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Appearance comparison and other appearance-related influences on body dissatisfaction in everyday life


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Although appearance comparisons, self-monitoring, and appearance-related comments have been linked to body dissatisfaction in prior studies, the combined and unique influences of these variables on state body dissatisfaction in daily life has yet to be explored. The present study addressed this gap, and also evaluated whether these state-based effects were stronger for individuals with trait-level body image disturbances (internalization and body dissatisfaction). Eighty-four women completed baseline measures of trait internalization and body dissatisfaction, and then reported momentary experiences of body dissatisfaction, appearance self-monitoring, appearance-related comments, and appearance-based comparisons at up to 10 random times daily for seven days. Multilevel analyses confirmed that both appearance comparisons and commentary (both negative and positive) were predictive of changes in state body dissatisfaction when modelled individually as well as in a combined (full) model. Appearance self-monitoring was not a significant predictor, either individually or in the full model. These within-person relationships were not moderated by individual differences in trait body dissatisfaction and internalization of appearance standards. Accordingly, experiences of body dissatisfaction in daily life may be a common reaction to negative appearance comments and unflattering comparisons, yet positive comments and/or efforts to avoid appearance-based comparisons may have a positive effect on one's body image.
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Situational predictors of body dissatisfaction
Fuller-Tyszkiewicz, M. Chhouk, J., McCann, L.,Urbina, G., Vuo, H. Krug, I., Ricciardelli,
L., Linardon, J. Broadbent,J., & Richardson, B. (2019). Appearance comparison and other
socio-contextual influences on body dissatisfaction in everyday life. Body Image, 28, 101-
This is a pre-print of an article published in Body Image. Personal use is permitted, but it
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Situational predictors of body dissatisfaction
Appearance comparison and other socio-contextual influences on body dissatisfaction in
everyday life.
Although appearance comparisons, self-monitoring, and appearance-related comments have
been linked to body dissatisfaction in prior studies, the combined and unique influences of
these variables on state body dissatisfaction in daily life has yet to be explored. The present
study addressed this gap, and also evaluated whether these state-based effects were stronger
for individuals with trait-level body image disturbances (internalization and body
dissatisfaction). Eighty-four women completed baseline measures of trait internalization and
body dissatisfaction, and then reported momentary experiences of body dissatisfaction,
appearance self-monitoring, appearance-related comments, and appearance-based
comparisons at up to 10 random times daily for seven days. Multilevel analyses confirmed
that both appearance comparisons and commentary (both negative and positive) were
predictive of changes in state body dissatisfaction when modelled individually as well as in a
combined (full) model. Appearance self-monitoring was not a significant predictor, either
individually or in the full model. These within-person relationships were not moderated by
individual differences in trait body dissatisfaction and internalization of appearance
standards. Accordingly, experiences of body dissatisfaction in daily life may be a common
reaction to negative appearance comments and unflattering comparisons, yet positive
comments and/or efforts to avoid appearance-based comparisons may have a positive effect
on one’s body image.
Keywords. appearance comparisons; body image disturbance; experience sampling;
ecological momentary assessment; internalization
Situational predictors of body dissatisfaction
1. Introduction
Body dissatisfaction levels in daily life are known to fluctuate (Fuller-Tyszkiewicz et
al., 2015; Lattimore & Hutchinson, 2010), even among those with elevated trait body image
disturbances (Fuller-Tyszkiewicz et al., 2018; Melnyk, Cash, & Janda, 2004). Accumulated
literature has drawn upon theoretical frameworks such as objectification theory (Fredrickson
& Roberts, 1997) and the tripartite influence model (van den Berg, Thompson, Obremski-
Brandon, & Coovert, 2002) and empirical findings from cross-sectional and experimental
studies to identify potential predictors of state-like shifts in body dissatisfaction in daily life.
Of these, perhaps the most commonly tested and supported predictor is appearance-based
comparisons (e.g., Fardouly, Pinkus, & Vartanian, 2017; Fitzsimmons-Craft et al., 2015;
Fitzsimmons-Craft et al., 2016; Leahey & Crowther, 2008; Leahey, Crowther, & Mickelson,
2007). Several other appearance-related predictors (notably, appearance self-monitoring and
appearance-related comments) have also been linked to state body dissatisfaction
(Fitzsimmons-Craft et al., 2015, 2016; Fuller-Tyszkiewicz, Dias, Krug, Richardson, &
Fassnacht, 2018; Jones, Crowther, & Ciesla, 2014; Mills & Fuller-Tyszkiewicz, 2018),
though there has been limited testing of these appearance-related predictors simultaneously.
The present study contributes incrementally to this body of literature by evaluating: (a)
individual and combined contributions of these appearance-related predictors of state body
dissatisfaction, and (b) moderation of these state-based relationships by trait-level individual
difference factors.
1.1. Influence of Personal Experiences of the Social Environment on Body
Situational predictors of body dissatisfaction
The tripartite influence model (van den Berg et al., 2002) identifies peers, family, and
the media as key sources of social influence on body image. These influences may be direct,
via teasing and other general appearance-related comments (positive or negative), or
instructions for how to attain a specific body size. These social influences may also be
conveyed indirectly, for instance, via modelling of behavior from others. Objectification
theory emphasizes that these sociocultural messages are persistent and pervasive, and have a
sexually objectifying nature (Fredrickson & Roberts, 1997). These messages encourage
women to internalize the objectifying observer’s perspective of their body, both in terms of
the importance of physical attractiveness and the need to strive for a highly idealized and
unrealistic physique (the ‘thin ideal’). This internalization manifests behaviorally as body
self-surveillance and comparison with others, ultimately leading to dissatisfaction with one’s
appearance because the ‘thin ideal is unattainable for most women.
Extant literature broadly supports the role of these appearance-related factors in body
dissatisfaction. Cross-sectional findings show that those with elevated trait body
dissatisfaction more regularly engage in appearance-related conversations with others (Jones,
Vigfusdottir, & Lee, 2004; Lawler & Nixon, 2011), appearance-related comparisons with
more attractive individuals (Bailey & Ricciardelli, 2010; O’Brien et al., 2009), and self-
monitoring of their appearance (Grippo & Hill, 2008). Trait body dissatisfied individuals are
also more likely to report feelings of appearance-related self-consciousness in social contexts
(Levinson & Rodebaugh, 2012), and are more likely to report being teased about their
appearance (Menzel et al., 2010). Furthermore, experimental studies have demonstrated more
negative body image following exposure to media portrayals of idealized physiques
(Hausenblas et al., 2013) and objectifying contexts that make one self-conscious of how they
look to others (Moradi & Huang, 2008).
Situational predictors of body dissatisfaction
More recently, researchers have used the experience sampling method (ESM) to
explore influences on body dissatisfaction experienced in daily life. Although this approach is
typically non-experimental, and hence does not control for extraneous influences as an
experimental design would, participants self-report their current body dissatisfaction at a
given moment in time as well as contextual variables (e.g., whether they were recently
exposed to appearance-related comments or engaged in appearance comparisons), potentially
enhancing ecological validity (Shiffman, Stone, & Hufford, 2008). Studies utilizing this
approach have shown that state body dissatisfaction ratings are elevated following upwardly
directed (i.e., against more attractive individuals) appearance comparisons (Fardouly, Pinkus,
& Vartanian, 2017; Fitzsimmons-Craft et al., 2015; Leahey & Crowther, 2008; Leahey,
Crowther, & Ciesla, 2011; Leahey, Crowther, & Mickelson, 2007; Myers, Ridolfi, Crowther,
& Ciesla, 2012; Ridolfi, Myers, Crowther, & Ciesla, 2011). There is also some evidence that
comparisons to social media images rather than in-person, or to dissimilar targets, may have
more pronounced effects on body dissatisfaction (Fardouly et al., 2017; Leahey & Crowther,
2008), although in an Australian context at least, evidence suggests that such comparisons
may be less common in daily life than in-person comparisons (Fardouly et al., 2017).
Fewer studies have evaluated the effects of appearance-related comments and
appearance self-monitoring on body dissatisfaction in daily life. However, the extant
literature suggests that state body dissatisfaction is more common when an individual is
focused on their appearance (Fitzsimmons-Craft et al., 2015; Stefano, Hudson, Whisenhun,
Buchanan, & Latner, 2016), and that engagement in appearance-related conversations may be
associated with greater body dissatisfaction (Jones et al., 2014; Mills & Fuller-Tyszkiewicz,
2018). Jones et al. (2014) found that appearance-related conversations were also related to
body self-monitoring. However, as the authors were interested in a specific form of
appearance conversation (fat talk), the unique effects of positive and negative appearance-
Situational predictors of body dissatisfaction
related comments on body dissatisfaction could not be ascertained. Fitzsimmons-Craft et al.
(2015) showed that appearance-related comparisons and body self-monitoring were
positively related, yet both were uniquely predictive of state body satisfaction
contemporaneously. Body self-monitoring remained a significant predictor in lagged analyses
(i.e., predicting body dissatisfaction at a subsequent time point), but appearance comparisons
did not. It is worth noting, however, that body comparisons were operationalized in
Fitzsimmons-Craft et al. (2016) as frequency of comparison, and direction of comparison was
not factored into analyses. As participants were only assessed three times per day, it is also
possible that the lengthy intervals between assessments led to under-estimation of the effects
of these predictors on body dissatisfaction (e.g., see Fuller-Tyszkiewicz, Karvounis,
Pemberton, Hartley-Clark, & Richardson, 2017 and Kockler, Santangelo, & Ebner-Priemer,
2018 for effects of timing on magnitude of state-based relationships).
1.2. Rationale and Hypotheses for Present Study
The present study builds on this prior research in two key respects: (a) it explores the
combined and relative contributions of these appearance-related predictors (self-monitoring,
comparisons, and comments) on changes in state body dissatisfaction; and (b) it evaluates
whether these relationships are moderated by trait-level differences in body image
(specifically, internalization of the thin ideal and trait body dissatisfaction). With the
exception of Fitzsimmons-Craft et al. (2016), we are unaware of any attempts to explore
some combination of these appearance-related variables for predicting state-like shifts in
body dissatisfaction in daily life. Given both the conceptual relation and empirical link
among these proposed predictors, modelling of these predictors separately is likely to have
overestimated the effects of each of these state-based influences separately, yet
underestimated their combined influence on state body dissatisfaction. Consistent with prior
research, it was predicted that state body dissatisfaction ratings would be higher following an
Situational predictors of body dissatisfaction
upward comparison relative to pre-comparison state body dissatisfaction levels (Hypothesis
1). Similiarly, it was predicted that negative appearance self-monitoring and appearance-
related comments would be predictive of increased state body dissatisfaction (Hypotheses 2
and 3, respectively). However, it was expected that positive appearance-related comments
would be predictive of decreased state body dissatisfaction (Hypothesis 4). It was also
expected that, in combination, the predictors would account for more variance in state body
dissatisfaction than any of these predictors modelled separately (Hypothesis 5). No
hypothesis was formulated regarding which predictor would have the strongest unique
contribution given the absence of prior literature to guide such predictions.
A secondary focus of the present study was to evaluate whether the strength of
association between these appearance-related predictors and state body dissatisfaction depend
on an individual’s level of trait body image disturbance. Evaluation of potential trait-level
moderators of state-based body image experiences is important because it may provide
further insights into why exactly some individuals have greater body image disturbances than
others. Guided by the premise that individuals with trait-level body image disturbances are
more reactive to negative influences on body dissatisfaction, it was predicted that individuals
who more strongly internalize the thin ideal and/or who are more dissatisfied with their
appearance in general would experience stronger increases in state body dissatisfaction
following exposure to upward comparisons, negative appearance comments, or through
engaging in appearance self-monitoring (Hypothesis 6).
2. Method
2.1. Participants
Participants were women aged 18-40 recruited through social media and online
advertisements to students at Deakin University. Although 108 women signed up for the
study and downloaded the smartphone app used for data collection, 24 participants were
Situational predictors of body dissatisfaction
excluded from the data analysis stage because they completed less than 50% of the
experience sampling assessments (nmax = 70 assessments). The decision was made to retain
participants with at least 50% compliance as this equates to approximately five assessments
completed per day, which appears to be towards the upper end of sampling frequency (and
completion) for prior ESM studies of body image and appearance comparisons (e.g., Leahey
& Crowther, 2008; Leahey et al., 2011). This reduced the final sample to 84 women, which is
sufficient to produce unbiased parameter estimates and standard errors for significance
testing of clustered data according to prior simulation work (e.g., Maas & Hox, 2005).
Demographic characteristics of the retained sample are shown in Table 1.
2.2. Materials
2.2.1. Trait-based measures. Trait thin-ideal internalization. The 5-item thin-ideal internalization subscale
of the Sociocultural Attitudes Towards Appearance Questionnaire Version 4 (SATAQ4;
Schaefer et al., 2015) was used to assess the extent to which participants endorse and accept
cultural ideals of physical appearance (e.g., “I think a lot about looking thin”). Items were
rated on a 5-point rating scale from 1 (strongly disagree) to 5 (strongly agree), and averaged
to produce a total score. This subscale has been shown to be internally consistent, uni-
dimensional, and correlate with measures of body image disturbance (Schaefer et al., 2015).
In the present study, internal consistency was acceptable (omega = .76). Trait body dissatisfaction. The 9-item version of the Body Satisfaction
subscale of the Body Change Inventory (Mellor, Fuller-Tyszkiewicz, McCabe, &
Ricciardelli, 2012; Ricciardelli & McCabe, 2002) was used to assess level of dissatisfaction
participants feel in general about their appearance. This scale assesses satisfaction with global
aspects of appearance (such as weight, shape, and muscles) and body regions (chest, legs,
thighs, etc.). Responses were rated on a 5-point rating scale (very unhappy to very happy),
Situational predictors of body dissatisfaction
reverse-coded, and then summed to form total scores with higher scores indicating higher
body dissatisfaction. Psychometric adequacy of this scale has been demonstrated in previous
studies (e.g., Fuller-Tyszkiewicz et al., 2012). Internal consistency was strong in the present
study (omega = .88).
2.2.2. State-based measures. State-based body dissatisfaction. Participants were asked to indicate their
current level of body satisfaction on an 11-point rating scale from 0 (completely dissatisfied)
to 10 (completely satisfied). Scores were reverse-coded so that higher scores indicated greater
dissatisfaction. This single item approach is consistent with several prior investigations of
body satisfaction (e.g., Fuller-Tyszkiewicz, Dias, et al., 2018; Pomerleau & Saules, 2007;
Rogers et al., 2017; Sonneville et al., 2012). Appearance self-monitoring. Participants were asked ‘Since the last time you
were signalled, to what extent did you think about how you looked?’ rated on a scale from 0
to 10. This item has been used previously, and shown to correlate with body image and
related constructs (e.g., Holland, Koval, Stratemeyer, Thomson, & Haslam, 2017). State appearance comparison behavior. At each time point, participants were
asked to indicate the level of body comparison behavior they had engaged in since they were
last signaled (11-point sliding scale where 0 = no comparisons, 10 = constantly making
comparisons). If participants responded with a value greater than zero, they were then
prompted to indicate how they felt they compared to their most recent comparison target: (1)
much worse, (2) worse, (3) the same, (4) better, or (5) much better. As per Leahey and
colleagues (Leahey et al., 2007, 2011; Leahey & Crowther, 2008), this second question
serves as the measure of appearance-related comparisons for statistical modelling purposes.
Responses were categorized as upward comparisons if participants selected options 1 or 2,
lateral for option 3, and downward for options 4 or 5. The impact of upward comparisons is
Situational predictors of body dissatisfaction
likely to depend on what it is compared against (Drutschinin, Fuller-Tyszkiewicz, De Paoli,
Lewis, & Krug, 2018). Consequently, for present analyses, these appearance comparison
categories were dummy coded such that upward comparisons (as reference category, value =
0) was compared against: (1) downward comparisons, (2) lateral comparisons, and (3) no
comparisons. Appearance-related comments. Participants were asked to indicate whether
they had received positive or negative appearance-related comments since the last survey.
Each response was coded as 1 (yes) or 0 (no), and both items were included in analyses.
2.3. Procedure
Following approval from the University’s Human Research Ethics Committee, the
study was advertised via social networking sites (Facebook, Gumtree, etc.) and through
advertising in lectures and labs at the university. Participants contacted the research team to
arrange a time to come to our research lab for orientation and commencement of participation
in the study. During this orientation session, participants received a plain language statement
that outlined the process, requirements, and expectations of the study. They were given an
opportunity to ask any questions about participation. Those who consented to participate then
completed the baseline survey via Qualtrics on a computer provided to participants (Phase 1).
Embedded within the baseline survey were instructions for how to download the smartphone
app to be used in Phase 2. The app, which is available for iOS and android users, generates a
random alphanumeric code which participants reported into the baseline survey to enable
linking of data across Phases 1 and 2.
The app was built within the freely available survey platform InstantSurvey
(Richardson, 2015a,b), and was designed to commence signaling surveys to participants the
morning after participants downloaded the app to their phones. Signals were scheduled to
occur 10 times per day at semi-random intervals for a period of 7 days. Surveys were set to
Situational predictors of body dissatisfaction
randomly signal within 1-2 hour blocks to ensure sampling across the timeframe of 9am to
10pm each day. Although prior state body image studies have typically used 3-6 assessments
per day for the ESM phase (e.g., Fitzsimmons-Craft et al., 2015, 2016; Leahey & Crowther,
2008; Leahey et al., 2011), 10 surveys within day were chosen in the present study to reduce
time interval between assessments. Recent work by Fuller-Tyszkiewicz et al. (2017) and
Kockler, Santangelo, and Ebner-Priemer (2018) shows that spacing ESM time intervals too
far apart can under-estimate the strength of relationship between predictor and outcome
Each survey in the ESM phase was designed to be brief (approximately 1-2 minutes
per survey) to balance participant burden from repeated assessment with desire to collect
multiple assessments throughout the day. A semi-random interval schedule was preferred to
avoid bias in predictability in fixed response scheduling (Napa Scollon, Kim-Prieto, &
Diener, 2003). The surveys were programmed such that participants had a 30-minute window
to complete each survey before it expired. After one week, participants were contacted and
reimbursed with a $20 gift voucher for their time commitment to the study.
2.4. Date Analytical Plan
2.4.1. Data screening and preliminary analyses. Data quality from both the baseline
and ESM phases was checked prior to main analyses. Less than 2% of cases had missing
baseline data (Phase 1). These missing values were imputed using expectation maximization
(Tabachnick & Fidell, 2007). There were no incomplete data within time points for the ESM
phase (Phase 2), although individuals differed in the number of assessments they completed
of the possible 70 across the 7-day testing period. Rather than impute for missing time points,
only those time points with data were included in analyses.
Individual differences in number of ESM surveys completed were explored in a
variety of ways to contextualise potential impact of completion rate on the validity of main
Situational predictors of body dissatisfaction
analyses. Correlations between number of assessments completed and scores on
trait/demographic variables were conducted to assess potential biases in amount of data
collected. The primary outcome variable (state body dissatisfaction) was also regressed on
the day of participation (from first to seventh), day of week, and time of day (coded in hour
blocks) to evaluate whether level of state body dissatisfaction systematically varied over
time. As detailed in the Results section, there was no evidence of time-related effects on state
body dissatisfaction, and hence no need to control for this in main analyses.
2.4.2. Main analyses. Study hypotheses were tested using multilevel modelling via
Mplus version 7.2 to control for non-independence of data introduced by the repeated
measures design of the present study (Hox, 2010). In all models (Hypotheses 1-6), Level 1
predictors were group-mean centered, and both the group-mean centred Level 1 predictor
(representing within-person effects) and the group-mean (representing between-person
effects) were entered as predictors of the DV (Enders & Tofighi, 2007). For models testing
trait-level moderation effects (Hypothesis 6), the trait-level predictors were entered grand-
mean centered at Level 2.
Body dissatisfaction state scores at time t were regressed onto body dissatisfaction
state scores from the previous time point (time t 1, to permit evaluation of change in this
DV), as well as measures of appearance comparisons (upward vs no comparison, upward vs
lateral, and upward vs downward comparisons, and frequency of comparisons as a covariate),
appearance-related comments (positive and negative), and appearance self-monitoring at time
t. As body dissatisfaction ratings were for the current moment, and all other variables asked
about since the last assessment, this design permitted evaluation of prospective (or lagged)
effects of these predictors on the DV, consistent with the primary aim of this study. Time lag
between assessments was also included as a covariate given that the semi-random assessment
schedule meant that the intervals between assessments were not equidistant. All analyses
Situational predictors of body dissatisfaction
involving effects of these predictors and covariates on state-based body dissatisfaction were
conducted within-day to further constrain the time lag between prior and current time points,
consistent with the approach taken in prior ESM studies of body image (e.g., Fitzsimmons-
Craft, 2015; Rogers et al., 2017).
The three state-level predictors (appearance comments, comparisons, and self-
monitoring) were first modelled in separate models (Hypotheses 1-4), and then combined into
a single model to evaluate their combined and relative contributions for predicting change in
state body dissatisfaction (Hypothesis 5). Moderation of these state-based associations by
trait-level body image variables (thin-ideal internalization and body dissatisfaction) were
conducted for state-based relationships that were shown to significantly vary in magnitude
across individuals (i.e., significant random effects). In cases where random effects were non-
significant, it was concluded that the relationship between these state-based variables was
comparable across individuals, and hence there was no basis for a moderation effect.
3. Results
3.1. Compliance Rates and Descriptive Statistics
The average number of responses completed per participant (out of a possible 70) was
45.3 (SD = 11.7), and the average interval between ESM assessments was 96 minutes (SD =
66 minutes). Compliance rates for ESM surveys were not significantly related to BMI, r(83)
= .03, p = .805 (two-tailed), employment status, r(83) = .01, p = .957 (two-tailed), or hours of
work per week, r(65) = -.23, p = .059 (two-tailed), main language spoken at home, r(83) = -
.17, p = .114 (two-tailed), highest level of education attained, F(4, 79) = 0.82, p = .515, trait
body dissatisfaction, r(83) = .12, p = .283 (two-tailed), or thin-ideal internalization, r(83) =
.03, p = .782 (two-tailed). However, compliance was significantly related with age, r(83) = -
.29, p = .007 (two-tailed) and whether an individual identified as having an Australian
Situational predictors of body dissatisfaction
cultural background, r(83) = .23, p = .039 (two-tailed). Participants who were younger and/or
of Australian background replied more frequently to the app-based alerts.
In total, state appearance comparisons were reported for 58.7% of assessment points.
When daily appearance comparisons were reported, lateral comparisons were most common
(60% of the time), followed by upward comparisons (29.5%), and downward comparisons
(10.5%). Positive and negative appearance-related comments were considerably less
frequent, reported for 7.5% and 0.9% of assessments overall, respectively.
As shown in Table 2, participants typically reported moderate levels of state body
dissatisfaction, although there was considerable variability in these estimates both between
and within individuals. On average, appearance self-monitoring and appearance comparison
frequency were low, but this fluctuated both within and across individuals. The sample as a
whole endorsed trait-levels of thin-ideal internalization and trait body dissatisfaction around
scale midpoints, with reasonable spread around these central points.
State body dissatisfaction ratings were separated further according to comment (no
comment, positive comment, or negative comment) and appearance comparison (no
comparison, lateral comparison, upward comparison, or downward comparison) to evaluate
how state body dissatisfaction varied across these conditions (see Figure 1). Significance
testing showed that, relative to ratings in the absence of an appearance comment, body
dissatisfaction ratings were significantly lower following exposure to a positive comment, z =
-5.15, p < .001, and higher following a negative comment, z = 2.62, p = .009. Relative to non-
comparison contexts, body dissatisfaction ratings were significantly higher following an
upward appearance comparison, z = 6.36, p < .001, and lower following a downward
comparison, z = -6.09, p < .001. State body dissatisfaction ratings did not differ for non-
comparison and lateral comparison contexts, z = -0.87, p = .386.
3.2. Reactivity and Time-related Effects on ESM Assessments
Situational predictors of body dissatisfaction
Reactivity to the ESM protocol was explored by evaluating potential increased or
decreased body dissatisfaction ratings across the testing period. MLM analyses revealed that
order of assessment was unrelated to state body dissatisfaction scores, b = .00, z = -0.46, p =
.648. In order to test for time of day effects, time was categorized by hour, with continuous
coding from first possible hour to last (9:00-9:59am = 0 to 9:00-9:59pm = 12), and treated as
a predictor in multilevel models with state body dissatisfaction as the outcome variable. This
model revealed a non-significant relationship between time of day and reported state body
dissatisfaction, b = .01, z = 0.48, p = .629. Weekday (0 = Weekday, 1 = Weekend day, with
Saturday and Sunday coded as weekend days) and day of assessment (first day, second day,
… seventh day) were both unrelated to state body dissatisfaction ratings, b = .05, z = 0.42, p
= .675, and b = .00, z = 0.02, p = .986, respectively.
3.3. Main Analyses
3.3.1. Individual predictors. Table 3 provides multilevel model results for each of
the appearance-related predictors tested separately. Consistent with Hypothesis 1, state body
dissatisfaction ratings significantly increased following instances of upward appearance
comparisons relative to downward comparisons, lateral comparisons, and non-comparison
events. The between-person effect of lateral vs upward and non-comparison versus upward
comparisons also significantly predicted body dissatisfaction; those with a higher proportion
of upward comparisons (relative to non-comparison and lateral comparisons) tended to have
higher state body dissatisfaction ratings across the ESM phase. Comparison frequency was
unrelated to body dissatisfaction, at either of the within- or between-person levels.
Hypothesis 2 was not supported by present data as self-monitoring failed to predict changes
in state body dissatisfaction. The person-mean for self-monitoring was also not predictive of
state body dissatisfaction ratings across the ESM phase.
Situational predictors of body dissatisfaction
In support of Hypotheses 3 and 4, instances of positive comments were associated
with decreased state body dissatisfaction whereas negative comments were followed by
increased state body dissatisfaction. At the between-person level, those who received more
positive appearance comments over the course of the ESM phase tended to report lower
average state body dissatisfaction ratings. The between-person effect of negative comments
was nonsignificant.
3.3.2. Combined model. Table 4 provides the results of the multilevel model testing
all predictors simultaneously. Receiving positive and negative comments, as well as
occurrence of upward comparisons remained significant unique predictors of changes in state
body dissatisfaction (relative to down, lateral, and no comparison contexts). At the between-
person level, individuals with greater frequency of appearance comparisons and more upward
comparisons relative to lateral comparisons tended to report higher state body dissatisfaction
across the testing period, whereas those who received more positive comments tended to
report lower state body dissatisfaction. Consistent with Hypothesis 5, this full model
accounted for more variance in state body dissatisfaction ratings (R2 = .30) than any of the
models with the predictors modelled separately (R2 ranged from .10 to .21).
3.2.3. Trait-level moderators. Of the state-based predictors of body dissatisfaction,
only the relationship between appearance self-monitoring and body dissatisfaction
significantly varied across individuals. However, the magnitude of this state-based
relationship was not significantly moderated by trait body dissatisfaction, b = .00, z = 0.73, p
= .463, or thin-ideal internalization, b = .00, z = -0.07, p = .947. As magnitude of the other
state-based relationships did not significantly vary across individuals, proposed moderators
were not directly tested for these effects. Thus, Hypothesis 6 was not supported.
4. Discussion
Situational predictors of body dissatisfaction
Consistent with tenets of the tripartite influence model (van den Berg et al., 2002) and
objectification theory (Frederickson & Roberts, 1997), several common appearance-related
behaviours (appearance-based comparisons, self-monitoring, and appearance-related
comments) have been shown to predict state-like shifts in women’s body dissatisfaction
levels in daily life (e.g., Fardouly et al., 2017; Fitzsimmons-Craft et al., 2015; Jones et al.,
2014; Leahey et al., 2007; Ridolfi et al., 2011). However, with the exception of Fitzsimmons-
Craft et al. (2015, 2016), who included self-monitoring and appearance comparisons in the
same model, there has been little attempt to integrate these findings into a consolidated model
of predictors. Hence, the present study builds on this prior research by evaluating the unique
and combined contributions of these appearance-related predictor variables for state-based
fluctuations in body dissatisfaction. A secondary aim was to determine whether these effects
are more pronounced for individuals with trait body dissatisfaction or who internalize
appearance standards.
4.1. Main Findings
Present findings are consistent with prior studies (Fardouly et al., 2017; Fitzsimmons-
Craft et al., 2015; Leahey et al., 2007, 2011; Leahehy & Crowther, 2008; Myers et al., 2012;
Ridolfi et al., 2011) in finding that negative upward comparisons are associated with state-
based increases in body dissatisfaction. As per Fitzsimmons-Craft et al. (2015), appearance
comparisons explained the most variance in state body dissatisfaction when modelled
separately, though this amount was smaller than variance explained by all predictors
combined (consistent with expectation). However, in the present study, appearance
comparison variables remained significant predictors in the full model, controlling for other
predictors. The inconsistency in results across the two studies may be due to
operationalization of appearance comparisons; whereas the present study distinguished
direction of comparison (upward, downward, and lateral), Fitzsimmons-Craft et al. (2015)
Situational predictors of body dissatisfaction
measured in terms of frequency of comparisons a variable that was also nonsignificant in
the present study.
Also noteworthy in the present study is that within-person effects were observed
regardless of whether upward comparisons were compared to downward, lateral, or no
comparison contexts, although effects were strongest when upward comparisons were
evaluated relative to downward comparisons. Although it may be reasoned that this contrast
is likely to be greatest because downward comparisons should be most favourable and lead to
reduction in state body dissatisfaction, this has not always been found in previous literature.
Several studies have either found no relationship or negative effects of downward
comparisons on aspects of body image and eating pathology (Drutschinin et al., 2018;
Fitzsimmons-Craft, 2017; Lin & Kulik, 2002). Given this evident variability across studies, it
is possible that the effect of downward comparison is moderated by other contextual factors,
such as who the downward target is, or the extent to which this comparison then activates
one’s negative appearance-related schemas. Even so, the findings of greatest negative impact
from upward comparisons as found in the present study and prior work suggests that
efforts to actively discourage individuals from engaging in unrealistic comparisons may help
to reduce body dissatisfaction experiences in daily life.
Exposure to appearance-related comments also predicted changes in state body
dissatisfaction, with negative comments producing a similar increase in body dissatisfaction
to that observed for upward comparisons. Positive comments reduced state body
dissatisfaction, but this effect was much smaller than the magnitude of increase in state body
dissatisfaction following exposure to negative comments. The benefits for body satisfaction
of positive comments may be small because the focus on appearance though well intended
may make appearance salient, and remind an individual of the ideal they are striving for as
well as their distance from this ideal (Herbozo, Stevens, Moldovan, & Morrell, 2017). It may
Situational predictors of body dissatisfaction
also be the case that the impact of positive appearance comments may depend on who is
delivering the comment and/or the perceived plausibility of the compliment. Unfortunately,
the identity of the comment-giver and perceived credibility of the message were not
measured in the present study to confirm or disconfirm these explanations. Further
examination of the context of these comments and response to them is warranted.
Several predictions were not supported by present data. First, appearance self-
monitoring (both within- and between-person) was not related to state body dissatisfaction
when modelled separately or together with other predictors. Although Fitzsimmons-Craft et
al. (2015) found within-person effects of body surveillance to be a significant predictor of
body dissatisfaction when modelled separately, it too was nonsignificant when modelled with
other predictors. Thus, self-monitoring may be less influential in relation to the other
predictors because appearance comments and comparisons may provide more direct
validation or invalidation of one’s perceived appearance. Second, only one of the state-based
relationships (appearance self-monitoring predicting changes in state body dissatisfaction)
was found to differ across individuals, and this variability was not moderated by trait-level
body image variables (dissatisfaction and thin-ideal internalization). Thus, although it was
posited that individuals with trait body image disturbances may be particularly vulnerable to
negative appearance-related influences on state body dissatisfaction, this was not supported
by the current data. Persistence of body image disturbances for these individuals may instead
arise from greater frequency of engagement with behaviors and cognitions that intensify body
dissatisfaction (e.g., Fuller-Tyszkiewicz, Dias, et al., 2018; Leahey et al., 2007; Rogers et al.,
Finally, there was some overlap in pattern of findings for within- vs between-
individual effects of the appearance-related predictors for the model with all predictors
entered simultaneously. Exposure to positive comments and engagement in lateral vs upward
Situational predictors of body dissatisfaction
comparisons were predictive of body dissatisfaction both within- and between-persons,
whereas self-monitoring was not a significant predictor at either level. However, a between-
person effect was found for comparison frequency in the absence of within-person effect for
this predictor, and negative comments had a within-person but not between-person effect on
body dissatisfaction. Fitzsimmons-Craft et al. (2015) found a similarly complex mixture of
significant and nonsignificant associations for between- vs within-person effects. Findings of
significant within-person effects in the absence of supporting between-person effects may
indicate that occurrence of these appearance-related experiences is more important than
frequency of occurrence for predicting body dissatisfaction levels. Conversely, in cases
where only the between-person effect was significant, this may signal that some effects that
arise cross-sectionally (i.e., from between-person data) reflect tendency for constructs to
reside in the same individual without causally influencing each other in daily life.
4.2. Limitations
Several design decisions warrant consideration. First, in the interest of balancing
breadth and frequency of assessment against participant burden, state-based constructs were
captured using coarse, single-item measures. This may have impacted magnitude of effects
observed. For instance, the impact of appearance self-monitoring on body dissatisfaction may
depend on whether the individual appraises their appearance with an ideal in mind, whether
that ideal is realistic, and whether they feel they are close to this ideal. Relatedly, to ensure
consistency with prior studies, the present study followed the approach of asking broadly
about appearance comparison occurrence and direction as used in prior ESM studies (e.g.,
Leahey et al., 2007, 2011; Myers et al., 2012; Rogers et al., 2017), and thus did not
differentiate comparisons made in-person vs via social media. Although these measurement
decisions may have produced a less precise signal of true effects, the present findings still
Situational predictors of body dissatisfaction
identified appearance commentary and comparisons as plausible risk factors for body
dissatisfaction in daily life.
Second, the time course for state-based effects remains unclear. The present study
utilized more frequent sampling within day (10 assessments) than prior studies, and were able
to replicate findings of appearance comparisons predicting change in state body
dissatisfaction. While this assessment schedule may enable evaluation of the impact of time
lag on their state-based associations, there is also risk that increased sampling adds to
participant burden, in turn reducing data quantity and/or quality. It is encouraging then that
there was limited evidence of time-related and reactivity effects on body dissatisfaction in the
present study. Unfortunately, guidance is lacking on the ideal number of assessments per day
for ESM studies; further trialling of different response schedules across studies may provide
an empirical case for optimal design (Fuller-Tyszkiewicz et al., 2017).
4.3. Implications and Future Research Directions
Present findings offer some support for generalizability of aspects of the tripartite
influence model (van den Berg et al., 2002) and objectification theory (Fredrickson &
Roberts, 1997) to the state-level. The bulk of accumulated evidence in support of these
models derive from cross-sectional and prospective studies with measures that assess these
appearance-based constructs in general rather than tying specific instances of exposure to
appearance-related influences to body dissatisfaction outcomes. Hence, present findings
(when coupled with other recent ESM studies) suggest that appearance-related comparisons
and comments in daily life may have model-predicted effects on state body dissatisfaction.
Even so, it is possible that the state-based version of these models deviate from or better
explain what is observed at the trait-level. The null effect of appearance self-monitoring in
the present study may indicate that this construct is less influential in-the-moment, or that its
impact may overlap with other, more proximal influences. For instance, general awareness
Situational predictors of body dissatisfaction
and self-monitoring of one’s appearance may encourage comparison with others. To the
extent that available others are closer to the ideal, such evaluations may produce body
dissatisfaction. In instances where comparators are of similar appearance or less attractive,
body dissatisfaction may reduce. In this way, self-monitoring may act as a catalyst for further
evaluation, yet the outcome of such evaluations may depend on the current environment one
ESM studies may offer further insights into the nature of the relationship between
contextual factors and body dissatisfaction experiences in daily life. While present findings
support the notion that direction of appearance comparisons may determine impact on state
body dissatisfaction, frequency of appearance comparisons failed to significantly predict
increases in state body dissatisfaction. Accumulated literature has yielded inconsistent results
for the effects of appearance comparison when comparisons have been operatonalised in
terms of frequency of occurrence (Drutschinin et al., 2018; Fitzsimmons-Craft et al., 2016;
Tiggemann & Polivy, 2010). A possible explanation is that greater frequency of comparisons
leads to a habituation effect, such that one or several instances of comparison may have
greater impact than many comparisons. Further testing of potential habituation effects is
warranted, as it may lead to more accurate prediction of when comparisons (both upward and
downward) are most likely to impact body image.
4.4. Conclusions
In summary, the present study offers further evidence to suggest that instances of
upward appearance-related social comparisons may lead to increases in state body
dissatisfaction. These findings seem robust to inclusion of other appearance-related factors
shown to influence body dissatisfaction, but also show that the focus in prior studies on
appearance comparisons may come at the expense of investigation of other body image
constructs that also contribute to body dissatisfaction. Although fewer in number,
Situational predictors of body dissatisfaction
accumulated studies suggest that appearance-related comments may also influence body
dissatisfaction (e.g., Jones et al., 2014; Mills & Fuller-Tyszkiewicz, 2018). As noted earlier,
further exploration of the content and context of these comments is warranted. Studies that
incorporate this broader range of predictors might also evaluate whether presence of a
potentially positive influence (e.g., a favourable, downward appearance comparison) may
counteract the effects on body dissatisfaction of recent occurrence of a negative influence
(e.g., negative appearance comment). Such findings may enhance the ecological validity of,
and understanding gained from, current models of body image disturbance.
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Table 1
Demographic characteristics of the sample (N = 84)
Descriptive Variable
Age (M ± SD)
24.30 ± 4.56
BMI (M ± SD)
23.15 ± 3.85
Culture (%)
Main Language (%)
Level of Education (%)
Still at secondary school
Year 12 or equivalent
Certificate / Diploma
Post Graduate
Employment Status (%)
Work Hours (M ± SD)
21.85 ± 12.50
Situational predictors of body dissatisfaction
Table 2
Descriptive Statistics for all Level-1 and Level-2 Variables
State body dissatisfaction
0 10
Appearance self-monitoring
0 10
Appearance comparison frequency*
0 10
Trait body dissatisfaction
9 45
Trait internalization
1 5
Note. *Calculated for instances where appearance comparison was reported. M = mean. SDW
= within-person standard deviation; SDB = between-person standard deviation. n/a = not
Situational predictors of body dissatisfaction
Table 3
Parameter estimates for each of the proposed appearance-related predictors tested
< .001
Comparison frequency (person-mean centered)
Comparison frequency (person-mean)
Downward vs upward comp (person-mean centered)
< .001
Downward vs upward comp (person-mean)
Same vs upward comp (person-mean centered)
< .001
Same vs upward comp (person-mean)
None vs upward comp (person-mean centered)
< .001
None vs upward comp (person-mean)
R-squared estimate = .21
< .001
Positive comment (person-mean centered)
< .001
Positive comment (person-mean)
Negative comment (person-mean centered)
Negative comment (person-mean)
R-squared estimate = .13
< .001
Self-monitoring (person-mean centered)
Self-monitoring (person-mean)
R-squared estimate = .10
Note. Comp = comparison. Covariates of time lag and state body dissatisfaction at prior time
point are omitted from table to maintain focus on proposed predictor variables.
Situational predictors of body dissatisfaction
Table 4
Parameter estimates for the proposed appearance-related predictors tested together
< .001
Comparison frequency (person-mean centered)
Comparison frequency (person-mean)
Downward vs upward comp (person-mean centered)
< .001
Downward vs upward comp (person-mean)
Same vs upward comp (person-mean centered)
< .001
Same vs upward comp (person-mean)
None vs upward comp (person-mean centered)
< .001
None vs upward comp (person-mean)
Positive comment (person-mean centered)
Positive comment (person-mean)
Negative comment (person-mean centered)
< .001
Negative comment (person-mean)
Self-monitoring (person-mean centered)
Self-monitoring (person-mean)
R-squared estimate = .30
Note. Comp = comparison. Covariates of time lag and state body dissatisfaction at prior time
point are omitted from table to maintain focus on proposed predictor variables.
Situational predictors of body dissatisfaction
Figure 1. State body dissatisfaction ratings by context. Comp = comparison.
4.41 4.28
No comp Lateral
State Body Dissatisfaction Ratings
... This micro-longitudinal assessment method can capture real-time observations from participants in their natural environment, potentially enhancing ecological validity (i.e., the extent to which a study can be generalized to real-life settings) and reducing retrospective recall bias (Smyth et al., 2009). Furthermore, recent EMA studies within the DE literature revealed that participants' levels of BD and DE meaningfully changed day-to-day over a study period of approximately 7 to 14 days, thus, demonstrating considerable within-person variabilities for the assessed variables (Fuller-Tyszkiewicz et al., 2019;Goldschmidt et al., 2014;Mason et al., 2019). These findings provide evidence for the suitability of EMA to investigate a range of ED-related constructs (i.e., BD and DE) and support its potential in advancing our understandings of these relationships on a state level. ...
... A recent EMA study by Carels et al. (2019) revealed that experiencing weight stigmatizing events (e.g., a parent or other relatives nagging you to lose weight) was associated with fewer positive and greater negative emotions. In another EMA study, Fuller-Tyszkiewicz et al. (2019) assessed experiences of receiving negative and positive appearance comments and levels of BD 10 times a day for 7 days from 84 female participants. They found that negative appearance comments predicted greater state BD, while positive comments decreased BD. ...
... Both negative and positive items were included in the analyses. This approach is consistent with previous studies examining appearance-based comments using EMA (Fuller-Tyszkiewicz et al., 2019;Tan et al., 2019). Non-Appearance-Based Evaluations. ...
Full-text available
The current study used ecological momentary assessment (EMA) to investigate whether appearance-based comments, social and performance-based evaluations affected levels of body dissatisfaction (BD) and urges to engage in disordered eating behaviours (DE) throughout daily life. A total of 620 participants completed a baseline questionnaire assessing sociodemographic variables. Participants then downloaded a mobile app which alerted them to complete short surveys assessing their levels of BD, DE urges, and experiences of receiving comments and evaluations six times per day for seven days. Negative appearance-based comments predicted greater levels of state BD, while positive appearance comments predicted lower levels of state BD. Negative social and performance-based evaluations predicted an increase in state BD, while positive evaluations predicted a decrease in this outcome variable. No significant predictor was found for the DE urge outcomes. The present findings suggest that receiving negative and positive feedback in various domain of one’s life may predict opposite outcomes for body image. However, these effects do not necessarily associate with urges to engage in DE in a non-clinical population.
... They are short, self-guided, and target specific symptoms/risk factors to provide focused benefit with either single or repeated use (Elefant et al., 2017). Microinterventions have been developed to target ED risk and protective factors in adults and early adolescents with promising results (e.g., Fuller-Tyszkiewicz et al., 2019;Matheson et al., 2020). ...
... One-week later, students completed a follow-up online survey. This follow up period is in line with current microintervention research where follow up periods span 1-3 weeks(Atkinson & Diedrichs, 2021;Fuller-Tyszkiewicz et al., 2019;Gobin, McComb, Mills, 2022;Matheson et al., 2020). ...
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Eating disorders (EDs) often emerge in late adolescence. Schools are ideal settings for prevention programs; however, cost and time limit implementation. Microinterventions may overcome these challenges. This study adapted two microinterventions (cognitive dissonance, self‐compassion) and assessed feasibility and acceptability among mid‐adolescents to provide proof‐of‐concept for further investigation. Feedback from staff (n = 5) and student (n = 15) focus groups contributed iteratively to the adaptation of intervention materials. Students in Grade 10 and 11 (N = 101, Mage = 15.80, SD = 0.68) were then randomly allocated by class to a 20‐min video‐based cognitive‐dissonance or self‐compassion intervention, accessed on their school devices. ED risk and protective factors were assessed at baseline, immediate postintervention (state outcomes), and 1‐week follow‐up (trait outcomes). Acceptability items were included at both timepoints. Implementation was deemed feasible. Girls generally reported greater acceptability than boys. Among girls, the self‐compassion intervention demonstrated greater acceptability. Among boys, some aspects of acceptability (e.g., lesson endorsement, utilization of techniques) were rated higher in the cognitive dissonance group whereas other aspects (e.g., understanding, interest) were greater in the self‐compassion group. All groups exhibited favorable changes in most state outcomes, however trait outcome change was varied. Microinterventions provide a feasible way of implementing prevention strategies in a time‐poor educational context. Future large‐scale evaluation is warranted to determine efficacy, following modifications based on current findings. This study shows promising feasibility and acceptability of two brief, self‐guided video‐based lessons (microinterventions) for adolescents in school classrooms, that use psychological techniques to target appearance pressures as a key risk factor for eating disorders. Such interventions are easier to implement in school settings than longer, facilitator‐led interventions, to encourage greater uptake and ongoing use. Findings support further research to evaluate effectiveness, to ultimately provide accessible and gender‐inclusive tools for busy schools.
... This finding suggests that body dissatisfaction could be state-based and mediate the influence of viewing images on social media and body image, with the immediate impact of exposure to such images influencing body dissatisfaction. Research conducted with women who had trait-level appearance ideal internalization and body dissatisfaction found appearance comparisons, and in particular upward comparisons (to those deemed more attractive) predicted increased state body dissatisfaction [82]. Adolescent girls who internalize appearance ideals and those with elevated trait body dissatisfaction may be at greater risk of making negative appearance comparisons when using social media and thus may be an important sub-group to consider for intervention. ...
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Background Adolescent girls appear more vulnerable to experiencing mental health difficulties from social media use than boys. The presence of sexualized images online is thought to contribute, through increasing body dissatisfaction among adolescent girls. Sexual objectification through images may reinforce to adolescent girls that their value is based on their appearance. This study explored how sexualized images typically found on social media might influence adolescent girls’ mental health, in positive and/or negative ways. Methods In-depth interviews were conducted with girls aged 14–17 years (n = 24) in Perth, Western Australia. Data were analyzed using thematic analysis. Results Participants identified body image as a major concern, reporting negative appearance comparisons when viewing images on social media. Appearance comparisons were perceived to exacerbate adolescent girls’ appearance-based concerns. Comparisons also influenced adolescent girls’ efforts to change their appearance and seek validation on social media. The importance of awareness and education from a younger age about social media and its influence on body image was emphasized, as was the need for strategies to promote positive body image and counteract negative body image. Conclusion The findings of this study have important implications for professionals working with adolescent girls and for the development of health promotion programs addressing social media use and body image concerns.
... Of the initial sample who commenced the EMA phase (n = 373), 77 were excluded as they completed less than 50% of the EMA surveys (n max = 42 assessments; six per day over 7-days). This approach was implemented to ensure that the participants retained in the sample completed a comparable number of surveys to related studies that observed effects between EMA-assessed variables within the body image and ED field (e.g., Fuller-Tyszkiewicz et al., 2019;Gittus et al., 2020;Tan et al., 2019). The current approach was also implemented to reduce biased results due to missing data (Shiffman et al., 2008). ...
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Dating apps may potentially serve as an environment that subjects young women to the harmful effects of appearance-related pressure. The current study assessed for the first time whether women's dating app use predicted body dissatisfaction (BD), urges to engage in disordered eating (DE), and negative mood in daily life. We also examined the unique effects of women's dating app partner preferences (i.e., seeking idealised versus non-idealised physical characteristics) on the aforementioned outcomes, and whether appearance-based rejection sensitivity (appearance-RS) moderated the effects of dating app use. Participants (N = 296; 100% women) first completed a baseline survey assessing lifetime dating app usage (i.e., current or former usage), partner preferences, and appearance-RS, followed by a 7-day smartphone-facilitated ecological investigation into momentary experiences of BD, DE urges (i.e., binge-eating/purging, dietary restraint, and exercise), and negative mood. Ninety-four women (32%) reported lifetime dating app usage, which, relative to non-use, predicted greater daily urges for binge-eating/purging and negative mood. However, appearance -RS failed to moderate these effects. Among dating app users, partner preferences were not a significant predictor of the central outcomes. These findings extend previous research by examining the unique effects of dating app use on everyday BD, DE urges, and negative mood. Replication and extension are encouraged.
... Another valuable theoretical perspective within the context of this study is the tripartite influence model (Thompson, Heinberg, Altabe & Tantleff-Dunn, 1999). This model proposes that appearance pressure from media, peers, and family contribute to body image disturbances directly and indirectly via beauty-ideal internalization and appearance-based social comparison (e.g., Fardouly et al., 2018;Fuller-Tyszkiewicz et al., 2019;Menzel, Sperry, Small, Thompson, Sarwer & Cash, 2011). Cross-cultural studies have supported this model, including the mediating role of beauty-ideal internalization, in cosmetic surgery consideration (e.g., Ching & Xu, 2019;Menzel et al., 2011;Stefanile et al., 2014;Sun, 2018;Vaughan-Turnbull & Lewis, 2015;Wu et al., 2020). ...
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There is an established relationship between acceptance of cosmetic surgery and psychological factors, including body image. However, qualitative research among diverse cultural groups is needed to provide a more fine-grained understanding of the influences on women’s attitudes towards cosmetic surgery. In this study, 20 Chinese and 20 Dutch women aged 18-50 years (MChinese = 34.20; MDutch = 34.70) participated in one-on-one semi-structured interviews. Data were analyzed using reflexive thematic analysis. We identified three themes that captured the factors that women perceived to foster favorable attitudes towards cosmetic surgery: (a) sociocultural pressures (e.g., normalization of cosmetic surgery, appearance-focused peers); (b) intrapersonal characteristics (e.g., beauty-ideal internalization, social comparison); and (c) benefits of beauty (e.g., attracting men, socioeconomic benefits). Conversely, two themes captured the factors perceived to reduce favorable attitudes towards cosmetic surgery: (a) intrapersonal characteristics (e.g., unconditional body acceptance, self-confidence); and (b) external considerations (e.g., health risks, financial costs). Overall, Chinese and Dutch participants shared many similarities in their opinions about what might affect cosmetic surgery consideration. The most striking cross-cultural differences concerned perceived socioeconomic benefits of beauty (mainly Chinese women) and women’s conceptualization of body appreciation. This study may enable a more comprehensive understanding about the factors influencing Chinese and Dutch women’s attitudes towards cosmetic surgery, and the nuances in these relationships across these cultures.
... Due to the harmful impact of a negative body image on mental and physical health, a growing body of research focuses on risk factors for the development of body dissatisfaction. Internalization of beauty ideals and appearance-related social comparison (Carlson Jones, 2004;Fuller-Tyszkiewicz et al., 2019), self-objectification (Augustus-Horvath & Tylka, 2009;Slevec & Tiggemann, 2011), exposure to idealized media images and social media use (Fardouly & Vartanian, 2016;Hargreaves & Tiggemann, 2004), low self-esteem and weightrelated teasing (Ata et al., 2007;Chen et al., 2007;Valois et al., 2019), heightened body mass (Barker & Galambos, 2003;Calzo et al., 2012), and deficits in social support (Gerner & Wilson, 2005;Stice & Whitenton, 2002) have been identified as risk factors. ...
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Purpose We aimed to synthesize the evidence for an association between childhood maltreatment and body image disturbances in adulthood. Information on maltreatment subtypes and mediator variables was included to gain further insights into the mechanisms of the association. In addition, we aimed to examine the role of body image disturbances in the development of negative mental health outcomes associated with childhood maltreatment. Methods Based on a comprehensive search strategy, eligible studies were identified in PubMed, Scopus, and Web of Science. The eligibility assessment was performed by two reviewers, and 132 articles were studied full-text. To reduce heterogeneity, only non-clinical samples were included in the meta-analysis. A meta-regression was computed to examine the influence of maltreatment subtype on body image disturbances. Results Our results provide evidence for a robust association between childhood maltreatment and cognitive-affective body image, both in clinical and community samples. Included studies ( N = 40) indicate that body image disturbances are especially pronounced in individuals suffering from Posttraumatic Stress Disorder (PTSD) after childhood maltreatment. The meta-analysis included 12 studies with a total of 15.481 participants, and indicates a small overall effect size (r = 0.21, 95% CI = [0.16, 0.26], p < .001). Meta-regression revealed no significant impact of maltreatment subtype in non-clinical samples. Conclusion Childhood maltreatment should be considered as a distal risk factor for the development of a negative cognitive-affective body image. We argue for future longitudinal studies which allow a better understanding of the pathways linking childhood maltreatment, body image disturbances and associated psychopathology.
With the recent proliferation of food delivery applications (‘apps’; FDAs), accessing a meal is more convenient and immediate than ever. These apps may potentially foster dysregulated eating behaviours, including maladaptive eating to cope with negative emotional states. Using ecological momentary assessment (EMA), the current study assessed whether FDA use at baseline predicted levels of EMA-assessed disordered eating urges and body dissatisfaction, whether negative mood and loneliness impacted disordered eating urges and body dissatisfaction at the state level, and whether the latter relationships were moderated by FDA usage frequency. Participants (N = 483; 78.7% women; 20.1% men; 1.2% other) completed a baseline questionnaire and were characterised as current FDA users (49.3%) or non-users (50.7%). Participants then completed a smartphone-facilitated investigation into their experiences of loneliness, negative mood, body dissatisfaction, and disordered eating urges, six times per day for 7-days. Across the entire sample, current FDA users at baseline reported greater EMA-assessed urges to overeat. At the state level, loneliness and negative mood predicted greater body dissatisfaction, with the latter also predicting greater urges for restrictive eating and overeating. Among current FDA users at baseline, at the state level, loneliness predicted greater body dissatisfaction, and negative mood predicted greater body dissatisfaction and urges for overeating. No moderating effects were observed for baseline FDA usage frequency. These results elucidate FDA use and daily experiences of loneliness and negative mood as factors elevating eating disorder (ED)-related risk. Further extensions of this research with nuanced measures of state FDA use are needed.
Objective: The pursuit of thinness and fear of gaining weight have been found to play an important role in eating disorder symptomatology. While these dimensions have typically been considered conjointly, emerging evidence suggests they may be distinct dimensions. The aim of this study was to explore the subjective experiences of fear of fatness and drive for thinness in young women with body image concerns. Method: Young women endorsing weight concerns (N = 29, mean age = 20.86, SD = 2.70 years) were interviewed and asked to describe an experience of fear of fat and drive for thinness, respectively. Results: Qualitative analysis was conducted and identified four themes: (1) precipitating events; (2) physiological, emotional, cognitive, and proprioceptive experiences; (3) coping strategies; and (4) sociocultural influences. While similarities emerged, the experiences of fear of fatness, and of drive for thinness also evidenced clear differences situating the former in the context of fear-based avoidance patterns, and the latter in approach-based reward models. Discussion: These findings provide additional support for the usefulness of considering fear of fat and drive for thinness as distinct constructs. Further research examining the contributions of each of these constructs to eating pathology is warranted.
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Evidence suggests that dissatisfaction with body image in women can be enhanced by exposure to media’s idealized images. The theory of social comparison and the avoidance hypothesis offer contradictory explanations of this relationship. We compare these two theories using a haptic virtual reality environment. We ask 42 female participants to interact with one of four types of virtual humans (VH) randomly assigned to them. The interaction task involves giving a virtual hug to a normal weight or overweight male or female VH. We verify the hypothesis that participants’ satisfaction with particular body parts and their anti-fat attitudes will determine the choice of the body area of the VH they will virtually touch. Our results show that: (1) touching VH lower torso is predicted by less anti-fat attitude, and avoidance of the upper torso and upper limb areas, and (2) touching VH shoulder and upper limbs areas is predicted by concerns with own stomach area and avoidance of VH lower torso and stomach waist areas. Our results tend to support the avoidance hypothesis as well as other research findings on anti-fat attitudes.
Appearance comparisons can negatively influence women’s body image, but little is known about the potential impact of comparison targets. We conducted an ecological momentary assessment study in which female undergraduate students (N = 146) completed a brief online survey at five random times every day for five days. In this survey, participants were asked if they had made an appearance comparison. If so, they were asked who they compared themselves to (i.e., close peer, acquaintance, stranger, celebrity/model), how they rated compared to that person (i.e., more attractive, just as attractive, less attractive), and how attainable that person’s appearance is to them. All participants then completed state measures of mood, appearance satisfaction, and intention to diet and exercise. Upward comparisons (i.e., to more attractive others) to all targets were associated with less appearance satisfaction, lower positive mood, and more thoughts of dieting and exercising than when no comparisons were made. There were indirect relationships between comparisons to celebrities/models versus all other targets and appearance satisfaction via perceived attainability of the target’s appearance. These findings suggest that celebrities may be particularly harmful appearance comparison targets in women’s everyday lives because their attractive appearance is perceived to be less personally attainable than other targets.
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Background and aims Whilst there are considerable benefits to Ecological Momentary Assessment (EMA), poor compliance with assessment protocols has been identified as a limitation, particularly in substance users. Our aim was to identify the pooled compliance rate of EMA studies in substance users and examine variables that may influence compliance with EMA protocols; such as the length and frequency of assessments. Design A meta‐analysis and meta‐regression of all possible studies (randomised controlled trials and longitudinal) which incorporated EMA protocols, examining substance use. Setting Studies took place from 1998 to 2017, in numerous countries worldwide. Participants One‐hundred and twenty six studies were identified, contributing a total of 19431 participants (52.31% male, mean age 28.86). Measurements Compliance data, the proportion of responses to the study protocol, were extracted from each study alongside prompt frequency, total length of assessment period, substance use population and device used to administer EMA prompts. Findings The pooled compliance rate across all studies was 75.06% (95% CI 72.37%, 77.65%). There was no evidence that compliance rates were significantly associated with prompt frequency (Q(3) = 7.35, p = .061), length of assessment period (Q(2) = 2.40, p = .301), substance type (Q(3) = 6.30, p = .098) or device administration (Q(4) = 4.28, p =.369). However, dependent samples (69.80%) had lower compliance rates than non‐dependent samples (76.02%; Q(1) = 4.13, p = .042). Conclusions The pooled compliance rate for Ecological Momentary Assessment studies in substance‐using populations from 1998 to 2017 was lower than the recommended rate of 80%, and was not associated with frequency or duration of assessments.
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Rumination is a cognitive process involving repetitive thoughts about negative experiences and emotions and is associated with psychopathology. Rumination has been implicated in mood and anxiety disorders, and there is a growing body of research on rumination in relation to eating disorder (ED) psychopathology. The current meta-analytic review focused on the literature addressing rumination and ED psychopathology. A comprehensive search process identified 38 studies, which primarily used cross-sectional designs with non-clinical samples. Results demonstrated that rumination was concurrently (r = 0.33) and prospectively (r = 0.22-0.23) associated with ED psychopathology, and that groups with ED psychopathology evidenced higher levels of rumination compared to non-ED control groups (g = 0.95), though no significant differences in rumination were observed when comparing anorexia nervosa to bulimia nervosa groups (g = 0.09). In addition, a narrative review of five experimental studies suggested that rumination in response to ED-related stimuli was related to increased negative affect and negative body-related cognitions across clinical and non-clinical samples. The type of rumination and sample population emerged as moderators of effect sizes, such that larger effects were observed among samples using ED-specific measures of rumination and heterogeneous samples compared to only non-clinical samples. Taken together, this literature demonstrates that rumination is a salient process in ED psychopathology, though the literature is characterized by methodological limitations and the need for more fully elaborated theories on the role of rumination in EDs. Findings are discussed in the context of existing models of rumination and ED psychopathology, with suggestions for future research in this area.
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Background: Previous research suggests that computerized interpretation bias modification (IBM) techniques may be useful for modifying thoughts and behaviours relevant to eating pathology; however, little is known about the utility of IBM for decreasing specific eating disorder (ED) symptoms (e.g. bulimia, drive for thinness). Aims: The current study sought to further examine the utility of IBM for ED symptoms via secondary analyses of an examination of IBM for individuals with elevated body dysmorphic disorder (BDD) symptoms (see Summers and Cougle, 2016), as these disorders are both characterized by threat interpretation biases of ambiguous appearance-related information. Method: We recruited 41 participants for a randomized trial comparing four sessions of IBM aimed at modifying problematic social and appearance-related threat interpretation biases with a placebo control training (PC). Results: At 1-week post-treatment, and relative to the PC, the IBM group reported greater reductions in negative/threat interpretations of ambiguous information in favour of positive/benign biases. Furthermore, among individuals with high pre-treatment bulimia symptoms, IBM yielded greater reductions in bulimia symptoms compared with PC at post-treatment. No treatment effects were observed on drive for thinness symptoms. Conclusions: The current study suggests that cognitive interventions for individuals with primary BDD symptoms may improve co-occurring ED symptoms such as bulimia.
The present study evaluated whether individuals with varying levels of trait body image flexibility differ in the severity, variability, and correlates of state body dissatisfaction experienced in their daily lives. One hundred and forty-seven women completed a baseline measure of trait body image flexibility, followed by a 7-day ecological momentary assessment phase in which participants self-reported state body dissatisfaction, disordered eating behavior, drive for thinness, and appearance comparisons at 10 semi-random intervals daily. Higher trait body image flexibility predicted lower average scores, less frequent reporting of high state body dissatisfaction, and less variability in their state body dissatisfaction ratings. Individuals with higher trait body image flexibility were also less likely to engage in a range of behaviors and cognitions previously shown to produce body dissatisfaction, including upward appearance comparisons , drive for thinness, binge eating, and dieting. However, few of these state-based relationships involving body dissatisfaction and these related behaviors and cognitions were moderated by trait body image flexibility. Overall, this pattern of findings suggests that body image flexible individuals may have less negative body image because they are less inclined to engage in behaviors and cognitions in their daily lives that encourage negative body image.
Background and Objectives: This study systematically reviewed the impact of Cognitive Bias Modification (CBM) on biases related to attention (CBM-A) and interpretation (CBM-I) for appearance and self-worth stimuli and the subsequent impact on eating disorder (ED) psychopathology. Method: The current review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), with 12 studies meeting inclusion criteria (CBM-A n = 5; CBM-I n = 7). Results: The literature provides preliminary support for CBM-A and CBM-I efficacy in eliciting bias change in varying degrees of psychopathology (Cohen’s d ranging between -1.67 and 1.34; 9 studies reflected improved bias, and 3 reflected no change or did not assess), while highlighting the less robust effects associated with improving ED psychopathology (d ranging between -1.30 and .61; 5 studies reflected symptom improvement, and 7 reflected no change or did not assess). Limitations: The review only considered peer reviewed research and did not report on the findings of unpublished data; thus, the current findings may not provide an accurate representation of CBM in EDs. Conclusions: The current findings highlight the potential of CBM as an adjunct intervention for EDs; however the limited number of investigations and high degree of heterogeneity across the included studies impedes on the generalisability of the findings.
This review highlights the contributions of Professor Thomas Cash to the scholarship of body image experiences in daily life, including his influence on subsequent research in this field. Cash's arguments for capturing a broad range of state-based body image experiences have been heeded, with recent studies exploring positive body image constructs as well as the more studied negative body image experiences. Appearance comparisons are the most commonly studied contextual influence on body image, and they seem to have a consistent effect. However, the experiences of body image in sexual contexts, and among adolescents, those who are pregnant, or have other physical characteristics that may increase the salience of appearance warrant further attention. Findings generally support Cash's contention that trait body image relates to likelihood and level of experience of body image in daily life, though the moderating effects of trait aspects on state-based relationships remains unclear. The discussion concludes with consideration of the impact of assessment schedules on obtained results. It is also discussed how accumulated knowledge regarding state-based body image experiences may be leveraged in treatment contexts, particularly in light of clear evidence that repeated assessment of body image in daily life increases self-awareness of one's body image characteristics.
Objective Although exercise is typically found to improve body satisfaction, this effect may be reduced or even reversed for trait body‐dissatisfied individuals. The reasons for this remain unclear. This study tested the possibility that these effects are due to appearance‐related motives and/or increased appearance awareness post‐exercise. Method Participants included 178 women who completed baseline measures of trait body dissatisfaction, and then completed an experience sampling phase in which they self‐reported state body satisfaction and appearance awareness levels, and recent exercise experiences at six time‐points daily for 10 days. Results Trait body‐dissatisfied individuals were more likely to exercise for appearance‐related reasons, and experienced less of an increase in state body satisfaction post‐exercise. Appearance‐motivated exercise also increased appearance awareness. After controlling for appearance motives, the moderating effect of trait body dissatisfaction on the exercise–state body satisfaction relationship reduced to non‐significance. Conclusions Collectively, the present findings offer some support for both motive‐ and appearance awareness‐based explanations for the reduced benefits of exercise on body satisfaction exhibited in individuals with trait body dissatisfaction. Targeting the reasons for exercise and what one focuses on during exercise may be viable ways to overcome potential negative impacts of exercise on body image for these individuals. Statement of contribution What is already known on this subject? While the physical and psychological benefits of exercise are well established, recent findings suggest that these benefits for body satisfaction may be reduced (and possibly reversed) for individuals with elevated trait body dissatisfaction. The reasons for this moderating effect remain unclear. What does this study add? • Trait body‐dissatisfied individuals more often engaged in exercise for appearance‐related reasons. • Appearance motives for exercise are associated with smaller body satisfaction gains post‐exercise. • Reduced body satisfaction was also linked to increased appearance awareness post‐exercise.
The current study used ecological momentary assessment to explore the frequency, trait predictors, and momentary consequences of positively-intended fat talk, a specific sub-type of fat talk that involves making negative comments about one's own appearance with the view to making someone else feel better. A total of 135 women aged 18-40 completed trait measures of appearance-based comparisons, thin-ideal internalisation, body shame, and body surveillance, before completing a state-based component, involving six short surveys delivered via a smartphone app at random points during the day for seven days. Findings indicate that both self- and other-fat talk are common in daily social interactions, and that individuals with higher levels of trait negative body image were more likely to engage in fat talk. Self-fat talk negatively impacted state body satisfaction levels. Possible theoretical and practical implications are outlined.
This meta-analytic review of prospective and experimental studies reveals that several accepted risk factors for eating pathology have not received empirical support (e.g., sexual abuse) or have received contradictory support (e.g., dieting). There was consistent support for less-accepted risk factors(e.g., thin-ideal internalization) as well as emerging evidence for variables that potentiate and mitigate the effects of risk factors(e.g., social support) and factors that predict eating pathology maintenance(e.g., negative affect). In addition, certain multivariate etiologic and maintenance models received preliminary support. However, the predictive power of individual risk and maintenance factors was limited, suggesting it will be important to search for additional risk and maintenance factors, develop more comprehensive multivariate models, and address methodological limitations that attenuate effects.
The present study evaluated the relation of key features of state body dissatisfaction experiences - inertia, instability from moment-to-moment, and average level across time-points - to trait body dissatisfaction and/or eating disorder risk. Participants included 161 women who completed measures of trait body dissatisfaction and disordered eating pathology, and then completed reported state body dissatisfaction and contextual influences (binge eating, dietary restraint, exercise, and appearance comparison behaviors) 6 times daily for 7 days. Results indicated that individuals with elevated trait body dissatisfaction were reliably different from those with healthier body image in terms of average state body dissatisfaction ratings, but not for inertia or instability. State mean and trait body dissatisfaction uniquely predicted eating pathology, although their predictive accuracy for clinical caseness was comparable. Cost vs. benefit of using state body image data for understanding trait body image and eating pathology is discussed.