مقایسه اجتماعی، تصویر منفی از بدن و اختلال رفتار غذایی: نقش تعدیل سبک مقابله ای

Abstract Comparing one's body to those of individuals perceived as more attractive is common among college women, and has been associated with increases in body dissatisfaction and disordered eating. Not all college women are vulnerable to the negative influence of these upward body comparisons; however, little is known about characteristics that may distinguish more vulnerable women. Coping styles, which represent individuals' responses to negative events, are a key area of opportunity for better understanding the relationship between body comparison and weight-related experiences in this population. College women (n = 628) completed an electronic assessment of demographics, upward body comparison, body dissatisfaction, disordered eating behavior, and coping styles. Controlling for reported BMI, positive reframing coping style moderated the relationship between upward body-focused comparison and body dissatisfaction (p = 0.02), such that women who engaged in more (vs. less) positive reframing showed a weakened relationship between upward body-focused comparison and body dissatisfaction. Controlling for BMI and body dissatisfaction, both self-blaming (p = 0.02) and self-distracting (p = 0.009) styles also moderated the relationship between upward body-focused comparison and disordered eating behaviors, such that women who more (vs. less) strongly endorsed self-blaming and self-distracting styles appeared more susceptible to the negative influence of upward body comparison. These findings underscore the importance of upward body comparison for body dissatisfaction and disordered eating among college women, and highlight coping style as a key factor in these relationships. Increased attention to upward body comparison and coping style may improve quality of life and contribute to the prevention of disordered eating in this vulnerable population.

. Introduction 1.1. Social comparison, negative body image, and disordered eating behavior: the moderating role of coping style The ubiquity of body dissatisfaction and weight concerns among U.S. women is well documented (Strahan, Wilson, Cressman, & Buote, 2006). College women appear to be exceptionally vulnerable to body dissatisfaction and weight concerns (Pritchard et al., 2007 and Strahan et al., 2006), which place them at risk for health problems such as substance abuse and depression (Tiggemann and McGill, 2004 and van den Berg et al., 2007). These women are also at a high risk for disordered eating symptoms (Stice and Shaw, 2002 and van den Berg et al., 2007). Among young women, frequent comparisons of one's body to that of others may serve to prompt and maintain body dissatisfaction (Leahey, Crowther, & Mickelson, 2007). Such social comparisons often are made toward others who are perceived to have “better” physical features (e.g., toward thin, attractive others). These upward comparisons highlight a woman's failure to achieve the accepted standard of attractiveness, and communicate that achieving this standard is possible (though actual achievement is unrealistic for most women). Consequent negative self-evaluations contribute to body dissatisfaction and disordered eating behaviors ( Arigo, Schumacher, & Martin, 2014) which are themselves associated with weight gain, depressed mood, and lower quality of life ( Tiggemann & Kuring, 2004). Although most college women make upward body comparisons, not all women are susceptible to their negative effects ( Stice, Mazotti, Weibel, & Argas, 2000). Improved understanding of the personal characteristics or behaviors that identify particularly vulnerable women could inform health promotion and disordered eating prevention programs on college campuses. 1.2. Coping style as a potential moderator Upward body comparisons can lead to immediate increases in negative affect and guilt (Leahey et al., 2007). If managed effectively, such feelings are transient; however, poor response to such feelings may prompt disordered eating symptoms and negatively influence quality of life (Arigo et al., 2014). Coping style, or one's method for managing negative situations or emotions (Carver, 1997), represents one potential influence on women's responses to upward body comparisons. Coping styles typically have been categorized as either adaptive or maladaptive (Schnider, Elhai, & Gray, 2007). “Adaptive” styles include actively engaging in a behavior to overcome the negative situation, seeking out support, or positive reframing (Carver, 1997 and Mahmound et al., 2012). These styles have been associated with better psychological functioning (Cash et al., 2005 and Mahmound et al., 2012). In contrast, “maladaptive” coping styles involve avoiding searching for a solution to a problem or withdrawing from the situation (Mahmound et al., 2012). Maladaptive styles include venting (i.e., actively expressing negative emotion), self-distraction (i.e., focusing away from the problem) and self-blame (i.e., taking full responsibility for a situation; Carver, 1997 and Schnider et al., 2007). College students who use maladaptive styles report higher levels of anxiety and depression, and poorer ability to adapt to stressful circumstances (Cash et al., 2005 and Mahmound et al., 2012). Regarding body and eating concerns, avoidant coping has been linked to body dissatisfaction and disordered eating attitudes and behaviors in a small number of studies, though active coping techniques have not shown the expected relationships with these outcomes (Cash et al., 2005, Koff and Sangani, 1997 and Sulkowski et al., 2011). To our knowledge, the role of coping style has not been examined with respect to the specific relationships between upward body comparisons and (1) body dissatisfaction, and (2) disordered eating behaviors. The present study examined relations between upward body comparison, coping styles, and body image and disordered eating behavior in a large sample of college women. We expected an inverse relationship between upward body comparison and body image, and a positive relationship between upward body comparison and disordered eating behaviors. The moderating effects of five coping styles (selected to capture both adaptive and maladaptive coping) on these relationships were also examined. The coping styles examined were positive reframing, self-distraction, self-blame, active coping, and venting. We predicted that (1) higher (vs. lower) positive reframing and active coping (i.e., greater identification with adaptive coping styles) would weaken the relationships between upward body comparisons and body image and disordered eating behaviors, while (2) higher (vs. lower) venting, self-blame, and self-distraction (i.e., greater identification with maladaptive coping styles) would strengthen these relationships.

3. Results On average, participants endorsed upward body comparison scores slightly above the mid-point of the scale used (M = 6.80, SD = 2.42). Participants' scores ranged from the scale minimum (2; strongly disagree) to its maximum (10; strongly agree), indicating that the scale was able to differentiate women who did and did not strongly identify with a tendency to make upward body comparisons. Participants also reported slightly positive body image quality of life (MBIQLI = 1.97) and moderate disordered eating behaviors (MEDEQ = 1.75), relative to previously-published averages ( Cash and Fleming, 2002 and Luce et al., 2008). Of note, 201 participants (32%) endorsed disordered eating behaviors at or above the clinical threshold for the EDE-Q (i.e., global scores of 2.3; Fairburn & Beglin, 1994), which is similar to published norms among college women (Luce et al., 2008). In addition, 109 participants (28%) endorsed binge eating behavior over the past month (MFrequency = 5.02 episodes, SD = 5.20), and 21 participants (3%) reported vomiting behavior (MFrequency = 5.50 episodes, SD = 5.64). These rates also correspond to norms for college women ( Luce et al., 2008). As purging was infrequent, and thus did not provide adequate variability in frequency, we did not include it as an outcome. Across participants, there was varied identification with each of the coping styles assessed (i.e., range from scale minimum to maximum). Table 1 presents full descriptive statistics. Table 1. Descriptive statistics for BMI, upward body comparison, body- and eating-related disturbance, and coping styles. Mean SD Minimum Maximum Body Mass Index (BMI) 22.89 4.03 15.10 49.09 Upward Body Comparison 6.80 2.42 1.00 10.00 Body Dissatisfaction (Body Image Quality of Life) 1.97 2.87 − 6.00 6.00 Disordered Eating (EDE-Q Global Score) 1.76 1.29 0 5.85 Restraint Subscale 1.53 1.40 0 6.00 Eating Concerns Subscale 1.09 1.24 0 6.00 Shape Concerns Subscale 2.47 1.64 0 6.00 Weight Concerns Subscale 1.98 1.52 0 6.00 Binge Eating Frequencyt 5.02 5.20 1.00 28.00 Purge (Vomiting) Frequencyt 5.50 5.64 1.00 20.00 COPE – Positive Reframing 5.01 1.66 2.00 8.00 COPE – Self-Distraction 4.72 1.46 2.00 8.00 COPE – Self-Blame 4.25 1.71 2.00 8.00 COPE – Active Coping 5.07 1.54 2.00 8.00 COPE – Venting 4.12 1.44 2.00 8.00 Note: Minimum and maximum values refer to sample ranges; all minimum and maximum values reflect scale floors and ceilings, with the exception of EDE-Q Global (min = 0, max = 6.0) and BIQLI (min = -19.0, max = 19.0); t indicates that values represent means and ranges for those who endorsed any binge or purge behavior in the past month (ns = 109 and 21, respectively). Table options 3.1. Relations among upward comparison, eating and weight concerns, and coping style Upward body comparison showed only a very weak correlation with BMI, indicating that upward comparisons were independent of BMI in this sample (R = 0.07, p = 0.09). As predicted, more frequent upward body comparison was associated with lower BIQLI (R = -0.24) and greater disordered eating behavior (Rs = 0.37–0.51), including binge eating frequency (R = 0.31, ps < 0.001). These relationships remained significant, and of moderate strength, when BMI was controlled (body image quality of life: R = -0.22; disordered eating: Rs = 0.29–0.56; ps < 0.001). Table 2 and Table 3 include correlation matrices without and with BMI controlled (respectively). Table 2. Correlation coefficients for relationships between BMI, upward body-focused social comparison, body image quality of life, eating pathology, and coping. SCBUP BIQLI EDE-Q Global Binges EDE-Q Restraint EDE-Q Eating Concern EDE-Q Weight EDE-Q Shape Cope Venting Cope Positive Reframing Cope Self-Blame Cope Self-Distraction Cope Active BMI 0.07 − 0.17*** 0.20*** 0.16** 0.09* 0.15*** 0.24*** 0.23*** 0.05 − 0.03 0.07 − 0.03 − 0.02 SCBUP – − 0.24*** 0.51*** 0.31*** 0.39*** 0.37*** 0.48*** 0.54*** 0.06 0.01 0.23*** 0.04 0.10* BIQLI – − 0.39*** − 0.32*** − 0.20*** − 0.37*** − 0.39*** − 0.40*** − 0.12** 0.18*** − 0.36*** − 0.04 0.09* EDE-Q Global – 0.38*** 0.81*** 0.87*** 0.92*** 0.94*** 0.11** 0.05 0.36*** 0.12** 0.06 Binges – 0.14* 0.48*** 0.32*** 0.40*** 0.07 − 0.13* 0.34*** 0.05 − 0.08 EDE-Q Restraint – 0.63*** 0.59*** 0.65*** 0.07 − 0.13* 0.35*** 0.05 − 0.08 EDE-Q Eating Concern – 0.75*** 0.76*** 0.12** 0.04 0.36*** 0.10* 0.02 EDE-Q Weight – 0.90*** 0.11** 0.30 0.37*** 0.14*** 0.04 EDE-Q Shape – 0.11** 0.30 0.37*** 0.14*** 0.06 Note: *p < 0.05; **p < 0.01; ***p < 0.001; BMI = Body Mass Index; SCBUP = Upward body-focused social comparison; BIQLI = Body Image Quality of Life Inventory; EDE-Q global = Eating Disorder Examination Questionnaire global; Binges = a question on the EDE-Q about binge episode frequency; EDE-Q Restraint = restrain subscale; EDE-Q Eating Concern = eating concern subscale; EDE-Q Weight = Weight subscale; EDE-Q Shape = shape subscale; Cope Venting = Brief Cope Venting Subscale; Cope Positive Reframing = Brief Cope positive reframing subscale; Cope Self-Blame = Brief Cope self-blame subscale; Cope Self-Distraction = Brief Cope self-distraction subscale; Cope Active = Brief Cope active subscale. Full-size table Table options Table 3. Correlation coefficients for relationships between BMI, upward body-focused social comparison, body image quality of life, eating pathology, and coping (controlling for BMI). SCBUP BIQLI EDE-Q Global Binges EDE-Q Restraint EDE-Q Eating Concern EDE-Q Weight EDE-Q Shape Cope Venting Cope Positive Reframing Cope Self-Blame Cope Self-Distraction Cope Active SCBUP – − 0.23*** 0.57*** 0.29*** 0.43*** 0.46*** 0.53*** 0.57*** 0.01 − 0.04 0.21*** 0.06 0.07 BIQLI – − 0.40*** − 0.29*** − 0.23*** − 0.37*** − 0.38*** − 0.42*** − 0.06 0.23*** − 0.39*** − 0.07 0.15* EDE-Q Global – 0.34*** 0.78*** 0.87*** 0.91*** 0.94*** 0.06 − 0.03 0.45*** 0.18** 0.06 Binges – 0.11 0.44*** 0.28*** 0.36*** 0.06 − 0.13* 0.33*** 0.05 − 0.08 EDE-Q Restraint – 0.56*** 0.55*** 0.64*** − 0.01 0.05 0.22*** 0.08 0.12 EDE-Q Eating Concern – 0.74*** 0.77*** 0.08 − 0.04 0.47*** 0.16** 0.02 EDE-Q Weight – 0.89*** 0.06 − 0.07 0.45*** 0.19** 0.04 EDE-Q Shape – 0.11 − 0.06 0.45*** 0.20*** 0.05 Note: *p < 0.05; **p < 0.01; ***p < 0.001; BMI = Body Mass Index; SCBUP = Upward body-focused social comparison; BIQLI = Body Image Quality of Life Inventory; EDE-Q global = Eating Disorder Examination Questionnaire global; Binges = a question on the EDE-Q about binge episode frequency; EDE-Q Restraint = restrain subscale; EDE-Q Eating Concern = eating concern subscale; EDE-Q Weight = Weight subscale; EDE-Q Shape = shape subscale; Cope Venting = Brief Cope Venting Subscale; Cope Positive Reframing = Brief Cope positive reframing subscale; Cope Self-Blame = Brief Cope self-blame subscale; Cope Self-Distraction = Brief Cope self-distraction subscale; Cope Active = Brief Cope active subscale. Full-size table Table options 3.2. Moderating effects of coping style Endorsement of active coping and venting styles did not affect the observed relationships between upward body comparison and BIQLI or disordered eating behavior (Global and subscales; ps > 0.24). Controlling for BMI, the relationship between upward body comparison and BIQLI was moderated by a positive reframing coping style (F[4,607] = 6.00, p = 0.01, ηp2 = 0.01), however. Women who reported stronger tendencies toward upward body comparison and positive reframing endorsed higher BIQLI, indicating benefit associated with positive reframing. In contrast, those with stronger tendencies toward upward body comparison and lower propensity for positive reframing endorsed lower BIQLI. Controlling for BMI and BIQLI, positive reframing did not affect the relationship between upward body comparison and global disordered eating behavior (F[5,606] = 0.01, p = 0.94), specific disordered eating subscales (ps > 0.70), or binge frequency (F[5,167] = 0.1.55, p = 0.21). Self-blame (F[3,615] = 0.23, p = 0.82) and self-distraction (F[3,617] = 0.03, p = 0.86) did not moderate the relationship between upward body comparison and BIQLI. Controlling for BMI and BIQLI, however, both self-blame (F[5,606] = 3.73, p = 0.05, ηp2 = 0.01) and self-distraction (F[5,608] = 4.90, p = 0.03, ηp2 = 0.01) moderated the relationship between upward body comparison and overall disordered eating behavior. Upward body comparison was more strongly associated with disordered eating at high levels of self-blame and self-distraction, suggesting that these coping styles may be associated with harmful eating behaviors in college women (See Fig. 1 for the effect of self-blame). In particular, self-blame moderated the effect on eating concerns (F[5,606] = 6.26, p = 0.01, ηp2 = 0.01), but did not influence relations with other disordered eating subscales (ps > 0.08). In contrast, self-distraction showed moderating effects only on restraint (F[5,606] = 4.18, p = 0.04, ηp2 = 0.01) and shape concern (F[5,608] = 4.44, p = 0.04, ηp2 = 0.01). Neither self-blame nor self-distraction were associated with relations between upward body comparison and binge frequency (ps > 0.16). Relationship between upward body comparison and disordered eating behaviors ... Fig. 1. Relationship between upward body comparison and disordered eating behaviors (EDE-Q global score) by level of identification with a self-distraction coping style. For illustration, self-distraction scores were split into tertiles, with the highest and lowest tertiles displayed here. This model controlled for the effect of body dissatisfaction and BMI.