The Role of Body Image in the Relationship Between Internet Use and Bulimic Symptoms: Three Theoretical Frameworks

Abstract

Exposure to traditional media has been associated with bulimic symptoms. However, to date, little is known regarding the effects of Internet exposure. The aim of this study was to explore the relationships between Internet use and bulimic symptoms within the competing frameworks of sociocultural, impression management, and self-objectification theory. A sample of 289 French women aged 18–25 years completed an online questionnaire assessing bulimic symptoms, body dissatisfaction, body image avoidance, self-surveillance, body shame, and weekly Internet use. Bootstrapping analyses revealed that body shame and body image avoidance mediated the effect of weekly Internet use on bulimic symptoms. Furthermore, when entered into a multiple mediation analysis, these two variables provided independent mediation pathways of equal magnitude. The findings support the usefulness of both the self-objectification and impression management frameworks for investigating the relationship between Internet use and bulimic symptoms. Longitudinal research would help to clarify these pathways further.

Introduction

In Western society, eating disorders (ED) and their subthreshold forms have a high prevalence of 10% among young women, with the highest rates for bulimic disorders, suggesting that special attention should be paid to bulimia-related symptoms.¹ The extant literature has highlighted that media and interpersonal pressure to be thin is associated with the development of bulimic symptoms.^2,3 While preliminary evidence exists for the relationship between Internet exposure and body image and disordered eating,^4–6 to date, little is known regarding the mechanism of these relationships. In particular, it is unclear which aspects of body image are most strongly associated with Internet use, and whether they contribute to explaining the relationship between Internet exposure and bulimic symptoms. Three theoretical frameworks within which body image and eating concerns have been conceptualized could potentially explain the relationship between Internet use and bulimic symptoms: sociocultural theory, self-objectification theory, and impression management theory. The aim of the current study was to evaluate the usefulness of these three theories.

First, sociocultural theory posits that Western society promotes an ultra-slender ideal, widely broadcast by the media, family members, and peers.⁷ Women are socialized to attempt to achieve this thin physique, and the endorsement of this ideal as a person standard, and ensuing attempts to attain it, may lead to body dissatisfaction, dieting and bulimic symptoms.^3,8 While the relationship between traditional media exposure and disordered eating has been found to be mediated by body dissatisfaction,⁹ little is known regarding the relationship between Internet use and bulimic symptoms. To date, few studies have provided initial evidence of the relationship between Internet use, body dissatisfaction, and disordered eating.^6,10 Moreover, social pressure to be thin has been shown to predict risk for bulimic symptoms.³ Therefore, body dissatisfaction might be a mediator in the relationship between Internet use and bulimic symptoms.

Second, objectification theory posits that women are socialized to internalize society's objectifying gaze, and view themselves as objects.¹¹ Such self-objectification could lead to negative outcomes, including self-surveillance, body shame, and disordered eating. Within this framework, the media are considered to disseminate objectifying content and thus promote self-objectification, and traditional media consumption has been shown to be associated with increased self-objectification.¹² Consistent with this, exposure to social networking sites has been associated with self-surveillance and self-objectification,^6,13 and self-objectification has been found to predict bulimic symptoms.¹⁴ Furthermore, body shame mediated the relationship between these two outcomes. These findings suggest that body shame and self-surveillance might mediate the relationship between Internet use and bulimic symptoms.

Third, impression management theory posits that individuals try to present a desirable image of themselves by selectively present aspects of themselves to others.¹⁵ Within this theory, individuals with high levels of body image avoidance and disordered eating have been found to prefer online social interactions, as they offer greater control over self-presentation.^16,17 Consistent with this, body image avoidance has been found to be associated with social media use.⁴ Furthermore, body image avoidance has also been associated with bulimic symptoms, and experiential avoidance of body image mediates the relationships between body dissatisfaction and bulimic symptoms.¹⁸ Thus, the relationship between Internet use and bulimic symptoms might be mediated by body image avoidance. However, to date, there have been no tests of this pathway.

Several conceptual frameworks have been used to examine factors contributing to the development of ED. Sociocultural theory, self-objectification theory, and impression management theory have each highlighted distinct mechanisms accounting for ED symptomatology. Given that these mechanisms are distinct, it is possible that they each contribute to the relationship between Internet use and disordered eating. However, the effects accounted for by each might be of different magnitude. Exploring these pathways concurrently would allow for the comparison of their contributions. The present study therefore aimed to explore the relationship between Internet use and bulimic symptoms within three theoretical frameworks: sociocultural theory, self-objectification theory, and impression management theory. Specifically, the aim was to explore the role of body dissatisfaction, self-surveillance and body shame, and body image avoidance as mediators in the relationship between Internet use and bulimic symptoms.

Method

Participants and procedure

The sample included 289 French young women who completed an online survey. Age ranged from 18 to 25 years (M = 21.94 years, SD = 1.98 years). Ten participants were excluded because of missing data (n = 7) or age (n = 3). Neither ethnic origin nor socioeconomic status was assessed. Participants were invited to complete an online survey, which was circulated via e-mail lists and social networks. All participants provided informed consent, and no financial compensation was offered. The study followed the ethical guidelines of the Helsinki declaration and received approval from the relevant institutional authorities.

Measures

Weekly time spent online

Participants estimated time spent on the Internet, both on weekdays and days of the weekend, through two items: “How long do you spend on average on the Internet on days of the weekend?” and “How long do you spend on average on the Internet on weekdays?” A total weekly average was calculated by summing these values.

Body dissatisfaction

The body dissatisfaction subscale of the Eating Disorder Inventory 2 (EDI-2)¹⁹ was used to assess body dissatisfaction. The body dissatisfaction subscale is composed of nine items scored on a 6-point scale ranging from 1 = “never” to 6 = “always.” An example item is “I think that my thighs are too large.” The continuous scoring method was used, as it offers greater sensitivity in nonclinical populations.²⁰ The reported internal reliability of this subscale is good (α = 0.90).⁸ In this study, the Cronbach's alpha was 0.88.

Self-surveillance and body shame

The Objectified Body Consciousness Scale (OBCS)²¹ was used to assess levels of self-surveillance (viewing the body as an outside observer) and body shame (feelings of shame when the body does not match up to cultural norms). Items were translated into French and then back-translated under the supervision of a collaborator fluent in both English and French. Each subscale includes eight items rated on a 7-point scale ranging from 1 = “strongly disagree” to 7 = “strongly agree.” Example items are, respectively, “I rarely compare how I look with how other people look” (reversed item) and “I feel like I must be a bad person when I don't look as good as I could.” The internal reliability of this scale was good (α = 0.89 for the self-surveillance subscale and α = 0.75 for the body shame subscale).²¹ In the present study, the Cronbach's alphas were 0.78 and 0.79, respectively.

Body image avoidance

Avoidance of body image was assessed using the Body Image Avoidance Questionnaire (BIAQ).¹⁷ The BIAQ is composed of 19 items scored on a 6-point scale ranging from 0 = “never” to 5 = “always.” An example item is “I wear baggy clothes.” The BIAQ reliability is reported to be good (α = 0.83).⁴ In the present sample, the Cronbach's alpha was 0.68.

Bulimic symptoms

The Bulimia subscale from the Eating Disorder Inventory 2 (EDI-2)¹⁹ was used to assess levels of disordered eating. Items were scored as a continuous measure. The subscale includes seven items scored on a 6-point scale ranging from 1 = “never” to 6 = “always.” An example item is “I stuff myself with food.” The reported internal reliability of this subscale is good (α = 0.80).²² In the present sample, the Cronbach's alpha was 0.82.

Body mass index

Body mass index (BMI) was calculated using women's self-reported height and weight.

Statistical analyses

Correlational analyses were conducted to examine the relationship between the variables. Scores were then converted to z scores in order to obtain standardized coefficients when conducting the mediation analysis. A multiple mediator model was tested in which body shame, body avoidance, self-surveillance, and body dissatisfaction were examined as concurrent mediators of the relationship between weekly time spent online and bulimic symptoms using a macro for SPSS.²³ Kappa-squared was used to evaluate effect size of indirect effect through significant mediators.²⁴ Effect sizes were interpreted using Preacher and Kelley's²⁴ recommendation, with small, medium, and large effect sizes defined as 0.01, 0.09, and 0.25, respectively. Analyses were performed using SPSS Statistics for Windows v21.

Results

In the present sample, participants spent an average of 24.31 hours (SD = 13.27 hours) online per week. Correlation analyses revealed that the majority of the variables were intercorrelated (Table 1). In particular, weekly time spent online was correlated with body shame (r = 0.14, p < 0.05), body image avoidance (r = 0.16, p < 0.01), and bulimic symptoms (r = 0.13, p < 0.05). Results from the multiple mediation analysis (Fig. 1) based on 5,000 bootstrapped resamples revealed that the total indirect effect of weekly time spent online on bulimic symptoms through body dissatisfaction, body shame, self-surveillance, and body avoidance was significant (β = 0.08, SE = 0.03 [95% CI 0.013–0.149]) and explained 27% of the variance in bulimic symptoms (p < 0.01; Fig. 1). The indirect effects of weekly time spent online on bulimic symptoms through body shame and body avoidance were significant (β = 0.04, SE = 0.02 [95% CI 0.007–0.087], k² = 0.07, SE = 0.03 [95% CI 0.01–0.13]; β = 0.03, SE = 0.02 [95% CI 0.003–0.070], k² = 0.06, SE = 0.03 [95% CI 0.02–0.12]). However, the indirect effects through self-surveillance was not significant (β = 0.00, SE = 0.01 [95% CI −0.013–0.023]), and the indirect effect through body dissatisfaction just failed to meet significance (β = 0.01, SE = 0.01 [95% CI −0.001–0.040]). Thus, only body shame and body image avoidance emerged as mediators in the relationship between Internet use and bulimic symptoms.

FIG. 1.

Multiple mediation analysis.

Table 1.

Bivariate Spearman Correlations Between Study Variables (N = 289)

Measure	1	2	3	4	5	6
1. Bulimic symptoms	1
2. Body avoidance	0.38^**	1
3. Body shame	0.46^**	0.55^**	1
4. Self-surveillance	0.32^**	0.28^**	0.43^**	1
5. Weekly time spent online	0.13^*	0.16^**	0.14^*	0.02	1
6. Body dissatisfaction	0.40^**	0.44^**	0.58^**	0.39^**	0.10^***	1

p < 0.05; ^**p < 0.01; ^***p < 0.10.

Discussion

The aim of this study was to explore the relationship between Internet use and bulimic symptoms within three theoretical frameworks: sociocultural theory, self-objectification theory, and impression management theory. Our results revealed that several mechanisms could be involved in the relationship between Internet use and bulimic symptoms, since, when considered concurrently, both body shame and body avoidance emerged as mediators with small effect sizes. These results provide initial support for considering the relationship between Internet use and bulimic symptoms within self-objectification theory and impression management frameworks. The Internet, and in particular social media, invites users to become active rather than passive media users, and to stay connected with their social circle through regular postings and status updates on multiple applications. While there may be social support advantages to this virtual connectedness, the expectation of having one's virtual presence assessed by others may increase feelings of objectification and self-objectification. Furthermore, the opportunities offered by the Internet to control one's presentation and selectively self-present in the most positive light, for example by posting one's most attractive pictures, might lead to the gradual creation of an “online self” that is somewhat closer to social ideals than individuals feel their actual selves to be. Consistent with this idea, it has been found that women are likely to delete online pictures of themselves that they feel do not present them at their most attractive.²⁵ However, it is important to recognize that the present study did not allow explorations of causality. It may be that individuals who are likely to experience shame when feeling that their grooming and presentation is lacking might be drawn to Internet communication in which their appearance remains hidden. Future research should attempt to clarify the direction of these relationships.

This study presents a number of limitations. It assessed for Internet use in general, without enquiring about the nature and content of the Internet use. Future studies should distinguish types of Internet utilization and in particular assess for passive Internet use versus active engagement with the Internet and social media. Nevertheless, as little is known regarding the relationship between Internet use and bulimic symptoms, explorations of even general use of the Internet are useful prior to considering specific aspects of Internet use. Finally, additional aspects of the different frameworks were not assessed, such as for example peer and family influences, and this constitutes an important limitation, as sociocultural models have highlighted that interpersonal relationships might be risk factors of ED.

In conclusion, this study suggests that body shame and body image avoidance might represent two of the mechanisms accounting for the relationship between Internet use and bulimic symptoms. Self-objectification and impression management should be considered as useful frameworks within which to explore the relationships between Internet use and body image and eating disturbance. Finally, further explorations of the relationship between Internet use and EDs grounded in sociocultural frameworks should assess for additional outcomes such as internalization of the thin ideal.

Footnotes

Author Disclosure Statement

No competing financial interests exist.

References

Stice

, Nathan

, Shaw

, et al. An 8-year longitudinal study of the natural history of threshold, subthreshold, and partial eating disorders from a community sample of adolescents. Journal of Abnormal Psychology, 2009; 118:587–597.

Levine

, Murnen

. “Everybody knows that mass media are/are not [pick one] a cause of eating disorders”: a critical review of evidence for a causal link between media, negative body image, and disordered eating in females. Journal of Social & Clinical Psychology, 2009; 28:9–42.

The McKnight Investigators. Risk factors for the onset of eating disorders in adolescent girls: results of the McKnight longitudinal risk factor study. American Journal of Psychiatry, 2003; 160:248–254.

Rodgers

, Melioli

, Laconi

, et al. Internet addiction symptoms, disordered eating, and body image avoidance. Cyberpsychology Behavior, & Social Networking, 2013; 16:56–60.

Tao

. The relationship between Internet addiction and bulimia in a sample of Chinese college students: depression as partial mediator between Internet addiction and bulimia. Eating & Weight Disorders—Studies on Anorexia, Bulimia & Obesity, 2013; 18:233–243.

Tiggemann

, Slater

. NetTweens the Internet and body image concerns in preteenage girls. The Journal of Early Adolescence, 2014; 34:606–620.

Thompson

, Heinberg

. The media's influence on body image disturbance and eating disorders: we've reviled them, now can we rehabilitate them?. Journal of Social Issues, 1999; 55:339–353.

Rodgers

, Chabrol

, Paxton

. An exploration of the tripartite influence model of body dissatisfaction and disordered eating among Australian and French college women. Body Image, 2011; 8:208–215.

Stice

, Schupak-Neuberg

, Shaw

, et al. Relation of media exposure to eating disorder symptomatology: an examination of mediating mechanisms. Journal of Abnormal Psychology, 1994; 103:836–840.

10.

Cash

, Smolak

. (2012) Body image: a handbook of science, practice, and prevention. New York: Guilford Press.

11.

Fredrickson

, Roberts

. Objectification theory. Psychology of Women Quarterly, 1997; 21:173–206.

12.

Harper

, Tiggemann

. The effect of thin ideal media images on women's self-objectification, mood, and body image. Sex Roles, 2007; 58:649–657.

13.

De Vries

, Peter

. Women on display: the effect of portraying the self online on women's self-objectification. Computers in Human Behavior, 2013; 29:1483–1489.

14.

Noll

, Fredrickson

. A mediational model linking self-objectification, body shame, and disordered eating. Psychology of Women Quarterly, 1998; 22:623–636.

15.

Leary

. Self-presentational processes in exercise and sport. Journal of Sport & Exercise Psychology, 1992; 14:339–351.

16.

Caplan

. Relations among loneliness, social anxiety, and problematic Internet use. CyberPsychology & Behavior, 2007; 10:234–242.

17.

Rosen

, Srebnik

, Saltzberg

, et al. Development of a body image avoidance questionnaire. Psychological Assessment: A Journal of Consulting & Clinical Psychology, 1991; 3:32–37.

18.

Timko

, Juarascio

, Martin

, et al. Body image avoidance: an under-explored yet important factor in the relationship between body image dissatisfaction and disordered eating. Journal of Contextual Behavioral Science, 2014; 3:203–211.

19.

Garner

. (1991) Eating disorder inventory-2: professional manual. Odessa, FL: Psychological Assessment Resources.

20.

Schoemaker

, van Strien

, van der Staak

. Validation of the eating disorders inventory in a nonclinical population using transformed and untransformed responses. International Journal of Eating Disorders, 1994; 15:387–393.

21.

McKinley

, Hyde

. The objectified body consciousness scale development and validation. Psychology of Women Quarterly, 1996; 20:181–215.

22.

Keel

, Baxter

, Heatherton

, et al. A 20-year longitudinal study of body weight, dieting, and eating disorder symptoms. Journal of Abnormal Psychology, 2007; 116:422–432.

23.

Preacher

, Hayes

. Asymptotic and resampling strategies for assessing and comparing indirect effects in multiple mediator models. Behavior Research Methods, 2008; 40:879–891.

24.

Preacher

, Kelley

. Effect size measures for mediation models: quantitative strategies for communicating indirect effects. Psychological Methods, 2011; 16:93–115.

25.

Pempek

, Yermolayeva

, Calvert

. College students' social networking experiences on Facebook. Journal of Applied Developmental Psychology, 2009; 30:227–238.