directly impact upon disordered eating. Such a finding is
contrary to the relationship theorized within the TIM.
Lastly, sisters, but not parents, directly impacted upon
disordered eating; however, they were equivalent to parents
in regards to their impact upon BID.
Currently, research investigating the influence of family
members in relation to BID and disordered eating has
typically focused on parents (e.g. Wertheim et al. 2002), or
only the influence of mothers (e.g. Benedikt et al. 1998).
Findings from such studies indicate that parents can be
important sociocultural agents in the development of BID
and disordered eating among young females (Benedikt et
al. 1998; Thelen and Cormier 1995). However, the
influence of sisters has been neglected, with preliminary
research (Bliss 2000,2005;TsiantasandKing2001)
indicating that sisters need to be considered in the
development of BID and disordered eating.
Utilizing the components theorized within the Tripartite
Influence Model (Thompson et al. 1999b) enabled examination
of the mediating role of social comparison and internalization
between mother, father and sister influence and BID.
Additionally, it was possible to examine the direct impact of
sister modeling and pressure upon the outcome of disordered
eating. The proposed relationships between the variables
indicated by the TIM have been supported in both adolescent
(Bliss 2005;Keeryetal.2004) and young adult females (van
den Berg et al. 2002). Thus, within the current study it was
expected that these relationships would be replicated. In terms
of the role family members have in the development of BID
and disordered eating, preliminary evidence indicates there is
a moderate degree of perceived modeling and low perceived
pressure from family members (Bliss 2000,2005). However,
this low level of perceived pressure has been shown to be
comparable with peers (Bliss 2005). Preliminary evidence also
Fig. 1 Baron and Kenny (1986) method for evaluating potential
indicates that sisters report similar levels of internalization and
body image dissatisfaction during adolescence (Bliss 2000)
and young adulthood (Tsiantas and King 2001). Thus, we
expected that the sample within the current study would yield
a similar pattern of findings.
Several studies (e.g., McCabe et al. 2006) indicate that
Australian female adolescents perceive their sister and
mother to be influential contributors to their body image.
Further, for adolescents, younger siblings can influence
their older siblings’eating behaviors (de Leeuw et al.
2007). However, past research typically obtains data from
only one sister, rather than a pair, thus it is difficult to
discern the degree of shared familial environmental factors.
Nonetheless, it can be speculated that sister pairs may be
exposed to a similar degree of modeling and pressure from
family members. For the current study, sisters displayed
moderate levels of agreement on the extent of parental dieting
and body concerns, however they perceived differential
degrees of modeling and pressure from each other. This
contrasts with previous research with adolescents where they
perceived similar levels of sister influence (Bliss 2000). The
difference in perceptions for the current sample of young
adult sisters may be due to 38% living independently from
home, hence having less contact with each other. Further, the
fact that the data obtained was for two different individuals,
i.e. younger or older sister, rather than the same individual,
such as their mother, may also account for the discrepancy.
While there are discrepancies in each others’perceptions
of their sister’s modeling, the importance of this modeling
is equal to that of their mother. Although Bliss (2000)
found that during adolescence sisters were more potent
modeling agents than mothers, the current study reaffirms
the inconsistency of maternal modeling as an important
influence for young adult females (Pike and Rodin 1991;
Sanftner et al. 1996; Stice 1998; Wertheim et al. 2002). It is
possible that young adult women, as compared to adoles-
cent girls, identify more strongly with their mother, and
therefore perceive more modeling cues. Lastly, parents and
sisters were equivalent direct communicators of the thin-
ideal, for both younger and older sisters.
The cognitive mechanisms of social comparison and
internalization have been established as both mediators
between sociocultural influence and BID, and contributors
to BID themselves (Krones et al. 2005; Stice et al. 2000,
2001;Thompsonetal.1999b). Young adult sisters
internalized the thin-ideal to a similar degree, indicating
that they take on similar levels of sociocultural messages
regarding the value of a thin body size. Due to the nature of
the sister relationship, such messages are likely to be from
shared environments, such as the family, peer group,
consumption of similar media, or each other.
Table 3 R
values of each path in the mediation analyses, and the
type of mediation obtained, to determine the role of BID as a mediator
between sister modeling and pressure and disordered eating
Agent to BID .03 .10**
Agent to bulimic .06** (.32**) .12** (.35***)
BID to bulimic .13*** .10**
Type of mediation None Partial
Agent to BID .03 .10**
Agent to restriction .10** (.24*) .04** (.20*)
BID to restriction .32*** .33***
Type of mediation None Full
The number in parenthesis is the standardized beta weight for the
direct relationship, evaluation of this against the standardized beta
from the regression equation allows interpretation of mediation
Family, Peers and Media Influence Scale—Family Subscale, scale
range is 3–15
Family and Peers Involvement Scale—Family subscale, scale range
*p<.05. **p< .01. ***p< .001
Table 2 R
values of each path of the mediation analyses, and the type of mediation obtained, indicating the role of internalization and social
comparison as mediators between familial pressure and BID
Agent to internalization .06* .05* .09**
Agent to BID .05 (.23*) .13** (.36***) .10** (.31**)
Internalization to BID .16*** .14*** .13***
Type of mediation Full Partial Partial
Agent to social comparison .10** .16*** .12**
Agent to BID .07 (.23*) .20** (.36***) .10** (.31**)
Social comparison to BID .16*** .13*** .15***
Type of mediation Full Partial Partial
The number in parenthesis is the standardized beta weight for the direct relationship, evaluation of this against the standardized beta from the
regression equation allows interpretation of mediation
Family and Peers Involvement Scale—Family Subscale, scale range is 2–10
*p<.05. **p< .01. ***p< .001
Past research indicates that social comparisons with a
younger or older sister during adolescence is predictive of
BID (Bliss 2000), thus it would be expected that sisters
would continue to be a target of comparison in young
adulthood. The current study found sisters compare their
physical appearance with female peers and their sisters
more so than either parent. Of note, sisters and peers were
of equal importance as a comparison target. While Schutz et
al. (2002) found that within young adolescence female
peers were more important targets of social comparison
than sisters, preliminary evidence from the current study
suggests that as young girls develop towards adulthood
there is a greater tendency to compare their appearance to
that of their sister. This is of importance as many studies
cite the importance of peers as comparison targets due to
perceived similarities (Jones 2001; Krones et al. 2005;
Schutz et al. 2002). These findings may indicate that sisters
are important contributors to the development of BID and
that further research is required to evaluate the comparative
importance of sisters and peers as sociocultural agents.
Young adult sisters have moderately similar levels of
BID, bulimic behaviors and dietary restriction. This
similarity confirms previous research with young adults
(Tsiantas and King 2001) and adolescents (Bliss 2000).
While not as substantial, mothers and daughters also have
comparable levels of BID (Pike and Rodin 1991) and
disordered eating (Benedikt et al. 1998; Moreno and Thelen
1993; Wertheim et al. 2002). Therefore, it may be
tentatively speculated that sisters are exposed to a family
subculture of body image and eating behavior, with female
family members acting as contributors to that subculture.
However, further study is required to firmly establish the
nature of this subculture. Future research is needed to
address this developmental period.
Regarding the second aim, although sister pairs reported
more modeling cues from all family members than direct
pressure to be thin, only pressure from family members to
be thin affected the outcome of BID. Consistent with the
TIM, father and sister pressure on BID were partially
mediated by both internalization and social comparison,
and mother pressure was fully mediated by internalization
and social comparison. These results have strengthened
prior support for the TIM within female adolescents (Bliss
2005; Keery et al. 2004) and young adult women (van den
Berg et al. 2002). As such, treatment and interventions for
disordered eating at a family level can incorporate the TIM
as a heuristic model, however there needs to be specifica-
tion as to the modality of communication within the family
environment. There has been a tendency within past
research to focus on a more general concept of influence,
despite the distinction between modeling and pressure, and
the differing outcomes of each communication method.
Thus, despite the TIM recognizing the influence of family
members, the model fails to take into account the
possibility that modeling and pressure exert differential
effects upon BID and disordered eating.
Contrary to the TIM, sister modeling had a direct effect
on both bulimic behaviors and dietary restriction. Bypass-
ing established mediators suggests that sisters are signifi-
cant modeling agents within young adulthood in regard to
eating behavior. Such modeling cues from their sister may
impact directly upon disordered eating by increasing the
incentive for a young adult female to undertake weight loss
behaviors, or perhaps through vicarious experiences in-
creasing their own sense of self-efficacy in relation to
dieting efforts. Sisters have previously been identified as
potent modeling agents and initiators of dieting within
adolescence (Bliss 2000; Vincent and McCabe 2000;
Wert h e i m e t a l . 1997). The impact of sisters within
adolescence also appears powerful enough to bypass
proposed mediators (Bliss 2005). Integrating the current
study’s findings with previous research suggests sisters are
an important influence on each other’s eating behavior
during adolescence and young adulthood. Further, through
utilization of the TIM peer influence was found to directly
impact on dietary restriction within young adult women
(van den Berg et al. 2002). Therefore, given peers’well
established role as both influential comparison targets and
significant influences on disordered eating, the finding that
sisters are equally important highlights the necessity to
consider their impact on BID and disordered eating y and,
therefore, treatment programs.
Although these findings strengthen the role sisters have
in BID and disordered eating, there are limitations that need
to be taken into account. The current study had diminished
power for the correlational analyses, thus the interpretation
of these results must remain tentative (Faul et al. 2007;
Howell 2007). Further, there is the need to consider the
possibility of response bias due to the low return rate.
Moreover, females with disordered eating may deny or
distort certain attitudes or behaviors, such as vomiting or
restrictive eating (Vitousek et al. 1991). However, Vitousek
et al. (1991) have argued that anonymous information
obtained for research purposes, rather than clinical pur-
poses, is more reliable, valid and less likely to be distorted.
It must also be considered that although instructions were
given each sister complete their questionnaire independent-
ly of one another, this may not have occurred. As a result,
correlations between sister pairs may have been artificially
inflated. Lastly, the cross-sectional and correlational nature
of the data, limits conclusions regarding causality. For
example, some individuals with BID and eating concerns
may be primed to interpret comments and actions of family
members in terms of a weight-shape schema. Thus, there
may a reciprocal relationship between perceived familial
influences and BID and disordered eating patterns.
Both theory and practice relating to BID and disordered
eating would profit from further exploration of the sister
role within the family environment, examining their impact
via modeling and pressure. Further, the TIM as a heuristic
model requires disaggregation of family influence and the
type of influence (i.e. modeling and pressure) in order to
firmly establish the inclusion of direct pathways from
sociocultural influences to disordered eating. Also of
benefit would be to examine the mediating role of social
comparison and internalization between peer modeling and
pressure and BID, as well as multiple regression analyses to
predict disordered eating within young adult sisters.
Although the TIM provides an adequate basis for
understanding the development and maintenance of BID
and disordered eating within adolescent and young adult
females, limitations are apparent. Prior research has indicat-
ed that modifications to the TIM are needed (Bliss 2005;
Keery et al. 2004; van den Berg et al. 2002); the current
study further supports this need for revision. Specifically,
the inclusion of direct pathways from specific sociocultural
influences to both bulimic behaviors and dietary restriction.
In summary, young adult sisters are comparable in terms of
body image, bulimic behaviors and dietary restriction. Further,
sisters undergo similar levels of internalization and social
comparison, processes known to impact upon BID and
disordered eating. These findings strengthen the proposal that
there may be a subculture of thinness within some families,
presenting a risk factor for BID and disordered eating. The
direct impact of sister modeling on disordered eating, and the
comparable levels of body image concerns, suggests that if
one sister has high levels of BID and disordered eating, it is
advisable to screen her sister for such disturbances. From a
clinical perspective, body image and disordered eating
treatment programs need to be implemented at both the
individual and family level.
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