Body image perception and self-esteem in eating disordered

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Lakehead University Knowledge Commons, Electronic Theses and Dissertations Retrospective theses 1987 Body image perception and self-esteem in eating disordered females : further validation of the silhouette body image test / by K. Jennifer Helm. -- Helm, K. Jennifer Downloaded from Lakehead University, KnowledgeCommons Body Image Perception and Self-Esteem in Eating Disordered Females: Further Validation of the Silhouette Body Image Test K. Jennifer Helm, Presented in Partial Fulfillment of the Requirements For the degree of Master of Arts Clinical Psychology Lakehead University August 1987 ProQuest Number: 10611315 All rights reserved INFORMATION TO ALL USERS The quality of this reproduction is dependent upon the quality of the copy submitted. In the unlikely event that the author did not send a complete manuscript and there are missing pages, these will be noted. Also, if material had to be removed, a note will indicate the deletion. ProOuest ProQuest 10611315 Published by ProQuest LLC (2017). Copyright of the Dissertation is held by the Author. All rights reserved. This work is protected against unauthorized copying under Title 17, United States Code Microform Edition © ProQuest LLC. ProQuest LLC. 789 East Eisenhower Parkway P.O. Box 1346 Ann Arbor, Ml 48106 - 1346 Permission has been granted to the National Library of Canada to microfilm this thesis and to lend or sell copies of the film- The author (copyright owner) has reserved other publication rights, and neither the thesis nor extensive extracts from it may be printed or otherwise reproduced without his/her written permission. L*autorisation a ete accordee a la Bibliotheque nationals du Canada de microfilmer cette these et de preter ou de vendre des exemplaires du film. L*auteur (titulaire du droit d'auteur) se reserve les autres droits de publication; ni la these ni de longs extraits de celle-ci ne doivent etre imprimes ou autrement reproduits sans son autorisation ecrite. ISBN 0-315-39586-9 Acknowledgements This research was supported in part by the Lakehead University, Senate Research Committee grant awarded to W.T. Melnyk, Ph.D. The author wishes to thank W.T. Melnyk, Ph.D. for supervising this thesis and H. McLeod, Ph.D. and H. Steiger, Ph.D. for their assistance and willingness to act as second and external readers. Also acknowledged are P. Leichner, M.D., Douglas Hospital, Montreal, and D. Johnson, R.N., Health Science Centre, Winnipeg, for their help in providing the patient population for this study. Ill Table of Contents Page Acknowledgements.. ii List of Tables iv List of Appendices.. Abstract... vi1 Introduction.. ^ Method Subjects.. IS Apparatus.. Procedure.. 20 Results... 24 Discussion.. 26 References... SI Appendices.. iv List o£ Tables Page Table 1 Percent body weight as determined by area of each silhouette 43 Table 2 Consistency of subjects estimations across trials 44 Table 3 Accuracy of subjects estimations to actual body size 45 Table 4 Correlations obtained between subjects actual body size and means of their estimations.. 46 Table 5 Characteristics of the clinical and control samples.. 21 List of Appendices Appendix A Appendix B Appendix C Appendix D Appendix E Appendix F Appendix G Appendix H Appendix I Appendix J Appendix K Appendix L Appendix M Appendix N Appendix 0 Appendix P Appendix Q Page Original Female Silhouettes.. 41 Original Male Silhouettes.. 42 Table 1.. 43 Table 2.. 44 Table 3 . . 45 Table 4 . . . . 46 Consent Forms 47 Patient Information Form.. 48 Eating Disorders Inventory,. 49 Rosenberg Self-Esteem Scale 50 Revised Silhouette Body Image Test.. 51 Verbatim Instructions to Subjects.. 52 Anova Table of Difference Between the Control Groups on the SBIT 53 Anova Table of Difference Between the Eating Disordered Subjects on the SBIT 54 Anova Table of Difference Between Control and Eating Disordered Groups on the SBIT 55 Anova Table of Difference Between the Eating Disordered Groups on the RSE.. 56 Anova Table of Difference Between the Control Groups on the RSE... 57 List of Appendices cont. Appendix R Appendix S Anova Table of Difference Between Control and Eating Disordered Groups on the RSE Correlation Table Between Self-Esteem and Body Image Perception for all Subjects.. Page 58 59 Abstract vli Previous research has shown that the available techniques for assessing body image perception do not provide valid and reliable measures. The present study was designed to further validate the Silhouette Body Image Test (SBIT), which was found to be a reliable and valid measure of body image perception on a population of non-eating disordered university students. In the present study, a sample of anorexics, bulimics and non-eating disordered females were administered the SBIT. Responses on the SBIT were compared to subject’s actual body size. Results indicated that eating disordered females significantly overestimated their body size when compared to non-eating disordered controls. Subjects level of self-esteem was measured with the Rosenberg Self-Esteem Scale (RSE) to examine the relationship between self-esteem and body image distortion. Eating disordered females scored significantly lower in level of self-esteem. Results indicated a significant negative correlation between low self-esteem and percent of overestimation of body size for all subjects. Implications and suggestions for future research are discussed. Introduction An important step during the developmental process of childhood is the perception of an integrated and organized physical structure called one's body image (Feshback & Weiner, 1982). Body image refers to the mental image one has of the physical appearance of one's body (Glucksman, 1972), including the attitudes and feelings of the individual towards her/his body {Gray, 1977). Schilder (cited in Bruch, 1973) describes body image as "the picture of our body that we form in our mind, that is to say, the way in which the body appears to ourselves" (p.87). Studies of body image have investigated such variables as body anxiety, body dissatisfaction, plasticity of body scheme, preferred body proportions, position of body image in space, and concept of body size (McCrea, Summerfield & Rosen, 1982). For the purpose of this study, body image refers to the individual's perception of body size. Ideally there should not be a discrepancy between an individual's actual body size and their body image. Body image distortion, however, is not an uncommon phenomenon with many individuals in our society. The concern about obesity and the belief that being beautiful means being thin, may be contributing factors to these distortions in body image (Gross, 1982). Since World War II, western culture has stressed appearances. Hsu (1983) believes, that in the female, this importance of physical attractiveness has taken the form of thinness. This phenomenon has been demonstrated through advertising, television, and the large numbers of diet and fitness books on best seller lists (Gross, 1982). Over the last 20 years, a thinner standard of bodily attractiveness for women has emerged. Garner, Garfinkel, Schwartz and Thompson (1980) found empirical support for this shift in body size by examining Miss America contestants and Playboy centerfolds between 1959 and 1978. They found that over the years, these women became increasingly thinner. For example. Playboy centerfolds in 1959 weighed approximately 91% of average weight, whereas in 1978, they weighed 83.5% of average. Furthermore, Garner et al. (1980) found that this decrease in body size was occurring at a time when the general population was becoming heavier. Metropolitan Life Insurance Company (1983) reports an increase in the average weight, for all heights, of women under the age of 30, over the last 20 years. This increasingly thinner standard of attractiveness was further supported by the work of Silverstein, Peterson and Perdue (1986) who examined the body sizes of models appearing in Vogue and Ladies Home Journal magazines between 1901 and 1981. The authors found that there were two periods where women became increasingly noncurvaceous. Body sizes steadily decreased from 1917 to 1925, at which point they increased again until approximately 1960. From this point on, body sizes for women have continued to decrease and be noncurvaceous. Garner et al. (1980) also found that there was an increase in the attention paid to eating disorders after 1960. This was measured by an increase in the number of diet articles run in women’s magazines from 1960 onwards. Silverstein et al. (1986) concluded that when the standard of bodily attractiveness becomes increasingly thinner, the number of women who develop eating disorders increases. Body image studies have been of interest to researchers for many years, but have only become a concern in the study of eating disorders during the last few decades (Garner, Garfinkel & Moldofsky, 1978). Two of these disorders, anorexia nervosa and bulimia nervosa, are of particular interest to studies of body image perception. Anorexia nervosa occurs most often' in adolescent females (Bryant & Bates, 1985; Provenzale, 1983; Humphries, Wrobel & Weingart, 1982; Crisp, 1980 & Bemis, 1978), however, there have been numerous reports of onset prior to puberty (Tolstrup, 1982) and later in adulthood (Hsu, 1983 & Tolstrup, 1982). Estimates of incidence range from 1 per 100 (Crisp, 1980) to 1 per 250 (Provenzale, 1983). The DSM-III (1980) classifies anorexia nervosa as an eating disorder that is usually present prior to adulthood and suggests the following diagnostic criteria: A. Intense fear of becoming obese, which does not diminish as weight loss progresses. B. Disturbance of body image, "feel fat" even when emaciated. e.g., claiming to C. Weight loss of at least 25% of original body weight or, if under 18 years of age, weight loss from original body weight plus projected weight gain expected from growth charts may be combined to make the 25%. D. Refusal to maintain body weight over a minimal normal weight for age and height. E. No known physical illness that would account for the weight loss (p.69). The incidence of bulimia nervosa is much less clear due to the secretive nature of the disorder, however, occurrence of this disorder does appear to have an alarmingly high rate (Johnson & Berndt, 1983). Estimates for college populations range from 3.9% to 19%, with approximately 85% female (Katzman, Wolchick, Braver, 1984; Pyle, Mitchell, Eckert, Halvorson, Neuman & Goff, 1983 & Halrai, Falk & Schwartz, 1981). The average age range for bulimia is early to mid 20s, with the age of onset at approximately 18 years of age (Johnson, Lewis & Hagman, 1984 & Johnson & Berndt, 1983), The DSM-III (1980) classifies bulimia as an eating disorder with a chronic, remitting course and suggests the following diagnostic criteria; A. Recurrent episodes of binge eating (rapid consumption of a large amount of food in a discrete period of time, usually less than two hours). B. At least three of the following: 1. consumption of high caloric, easily ingested food during a binge. 2. inconspicuous eating during a binge. 3. termination of such eating episodes by abdominal pain, sleep, social interruption, or self-induced vomiting. 4. repeated attempts to lose weight by severely restrictive diets, self-induced vomiting, or use of cathartics or diuretics. 5. frequent weight fluctuations greater than 10 pounds due to alternating binges and fasts. C. Awareness that the eating pattern is abnormal and fear of not being able to stop eating voluntarily. D. Depressed mood and self-deprecating thoughts following eating binges. E. The bulimic episodes are not due to Anorexia Nervosa or any known physical illness (p.70). Bruch (1973) argues that "a disturbance of delusional proportions in the body image and body concept" (p.251) is an essential criterion for the diagnosis of anorexia nervosa. Body image distortion in anorexia nervosa has received so much attention over the last decade that numerous review articles have been written in an attempt to integrate the material (Slade, 1985; Garner, 1981 & Garner & Garfinkel, 1981-82). Many studies have shown that anorexics significantly overestimate their body size unlike normal controls (Bell, Kirpatrick & Rinn, 1986; Touyz, Beaumont, Collins, McCabe & Jupp, 1984; Buvat-Herbaut, Hebbinckuys, Lemaire & Buvat, 1983; Casper, Offer & Ostrov, 1981; Strober, 1981; Garfinkel, Moldofsky & Garner, 1979; Garfinkel, Moldofsky, Garner, Stancer & Coscina, 1978; Pierloot & Houben, 1978; Slade & Russel, 1973a & Slade & Russell, 1973b). Unfortunately, there are just as many studies that found the anorexic’s overestimation to be no different than