The Skinny on Body Dissatisfaction: A Longitudinal Study of Adolescent Girls and Boys

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Journal of Youth and Adolescence, Vol. 35, No. 2, April 2006, pp. 229 ( C 2006)DOI: 10.1007/s10964-005-9010-9The Skinny on Body Dissatisfaction: A Longitudinal Studyof Adolescent Girls and BoysSarah Kate Bearman,1,2,6 Katherine Presnell,3 Erin Martinez,4 and Eric Stice4,5Received August 25, 2005; accepted October 19, 2005Published online: 15 February 2006The present study tested whether theoretically derived risk factors predicted increases in body dis-satisfaction and whether gender moderated these relations with data from a longitudinal study of 428adolescent girls and boys because few prospective studies have examined these aims, despite evi-dence that body dissatisfaction increases risk for various psychiatric disturbances. Body dissatisfactionshowed significant increases for girls and significant decreases for boys during early adolescence. Forboth genders, parental support deficits, negative affectivity, and self-reported dietary restraint showedsignificant relations to future increases in body dissatisfaction. Ideal body internalization and bodymass index did not demonstrate significant relations to future increases in body dissatisfaction; peersupport deficits showed a marginal relation to this outcome. Gender did not moderate these relations,despite adequate power to detect interactive effects.KEY WORDS: body dissatisfaction; adolescence; gender differences.Considerable research has been devoted to under-standing the consequences of body dissatisfaction, or dis-pleasure with ones weight and shape (Thompson et al.,1999). Historically, much of this research has focusedon females because of the dramatic rise in body dissatis-faction following puberty (Rosenblum and Lewis, 1999)and the greater sociocultural emphasis on appearance andthinness for females. However, recent research has indi-cated that body dissatisfaction is also a substantial con-cern among adolescent boys (Jones, 2004; Presnell et al.,2004). For both genders, the desire to alter shape or weightis common (Ricciardelli and McCabe, 2001), and is as-sociated with emotional distress (Johnson and Wardle,2005), dramatic measures to alter appearance, such ascosmetic surgery or steroid use (Hoffman and Brownell,1997; Thompson et al., 1999), as well as psychiatric dis-turbances such as depression (Stice and Bearman, 2001)1University of Texas, Austin, Texas.2Judge Baker Childrens Center, Harvard Medical School, 53 ParkerHill Avenue, Boston, Massachusetts, 02120-3225.3Southern Methodist University, Dallas, Texas.4University of Texas, Austin, Texas.5University of Texas, Austin, Texas.6To whom correspondence should be addressed to; e-mail: eating disorders (Keel et al., 1997; Stice et al., 2002).Although the deleterious impact of body dissatisfactionhas been well established, particularly for girls, the fac-tors that increase the risk for body image concerns are lesswell understood.Recent research has identified factors that are asso-ciated with body dissatisfaction, but relatively few studieshave examined these relations prospectively (see Jones,2004; Presnell et al., 2004; Stice and Whitenton, 2002for exceptions) or with regard to the timing of the onsetof body dissatisfaction as adolescents progress throughpuberty. Moreover, little is known about whether the riskfactors for body dissatisfaction differ by gender. Accord-ingly, the goals of the present study were to (a) exam-ine the ways in which rates of body dissatisfaction differby age, gender, and other individual characteristics in acommunity sample of adolescent boys and girls; (b) ex-amine the prospective influence of social, psychological,and biological factors on the development of body dis-satisfaction for adolescent girls and boys; and (c) test forgender differences in these risk factors. Such informationis imperative in order to clarify etiologic models, informpreventive efforts, and help identify characteristics of sub-groups at high risk for body dissatisfaction and relatedproblems.2290047-2891/06/0400-0229/0 C 2006 Springer Science+Business Media, Inc.230 Bearman, Presnell, Martinez, and SticeIdeal Body InternalizationAccording to the gender intensification hypothesis(Hill and Lynch, 1983), as adolescents mature physicallyand emotionally they begin to identify more strongly withtheir same-gender stereotype. For girls, this stereotypeemphasizes the importance of physical attractiveness as akey evaluative dimension for females (Stice et al., 2000;Wichstrom, 1999), and in Western culture, physical at-tractiveness in women is inextricably linked with thinness(Nichter and Nichter, 1991). In contrast to the thin-idealespoused for females, research suggests that some boyssubscribe to an ideal that emphasizes a mesomorphic buildvaluing muscularity over thinness (Smolak et al., 2001).Research confirms that adolescent boys are more likelythan girls to engage in behaviors to increase weight andmusculature (McCabe and Ricciardelli, 2001, 2004).Theoretically, girls and boys who have internalizedthese ideals would be vulnerable to body dissatisfactionwhen this ideal is not actualized. For girls, the discrepancybetween ideal and actual shape is amplified following pu-berty, because increases in adiposity move girls furtherfrom the thin-ideal (McCarthy, 1990). Simultaneously,girls increasingly identify with the female stereotype andfocus on appearance as its central evaluative dimension.This confluence of events during adolescence creates a pe-riod of significant vulnerability for girls. In support of thistheory, thin-ideal internalization (i.e., the degree to whichone buys into the importance of thinness) increases forgirls during this time and predicts increases in body dissat-isfaction for adolescent girls (Stice and Bearman, 2001).The relation between the internalization of the male idealand body dissatisfaction in boys has received less exami-nation, although research has demonstrated that drive formuscularity correlates with low self-esteem and efforts toincrease body mass (McCreary and Sasse, 2000), and in-ternalization of sociocultural attitudes toward appearancealso correlates with weight control techniques for boys(Smolak et al., 2001). In one study that directly examinedthe relation between internalized appearance ideals andbody dissatisfaction among boys, internalized appearanceideals were a robust predictor of changes in body dissat-isfaction (Jones, 2004).Body MassAs girls advance through puberty, the increased adi-posity moves them farther from the thin-ideal, thus con-tributing to decreased body image satisfaction. In sup-port of this assertion, previous research has verified thatincreases in body mass also prospectively predict girlsbody dissatisfaction (Stice and Whitenton, 2002). In con-trast, the changes brought about by puberty theoreticallymove boys closer to the larger, more muscular ideal. How-ever, the evidence regarding the trajectory of male bodydissatisfaction indicates that adolescent boys are oftensplit between those who desire to lose versus gain weight(McCabe et al., 2001; Neumark-Sztainer et al., 1999).Although body mass emerged as a significant predictorof body dissatisfaction for boys in one prospective study(Field et al., 2001), another found null effects (Barkerand Galambos, 2003). These inconsistent findings maysuggest a more complex relation between body mass andbody dissatisfaction in boys. For example, one prospec-tive investigation suggested that dissatisfaction in boysis associated only with being under or overweight, whileaverage weight boys were the most satisfied with theirphysical appearance (Richards et al., 1990). Further sup-port comes from another study that found that body massprospectively predicted body dissatisfaction in a sampleof adolescent boys, but this relation showed a significantquadratic component, as opposed to the linear relationobserved in girls (Presnell et al., 2004). Thus, being ei-ther underweight or overweight was associated with bodydissatisfaction for males, whereas girls dissatisfaction in-creased with increasing body mass.Social SupportSocial support has also been explored as a risk fac-tor for the development of body dissatisfaction. Theo-retically, gender intensification is triggered not only bygirls actual physical maturation and consequent weightgain, but also by the way in which peers and parents re-spond to these changes (Wichstrom, 1999). Deficiencies inboth the quantity and quality of social support have beenlinked with a host of psychosocial concerns for adoles-cents, including low self-esteem and body dissatisfaction.Hence, adolescents who feel unconditionally accepted bytheir support network may be less likely to try to attainacceptance by conforming to the thin ideal. In contrast,those who experience rejection from peers and parentsmay attribute this lack of support in part to their physicalappearance.Empirical support for this relation has been incon-sistent. Stice and Whitenton (2002) found that deficits insocial support predicted body dissatisfaction for adoles-cent girls, and another prospective study found that a sup-portive maternal relationship was significantly associatedwith increased body satisfaction (Barker and Galambos,Adolescent Body Dissatisfaction 2312003). However, a 3rd study with a smaller sample sizefailed to demonstrate the relation between social supportand body dissatisfaction in girls (Byely et al., 2000). Be-cause appearance is not as central an evaluative dimensionfor boys, however, deficits in social support may not beas strongly linked to body dissatisfaction for boys. The1 prospective study that investigated the effects of socialsupport on both boys and girls body image failed to finda significant effect (Presnell et al., 2004), and anotherprospective study found that although parental supportpredicted girls greater body satisfaction, it was not re-lated to this outcome for boys (Barker and Galambos,2003). Furthermore, a cross-sectional study found thatparental feedback about weight was not correlated withbody dissatisfaction for males (Schwartz et al., 1999).More research on this risk factor is warranted to deter-mine the effects of interpersonal variables such as socialsupport on boys body dissatisfaction.DietingFor adolescent girls who believe that achievingthe thin-ideal will result in psychosocial benefits andwho have received messages that they deviate from thisideal, dieting may serve as a strategy for altering theirphysique (McCabe and Ricciardelli, 2001). Theoretically,as adipose tissue increases following puberty, adolescentgirls may attempt to counter this change by restrictingtheir caloric intake. However, research suggests that self-reported attempts to restrict caloric intake predict weightgain, rather than weight loss (Stice et al., 2005). Thus,dieting may result in the opposite of its intended effectincreasing girls frustration and reducing their feelingsof self-efficacy for producing weight change. In keepingwith this theoretical assertion, girls self-reported diet-ing attempts predicted increases in body dissatisfaction(Barker and Galambos, 2003).As previously discussed, while body mass has a lin-ear relation with body dissatisfaction for girls, researchsuggests that boys are split between those who wish tolose weight and those who wish to gain weight (McCabeet al., 2001; Neumark-Sztainer et al., 1999). Dieting maytherefore increase the risk for body dissatisfaction amongthose boys who are trying to reduce body mass and ex-perience the dietary failure and weight gain that has beenassociated with self-reported dieting in girls (Stice et al.,1999; Stice et al., 2005). On the other hand, some boysmay be more likely to try to increase size and musculature,as one cross-sectional study demonstrated (McCabe andRicciardelli, 2001). For these boys, changes in diet mightreflect an attempt to increase lean muscle mass. Attemptsto manage weight did not predict body dissatisfactionin one prospective study of adolescent boys (Barker andGalambos, 2003).Negative AffectAffective disturbances have also been implicatedin the development of body dissatisfaction (Taylor andCooper, 1992). Theoretically, depressed affect induces apreference for, and selective attention to, negative infor-mation about oneself and the world (Beck, 1976). Thisinformation processing bias may result in increased atten-tion to displeasing body characteristics and foster negativecomparisons of ones body with others bodies. This hy-pothesis has received mixed empirical support, however.Acute negative affect inductions produced acute bodydissatisfaction among girls (Baker et al., 1995; Taylorand Cooper, 1992), suggesting at least a short-term rela-tion between negative mood and body distress. However,prospective studies have found that neither negative affect(Presnell et al., 2004) nor depressive symptoms (Sticeand Whitenton, 2002) predicted body dissatisfaction foradolescent girls. There is some evidence that this relationmay be stronger for boys than girls. One study found thatnegative affect predicted body dissatisfaction in boys, butnot girls (Presnell et al., 2004). In addition, negative affectwas associated with body change strategies in a sample ofadolescent boys (Ricciardelli and McCabe, 2003). Furtherexamination of this variable is needed to determine the na-ture of the relationship between affective disturbances andbody dissatisfaction, and whether this relation differs bygender.AgeAs previously discussed, pubertal weight gain isthought to increase girls risk of body dissatisfaction,whereas for boys increases in weight may increase sat-isfaction with ones weight and shape, assuming that thisincrease represents lean muscle mass. Indeed, a recentstudy by McCabe and Ricciardelli (2004) noted that early-maturing girls and girls who physically matured at thesame time as their peers reported higher levels of bodydissatisfaction than girls whose pubertal development wasdelayed relative to peers. In contrast, boys who physicallymatured earlier than their same-sex peers had the high-est levels of body satisfaction. Thus, one might assumethat age for girls would be associated with increasing232 Bearman, Presnell, Martinez, and Sticelevels of body dissatisfaction, whereas for boys the re-verse would be true. In accordance with this assertion,prior research has demonstrated that boys show a declinein body dissatisfaction over time (Jones, 2004). For girls,some research has indicated that older girls evidence sig-nificantly greater levels of body dissatisfaction than theiryounger counterparts (Jones, 2004). However, this has notbeen explicitly tested using a co-ed sample of adolescents.Present StudyWhereas prior studies provide some preliminary sup-port for several of the hypothesized risk factors for bodydissatisfaction and potential gender differences amongthose risk factors, this literature has certain limitations.Much of this previous research has examined risk factorsfor body dissatisfaction separately in samples of boys andgirls (e.g. Jones, 2004; McCabe and Ricciardelli, 2004)rather than a co-ed sample. This study improves uponprior research by testing whether gender moderates therelation of each risk factor to later development of bodydissatisfaction. An explicit test of the gender-by-risk fac-tor interaction is required in order to demonstrate thatthe predictor variables are associated with different levelsof risk for girls versus boys (Baron and Kenny, 1986).In view of these gaps in the literature, the current studysought to directly compare a sample of boys and girls inorder to elucidate the processes by which adolescents be-come body dissatisfied, and whether these processes differfor girls versus boys.Hypotheses1. The developmental course of body dissatisfactionwill be moderated by gender. Specifically, bodydissatisfaction will increase among girls over thecourse of the study whereas rates of body dissat-isfaction will decrease for boys over time. Fur-thermore, girls will show higher rates of bodydissatisfaction than boys overall.2. The relations among certain hypothesized predic-tors of body dissatisfaction will be moderated bygender. Ideal body internalization, dieting, bodymass and deficits in social support will be strongerpredictors of increased body dissatisfaction forgirls due to hypothesized gender differences inthe conception of size and shape and the cen-trality of appearance as an evaluative dimension.Based on previous findings, we hypothesize thatnegative affect will be a stronger predictor of bodydissatisfaction for boys.METHODParticipantsParticipants were 247 adolescent girls and 181 ado-lescent boys from four public and four private mid-dle schools in a large metropolitan area of the South-western United States. Adolescents ranged in age from12 to 16 (M = 13.57). The sample was composed of2% Asian/Pacific Islanders, 4% African Americans, 64%Caucasians, 18% Hispanics, 1% Native Americans, and5% who specified other or mixed racial heritage, whichwas representative of the ethnic composition of theschools from which we sampled (2% Asian/Pacific Is-landers; 8% African Americans, 65% Caucasians, 21%Hispanics; 4% other or mixed). Highest educational at-tainment for parents ranged from grade school graduate(2%) to graduate degree (19%) with a mode of collegegraduate (42%).ProceduresThe study was presented to parents and participantsas an investigation of adolescent mental and physicalhealth behaviors. Parents of all 8-grade girls and boysfrom the participating schools were sent a description ofthe study along with an informed consent letter, and ac-tive parental consent and adolescent assent were obtainedfrom all participants. This resulted in an average partic-ipation rate of 53% of eligible students across schools,similar to that observed in other school-recruited samplesusing active consent procedures and structured interviews(e.g., 61% for Lewinsohn et al., 1994).Participants completed a self-report questionnaire,participated in a structured psychiatric interview, and hadtheir weight and height measured by research assistantsat baseline (T1) and at 1- and 2-year follow-up (T2 andT3, respectively). Assessments took place during elec-tive courses during regular school hours, immediately af-ter school on the school campus, or in the participantshomes. Interviews were conducted by clinical assessorswith a bachelors, masters, or doctoral degree in psychol-ogy. Clinical assessors attended 24 hours of training, andwere required to show a minimum () agreement withexpert raters of 0.80 before starting data collection. Par-ticipants received a $15 gift certificate to a local book andmusic store as compensation for participating in the study.This project received human subjects approval from theUniversity of Texas Institutional Review Boards, as wellas from the Austin Independent School District.Adolescent Body Dissatisfaction 233MeasuresIdeal Body InternalizationThe Thinness and Restricting Expectancy Inventory(TREI; Hohlstein et al., 1998) assessed ideal-body inter-nalization for the girls. Participants indicated their levelof agreement with statements concerning expected socialand psychological benefits from achieving thinness usinga 5-point response format ranging from 1 = stronglydisagree to 5 = strongly agree. The TREI has ade-quate internal consistency ( = 0.98), testretest reliabil-ity (r = 0.80), and convergent validity (Hohlstein et al.,1998). Because it has been demonstrated that the idealbody type for boys differs from that of girls (Smolak et al.,2001) items were modified to reflect the expected benefitsfrom achieving leanness and muscularity as well as thin-ness for males. This scale had a = 0.80 for the combinedsample at T1 ( = 85 at T1 for boys and a = 0.80 at T1for girls).Body MassThe body mass index (BMI = kg/M2) was used to re-flect adiposity (Pietrobelli et al., 1998). Height was mea-sured to the nearest millimeter using stadiometers andweight was measured with digital scales. Two measuresof height and weight were obtained and averaged. TheBMI shows convergent validity (r = 0.800.90) with di-rect measures of total body fat such as dual energy X-rayabsorptiometry (Pietrobelli et al., 1998).Social SupportPerceived social support was measured with itemsadapted from the Network of Relationships Inventory(Furman and Buhrmester, 1985) assessing companion-ship, guidance, intimacy, affection, admiration, and reli-able alliance from parents and peers. Items are averagedfor analyses to form separate scales of parental supportand peer support. The internal consistency (M = 0.89),testretest reliability (M1month r = 0.69), and conver-gent and criterion validity of this measure have been doc-umented (Furman and Buhrmester, 1985; Furman, 1996).At T1, parental support had an = 0.87 and peer supporthad an = 0.89.DietingThe Dutch Restrained Eating Scale (DRES; vanStrien et al., 1986a,b) was used to assess dieting. Par-ticipants indicate the frequency of dieting behaviors us-ing 5-point scales (1 = never to 5 = always) and items areaveraged for analyses. This scale has shown internal con-sistency ( = 0.95), test-retest reliability (r = 0.82), con-vergent validity (with self-reported caloric intake), andpredictive validity for future increases in bulimic symp-toms (Stice, 2001; van Strein et al., 1986). This scale hadan = 0.92 at T1.Negative AffectivityTwelve items from Buss and Plomins (1984) Nega-tive Affect Scale were used to assess a propensity towardbecoming emotionally distressed. Items were averaged foranalyses. Research has found this scale to possess accept-able internal consistency ( = 0.82), test-retest reliability(r = 0.80), and predictive validity for onset of depression(Buss and Plomin, 1984; Hayward et al., 1998). This scalehad an = 0.79 at T1.Body DissatisfactionBody dissatisfaction was assessed with an adaptedform of the Satisfaction and Dissatisfaction with BodyParts Scale (Berscheid et al., 1973), which asks partic-ipants to indicate their level of satisfaction with 9 bodyparts using a 5-point scale ranging from 1 (extremely sat-isfied) to 5 (extremely dissatisfied). Items are averagedfor analyses. This scale has shown internal consistency( = 0.94), test-retest reliability (r = 0.90), and predictivevalidity for future increases in bulimic symptoms (Stice,2001). Because some of the items on this scale appearedto assess satisfaction with body parts more relevant forfemales than males, 4 of the items were modified on thequestionnaires completed by males. This scale had an = 0.92 at T1 ( = 0.93 for girls and = 0.89 for boys).RESULTSAnalytic OverviewPreliminary AnalysesPreliminary analyses tested for baseline differencesbetween girls and boys on all study variables and demo-graphic factors. Attrition analyses tested whether partic-ipants who dropped from the study differed significantlyfrom those who did not. Repeated measures ANOVA mod-els examined change in each of the predictor variablesand body dissatisfaction over the 3 measurement periods234 Bearman, Presnell, Martinez, and Sticeby gender, with time as a 3-level within subjects factorand gender as a 2-level between-subjects factor. A prioriplanned comparisons were conducted to test for signif-icant changes in each study variable at all time pointsseparately for girls and boys.Descriptive AnalysesHierarchical linear models (HLM; Bryk et al., 2000)probed the relations between all T1 risk factors and ageon increases in body dissatisfaction over time, to inves-tigate whether girls evidenced greater increases in bodydissatisfaction than boys as they increased in age over thecourse of the study (hypothesis 1). The following equationwas generated for these exploratory analyses:Level 1 : Y = B0i + B1i (AGEi) + RiLevel 2 : B0i = G00 + U0iB1i = G01 + G11 (SEX) + U1iIn which where B0i represents body dissatisfaction for in-dividual i at the 1st data collection (T1); B1i representsthe linear trend in body dissatisfaction scores across the3 data collections for individual i; AGEi represents thelinear trend for participant age across the 3 data collec-tions for individual i; and Ri represents random error inbody dissatisfaction for individual i. For Level 2 of thesemodels, G00 represents mean status of body dissatisfactionfor all participants at 1st data collection; U0i representsrandom error in B0i for individual i; G01 represents meanlinear change in body dissatisfaction for all participants,and G11 represents mean linear change in body dissatis-faction as predicted by sex, and U1i represents randomerror in B1i for individual i. Sex (0 = girls, 1 = boys) wasentered as a Level 2 time invariant covariate in order todetermine whether the slope generated by the Level 1equation varied by the different levels of sex at Level 2.Finally, independent t-tests performed in SPSS comparedthe means of girls and boys level of body dissatisfac-tion across all measurement periods at ages 13, 14, 15,and 16 to determine the age at which gender differencesemerged.Prospective AnalysesHierarchical linear models tested the univariateprospective relations between all T1 risk factors andage on increases in body dissatisfaction over time. T1values for the outcome (initial body dissatisfaction) wereused to estimate the parameters of change over time foreach individual, thereby ensuring a truly prospective test(Raudenbush and Byrk, 2002). For all models, baselinelevels of the risk factors were entered as Level 2time-invariant covariates, and the following equation wasgenerated:Level 1 : Y = B0i + B1i (TIMEi) + RiLevel 2 : B0i = G00 + U0iB1i = G01 + G11 (RISK FACTOR) + U1iwhere B0i represents body dissatisfaction for individuali at the 1st data collection (T1); B1i represents the lineartrend in body dissatisfaction scores across the 3 datacollections for individual i; TIMEi represents the lineartrend for time across the 3 data collections for individual i;and Ri represents random error in body dissatisfaction forindividual i. For Level 2 of these models, G00 representsmean status of body dissatisfaction for all participants at1st data collection; U0i represents random error in B0i forindividual i; G01 represents mean linear change in bodydissatisfaction for all participants, and G11 representsmean linear change in body dissatisfaction as predictedby baseline levels of each risk factor and U1i representsrandom error in B1i for individual i.To assess whether gender moderated the relation be-tween T1 risk factors and future growth in body dissat-isfaction (hypothesis 2), HLM models were generated toassess the effect of Level 2 time-invariant covariates ofgender (0 or 1), T1 risk factor, and the interaction of gen-der and the T1 risk factor on the slope of the Level 1unconditional model of body dissatisfaction over time:Level 1 : Y = B0i + B1i (TIMEi) + RiLevel 2 : B0i = G00 + U0iB1i = G10 + G11 (SEX) + G12(RISK FACTOR) + G11 (SEXRISK FACTOR) + U1iFor significant interactions, follow up analyses of the sim-ple effects of the T1 risk factor on growth in body dissat-isfaction were conducted separately for boys and girls.Finally, risk factors that showed a significant prospectiverelation with growth in body dissatisfaction were enteredsimultaneously into a multivariate model in order to deter-mine the unique contribution of each significant predictorto growth in body dissatisfaction.Preliminary AnalysesOf the original 428 participants, 15 did not providedata at T2 (3%), and 19 did not provide data at T3 (4%),although only 10 participants did not provide data at bothT2 and T3 (2%). Attrition analyses indicated that partic-ipants who dropped out of the study did not differ fromAdolescent Body Dissatisfaction 235Table I. Correlations Among the T1 Putative Risk Factors and T1, T2, and T3 Body Dissatisfaction, AlongWith Means and Standard Deviation for Boys and Girls2 3 4 5 6 7 8 9 M SD1. Ideal Body Intern 0.06 0.12 0.01 0.01 0.16 0.11 0.07 0.10 3.22 0.752. Body Mass Index 0.09 0.06 0.04 0.42 0.30 0.31 0.19 21.66 4.693. Negative Affect 0.19 0.02 0.25 0.32 0.28 0.26 2.68 0.614. Support-Parent 0.10 0.08 0.32 0.22 0.28 3.96 0.845. Support-Peer 0.08 0.10 0.14 0.17 4.16 0.776. Dietary Restraint 0.38 0.31 0.32 2.02 0.877. T1 Body Dis 0.61 0.54 2.66 0.888. T2 Body Dis 0.66 2.68 0.849. T3 Body Dis 2.74 0.83Note. Absolute correlations greater than 0.09 are significant at p < 0.05.those who provided complete data on any of the variablesconsidered in this study at T1. Because HLM uses full-information maximum likelihood estimation for missingdata, the effective N for analyses was 428. Independentt-tests indicated that girls reported higher levels of bodydissatisfaction, peer social support, negative affectivityand dietary restraint at T1; no other gender differenceswere significant. Means and standard deviations for allbaseline variables, and the correlations among them, areprovided in Table I. Repeated measures ANOVA modelsdemonstrated that there were differences between boysand girls over time with regard to ideal body internal-ization, F(2, 748) = 3.267, p < 0.05, with boys showinggreater increases than girls over the course of the study.A gender by time interaction also emerged for peer so-cial support deficits, with boys showing relative increasesin peer social support, while girls reported decreases inpeer social support, F(2, 776) = 6.89, p < 0.05. Girls alsoevidenced greater increases in dietary restraint over timethan boys in the study, F(2, 772) = 9.93, p < 0.05. Noother significant time by gender interactions were noted.A priori planned comparisons were conducted to test forsignificant changes in each study variable at all time pointsseparately for girls and boys. Unadjusted means and stan-dard deviations for boys and girls at each measurementperiod, and the results of the paired t-tests, are reportedin Table II. Means and standard deviation for all baselinemeasures by gender are reported in Table III.Descriptive AnalysesThe mean body dissatisfaction score for girls was 2.7at T1, 2.8 at T2, and 2.9 at T3, which reflects a neutrallevel of satisfaction. The mean body dissatisfaction scorefor boys was 2.6 at T1, and 2.5 at T2 and T3, correspond-ing with the midpoint between neutral and moderatelysatisfied. If body dissatisfaction is defined as a score thatcorresponds to an average response of moderately dissat-isfied or extremely dissatisfied, the rates of body dissatis-faction were 37% (T1), 35% (T2), and 44% (T3) for girlsand 23% (T1), 19% (T2), and 16% (T3) for boys. Thisis consistent with the relatively higher rates of body dis-satisfaction among girls than boys found in other studies(e.g. Keel et al., 1997) and similar to the rates of body dis-satisfaction found in other studies (Fox et al., 1994; Sticeand Whitenton, 2002). It is noteworthy that girls who re-ported being extremely satisfied or moderately satisfiedwith their bodies had a significantly lower mean bodymass (M = 19.78) than boys who reported being similarlysatisfied (M = 21.98, t = 3.09, p < 0.005). Girls whoreported being extremely or moderately dissatisfied withtheir weight (M = 24.36) did not differ statistically frommales who reported similar dissatisfaction (M = 21.72).7To probe the relation between age and increases inbody dissatisfaction, the univariate relation between ageand body dissatisfaction was first investigated in an indi-vidual model to test whether T1 age was associated withgrowth in body dissatisfaction over time. The main effectof age was not significant. To test whether this relationwas moderated by gender, gender was entered at Level 2,and results indicated that the cross-level interaction of ageand gender was significant, with increases in age associ-ated with increases in body dissatisfaction for girls butnot for boys ( = 0.12, t = 5.62, p < 0.001). Next,7 Because previous research indicates that body mass may deviate froma linear relation for boys (Muth and Cash, 1997; Presnell et al., 2004),we tested for higher-order effects. An orthogonal polynomial analysisof the Gender BMI effect indicated a significant Gender Linearinteraction (r = 0.685, p 0.001) Follow-up tests of the simple effectsseparately for boys versus girls suggested that while the relation ofBMI and body dissatisfaction had a significant linear component forgirls, but not for boys. On the other hand, a quadratic (u-shaped) modelwas supported at T1 for boys (r = 0.280, p 0.05), but not for girls.Although the quadratic model was no longer supported for boys atT2 and T3, BMI and body dissatisfaction continued to deviate from alinear association for boys in this sample.236 Bearman, Presnell, Martinez, and SticeTable II. Means and Standard Deviations Separately for Girls and Boys on Study Variables, and Results of the PairwiseComparisons at Time points 1, 2, and 3Variable Time 1 (Baseline) Time 2 (1-year follow-up) Time 3 (2-year follow-up)M SD M SD M SDIdeal body internalizationGirls 3.22a 0.67 3.33b 0.73 3.32 0.75Boys 3.22a 0.84 3.29a 0.79 3.51b 0.76Body massGirls 21.56a 4.74 22.06b 4.71 22.54c 4.83Boys 21.78a 4.64 22.49b 4.63 23.34c 5.14Negative affectGirls 2.78 0.60 2.79 0.73 2.72 0.72Boys 2.57a 0.59 2.48 0.71 2.45b 0.41Social supportparentsGirls 3.92 0.90 3.89 0.94 3.87 0.93Boys 4.00a 0.74 3.89b 0.82 3.87b 0.79Social supportPeersGirls 4.35 0.72 4.37a 0.75 4.27b 0.82Boys 3.91a 0.75 3.89a 0.83 4.11b 0.70Dietary restraintGirls 2.13 0.91 2.14 0.87 2.13 0.87Boys 1.87a 0.80 1.61b 0.66 1.58b 0.69Body dissatisfactionGirls 2.74a 0.95 2.82 0.90 2.91b 0.84Boys 2.55 0.76 2.48 0.77 2.49 0.75Note. Means in the same row with different subscripts are significantly different at p < 0.05.independent t-tests compared the means of girls and boysreported levels of body dissatisfaction aggregated acrossall measurement periods at ages 13, 14, 15 and 16 todetermine the age at which gender differences in bodydissatisfaction emerged. At age 13, regardless of mea-surement period, boys and girls reported similar levels ofbody dissatisfaction (M girls = 2.71; M boys = 2.58) andthere were no significant differences. By age 14, how-ever, girls reported significantly higher levels of bodydissatisfaction (M = 2.74) compared to boys (M = 2.56,t = 2.03, p < 0.05), and girls mean level of body dis-satisfaction continued to increase with age, while meanTable III. Means and Standard Deviations for Each T1 Variable byGenderGirls BoysM SD M SDIdeal body internalization 3.22 0.67 3.22 0.84Body mass 21.56 4.74 21.78 4.64Negative affect 2.78a 0.60 2.57b 0.59Social supportParents 3.92 0.90 4.00 0.74Social supportPeers 4.35 a 0.72 3.91b 0.75Dietary restraint 2.13a 0.91 1.87b 0.80T1 body dissatisfaction 2.74a 0.95 2.55b 0.76T2 body dissatisfaction 2.82a 0.90 2.48b 0.77T3 body dissatisfaction 2.91a 0.84 2.49b 0.75Note. Means in the same row with different subscripts are significantlydifferent at p < 0.05.level of body dissatisfaction decreased for boys, as evi-denced by levels of body dissatisfaction reported at ages15 (M: girls = 2.90; M: boys = 2.49, t = 4.75, p < 0.001)and at age 16 (M: girls = 2.95; M: boys = 2.35, t = 5.62,p < 0.001).Risk Factors for Increases in Body DissatisfactionAs hypothesized, initial elevations in dietary restraint( = 0.05, t = 2.39, p < 0.05), negative affect ( = 0.07,t = 2.20, p < 0.05), and deficits in parental social sup-port ( = 0.05, t = 2.02, p < 0.05), predicted growthin body dissatisfaction in the combined sample of boysand girls over the study period. Deficits in peer socialsupport approached statistical significance as a predic-tor of growth in body dissatisfaction ( = 0.04, t = 1.89,p = 0.06). However, ideal body internalization, and body-mass index did not show significant prospective relations.These models are reported in Table IV.To test whether gender moderated any of the uni-variate effects of the risk factors, interaction terms werecomputed for gender and each of the T1 independent vari-ables and added to the models described earlier. No signif-icant interactions with gender were observed among theputative risk factors.Risk factors showing significant univariate relationswere then included in a multivariate regression model.Adolescent Body Dissatisfaction 237Table IV. Univariate Relations of Each Risk Factor to Adolescent Boys and Girls Increases in Body DissatisfactionFixed effect Random effectEffect Parameter Coefficient SE t p Parameter Variance 2 df pIdeal body internalization 0 2.65 0.042 63.22 < 0.001 U0 0.540 1557.3 420 < 0.0011 0.01 0.024 0.61 ns U1 0.041 562.68 419 < 0.001Body mass index 0 2.65 0.042 63.22 238 Bearman, Presnell, Martinez, and SticeRisk Factors for Increases in Body DissatisfactionDespite this, ideal body internalization did notemerge as a prospective predictor of body dissatisfac-tion in this study. This is inconsistent with some previousresearch that has supported this relation for girls (Jones,2004; Stice and Whitenton, 2002) and boys (Jones, 2004).However, another prospective study that examined thin-ideal internalization in a co-ed sample also did not findsupport for the predictive relation to body dissatisfac-tion (Presnell et al., 2004). Ideal body internalization isthought to lead to body dissatisfaction through frustrationengendered by failing to attain an ideal one holds in highesteem. Because there was no interaction of gender andideal body internalization, these null findings cannot beattributed to gender differences in the way adolescentsconceptualize the ideal body size and shape. As an aside,ideal body internalization also did not interact with obe-sity to predict body dissatisfaction for the current sample,suggesting that this variable does not predict increases inbody dissatisfaction even among those adolescents whodeviated substantially from the culturally sanctioned ideal.Curiously, in the current study BMI also did not pre-dict body dissatisfaction for adolescent boys and girls.This is in contrast to previous research (Barker and Galam-bos, 2003; Presnell et al., 2004; Rosenblum and Lewis,1999), which has demonstrated that BMI is a consistentpredictor of girls dissatisfaction and, in one study (Fieldet al., 2001) for boys as well. Theoretically, increases inbody weight cause ones body to diverge from the ideal,thus leading to dissatisfaction (McCarthy, 1990). Becausegender did not moderate the relation between body massand body dissatisfaction, this study does not offer evidencethat body weight operates differently for girls and boysin terms of predicting body dissatisfaction, as suggestedby theorists who maintain that boys strive for increases inbody mass (Jacobi and Cash, 1994; McCreary and Sasse,2000; Smolak et al., 2001). It should be noted, however,that our measure of body dissatisfaction does not distin-guish between displeasure with being too large versusbeing too small.It is also worth noting that whereas girls in this studyshowed a linear association between BMI and body dis-satisfaction at all measurement points, boys deviated froma linear association throughout the duration of the study.More puzzling, boys who endorsed the highest levels ofdissatisfaction with their bodies were nearly identical inweight to boys who endorsed the greatest satisfaction.This suggests that ones perception of weight may be ofgreater psychological relevance than ones physical di-mensions. It may also be the case that BMI is too broada measurement of the physical changes that adolescentgirls and boys undergo during this important develop-mental phase, as it does not distinguish between weightgained via lean muscle versus fatty tissue. Thus, boys whoweigh more due to increased muscle mass may be verysatisfied with their physique, whereas boys whose weightincreases as a result of adipose tissue may be displeasedwith this increase.Initial elevations in negative affect predicted in-creased body dissatisfaction for the combined sample.Theoretically, the processing biases associated with affec-tive disturbances could result in a preference for informa-tion about ones physique that confirms a negative sense ofoneself (Beck, 1976). Although consistent with a previousstudy that found that negative affect was a prospective pre-dictor of boys body dissatisfaction (Presnell et al., 2004)this relation was not moderated by gender in this sample,and thus is difficult to reconcile with previous prospectivestudies that found that affective disturbances did not pre-dict body dissatisfaction for girls (Presnell et al., 2004;Stice and Whitenton, 2002). To our knowledge, this is the1st study to demonstrate this effect for a sample of bothboys and girls.Deficits in social support from parentsand to alesser extent from peerspredicted body dissatisfactionfor both boys and girls. Presumably, deficits in socialsupport might escalate vulnerability to body dissatisfac-tion as individuals strive to gain social acceptance throughconformity with body ideals, whereas supportive relation-ships with friends and family might offer protection fromfeelings of body dissatisfaction. This relation for girls hasreceived support in prior research (Stice and Whitenton,2002), although Jones (2004) found that peer acceptanceabout appearance predicted girls body dissatisfaction, butdid not predict body dissatisfaction in a separate sampleof boys. In the current sample, parental support deficitswere a more robust predictor of body dissatisfaction thanpeer social support deficits, and remained a significantpredictor of body dissatisfaction in the multivariate anal-yses while peer support deficits dropped out of the model.Although it is widely believed that peer influence be-comes increasingly salient throughout adolescence, thisstudy supplies some evidence that parental relationshipsretain their relevance and remain a powerful predictor ofadolescent body dissatisfaction.As hypothesized, increases in self-reported dietaryrestraint predicted increases in body dissatisfaction. Intheory, attempts to manage ones weight via dietary re-straint could cultivate body dissatisfaction for both girlsand boys because the frustration associated with dietaryfailure may increase displeasure with ones shape andAdolescent Body Dissatisfaction 239weight. Furthermore, self-reported dieting has been foundto predict weight gain (Klesges et al., 1992), which mayalso amplify feelings of body dissatisfaction. Consis-tent with this evidence, it has recently been suggestedthat identifying oneself as a dieter is a marker for apropensity to overeat, and therefore individuals who ex-press the need to employ dietary restraint do so becausethey have a tendency to chronically over consume whennot actively attempting to restrict their caloric intake(Lowe and Levine, 2005; Presnell and Stice, 2003). Al-though this relation has been supported for girls (Barkerand Galambos, 2003), attempts to manage weight didnot predict body dissatisfaction for boys in the oneprospective study we located that examined this variable(Barker and Galambos, 2003). Gender did not moder-ate this relation, indicating that self-reported dietary re-straint does not exert differential risk for boys versusgirls.None of the risk factors that predicted body dissatis-faction for the co-ed sample were moderated by gender-despite adequate power ( > 0.88) to detect small effectsin this sample (Cohen, 1988). This is an important point,because the bulk of research in this area focuses primarilyon girls, and researchers have theorized that the processesby which males and females become body dissatisfied aredissimilar (Keel et al., 1998; Tiggemann and Penning-ton, 1990). Although girls in this study evidenced higheroverall levels of body dissatisfaction than boys, the ratesof body dissatisfaction among boys were not insubstan-tial, and the risk factors were equivalent. This suggeststhat interventions targeting youth at risk for developingbody dissatisfactionas well as the psychiatric outcomesthat are associated with body dissatisfaction (e.g. depres-sion, eating disorders)should focus on both boys andgirls. Results do suggest, however, that while girls uni-formly wish to be thinner, boys are divided amongst thosewho desire to gain weight and those who desire to loseweight. Thus, interventions for boys may need to tar-get both ends of the spectrum. The results of this studyfurther indicate that an intervention aimed at individualswho express the need to diet may be especially helpfulin decreasing levels of body satisfaction. Additionally, in-terventions that focus on increasing positive affect andpeer and parental support would be particularly useful.Finally, this study indicated that the pivotal time to inter-vene with adolescents in order to prevent body dissatis-faction might differ for boys and girls. Boys appear to bemost body dissatisfied in early adolescence, whereas girlsbecome increasingly displeased with their physique asthey progress into middle and late adolescence, suggest-ing that the optimal timing for intervention may differ bygender.Study LimitationsIt is important to consider the limitations of this studywhen interpreting the findings. 1st, the low participationrate limits the generalizability of this sample. 2nd, be-cause both the measure of body dissatisfaction and thin-ideal internalization were modified in order to includeitems relevant for both genders, it is possible that thismay have introduced some measurement artifact. How-ever, our results are commensurate with previous stud-ies that have examined these constructs, increasing ourconfidence that they were adequately assessed. 3rd, thisstudy did not differentiate between dissatisfaction withbody parts that are perceived to be too small versus toolarge, a distinction that may have important theoreticalconsequencesespecially for boys. Fourth, we did notexamine other possible relations of study variables; forexample, it is possible that body dissatisfaction may bereciprocally related to a number of the risk factors in thecurrent study, or that risk factors may interact with oneanother to predict body dissatisfaction. Finally, whereaslongitudinal data provide information regarding temporalprecedence, 3rd variable explanations cannot be ruled outwith a non-experimental design. Therefore, it is possiblethat some shared causal variable increases both the riskfactors and body dissatisfaction.CONCLUSIONSIn this study, girls showed higher overall rates ofbody dissatisfaction than boys, and these rates increasedover the course of the study while the reverse was true forboys. Nonetheless, our data suggest that a considerablenumber of adolescents experience body dissatisfaction,and that the variables that increase risk are analogous re-gardless of gender. Whereas the malleable risk factorsmeasured in this study were not moderated by gender,there remained some striking distinctions between thegirls and boys in this study. Girls who reported satisfactionwith their bodies were significantly thinner than boys whoreported the same level of satisfaction, and as girls aged,they became increasingly dissatisfied. Because body dis-satisfaction is a ubiquitous concern for adolescents andassociated with significant emotional distress as well aspsychological impairment, efforts to clarify its etiologyand interrupt this trajectory are of vital importance.ACKNOWLEDGMENTSThis study was supported by a career award(MH01708) and an individual research service award240 Bearman, Presnell, Martinez, and Stice(MH12834) from the National Institutes of Mental Health.Thanks go to project research assistants, Melissa Fisher,Katy Whitenton, and Natalie McKee, as well as to themany undergraduate volunteers who assisted with thisproject. Our gratitude also goes to the Austin IndependentSchool District and the participants who made this studypossible.REFERENCESBaker, J. D., Williamson, D. A., and Sylve, C. (1995). Body imagedisturbance, memory bias, and body dysphoria: Effects of negativemood induction. Behav. Ther. 26: 747759.Barker, E. T., and Galambos, N. L. (2003). 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