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University of Dayton University of Dayton eCommons eCommons Graduate Theses and Dissertations Theses and Dissertations 2010 Variables hypothesized to moderate the effects of thin-ideal Variables hypothesized to moderate the effects of thin-ideal media on body image: borderline personality tendencies, past media on body image: borderline personality tendencies, past abuse, and self-esteem abuse, and self-esteem Susan Frances Folger University of Dayton Follow this and additional works at: https://ecommons.udayton.edu/graduate_theses Recommended Citation Recommended Citation Folger, Susan Frances, "Variables hypothesized to moderate the effects of thin-ideal media on body image: borderline personality tendencies, past abuse, and self-esteem" (2010). Graduate Theses and Dissertations. 2700. https://ecommons.udayton.edu/graduate_theses/2700 This Thesis is brought to you for free and open access by the Theses and Dissertations at eCommons. It has been accepted for inclusion in Graduate Theses and Dissertations by an authorized administrator of eCommons. For more information, please contact [email protected], [email protected]  VARIABLES HYPOTHESIZED TO MODERATE THE EFFECTS OF THIN-IDEAL MEDIA ON BODY IMAGE: BORDERLINE PERSONALITY TENDENCIES, PAST ABUSE, AND SELF-ESTEEM Thesis Submitted to The College of Arts and Sciences of the UNIVERSITY OF DAYTON In Partial Fulfillment of the Requirements for The Degree Master of Arts in Clinical Psychology By Susan Frances Folger UNIVERSITY OF DAYTON Dayton, Ohio May 2010  APPROVED BY Roger iC Reeb Chairperson, Thesis Committee Catherine L. Zois Thesis Committee Member Melissa LaymaA-Guadaljipe Thesis CommitteeMerriber Concurrence: David W. Biers Chair, Department of Psychology ii  © Copyright by Susan Frances Folger All rights reserved 2010  ABSTRACT Variables Hypothesized to Moderate the Effects of Thin-Ideal Media on Body Image: Borderline Personality Tendencies, Past Abuse, and Self-Esteem Name: Folger, Susan Frances University of Dayton Advisor: Dr. Roger N. Reeb One factor that has been found to contribute to the development of eating disorders is thin-ideal media present in Western culture. However, not everyone is susceptible to negative effects of thin-ideal media, so it is important to understand how other variables moderate this relationship. In order to explore the main hypothesis of the study, that a set of interrelated psychosocial variables (self-esteem, borderline personality disorder tendencies, past abuse/neglect) moderate the effects of thin-ideal media on body image, the study first aimed to demonstrate that body image becomes more negative after viewing thin-ideal media. Support for this hypothesis was obtained by utilizing a series of Analysis of Variance procedures. Also, a post-experimental inquiry demonstrated that even if participants were aware of the study’s purpose, a majority reported changes in body image because of viewing thin-ideal media. The second hypothesis, that there is a relationship between body image problems and eating disorder tendencies, was supported by bivariate correlational analyses. Greater body image disturbance is related to more disordered eating tendencies. The third hypothesis, that there is a correlation between the hypothesized moderator variables and eating/body image problems, was also supported iii  by bivariate correlational analyses. Low self-esteem and higher levels of borderline personality traits and past abuse/neglect are related to body image/eating problems. A series of hierarchical multiple regression analyses were employed to explore whether self-esteem, borderline personality tendencies, and past abuse/neglect moderated the effect of thin-ideal media on body image. Partial support was found for this hypothesis; borderline personality disorder tendencies and past abuse/neglect (specifically sexual abuse, physical abuse, and emotional neglect) moderated the effects of thin-ideal media on negative emotion. Self-esteem closely approached significance as a moderator variable on negative affect as well. These variables moderated the effect of thin-ideal media on negative emotion and not on other body image measures, which reflects that affect may be a fluctuating attribute. The results are important in that they lead to a more comprehensive understanding of eating disorder etiology and can inform prevention and intervention programs at the individual and community level. Limitations of this study and recommendations for future research are presented. iv  ACKNOWLEDGEMENTS I would like to give special thanks to my thesis chair and advisor, Dr. Roger N. Reeb, for his support and time throughout this process, as well as his willingness to help me complete this project in a timely fashion. I would also like to thank Dr. Melissa Guadalupe and Dr. Catherine Zois for their flexibility, willingness to serve on this thesis committee, and genuine interests in the program of research. I would like to thank the Graduate School at the University of Dayton for helping fund this research through the 2009 Summer Fellowship Grant and the Psychology Department at the University of Dayton for also helping fund this research. Thanks is given to Dr. Frederick Coolidge for allowing me to use the Coolidge Axis II Inventory - Revised to measure borderline personality disorder tendencies. Special thanks are due to Kathleen Burkhart, who helped with the more tedious, but very important, data scoring and entry. Special thanks are given to the graduate students at the University of Dayton who have explored this line of research before me, including Nicole Bosse, Melanie Ferrell, and Michelle Jessup. Their research and findings helped form this present study. I would like to thank my parents, Will and Mary Folger, and my siblings, Chris, Shannon, and Tim, for their unconditional love and continued support in whatever endeavor I pursue. v  TABLE OF CONTENTS ABSTRACT...............................................................................................................................iii ACKNOWLEDGEMENTS.......................................................................................................v LIST OF TABLES...................................................................................................................viii CHAPTER I. INTRODUCTION............................................................................................. 1 Description of Eating Disorders.......................................................................3 Associated Disorders.........................................................................................5 The Effect of Thin-Ideal Media........................................................................7 Hypothesized Moderator Variables................................................................. 9 Borderline Personality Disorder Tendencies.....................................9 Self-Esteem.......................................................................................... 13 Childhood Abuse/Neglect...................................................................16 The Present Study............................................................................................ 20 II. METHOD......................................................................................................... 22 Participants.......................................................................................................22 Materials........................................................................................................... 23 Procedure.......................................................................................................... 31 Overview of Statistical Analysis Procedures................................................34 III. RESULTS......................................................................................................... 37 IV. DISCUSSION...................................................................................................81 Summary and Conclusions........................................................................... 105 APPENDICES A. Demographic Questionnaire..............................................................................108 B. Rosenberg Self-Esteem Scale (RSES)..............................................................110 C. Coolidge Axis II Inventory-Revised (CATI+).................................................112 vi  D. Childhood Trauma Questionnaire (CTQ)........................................................114 E. Eating Disorder Inventory-3 (EDI-3)............................................................... 116 F. Body Esteem Scale (BES)..................................................................................118 G. Positive and Negative Affect Schedule (PANAS)..........................................120 H. Appearance Self-Efficacy Scale (ApSES).......................................................121 I. Sociocultural Attitudes Towards Appearance Questionnaire (SATAQ)........................................................................................................124 J. Physical Appearance State and Trait Anxiety Scale: State Version (PASTAS)...................................................................................................... 126 K. Personal Reactions...............................................................................................127 L. Informed Consent.................................................................................................128 M. Debriefing Form...................................................................................................130 REFERENCES........................................................................................................................ 132 FOOTNOTES.......................................................................................................................... 141 vii  LIST OF TABLES 1. Order of Survey Administration................................................................................. 33 2. Means and Standard Deviations for Body Image Measures as a Function of Group and Time.......................................................................................................39 3. Relationship Between Body Image Measures and Eating Disorder Tendencies....................................................................................................................43 4. Relationship Between Hypothesized Moderator Variables and Eating Disorder Tendencies................................................................................................... 54 5. Relationship Between Hypothesized Moderator Variables and Body Image Measures...........................................................................................................56 6. Hierarchical Multiple Regression Analyses Examining Interrelated Set of Psychosocial Variables as Moderators of Thin-Ideal Media Effects on Body Image..............................................................................................................................64 viii  CHAPTER 1 Introduction The eating disorders (ED) anorexia nervosa (AN) and bulimia nervosa (BN) are common types of psychopathology for young women1, and these disorders are debilitating conditions that warrant clinical attention. The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition text revision (DSM-IV-TR), as published by the American Psychiatric Association (APA, 2000), notes that body image is a central criterion of ED. Furthermore, one factor believed to contribute to the development of body image problems and ED is the thin-ideal media present in Western culture, as the DSM-IV-TR notes that “... in industrialized societies... being considered attractive is linked to being thin” (APA, 2000, p. 542). In a meta-analysis by Groesz, Levine, and Mumen (2002) of 25 studies examining the effects of thin-ideal media on body image, body satisfaction was found to be more negative after viewing thin media images as compared to viewing average size models, plus size models, or inanimate models. Not everyone is highly susceptible to the negative effects of thin-ideal media, as evidenced by the fact that not all people who view the media in Western society develop ED or body image problems. Therefore, it is important to understand how other variables influence this relationship; that is, under what circumstances or for whom does thin-ideal media have this debilitating effect?  2 To explore the effects that other variables have on the relationship between the thin-ideal media and eating disorder tendencies/body image disturbance, it is important to distinguish between moderating variables and mediating variables. Confusion exists in the literature regarding moderator and mediating variables; therefore, Frazier, Tix, and Barron (2004) clarify these issues. A moderator variable “.. .alters the direction or strength of the relation between a predictor and an outcome” (Frazier et al., 2004, p. 116). Moderator variables attempt to answer questions of “when” or “for whom” a variable has a given effect. In other words, a moderating effect is “... an interaction whereby the effect of one variable depends on the level of another” (Frazier et al., 2004, p. 116). In contrast, a mediator “... explains the relation between a predictor and an outcome” (Frazier et al., 2004, p. 116). A mediator variable attempts to answer “how” or “why” a predictor causes an outcome variable. A mediating variable is the “... mechanism through which a predictor influences an outcome variable” (Frazier et al., 2004, p. 116), and an example of such is when changes in body image (the mediator variable) is the mechanism through which psychotherapy leads to improvement in ED. The present study seeks to examine the extent to which a set of interrelated psychosocial variables (self-esteem, borderline personality disorder tendencies, and history of abuse) moderates the effect of thin-ideal media on body image. While previous research documents the relationship between each of these variables and body image/eating disorder tendencies, the hypothesis that they play a role in moderating effects of thin-ideal media has not been examined, and so this study is expected to yield unique contributions to the literature. The introduction is divided into four sections. In the first section, a general description of ED will be provided, including associated disorders and a description of  3 subclinical ED. The second section will provide a selective review of research demonstrating the negative effect that thin-ideal media has on body image. The third section, which focuses on variables hypothesized to moderate effects of thin-ideal media on body image, will (a) provide a selective review of research examining the relationship of each of these variables (borderline personality tendencies, history of abuse/neglect, and self-esteem) to body image and eating problems and (b) consider each variable’s potential as a moderator. The final section will lay the groundwork for the present study and state the hypotheses to be examined. Description of Eating Disorders Anorexia nervosa (AN) and bulimia nervosa (BN) are the two specific eating disorders (ED) that are included in the Diagnostic and Statistical Manual of Mental Disorders, fourth edition text revision (DSM-IV-TR), as published by the American Psychiatric Association (APA, 2000). AN is characterized in the DSM-IV-TR by weighing less than 85% of what is expected for a specific age and height (APA, 2000). This can occur through weight loss or a lack of weight gain during a developmental period of growth. AN involves an intense fear of becoming fat or overweight, and those suffering from AN experience their bodies in disturbing ways. For example, they may deny the seriousness of being underweight, or their self-evaluation may depend on their own body shape and weight. Also, in postmenarcheal females, amenorrhea (consecutively missing three menstrual cycles) occurs (APA, 2000). BN is characterized in the DSM-IV-TR by recurrent episodes of binge eating, in which a person consumes a larger amount of food than what would be expected for the given period of time and situation, and the person experiences a lack of control over food  4 intake during the binge eating session (APA, 2000). A person repeatedly engages in compensatory behaviors in order to not gain weight, like self-induced vomiting, fasting, excessive exercise, and the misuse of diuretics, laxatives, or enemas. For someone with BN, body weight and shape influence self-evaluation. These behaviors of binging and purging occur at least twice a week for three months, and the disturbance does not occur only within the context of AN (APA, 2000). There are two subtypes of each ED that depend on behavior in the current ED episode. For AN, the DSM-IV-TR notes that the binge-eating/purging subtype is diagnosed based on binge-eating or purging behaviors (i.e. the use of laxatives, diuretics, or self-induced vomiting) that are engaged in to lose weight. The restricting subtype is diagnosed based on excessive exercise, dieting, and/or fasting that are utilized to lose weight (APA, 2000). For BN, the DSM-IV-TR notes that the purging subtype is diagnosed if a person regularly engages in purging behaviors, like self-induced vomiting or misuses diuretics, laxatives, or enemas. The nonpurging subtype is diagnosed if a person does not regularly engage in typical purging behaviors. Rather, the person engages in other compensatory behaviors, like excessive exercise and fasting, to lose weight (APA, 2000). In addition to clinical diagnoses, many people exhibit ED tendencies that do not meet criteria as outlined by the DSM-IV-TR for AN or BN. Herzog, Hopkins, and Bums (1993) explain that someone may not meet criteria for amenorrhea and therefore not be diagnosed with AN, even though they display the other destructive symptoms. Similarly, someone may not binge two times a week for three consecutive months, and therefore would not be diagnosed with BN, even though all other symptoms were displayed. These  5 behaviors are still problematic and are labeled as subclinical ED. Herzog and colleagues found that people with subclinical eating disturbances were at higher risk to develop clinical ED. In a study investigating disordered eating behaviors in adolescents, Croll, Neumark-Sztainer, Story, and Ireland (2002) found that 56% of ninth-grade females, 28% of ninth-grade males, 57% of twelfth-grade females, and 31% of twelfth-grade males reported disturbed eating behaviors. The disordered eating behaviors designed to lose or control weight were skipping meals, fasting, binge-eating, vomiting, using diet pills and laxatives, and smoking cigarettes. Croll and colleagues (2002) emphasized the importance for health professionals to be aware of the high prevalence of subclinical eating disorder patterns, so that such problems can be identified and the proper resources made available. This would help lessen full ED development. Subclinical ED are important to consider, as Hoyt and Ross (2003) acknowledged high prevalence rates of these problems, especially in the college setting, in which they found that 12.9% of the population struggled with subclinical ED. Associated Disorders The DSM-IV-TR notes that people suffering from AN or BN often exhibit depressive symptoms, but AN and BN are different from major depressive disorder (MDD) because, even if depressed individuals experience weight loss, they do not exhibit a desire to lose weight or fear of weight gain (APA, 2000). Comorbidity does exist though, and Pearlstein (2002) noted in a review that those with AN have a lifetime prevalence rate of 46 to 74% for MDD and those with BN have a lifetime prevalence rate of 50 to 65% for MDD. Bulik, Sullivan, Tozzi, Furberg, Lichtenstein, and Pedersen (2006) found similar results, in that 59.4% of 102 people with AN had MDD as well.