Appearance investment: The construct that changed the field of body image

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ARTICLE IN PRESS

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Body Image xxx (2019) xxx–xxx

Contents lists available at ScienceDirect

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Review article

Appearance investment: The construct that changed the field of body image Josée L. Jarry ∗ , Nicole A.L. Dignard, Lauren M. O’Driscoll University of Windsor, Windsor, Canada

a r t i c l e

i n f o

Article history: Received 14 September 2019 Accepted 14 September 2019 Available online xxx Keywords: Appearance investment Appearance schemas inventory Literature review

a b s t r a c t In the mid-1990s, Thomas F. Cash developed the construct of appearance investment and an instrument to measure it, the Appearance Schemas Inventory (ASI). This was followed by a significant revision of this measure, the ASI-R. This instrument distinguished two dimensions to appearance investment, one referring to engagement in behaviours meant to improve appearance esthetics, and one referring to the importance of appearance for self-definition. The construct of appearance investment and its measurement gave rise to a new area of research that widened our understanding of body image beyond the ubiquitous construct of satisfaction. In this paper, we review the literature on appearance investment and offer conclusions based on the different study designs in which either the ASI or ASI-R were used. This is followed by general conclusions about the current state of the research on appearance investment, and future directions to improve our understanding of the factors contributing to the development of excessive investment in appearance. © 2019 Elsevier Ltd. All rights reserved.

Contents 1. 2. 3.

4.

Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00 Method . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00 Results . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00 3.1. Validation studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00 3.2. Correlation studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00 3.3. Experience sampling studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00 3.4. Cross-sectional studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00 3.5. Experimental studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00 3.6. Longitudinal studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00 3.7. Intervention studies . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00 Discussion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00 4.1. Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00 Acknowledgements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00 Appendix A . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 00

1. Introduction Thomas F. Cash is largely responsible for the development of the field of body image research by distinguishing it from that

∗ Corresponding author at: Department of Psychology, University of Windsor, 401 Sunset Avenue, Windsor, ON N9B 3P4, Canada. E-mail address: [email protected] (J.L. Jarry).

of eating disorders. Until his seminal work, the construct of body image mostly was assimilated into that of disordered eating, which is understandable given that body image disturbance is a core element of eating pathology and drives much of its behavioural expression (American Psychiatric Association, 2013). Before Cash’s work, Cooper and Fairburn (1987) proposed that women with eating disorders over valued their appearance and were excessively invested in it, to the point of gauging their self-worth based on their body weight. In this conceptualisation, however, body image

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is assimilated to body weight and shape in the context of disordered eating. Although invaluable to the understanding of the forces motivating the development and maintenance of disordered eating, this view of body image was limited both in terms of its scope and the population of interest. Cash recast and widened the construct of body image bringing to our attention the fact that body image is a universal attribute that is subject to individual differences. Indeed, not everyone has an eating disorder with associated body image disturbances, but everyone has a body image. This conceptualisation of body image propelled its study by making it an individual difference measurable in everyone. Cash further developed the field of body image study by conceptualising it as a multidimensional construct (Cash, 2011). This construct includes an attitudinal and a behavioural component. The attitudinal component further includes an evaluative and an investment component. The evaluative component consists of the degree of satisfaction with appearance. In Cash’s new vision, this included not only satisfaction with weight and shape, as previously conceptualized, but also satisfaction with overall appearance, and specific body parts and features such as skin tone and hair texture. He also included satisfaction with body functions such as strength. In addition to his contribution to the conceptualisation of body satisfaction, Cash developed a series of instruments to assess these specific dimensions of body satisfaction such as the Body Image States Scale (BISS; Cash, Fleming, Alindogan, Steadman, & Whitehead, 2002) and the Multidimensional Body-Self Relations Questionnaire (MBSRQ; Cash, 2000). This further allowed the evolution of the field of body image studies by making the results of separate studies comparable given the use of common instruments. This body of knowledge then made possible an incremental understanding of body image, what it is, what it does to people, and the factors that affect it. Cash then brought to our attention that fact that appearance not only can be the object of various levels of satisfaction but that it also varies in terms of importance: looking a certain way does not have the same importance for everyone. Cash further expanded on the notion of the importance of appearance to make it more than how important certain body parts or features are for global appearance satisfaction. He developed the notion of body image investment, which addresses the importance of appearance for the self. Cash defined body image investment as the extent to which people are appearance schematic, which consists of a behavioural and a cognitive component (Cash, Jakatdar, & Williams, 2004). The former is called motivational salience and consists of the extent to which people attend to their appearance with the goal of making it esthetically pleasing. Cognitive investment is captured by self-evaluative salience, which consists of the extent to which appearance is a centrally defining feature of the self. This dimension includes the attribution of life outcomes to appearance and its influence on mood and self-evaluation. Self-evaluative salience captures the essence of what it means to be appearance schematic. Appearance schemas, like all schemas, influence the perception and processing of information. In this case, information about the self, others, and the environment is processed in terms of appearance. Cash and colleagues first developed the Appearance Schemas Inventory (ASI; Cash & Labarge, 1996) to measure appearance schematicity, and later revised the ASI into the ASI-R (Cash, Melnyk, & Hrabosky, 2004), which consists of the Motivational Salience (MS) and the Self-Evaluative Salience (SES) subscales. Since its inception, the construct of appearance investment has generated a large amount of research and has been used in different ways by researchers. Researchers have used it in simple correlations, as an independent/predictor/moderator variable, as a mediator, and more rarely as a dependent/outcome variable. In this paper, we attempted to paint a picture of how the construct

of appearance investment and its associated measures, the ASI and the ASI-R, have been used in research to date. We also discuss what appearance investment and its measurement have added to our understanding of body image, the factors that may affect it, and how it may impact human subjective states and behaviour. We further comment on the current state of research on appearance investment and propose new avenues of research.

2. Method We performed three separate searches using a combination of the University library catalogue and PsychInfo. In March 2018, a research assistant searched the library catalogue and PsycINFO using the following terms: “appearance investment,” “body image investment,” “ASI/Appearance Schemas Inventory,” or “ASI-R/Appearance Schemas Inventory-Revised” within the “Test/Measures” section of the article. These searches yielded 87 articles, 12 of which were not accessible, of which 10 were not written in English. These articles were screened by the second author (ND) according to the following criteria: (a) written in English, (b) original empirical research (i.e., not a review or meta-analysis), (c) published in a peer-reviewed journal, and (d) used the ASI or ASIR and reported on analyses and/or results pertaining to their use. Based on these criteria, eight articles were rejected as follows: one because it was written in Portuguese, five because they did not use the ASI or ASI-R, and two because they were review articles. In October 2018 the second author searched PsycINFO for articles that cited the initial validation studies for the ASI and ASI-R which yielded 146 and 211 citations respectively. These citations were screened using the same criteria described previously. From the 146 citations of the ASI validation study, two additional articles were identified. From the 211 citations of the ASI-R validation study, 95 additional studies met criteria (a) and (c) and were screened by the second authors for criteria (b) and (d). Of these 95 articles, 71 were rejected as follows: five were not available, five were not original empirical research, and 61 did not use the ASI or the ASI-R. All articles were screened for references pertaining to the use of the ASI or ASI-R not previously identified using the search strategy. No additional articles were identified through this method. In August 2019, a third search was conducted by the first author using the same search terms as in previous searches. This search yielded 133 articles, seven of which had not been identified in previous searches, which included two that had been published since the previous searches. One of these seven articles was omitted because it did not meet inclusion criteria (d). Additionally, the authors identified three studies that were known to them but had not been identified in any of the previous searches. Thus, combined a total of 102 articles were retained for meeting inclusion criteria. All relevant information was extracted from the articles by the second author and was independently corroborated by the first and third authors.

3. Results 3.1. Validation studies We located a total of 18 validation studies in which either the ASI or the ASI-R were used (see Table 1). The ASI was used in five validation studies, one of which was the validation of the ASI itself (Cash & Labarge, 1996). Three of these studies were conducted in the United States, one in the UK, and one in Spain. Four studies were conducted with female undergraduates. One of these also included community women and one combined undergraduate students with primary and secondary school students. In only one study did the sample include male and female participants.

Please cite this article in press as: Jarry, J. L., et al. Appearance investment: The construct that changed the field of body image. Body Image (2019), https://doi.org/10.1016/j.bodyim.2019.09.001

Authors & Year

Sample Characteristics / Country

Scale / Construct Validated

Female undergraduate students / United States

Bramwell & Morland, 2009

Community women, university staff, and undergraduate students / UK

Cash & Labarge, 1996

Female undergraduate students / United States

Hart et al., 2008

Male and female undergraduate students / United States

˜ et al., 2006 Perpiná

Female students aged 14 to 29 recruited from primary, secondary, and post-secondary schools / Spain

Physical Appearance Ambiguous Feedback Scale (PAAFS) / body image cognitive biases, measured with ratings of ambiguous statements as positive or negative. A higher score means a more negative interpretation. Genital Appearance Satisfaction (GAS) / satisfaction with appearance of genitals Appearance Schemas Inventory (ASI) / body image investment (original validation study) Social Appearance Anxiety Scale (SAAS) / fear of negative evaluation of one’s appearance (as a feature of social anxiety) Situational Inventory of Body-Image Dysphoria (SIBID-S) / Spanish version

Results

BIATQ-P, EDI-2 (-BD, -DT & -B), FNAE, MCSDS, MBSRQ-AE, PASTAS

ASI positively correlated with PAAFS-A and PAAFS-G.

BSS, RSES

ASI positively correlated with GAS and BSS and negatively correlated with RSES. ASI positively correlated with SIBID, BIQ, BIAQ, SCS-R, FNE, BDI, and BULIT-R. ASI negatively correlated with MBSRQ, BASS, and TSBI. ASI negatively correlated with MBSRQ-AE, and positively correlated with BDI, BIQ, FNE, MBSRQ-OP, MBSRQ-AO, SAAS, SIAS, SPS, and SPAS1 . ASI positively correlated with the Spanish SIBID-S.

BASS, BDI, BIQ, BIAQ, BULIT-R, FNE, MBSRQ, MCSDS, SCS-R, SIBID, TSBI

BDI, BIQ, FNE, MBSRQ-AS, MCSDS-SF, SIAS, SPAS, SPS

BAT, BESb , BSQ, EAT-26, RS, RSES

Studies using the ASI-R Authors & Year

Sample Characteristics / Country

Cash & Grasso, 2005

Male and female undergraduate students / United States Male and female undergraduate students / United States

Cash, Jakatdar et al., 2004

Cash, Jakatdar et al., 2004

Male and female undergraduate students / United States

Cash, Jakatdar et al., 2004

Male and female undergraduate students / United States

Cash et al., 2005

Male and female undergraduate students / United States

Scale / Construct Validated

Other measures

Use of Subscales

None

BICSI, BIDQ, BIQLI

SES & MS

Body Image Quality of Life Inventory (BIQLI) / positive and negative effects of body image on psychosocial quality of life Appearance Schemas Inventory-Revised (ASI-R) / body image investment (original validation study)

BIQ, EAT-26, LOT-R, RSES, SIBIDS-S, SSAS

SES & MS

BIQ, BIQLI, SIBID-S, SATAQ-3, PSPSa , RSES, EAT-26

Total, SES & MS

Body Image Disturbance Questionnaire (BIDQ) / emotional and psychosocial impairment associated with body dissatisfaction Body Image Coping Strategies Inventory (BICSI) / mean of coping with everyday body image threats

CES-D, EAT-26, FNE, MBSRQ-AS, PDS-I, SIBID-S

SES & MS

BIQ, BIQLI, EAT-26, RSES, SIBID-S, SSAS

SES & MS

Results Reported norms and test-retest reliability for each scale. Women reported higher SES and MS than did men. SES, but not MS, negatively correlated with BIQLI; correlation larger in data drawn from females than males. For women, ASI-R, SES, and MS positively correlated with BIQ, SIBID-S, and SATAQ-3; ASI-R and SES negatively correlated with BIQLI. For men, ASI-R and SES positively correlated with BIQ, SIBID-S, and SATAQ-3; MS positively correlated with SIBID-S; SES negatively correlated with BIQLI. Correlations between BIDQ and SES and MS positive in both men and women, but correlation between BIDQ and MS significant only for women. BIDQ more strongly correlated with SES than with MS. For SES, correlations with BISCI-A and -AF positive for both men and women, and correlation with BICSI-PRA negative in women but positive in men. For MS, correlation with BICSI-A not significant for either men or women, correlation with BICSI-AF positive for both men and women, and correlation with BICSI-PRA positive in men but nonsignificant in women.

ARTICLE IN PRESS

Altabe et al., 2004

Other measures

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Studies using the ASI

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Please cite this article in press as: Jarry, J. L., et al. Appearance investment: The construct that changed the field of body image. Body Image (2019), https://doi.org/10.1016/j.bodyim.2019.09.001

Table 1 Validation studies using the Appearance Schemas Inventory (ASI) or ASI-Revised (ASI-R).

3

Other measures

Use of Subscales

Results

Women planning to undergo breast reconstruction following cancer-related mastectomy / United States

Appearance Schemas Inventory-Revised (ASI-R)

–

–

Dignard & Jarry, 2019

Female undergraduate students / Canada

Body Appreciation Scale-2 (BAS-2) / positive body image

BDI-II, BSQ-14, IES-2, RSES

SES & MS

Giovannelli, Cash, Henson, & Engle, 2008

Male and female undergraduate students / United States

Importance × satisfaction composite version of the BASS (BASS Importance composite)

BIQ, BIDQ, BIQLI, EAT-26, RSES

SES & MS

Jakatdar, Cash, & Engle, 2006

Female undergraduate students / United States

BISS, BIQLI, EAT-26, MBSRQ-AS, PDS-I SIBID-S

SES & MS

Moreira, Silva, Marques, & Canavarro, 2010

Female post-operative patients with breast cancer / Portugal

DAS-24, ESS-BS, WHOQOL-BREF

SES & MS

Portuguese BIS positively correlated with SES and non-significantly negatively correlated with MS.

Moss & Rosser, 2012

Online sample of men and women / unknown

DAS-24, PANAS

SES & MS

SES and MS positively correlated with CARSAL and CARVAL1 .

Rusticus et al., 2008

Convenience sample of men and women / unknown

Assessment of Body-Image Cognitive Distortions (ABCD) / distortions in processing/cognitions related to appearance Body Image Scale (BIS) / Portuguese version, brief measure of BI for use with cancer patients CARSAL and CARVAL / cognitive salience and evaluation of appearance Appearance Schemas Inventory-Revised (ASI-R)

BIQLI

Total, SES & MS

Smith & Davenport, 2012

Hispanic college women / United States

Appearance Schemas Inventory-Revised (ASI-R)

MBSRQ

Total, SES & MS

ASI-R Total score not invariant for all groups, indicating that it may not carry the same meaning across ages and genders. Young and middle-aged women reported greater SES and MS than did male counterparts. Older adult women reported greater MS, but not SES, than older adult men. ASI-R Total, SES, and MS scores for Hispanic women differed from norms for Caucasian and African American women. Intercorrelations between ASI-R subscales consistent with Caucasian samples. In Hispanic women, MS, but not ASI-R total or SES, positively correlated with MBSRQ. ASI-R Total, SES, and MS strongly positively correlated with MBSRQ-AO and -OP. SES, but not ASI-R or MS, negatively correlated with MBSRQ-AE. ASI-R. SES, but not MS, negatively correlated with MBSRQ-HE and -BAS.

Did not include separate analyses for male and female participants.

Exploratory factor analysis revealed three factors of special relevance to women with breast cancer: Appearance Self-Evaluation, Appearance Power/Control, and Appearance Standards and Behaviour. SES and MS negatively correlated with BAS-2. Correlation between BAS-2 and SES smaller than between BAS-2 and MS. IES-2 negatively correlated with both SES and MS. Correlation between IES-2 and SES larger than between IES-2 and MS. In male and female students, BASS Evaluation negatively correlated with SES, and BASS Importance composite positively correlated with MS. In female students but not in male students BASS Importance composite was positively correlated with SES. Where significant, correlations larger in data drawn from female students than from male students. SES and MS positively correlated with ABCD 37-item, Form A and Form B. Correlations larger for SES than for MS.

ARTICLE IN PRESS

Sample Characteristics / Country

Chua, DeSantis, Teo, & Fingeret, 2015

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1

Scale / Construct Validated

Authors & Year

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Studies using the ASI-R

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Table 1 (Continued)

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The ASI was used to validate measures of interpretation of ambiguous appearance feedback (Altabe, Wood, Herbozo, & Thompson, 2004), appearance social anxiety (Hart et al., 2008), ˜ Gallego, & Botella, 2006), and satappearance dysphoria (Perpiná, isfaction with the appearance of the genitals (Bramwell & Morland, 2009). In all five studies, correlations with the ASI were as expected such that higher ASI scores were positively related to negative body image and psychological functioning such as depression, and negatively related to their corollary such as body satisfaction and self-esteem. In the one study in which the sample included males and females, results showed no differences between genders in the pattern of correlation between the ASI and other measures (Hart et al., 2008). The ASI-R was used in 13 validation studies, six of which were done by Cash and colleagues, including one that was the original scale validation (Cash, Melnyk et al., 2004). Nine studies were conducted in the United States, two in Canada, and one in Portugal. One was an online study with no specification of participants’ country of residence (Moss & Rosser, 2012). In eight of these studies, the sample included males and females, all of which were undergraduate students except for the study conducted by Rusticus, Hubley, and Zumbo, (2008) in which undergraduate students and community citizens were combined, and the study by Moss and Rosser (2012) in which the origin of the sample was not specified. Five studies included only women. In three of these, the women were undergraduate students and in two, they were breast cancer patients. Eight studies were validations of new measures of negative body image, one was an investigation of norms for several body image measures including the ASI-R, one explored the factor structure of the ASI-R for women with breast cancer, one tested norms and elements of construct validity of the ASI-R in English speaking Hispanic women, one tested the invariance of the ASI-R, and one tested the construct validity of a measure of positive body image. Correlations between the ASI-R and measures of either body image or psychological functioning were as expected with higher ASI-R scores being associated with higher scores on measures of dysfunction, and lower score on measures of health or well-being. Further, the factor structure and scores/norms for the ASI-R were found to vary depending on the population studied. Unlike the findings associated with the ASI, there were differences in patterns of correlations between genders with the ASI-R. For example, although women higher in SES reported lower positive rational acceptance coping related to their appearance, males high in both SES and MS reported more positive rational acceptance coping related to their appearance (Cash, Santos, & Williams, 2005). Similarly, women higher in MS also reported higher appearance dissatisfaction and giving more importance to this dissatisfaction, more situational appearance dysphoria, and higher endorsement of the thin ideal. In contrast, men higher in MS reported only higher situational appearance dysphoria (Cash, Melnyk et al., 2004). 3.2. Correlation studies We located a total of 38 correlational studies that investigated appearance investment using either the ASI or the ASI-R (see Table 2). Studies were conducted in a total of seven countries, most in the Unites States (n = 17), followed by Australia (n = 9) and the United Kingdom (n = 7). The ASI was used in 10 studies and the ASI-R in 28. Of the latter, 19 distinguished the SES and MS subscales, whereas eight used total scores only. Although most studies sampled females, mixed gender samples were used in 11 studies and a male sample only was used in two (Martins, Tiggemann, & Churchett, 2008; Ryan, Morrison, & McDermott, 2010). Appearance investment also was studied in clinical populations, such as those with body dysmorphic disorder (Grocholewski, Kliem, & Heinrichs, 2012; Hrabosky et al., 2009) and eating disorders (Hrabosky et al.,

5

2009), as well as in several other specific populations, such as goths (Swami, 2017), women who wear the hijab (Swami, Miah, Noorani, & Taylor, 2014), brides-to-be (Prichard & Tiggemann, 2011), fashion models (Swami & Szmigielska, 2013), and gay men (Martins et al., 2008). Overall, results reveal that higher appearance investment is related to more negative appearance related outcomes. For example, ASI and ASI-R total scores are related to higher body comparison (Johnson, Kim, Lee, & Kim, 2014), body comparison for selfevaluative reasons in men (Ryan et al., 2010), internalization of appearance ideals and of the fit ideal (Swami & Szmigielska, 2013), perceived sociocultural pressure to improve or maintain appearance (Muise & Desmarais, 2010), perceptions of parental influence on weight concerns and appearance-related interactions, and awareness of media messages (Sinton & Birch, 2006). Further, both MS and SES are associated with appearance-related psychopathology, including body dysmorphic disorder (Grocholewski et al., 2012; Hrabosky et al., 2009), and anorexia and bulimia nervosa (Hrabosky et al., 2009). Only one study yielded contradictory results in which scores on a modified, 13 item, version of the ASI-R were related to higher body satisfaction (Muise & Desmarais, 2010). Details on which items exactly were removed were sparse, but the two examples of removed items were from the SES subscale, which suggests that the 13 items retained may have predominantly belonged to the MS subscale. Similarly, higher ASI and ASI-R total scores are related to appearance modification practices such as dieting and the use of diet pills (Johnson et al., 2014), buying anti-aging products (Muise & Desmarais, 2010), as well as willingness to undergo cosmetic surgery for social reasons and consideration of undergoing cosmetic surgery (Slevec & Tiggemann, 2010). Distinguishing subscales of the ASI-R, SES and MS scores both are related to appearance modification practices such as dietary restraint (Lamarche & Gammage, 2012); hair removal (i.e., back and buttock hair removal in straight men; Martins et al., 2008); pre-wedding beauty, diet, and exercise regimens (Prichard & Tiggemann, 2011); and buying clothes for assurance and fashion (Tiggemann & Lacey, 2009). In terms of general psychological and social adjustment, higher appearance investment consistently is related to dysfunction. For example, higher ASI total scores are related to lower general and social adjustment, and higher anxiety, social anxiety, and depression (Atherton & Robertson, 2006) and both SES and MS are associated with lower levels of quality of life (Gawlik, Elias, & Bond, 2016; Moreira, Silva, & Canavarro, 2010). Again, and likely for the same reasons as described above, the one exception to this pattern was found in the Muise and Desmarais (2010) study that showed a positive correlation between the modified 13-item ASI-R and selfesteem. The association between appearance investment and relationship functioning was examined in several studies. In the one study in which this association was examined using the ASI, women with higher appearance investment also conformed more to gender norms and were more accepting of sexism (Cash, Ancis, & Strachan, 1997). One study (Laus, Almeida, & Klos, 2018) investigated the association of relationship status and satisfaction with body image in men and women. Among men, a non-cohabiting relationship status predicted greater MS but not SES, whereas greater relationship satisfaction predicted lower SES but not MS. Among women, married and cohabiting relationship statuses predicted greater SES and MS and a cohabiting relationship status predicted greater SES, whereas romantic functioning did not predict SES or MS. Another study (Ledoux, Winterowd, Richardson, & Clark, 2010) examined the association of appearance investment with negative self-schemas and attachment styles in heterosexual women. Both SES and MS were associated with negative core beliefs about the self and insecure attachment with men, with SES

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Authors & Year Annis, Cash, & Hrabosky, 2004

Atherton & Robertson, 2006

Sample Characteristics Community and university women currently overweight, never overweight, and formerly overweight Male and female lower limb prosthesis users

Country

Other Measures a

United States

BES , Brief FNE, CES-D, ESWLS, MBSRQ*, SIBID, SSQ-E, TSBI

United Kingdom

HADS, SCSa , TAPES

United States

FIDS, GAI, MBSRQ, MFRQ, SATAQ, SIBID

Davison & Birch, 2004

9-year-old girls and their parents

United States

ChEAT, FSQ, IPIEC, questions about perceptions of parental concern about weight

Jung & Lee, 2006

Female undergraduate students

United States and South Korea

BIQ, EDI* MBSRQ*, RSES

Sansone, Chu, & Wiederman, 2010

Female psychiatric inpatients

United States

BAT, OBCS*, PDQ-4, SCSb ,

Sinton & Birch, 2006

11-year-old girls

United States

BESb , IPIEC, MMIS, perceived family influence on weight concerns

Swami & Mammadova, 2012

Community women

United Kingdom

ACSS, DIRI-RS, LPS, relationship satisfaction items

Swami & Szmigielska, 2013

Female models and non-models

United Kingdom

BAS, EDI-2*, PFRS, SATAQ-3, SPAS

Tiggemann, 2006a

Male and female secondary school students

Australia

EDI*, PFRS, rating of current weight status and appearance satisfaction

ARTICLE IN PRESS

Female undergraduate students

Currently and formerly overweight women reported higher ASI relative to never overweight women. ASI total and Body Image Vulnerability factor negatively correlated with general and social adjustment, and positively correlated with anxiety, social anxiety, and depression. Body Image Vulnerability factor positively correlated with public self-consciousness, and Appearance Stereotypes factor positively correlated with depression and social anxiety. Self-Investment factor not related to adjustment or self-consciousness1 . ASI scores positively correlated with gender attitudes related to evaluative beliefs about males and females and about sexuality roles, tendency to modify behaviour to conform with gender norms, and passive-acceptance of sexism Among parents, higher ASI associated with greater fat stereotypes and tendency to respond in a socially desirable manner. No association between parents’ ASI and girls’ fat stereotypes. U.S. and Korean women with higher ASI reported lower body satisfaction overall and lower self-esteem relative to those with lower ASI. Korean women reported lower ASI, more negative body image, and lower self-esteem than did U.S. women. Participants who scored above the cut-off on two measures of borderline personality disorder traits reported higher ASI. ASI positively correlated with depression, perceptions of parental influence on weight concerns, appearance-related interactions with other girls, and awareness of media messages. ASI positively correlated with consideration of cosmetic surgery, perfectionist self-promotion, non-disclosure of imperfection, and non-display of imperfection. Fashion models had higher ASI scores than did non-models. In models, ASI positively related to internalization of appearance ideals, including internalization of the fit ideal. Girls with missing values for self-reported weight reported higher ASI compared to girls who reported their weight. The effect of missing value status on ASI not significant in boys.

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Table 2 Correlation studies of factors associated with appearance investment.

Authors & Year

Sample Characteristics

Country

Use of Subscales

Other Measures

Results

United States

Total

Cho et al., 2018

Community men and women

United States

Total

Gawlik et al., 2016

Women diagnosed with Type I diabetes

Australia

SES & MS

DQoL-Brief

Goulet et al., 2017

Female undergraduate students from a Catholic university Community men and women diagnosed with body dysmorphic disorder or social phobia, and healthy controls Men and women in treatment diagnosed with anorexia nervosa, bulimia nervosa or body dysmorphic disorder, and psychiatric controls

United States

SES

EAT-26, GLTEQ, MBSRQ, RSES

Germany

SES & MS

BDDDM, BDD-YBOCS*, BDI, Mini-DIPS SIAS, SPS

Participants with body dysmorphic disorder reported higher SES and MS than did those with social phobia or healthy controls1 .

United States

SES & MS

BICSI, BIDQ, BIQLI, MBSRQ*

Body dysmorphic disorder, anorexia nervosa, and bulimia nervosa groups all reported higher SES and MS compared to psychiatric controls. Participants with body dysmorphic disorder reported higher SES and MS than did those with anorexia nervosa and higher SES than did those with bulimia nervosa. Anorexia nervosa and bulimia nervosa groups did not differ on either subscale1 . Objectified body consciousness and ASI-R predicted body comparison for U.S. and Korean women. For U.S. women, objectified body consciousness and ASI-R predicted extreme dieting and use of diet pills through low body satisfaction. In adult-onset psoriasis, SES and stigmatization predicted social anxiety. Gender not a significant predictor of social anxiety in adult-onset psoriasis. In pre-adult onset, SES, stigmatization, and female gender predicted social anxiety. Pre- and adultonset psoriasis groups did not differ on MS. SES and MS positively predicted dietary restraint. SES positively predicted exercise dependence. Neither SES nor MS predicted leisure-time physical activity.

Hrabosky et al., 2009

Johnson et al., 2014

Female undergraduate students

United States and South Korea

Total

PACS, MBSRQ*, RAMB

Łakuta & Przybyła-Basista, 2017

Men and women with psoriasis

Poland

Total, SES & MS

BDI, BSQ-BE SAQ, stigmatization Scale, Psoriasis Severity

Lamarche & Gammage, 2012

Female undergraduate students

Canada

SES & MS

BIQ, EDS, GLTEQ, TFEQ

When shown images of head and neck-cancer patients at various stages of recovery pre- and post-reconstructive surgery, participants with high appearance investment rated disfigurements as more severe than did those less invested. MS negatively correlated with quality of life. SES positively correlated with age and metabolic control and negatively correlated with quality of life. Women who restricted insulin for weight control reported greater SES. Spirituality predicted lower SES.

ARTICLE IN PRESS

Female undergraduate students

Grocholewski et al., 2012

CSW, 4 items assessing beliefs of the malleability of beauty Ratings of disfigurement, SAM

Beliefs about the malleability of beauty positively correlated with ASI-R.

Burkley et al., 2014

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Table 2 (Continued)

7

Country

Use of Subscales

Other Measures

Community men and women involved and not involved in a romantic relationship

United States

SES & MS

MBSRQ*

Ledoux et al., 2010

Female undergraduate students

United States

SES & MS

RQ, YSQ-SF

Martins et al., 2008

Community men

Australia

SES & MS

Body hair removal practices questionnaire

Moreira, Silva, Canavarro et al., 2010

Female breast cancer patients

Portugal

SES & MS

FNE, HADS, WHOQOL- Brief

Muehlenkamp, Peat, Claes, & Smits, 2012

Female undergraduate students

United States

Total

BDI-II, DSHI, EDI-3*

Muise & Desmarais, 2010

Community women recruited online and at a tradeshow for anti-aging products

Canada

Total of 13 retained items

AASa , PSPSb , likelihood of buying anti-aging products, ratings of body satisfaction

Partridge & Robertson, 2011

Men and women receiving dialysis treatment

United Kingdom

Total, SES & MS

BIDQ, HADS, SCSa

Prichard & Tiggemann, 2011

Brides-to-be

Australia

SES & MS

DEBQ-Restraint, pre-wedding health and beauty enhancing behaviours

Results For men, length of time being single negatively correlated with both SES and MS, and relationship satisfaction negatively correlated with SES. Single men reported lower MS than non-cohabiting men. For women, length of time being single negatively correlated with MS, but relationship satisfaction related to neither SES or MS. Single women reported lower SES and MS than did cohabiting and married women. SES and MS positively predicted a preoccupied attachment style with men. SES positively predicted impaired autonomy and negative performance self-schemas. In gay men, back, buttock and pubic hair removal more common than in straight men and related to higher MS but not SES. In straight men, back and buttock hair removal related to higher MS and SES, and pubic hair removal related to MS only. In both groups, frequency of hair removal positively related to MS but not to SES. SES and MS negatively correlated with psychological and social quality of life and positively correlated with depressive symptoms. SES positively correlated with fear of negative evaluation. Participants with both non-suicidal self-injury and disordered eating symptoms reported higher ASI-R relative to non-suicidal self-injury only or disordered eating only groups. Disordered eating only participants reported greater ASI-R and body dissatisfaction compared to non-suicidal self-injury only participants. ASI-R positively correlated with reported likelihood of buying anti-aging products, body satisfaction, and perceived sociocultural pressure to maintain or improve appearance. After controlling for age and income, anxiety about aging and ASI-R positively predicted the likelihood of buying anti-aging products. SES but not MS highly correlated with anxiety, depression, and body image disturbances, defined as preoccupation with appearance-related concerns and associated affective and behavioural responses1 . Brides-to-be reported levels of SES and MS comparable to normative data. Higher SES and MS positively related to pre-wedding beauty, diet, and exercise regimens. SES related to wedding weight discrepancy. MS related to appearance-related (e.g., getting a manicure, tanning), and exercise/eating behaviours.

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Sample Characteristics

Laus et al., 2018

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Table 2 (Continued)

Authors & Year

Sample Characteristics

Country

Use of Subscales

Other Measures

Female undergraduate students

United States

Total

Ryan et al., 2010

Gay and bisexual men

United Kingdom

SES & MS

Shaw et al., 2018

Women diagnosed with breast cancer and either single or in a relationship

Australia

SES & MS

BIS, DAS, ECRS, ICQ, SCSb

Slevec & Tiggemann, 2010

Middle-aged women (35 to 55 years old)

Australia

Total

AASa , ACSS, MBSRQ*, questions about media consumption

Swami, 2017

United Kingdom

SES & MS

Swami et al., 2014

Community women who identify as goth and a matched sample Muslim women

United Kingdom

SES & MS

BAS-2, PFRS, “being a goth is an important part of my identity” DRI, EDI*, PFRS, SATAQ-3, SPAS, hijab index

Swami et al., 2016

Community men and women

United States

SES & MS

BAS-2, CNS, NES, RSES, SATAQ-3

Teo et al., 2018

Women diagnosed with breast cancer at various stages of breast reconstruction Male and female adults with and without tattoos

United States

Total

Australia

SES & MS

BIS, Breast symmetry (vertical and horizontal extent) DAIS, US, 19-items assessing various reasons for getting a tattoo

Tiggemann & Hopkins, 2011

Community men and women with and without tattoos and/or piercings

Australia

Total

Tiggemann & Lacey, 2009

Community sample of women aged 18 to 55 years old

Australia

SES & MS

Tiggemann & Golder, 2006

ABCD, CES-D, EAT-26, MBSRQ* RSES, questions assessing body talk, co-rumination, and quality of friendships ADMI-60, DMS, MBCMS, UBMI

DAIS, US, music preference ratings, extent of tattoos and piercings, reasons for obtaining tattoos and piercings MBSRQ*, RSESM , function and enjoyment of clothing shopping, and satisfaction with clothing and appearance in clothing

Results Negative body talk positively correlated with ASI-R. Neither self-accepting/positive body talk, nor body-related co-rumination correlated with ASI-R. SES and MS positively correlated with male body comparison for self-evaluative reasons and with behavioural investment in muscularity. For all men, body comparison for self-evaluative reasons positively predicted SES and MS. For gay men only, hypermasculinity positively predicted SES. Single women reported higher SES but not MS relative to partnered women. Among single women, SES but not MS positively correlated with dating anxiety. Neither SES nor MS correlated with interpersonal competence in single women. ASI-R positively correlated with willingness to undergo cosmetic surgery for social reasons, such as career advancement, and with consideration of undergoing cosmetic surgery. Women who identified as goth reported higher SES than did women in the matched control sample. No significant differences in MS between samples. Controlling for religiosity, women who wore the hijab had lower SES and MS than did those who did not wear the hijab. Women reported higher SES and MS than did men. SES and MS both negatively correlated with body appreciation (BAS-2), but correlations larger for SES than MS. In men but not in women, the link between connectedness to nature and body appreciation mediated by lower MS and internalization of the muscular ideal. After controlling for clinical factors related to treatment and reconstruction as well as BMI, ASI-R associated with greater body dissatisfaction. Women had higher SES and MS than did men. No difference in SES between those with and without a tattoo. Effect of gender on SES and MS not related to having a tattoo or not. No difference in ASI-R based on tattoo or piercing status1 .

SES and MS positively related to buying clothes for assurance, to boost morale, and for fashion. SES negatively correlated with enjoyment of clothes shopping. MS positively correlated with enjoyment of clothes shopping. Neither SES nor MS correlated with BMI, but SES negatively correlated with age.

M

Modified from original version. * Selected subscales used. Did not include separate analyses for male and female participants.

1

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Table 2 (Continued)

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more strongly related to these variables than MS. An additional study (Shaw, Sherman, Fitness, & Elder, 2018) examined partnered and un-partnered women survivors of breast cancer. Un-partnered women reported greater SES than did partnered women. Though MS was not related to interpersonal competence or dating-related anxiety in either group of women, among un-partnered women higher SES predicted greater dating anxiety. The pattern whereby SES is associated with more negative outcomes than is MS again is evident in correlational studies. For example, although higher SES and MS are correlated with lower quality of life in Type 1 diabetic women, only SES is associated with insulin omission (Gawlik et al., 2016), a serious type of medication non-compliance used for weight loss. In individual with psoriasis, only the SES subscale is related to social anxiety (Łakuta & Przybyła-Basista, 2017). Similarly, in individuals chronically receiving dialysis, only the SES scale is associated with anxiety, depression, and body image disturbances (Partridge & Robertson, 2011). In terms of well-being measurement, although scores from both SES and MS subscales are negatively associated with positive body image, these correlations are larger for the SES than for the MS scale (Swami, Barron, Weis, & Furnham, 2016). Similarly, SES is negatively correlated with enjoyment of clothing shopping, but MS is positively related to this variable (Tiggemann & Lacey, 2009). 3.3. Experience sampling studies We located five experience sampling studies in which appearance investment was measured (see Table 3). Four were conducted in the US and one in the UK. The ASI was used in two studies and the ASI-R in three. In the latter, the SES and MS subscales were distinguished. The sample consisted of female undergraduates in four studies and of community women in one. In four studies, appearance investment was used as a predictor and in one, the ASI was used as an outcome variable. In the two studies in which the ASI was used, higher ASI scores were associated with more frequent appearance comparisons (McKee et al., 2013) and with greater eating pathology (Myers, Ridolfi, & Crowther, 2015). In all three studies in which the ASI-R was used, SES but not MS was related to body dissatisfaction. Two studies tested the association of the SES and MS subscales with fluctuations in body satisfaction. Both SES and MS were associated with such fluctuations in one study (Melnyk, Cash, & Janda, 2004), but this association was present only with SES in the other (Rudiger, Cash, Roehrig, & Thompson, 2007). Finally in one study conducted with women attempting to lose weight higher SES, but not MS, was associated with higher dietary restraint and weight/shape dissatisfaction and high MS was associated with lower body mass index (Lattimore & Hutchinson, 2010). 3.4. Cross-sectional studies We located eight cross sectional studies in which appearance investment was used as a mediator (see Table 4). Three studies were conducted in Australia, two in Canada, and one in each of the following countries: UK, Poland, and Malaysia. The ASI was used in two studies and the ASI-R in six. Within the latter, only two distinguished the SES and MS scales (Łakuta, Marcinkiewicz, ´ Bergler-Czop, & Brzezinska-Wcisło, 2016). Female undergraduates, middle aged women, and adolescent girls were examined in one study each. Mixed gender samples were examined in the remaining studies including adolescents in two studies, undergraduates in one, a mixed community and undergraduate sample in one, and individuals suffering from psoriasis in one. Four studies examined the association of consumption of media such as Instagram, television, and magazines with body dissatisfaction and its manifestations such as dieting, drive for muscularity,

and the wish to be thin. The ASI was used as a mediator in one study and the ASI-R total score was used as an individual mediator in two, and as part of a cognitive processing composite measure in one study (Slevec & Tiggemann, 2011). In all, appearance investment mediated the association between these predictors and the outcome variables such that higher media consumption was associated with higher investment, which in turn was associated with higher scores on indices of body dissatisfaction and disordered eating. In the remaining four studies investment was a significant mediator of the association between fear of negative evaluation and dieting (Chang, Jarry, & Kong, 2014), severity of psoriasis and depression (Łakuta et al., 2016), perfectionism and body satisfaction (Sherry et al., 2009), and sociocultural appearance influences and need to exercise (White & Halliwell, 2010; see Table 4). All but one examined males and females. As mentioned above, the SES and MS subscales were distinguished in two studies. In one, both were significant mediators but only SES was a full mediator (Chang et al., 2014), in the other, SES was part of a significant mediation sequence but MS was uncorrelated to either predictor or outcome variables (Łakuta et al., 2016). The ASI-R was used as a moderator in only two studies. One was conducted in Australia on women with breast cancer (Sherman, Woon, French, & Elder, 2017) and one in the UK on male undergraduates (Tod & Edwards, 2013). In the former, the association of breast cancer specific body image distress with depression and stress was higher in women with higher SES scores, whereas MS was not associated with either predictor or outcome variables. In the other, the association between the desire to engage in muscle building and the actual engagement in muscle building was equally more pronounced in men high in SES and MS than in men low on these two variables. 3.5. Experimental studies We located 18 experimental studies in which appearance investment was measured (see Table 5). The ASI was used in seven studies. The country from where these studies were conducted were as follows: two in Australia, two in the US, and one in the UK, Korea, and the Netherlands. Age and gender varied from adolescent boys and girls (Hargreaves & Tiggemann, 2002, 2004b) to adult community women (Ashikali & Dittmar, 2012). In six of these studies, the ASI was used as a moderator and in one it was used as a dependent variable. In five studies, the independent variable was an “appearance condition” consisting of images of the thin/muscular ideal and their control. In one study, the independent variables consisted of audio recordings documenting either the social advantages of attractiveness or television violence and aggression. In the other, there were two independent variables: an appearance priming and a Stroop test conditions. In the one study that used the ASI as a dependent variable (Ashikali & Dittmar, 2012), exposure to the thin ideal had no impact on ASI scores. However, exposure to materialistic advertisements resulted in higher ASI scores. In the six studies that used the ASI as a moderator, participants with higher ASI scores had more pronounced negative body image responses to ideal appearance images, such as lower appearance satisfaction (Kim & Park, 2016) or higher objectified body consciousness (Veldhuis, Konijn, & Seidell, 2014), than did participants with lower ASI scores. They also showed evidence of greater schematicity, such that participants with higher investment reported lower appearance satisfaction after being exposed appearance information (Lavin & Cash, 2001) and showed higher colour naming interference on Stroop appearance word after appearance priming than did all other study groups (Labarge, Cash, & Brown, 1998). The ASI-R was used in 11 studies as follows: moderator in five studies, dependent variable in one study, group equivalence vari-

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Community women attempting weight loss

United Kingdom

Country

ASI-R, RS, BMI. Daily post-evening meal ratings of mood and body/weight satisfaction, meal content, perceived meal calorie for 7 days

Predictor

BSQ-16, weight and shape dissatisfaction ratings

Outcome Variable

Measurement of BI Investment ASI-R

SES & MS

Use of Subscales

McKee et al., 2013

Female undergraduate students

United States

Comparison direction, target similarity, envy, inspiration, pride, and anxiety ratings

ASI

–

Melnyk et al., 2004

Female undergraduate students

United States

Physical appearance comparisons and other types of comparisons (RSCR, adapted version) completed following text message prompts 3 times per day for 7 days, ASI, body image quality of life, close friend diversity BISS tracked using an automated telephone response system over 6 days

ASI-R, BASS, BISCI, EAT-26, SIBID-S

ASI-R

SES & MS

Myers et al., 2015

Female undergraduate students with and without eating pathology

United States

Eating pathology vs. no eating pathology (EDDS)

ASI

–

Rudiger et al., 2007

Female undergraduate students

United States

ABCD, ASI-R, BIDQ, EAT-26, PSPS

ASI, reaction times to appearance- and non-appearance words on word-stem completion task cued by PDA prompts for 5 days BISS completed online once per evening for 10 days

ASI-R

SES & MS

Results SES but not MS positively correlated with dietary restraint and weight/shape dissatisfaction. MS but not SES negatively correlated with BMI. Neither SES nor MS related to state body satisfaction, mood, or perceived caloric intake. Higher ASI related to more frequent physical appearance comparisons. ASI did not predict comparison direction, target similarity, envy, inspiration, pride, or anxiety.

State body satisfaction negatively correlated with SES but not MS. Variability in state body satisfaction positively correlated with SES and MS. Women with eating pathology reported greater ASI than did those without eating pathology.

SES but not MS negatively correlated with state body satisfaction and positively correlated with variability in state body satisfaction. SES no longer predictive of either when other measures of body image disturbance were controlled (i.e., eating pathology, trait body dissatisfaction, BMI, and body-image cognitive distortions).

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Table 3 Experience sampling studies using the Appearance Schemas Inventory (ASI) or ASI-Revised (ASI-R).

Predictor

Mediator(s)

Malaysia

Instagram usage (duration)

BASS

ASI-R (Total), BIQ, RSES

Chang et al., 2014

Female undergraduate students

Canada

BFNE-II

EDE-Q-Dietary restraint

ASI-R (SES & MS)

Clark & Tiggemann, 2007

9- to 12-year-old girls

Australia

AAQ, frequency of appearance media exposure ratings, PCS

BESC, CFRS, dieting behaviour ratings

ASI-R (Total; simplified for children)

Łakuta et al., 2016

Male and female psoriasis patients

Poland

Severity of psoriasis (BSAI)

BDI (Polish version)

Sherry et al., 2009

Community and university men and women Middle-aged women (35 to 55 years old)

Canada

PSPS

BIRS

ASI-R (SES; Polish translation), SS (Polish version), BSQ ASI

Australia

Media exposure frequency (magazines and television)

BASS, EDI-BD

Tiggemann, 2005

Male and female high school-aged adolescents

Australia

Television viewing (total exposure, selective viewing of specific genres, motives for viewing), gender

EDI

White & Halliwell, 2010

Boys and girls aged 11-16

United Kingdom

PSIQ

EES

Cognitive processes composite: ASI-R (Total), SATAQ-3 (5 items), PACS, AASa -A ASI (10-item version), SATAQ

ASI-R (Total), BPSS

Results ASI-R and self-discrepancy mediated effect of Instagram use on body dissatisfaction. This effect moderated by self-esteem: negative effect of Instagram use on body dissatisfaction through ASI-R and self-discrepancy stronger for those with lower self-esteem1 . SES and MS both had indirect effects, but only SES fully mediated effect of fear of negative evaluation on dietary restraint. Older age, peer conversations about appearance, and lower autonomy associated with higher ASI-R. ASI-R partially mediated relationship between sociocultural factors (i.e., media exposure and peer conversations about weight/shape) and body-esteem and self-ideal discrepancy. ASI-R fully mediated relationship between peer appearance conversations and body dissatisfaction. Relationship between psoriasis and severity of depression sequentially mediated by stigmatization, SES, and negative emotional attitudes toward the body1 . Dimensions of perfectionistic self-presentation correlated with ASI. ASI partially mediated relationship between self-imposed perfectionistic expectations and body dissatisfaction1 . Television and magazine exposure positively correlated with cognitive processes composite (including ASI-R). Composite in turn positively associated with body dissatisfaction and disordered eating. Girls had higher ASI than boys. In girls, watching soap operas related to higher ASI. ASI positively related to drive for thinness, bulimia, and drive for muscularity in girls and boys. Time spent watching soap operas positively related to drive for thinness in boys and girls and related to drive for muscularity in boys, with this relationship mediated by internalization of the thin ideal and ASI (evaluated in separate models). Using TV for social learning and to ease negative affect related to ASI for both boys and girls. Girls reported greater ASI-R than boys. For both girls and boys, perceived need to exercise positively related to ASI-R. ASI-R mediated relationship between sociocultural pressures and body image disturbances. Both ASI-R and body dissatisfaction fully mediated relationship between sociocultural pressures and perceived need to exercise (but not actual exercise behaviour).

Moderator Analyses Authors & Year

Sample Characteristics

Sherman et al., 2017

Women diagnosed with breast cancer post-mastectomy with nipple-preserving reconstructive surgery Male undergraduate students

Tod & Edwards, 2013

1

Country

Predictor

Criterion

Moderator(s)

Results

Australia

BIS-C

DASS-21, IES-C

ASI-R (SES), SCS-12

Association between cancer specific body image distress and depression/stress more pronounced for women high in SES than for those low in SES.

United Kingdom

DMS-D

DMS-B

ASI-R (SES & MS); BIDQ; SIBID-SF

SES and MS moderated relation between the desire and behavioural engagement subscales of the DMS, with the correlation between these subscales stronger at higher SES and MS.

Did not include separate analyses for male and female participants.

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Male and female undergraduate students

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Sample Characteristics

Ahadzadeh, Pahlevan Sharif, & Ong, 2017

Slevec & Tiggemann, 2011

Country

Criterion

Authors & Year

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Table 4 Cross-sectional studies with appearance investment as a mediator or moderator.

Authors & Year

Sample Characteristics

Country

Community women

United Kingdom

Hargreaves & Tiggemann, 2002

Adolescent boys and girls

Australia

Hargreaves & Tiggemann, 2004

Adolescent boys and girls

Labarge et al., 1998

Role of BI Investment

Other Measures a

Results

Materialistic vs. non-materialistic advertisements, and thin model vs. product advertisements Appearance-related vs. nonappearance-related television commercials

Dependent variable

BES , CES-D, ESWLS, FNAE-B, MBSRQ, SIBID, SSQ-E, TSBI

Thin ideal internalisation positively related to ASI. No effect of thin-ideal image exposure on ASI. Materialistic ads resulted in higher ASI than non-materialism ads.

Moderator

Only highly appearance schematic participants reported higher body dissatisfaction after viewing the appearance-related commercials.

Australia

Thin ideal images for women vs. muscular ideal for men vs. non-appearance commercials

Moderator

Word recall task, state mood and body dissatisfaction ratings (using VAS), television consumption questionnaire, word-stem completion task Body dissatisfaction ratings, PACS, mood ratings, state appearance comparison ratings

United States

Modified Stroop Task with neutral task or appearance prime. Participants in the appearance prime condition weighed while standing in front of a tri-fold mirror and asked to state their height, eye colour, and hair colour. Participants in the neutral condition completed a social desirability scale. Audio-recording with information about appearance biases and discrimination or television violence and aggression

Moderator

Not reported, completed in another study

Moderator

10 visual analogue scales assessing state mood and body satisfaction, 4 questions assessing comprehension of audio material PACS, RSES, appearance satisfaction ratings

Lavin & Cash, 2001

Female undergraduate students

United States

Kim & Park, 2016

Female undergraduate students

South Korea

Veldhuis et al., 2014

Females aged 11-18

Netherlands

Facebook newsfeed photographs of attractive vs. unattractive women Media models (extremely thin vs. thin vs. normal weight), and peer comments (6 kg underweight vs. 3 kg underweight vs. normal weight)

Moderator

Moderator

EDI-E, OBC-Youth, SATAQ

ASI/PACS positively related to trait social comparison and body dissatisfaction in both boys and girls. No effect of ASI/PACS on mood. High ASI/PACS reported greater appearance social comparisons with commercials than did medium and low ASI/PACS; effect was stronger after viewing thin/muscular-ideal than non-appearance commercials. No significant interactions between ASI/PACS and gender on any of the outcome variables. Participants high on ASI and primed to think of appearance slower to colour name appearance words compared to non-appearance words than were those low on ASI or who were not primed to think of appearance. No effect of ASI on the percentage of words accurately recalled, but positive correlation between ASI and percentage of appearance words recalled among those highly in ASI.

Those high on ASI reported lower state body satisfaction after listening to appearance-related information tape than did those less invested or who listened to the neutral tape.

Moderate and high ASI reported lower appearance satisfaction following exposure to images of attractive compared to unattractive women on Facebook (no group differences for low ASI). High ASI girls reported greater objectified body consciousness after exposure to extremely thin compared to thin or normal weight models (no difference between groups for low ASI); effect stronger after “3 kg underweight” comments from peers than after other comments.

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Studies using the ASI

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Table 5 Experimental Studies Using the Appearance Schemas Inventory (ASI) or ASI-Revised (ASI-R).

Female undergraduate students

Canada

Country

Weight-based derogatory media vs. media images with neutral comments

Manipulation

Moderator

Role of BI Investment SES

Use of Subscales

BDI-II, BISS, FNAE, PANAS, RSES, SSES

Other Measures

Herbozo & Thompson, 2010

Female undergraduate students

United States

Ambiguous vs. nonambiguous appearance-related feedback

Equivalence

Total

Ip & Jarry, 2008

Female undergraduate students

Canada

Thin images vs. neutral products

Moderator

SES & MS

BISS, DEBQ, EDE-Q, MHBI, PARTS, intentions to use body change strategies scores, mood ratings, SACS, SATAQ-3 BIQ, BISS, CTS, PANAS, RSES

Jarry & Kossert, 2007

Female undergraduate students

Canada

Performance feedback (success vs. failure) and advertisement exposure (thin models vs. neutral products)

Dependent variable

Total, SES & MS

BIQ-E, BISS, PANAS, RAT, RSES, SSES

Karpiak & Stratigis, 2016

Male and female undergraduate students at a Jesuit university

United States

Religious messages (compassion or authoritarian) vs. neutral messages

Equivalence

Total

Advertising effectiveness rankings, BESAA, RCI-10, SVS

Results Women with lower SES reported lower body satisfaction and appearance self-esteem following exposure to weight-based derogatory media compared to media with neutral comments (no group difference for higher SES). ASI-R administered prior to manipulation to establish equivalence of groups.

Higher SES reported greater body dissatisfaction and current-ideal discrepancy than did lower SES. Higher MS reported greater body image importance than did lower MS. Higher SES and MS reported lower appearance self-esteem and greater body image importance following exposure to thin model compared to neutral product images (no group difference for lower SES or MS). Participants who received failure feedback reported marginally lower ASI-R, SES, and MS after seeing thin models relative to products. After receiving failure feedback, participants who viewed thin models reported significantly lower SES (marginal after controlling for BMI) and marginally lower ASI-R than did those who received success feedback. ASI-R administered prior to manipulation to establish equivalence of groups. ASI-R negatively correlated to benevolence and spirituality values, and positively correlated with power values. No effect of gender on ASI-R or correlations between ASI-R and other study variables.

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Sample Characteristics

Boersma & Jarry, 2013

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Authors & Year

G Model

Studies Using the ASI-R

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Table 5 (Continued)

Sample Characteristics

Lane, Mulgrew, Mahar, White, & Loughnan, 2017

Community women

Australia

Attentional biases using visual-dot-probe task, appearance-cued, neutral-cued, and typical conditions)

Correlated with attention bias

SES

BISS, BSQ, DPT, MBRSQ

Mills et al., 2014 Study 3

Female undergraduate students

Australia

Accurate full-body photo of themselves vs. image modified to make them appear either thinner or heavier.

Moderator

Total

BCQ, CDS, CTS, mood ratings, PANAS-X, perceptions of body in image ratings

Palayiwa, Sheeran, & Thompson, 2010

Female undergraduate students

United Kingdom

Equivalence

Total

Watts et al., 2008

Female undergraduate students

Australia

Negative appearance comments (intention to ignore vs. no intention to ignore) Body related images vs. neutral scenes

Moderator

SES & MS

AASb , FNE, personal experience of negative appearance-comments ratings APT, EDI, SATAQ-3, RS

Yamamiya & Thompson, 2009

Male undergraduate students

United States

Covariate

Total

MIFIQ, RSRR

Yu & Jung, 2018

Female undergraduate students

United States

Moderator

SES & MS

BIQ, PASTAS, RSES, 3 VAS assessing state body satisfaction

Country

Manipulation

Images of attractive women vs. household products, and psychological message (beauty ideals vs. marketing strategies) Thin, nonidealized model, or non-model images

Role of BI Investment

Use of Subscales

Other Measures

Results In appearance-cued condition, attentional bias for positive-appearance words negatively related to SES (no effect for negative-appearance words). High ASI-R reported lower self-esteem (appearance, social and total), greater body dissatisfaction, and recalled looking heavier in their photos than did low ASI-R. Low ASI-R recalled looking heavier in the heavy photo condition and thinner in the thin photo condition (no group difference for high ASI-R). High ASI-R reported less positive mood in the heavy photo condition than in the thinner photo conditions (no group difference for low ASI-R). ASI-R administered prior to manipulation to establish group equivalence. Neither SES nor MS moderated effect of affective priming task on automatic evaluation of body-related images. ASI-R tested as covariate in statistical analyses; results related to the ASI-R not reported.

SES and MS negatively correlated with self-esteem and positively correlated with body dissatisfaction and body anxiety. These correlation stronger for SES than for MS. Neither SES or MS moderated the effect of image type on outcome variables.

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Studies Using the ASI-R

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Table 5 (Continued)

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able in three studies, and as a correlated or covariate variable in two studies. Four studies were conducted in the United States. Canada, and Australia each housed three of these studies. One was conducted in the United Kingdom. Eight of these studies were conducted with female undergraduate students, one with women from the community, one with both male and female participants, and one with males only. In the five studies in which the ASI-R was used as a moderator, the SES subscale was used in one (Boersma & Jarry, 2013), both the SES and the MS subscales were used in three (Ip & Jarry, 2008; Watts, Cranney, & Gleitzman, 2008; Yu & Jung, 2018), and the total ASI-R was used on one (Mills, Shikatani, Tiggemann, & Hollitt, 2014). In all five of these studies, the independent variable consisted of some form of body-related images such as the thin ideal, and their control such as product images (e.g., Ip & Jarry, 2008), or photos of the participants that were either accurate or modified to look heavier or thinner (Mills et al., 2014). Of these five studies, three uncovered significant results. In one, women high in both SES and MS reported more negative appraisals of their body after viewing thin ideal images than neutral images, but this effect was more pronounced and encompassed more appearance related dimensions for women high in SES than for women high in MS (Ip & Jarry, 2008). In another, women high in overall appearance investment recalled being heavier in previously viewed photos of themselves regardless of whether these photos were accurate or manipulated to make them appear larger or thinner. In this same study, highly invested women reported being unaffected by their alleged size as conveyed to them through either accurate or size enlargement/reduction photos (Mills et al., 2014). Finally, in one study women low, rather than high, in SES reported lower body satisfaction after viewing weight derogatory media (Boersma & Jarry, 2013). The ASI-R was used as a dependent variable in only one study and it was found to be responsive to experimental manipulation albeit in a paradoxical way. Women who received an ego threat in the form of false failure feedback on an intellectual task and who subsequently saw thin ideal images reported lower SES than did women who received success feedback and also saw thin images (Jarry & Kossert, 2007). 3.6. Longitudinal studies We located a total of five longitudinal studies examining appearance investment in some capacity (see Table 6). All five studies were conducted in different countries, namely Australia (Tiggemann, 2006b), Germany (Margraf, Meyer, & Lavallee, 2013), Portugal (Moreira & Canavarro, 2010), the United States (Morgan et al., 2012), and the Netherlands (van de Grift et al., 2016). The ASI-R was used in four studies and the ASI in one. In the four studies that used the ASI-R, total scores were used in one (Margraf et al., 2013), and three distinguished the ASI-R subscales (Moreira & Canavarro, 2010; Morgan et al., 2012; van de Grift et al., 2016). The length of follow-up ranged from six months (Moreira & Canavarro, 2010) to three years (Morgan et al., 2012). Of these five studies only two were focussed on the evolution of appearance investment over time, either as a predictor or an outcome variable, in a general population without clinical features (Morgan et al., 2012; Tiggemann, 2006b). Of the remaining three, one focused on men and women who considered, or obtained, cosmetic surgery (Margraf et al., 2013), one examined women with breast cancer (Moreira & Canavarro, 2010), and one examined transmen (van de Grift et al., 2016). In three studies examining appearance investment as a predictor, a consistent pattern emerged. Higher scores on the ASI and SES predicted negative psychological outcomes over time. Specifically, the ASI total score predicted increased body dissatisfaction in adolescent girls (Tiggemann, 2006b). In women with breast cancer SES predicted greater self-consciousness, body shame, and depression.

In contrast, MS predicted lower body shame and depression, and higher appearance satisfaction and quality of life in this population (Moreira & Canavarro, 2010). Further in women and men with high autonomous eating regulation, defined as internally driven or intuitive eating, those with high MS were likely to maintain rather than increase their percent body fat over time (Morgan et al., 2012). Three studies examined appearance investment as an outcome variable. Tiggemann (2006b) found that higher consumption of media, such as television and magazines, predicted higher ASI scores over time, although this effect disappeared after controlling for initial ASI scores. Interestingly, receiving cosmetic surgery reduced investment in appearance in men and women as measured by the ASI-R total score (Margraf et al., 2013). In transmen, mastectomy had no impact in ASI-R total or subscales scores (van de Grift et al., 2016). 3.7. Intervention studies We could locate only eight intervention studies that reported statistics on appearance investment (see Table 7). All studies were conducted in the United States. The ASI and ASI-R were used in four studies each. The SES and MS subscales were distinguished in three of the studies in which the ASI-R was an outcome variable. In five, the sample included only women and in three, men and women were included. All interventions focussed on body image and appearance. Three studies examined a single-session intervention. The remaining examined interventions spanning 3 weeks to 4 months. Six studies used a control or comparison group and two used a pre-, post-intervention design. Only one study focussed on women with eating disorders (Bhatnagar, Wisniewski, Solomon, & Heinberg, 2013), the three focused on undergraduate students with high body dissatisfaction. In terms of findings, the three studies in which a single intervention was examined yielded null results. Significant intervention effects were found in five studies, all of which examined multisession interventions. Of those, two distinguished the SES and MS subscales of the ASI-R and both showed a reduction in SES postintervention with no effect on the MS subscale (Bhatnagar et al., 2013; Cash & Hrabosky, 2003). The ASI was used in the remaining three studies and all showed a significant reduction in ASI scores. Four studies included a follow-up, two of these after single session interventions with null results post-intervention and no further improvements at follow-up (Blashill, Rooney, Luberto, Gonzales, & Grogan, 2018; Ridolfi & Vander Wal, 2008). In the two studies with follow-up that had showed an effect of intervention, this effect was maintained at 2-month follow-up in one study (Grant & Cash, 1995), but lost in the other (Bhatnagar et al., 2013). 4. Discussion Overall, validation studies uncovered a pattern of results that is consistent with studies conducted with a variety of methodologies. For both women and men, SES is associated with more dysfunction than is MS, and these associations are more pronounced with SES than with MS (i.e., Cash, Jakatdar et al., 2004). However, there also are gender differences such that MS is associated with less dysfunction in men than it is in women (Cash, Melnyk et al., 2004). Further, some of these differences suggest that SES and MS may not have exactly the same meaning for men and women. Especially striking is the reversal of the association between SES and positive rational acceptance of appearance, whereby among those high in SES, women reported lower appearance acceptance whereas men reported higher acceptance (Cash et al., 2005). There are several possible interpretations for this finding. Notably, men score lower on the SES scale than women do (Cash, Melnyk et al., 2004;

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Time Span

Measure of Investment

Additional Scales

Margraf et al., 2013

Community men and women who underwent aesthetic surgery or who were interested in aesthetic surgery but did not undergo it

Germany

3 (T1), 6 (T2), and 12 (T3) months

ASI-R

Total

BAI, BII, BQSWB, DCQ, EuroQoL 5D, RSES, SCL-90, life satisfaction ratings, rating of perceived impairment

Moreira & Canavarro, 2010

Women diagnosed with breast cancer

Portugal

Immediately after primary surgery (T1), and 6 months (T2)

ASI-R

SES & MS

DAS-24, ESS, HADS, WHOQOL-Brief, “how satisfied are you with your physical appearance?”

Morgan et al., 2012

Male and female freshmen college students

United States

3 years of college at 8 time points

ASI-R

SES & MS

BASS, REBS

Tiggemann, 2006b

Female adolescents in Grade 8 to 10 at 11 different high schools

Australia

Baseline (T1) and 12 months later (T2)

ASI simplified 10-item version

–

EDI-DT, FRS, SATAQ

van de Grift et al., 2016

Transmen undergoing mastectomy surgery vs. cisgender undergraduates

The Netherlands

Preoperative (T1) and 6 to 10 months postoperative (T1)

ASI-R

Total, SES & MS

BIQLI, BIS, MBSRQ, RSES, SIBID, perceived effect of surgery

Results At baseline, no differences in ASI-R between the surgery and non-surgery groups. ASI-R decreased for the surgery group in comparison to the non-surgery group, who showed a slight increase from T1 to T2 followed by a decrease to baseline at T3.2 No effect of time on SES or MS. T1 SES positively predicted, and T1 MS negatively predicted, T2 body shame and depression. T1 SES positively predicted Time 2 self-consciousness and T1 MS positively predicted T2 appearance satisfaction and quality of life. Women with low autonomous eating regulation style and high MS showed the highest initial body fat percentage and the steepest increase in percent body fat over time. Men with low autonomous eating regulation and low MS demonstrated increased body fat over time. Women and men with high autonomous eating regulation and high MS showed decreased percent body fat over time. SES not a significant predictor. ASI decreased over time. Time spent reading appearance magazines and watching soap operas at T1 positively predicted T2 ASI (but not after controlling for T1 ASI). T1 ASI positively predicted T2 body dissatisfaction. Neither ASI-R Total, SES, nor MS scores influenced by mastectomy for transmen. Postoperative transmen scored lower on MS, but not ASI-R Total or SES, in comparison to cisgender female undergraduates.

Applicable to studies that used the ASI-R only. Did not include separate analyses for male and female participants.

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Country

Use of Subscales1

Authors & Year

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Table 6 Longitudinal studies examining appearance investment.

Sample Characteristics

Country

Intervention Characteristics

Measurement Points

Results CBT for BID group reported lower SES than wait-list control at T2, with no group differences at T3. No effect of treatment on MS at T2 or T3. No effect of any treatment conditions on ASI-R total.

United States

8-week group CBT for body image disturbances (BID) vs. waitlist control

Baseline (T1), Post-Intervention (T2), and 2 months follow-up (T3)

Blashill et al., 2018

Female undergraduate students who engage in tanning

United States

Pre- (T1), Post-Intervention (T2), and 1 month follow-up (T3); ASI-R total administered at T1 and T3

Cash & Hrabosky, 2003

Male and female undergraduate students with high body dissatisfaction Male and female undergraduate students with high body dissatisfaction

United States

Single session exposure to a facial morphing image of themselves aging with and without UV exposure and health information about effects of tanning vs. mindfulness and health information vs. health information only 3-week self-help program for body image completed independently

Baseline (T1) and Post-Intervention (T2)

Participants reported lower T2 SES relative to T1. No effect of treatment on MS.

United States

10-week minimal contact self-help program using Cash’s, 1991 programme with once-weekly 5-10-minute phone check-ins

Pre- (T1) and PostIntervention (T2)

Grant & Cash, 1995

Female undergraduate students with high body dissatisfaction

United States

Pre- (T1), Post-Intervention (T2), and 2-month follow-up (T3)

Peterson, Tantleff-Dunn, & Bedwell, 2006

Female undergraduate students

United States

Ridolfi & Vander Wal, 2008

Female undergraduate students

United States

Strachan & Cash, 2002

Community men and women

United States

11 treatment sessions over a 4-month period following Cash’s, 1991 programme. Modest-contact CBT (programme and 20-minute weekly meeting with assistant, who assigned and checked homework, answered questions, and encouraged compliance) vs. group CBT (programme and 90-minute weekly therapist assisted group therapy). Single 15 minute audiotape sessions with images viewing: Feminist BI theory vs. psychoeducational BI vs. neutral control group Single information session on body image, eating disorders, and media portrayals of women’s appearance vs. stress management session on how to identify sources of stress and how to manage stress. 6 weeks self-help psychoeducation and self-monitoring vs. self-help BI CBT intervention plus psychoeducation and self-monitoring

Participants reported lower T2 ASI scores relative to T1. Reductions in ASI scores equivalent to that reported by Grant and Cash (1995); see below. Participants in both treatments reported lower T2 ASI scores relative to T1. Improvements maintained at T3.

Cash & Lavallee, 1997

Pre- (T1) and Post-Intervention (T2)

Pre- (T1), Post-Intervention (T2) and 1-month follow-up (T3)

Pre- (T1) and Post-Intervention (T2)

No significant effects of intervention on ASI factors (Body Image Vulnerability, Self-Investment, and Appearance Stereotyping). No significant effect of interventions on ASI-R total, MS, or SES, either at post-intervention or follow-up.

ASI scores significantly and equivalently lower at T2 for both treatment conditions.

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Table 7 Body image intervention studies with appearance investment as an outcome variable.

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Rusticus et al., 2008). It is possible that this lower endorsement is associated with an experience of the ASI-R items that is not only quantitatively, but also qualitatively different for men compared to women. Men may impart the SES items with more positive meaning than do women, which may explain differences in the pattern of association between SES and other measures for men and women. Similarly, the interpretation of the MS items may be different for men and women. Many of the MS items pertain to behavioural management of appearance for esthetic purposes. The actual meaning of such behaviour may be different for each gender and be associated with more importance (Cash, Melnyk et al., 2004) and emotional distress (Cash, Phillips, Santos, & Hrabosky, 2004) for women. These findings further highlight the importance of measurement invariance analyses to ascertain that scores can be compared meaningfully across groups and that patterns of correlations are comparable between groups. For example, although Rusticus et al. (2008) showed through scalar invariance analyses that SES and MS means for young, middle aged, and older men can be compared, this is not so for women for whom the SES and MS means of only young and middle aged groups are comparable. These findings have implications for all studies assessing the association between various constructs and for different groups. Variability in how scale items are interpreted by different groups, such as men and women, means that the pattern of association between constructs may be different for these groups, and may not be interpretable in the same way. The results of the correlational studies also are consistent with those of studies from other methodologies. Overall, higher appearance investment is related to poorer psychological and behavioural outcomes. In the correlational studies, this is evident for a wide array of populations, both clinical and non-clinical, and for a large number of outcome variables, some related to appearance and some to general psychological functioning such as depression and anxiety. Further, the results of studies that distinguished SES and MS reveal quite a consistent pattern of association between the two scales and a wide array of other variables, whereby SES is associated with a larger number of negative outcomes than is MS. When both types of investment are associated with negative outcomes, correlations with the SES scale are larger than are those with the MS scale. Finally, MS is occasionally associated with positive outcomes, such as enjoying clothing shopping, whereas SES was not found to be part of such positive associations. This suggests that not distinguishing the ASI-R subscales in studies examining appearance investment may lead to a loss of information. Although correlational studies do not allow the establishment of causality, they provide valuable information on the basis of which studies aiming to determine causal links can be designed. For example, the present review includes studies demonstrating a link between appearance investment and attachment style in women whereby higher appearance investment is associated with a more insecure attachment style with men. The correlational design leaves intact the question of whether becoming invested in appearance leads to the development of an insecure attachment style or whether the reverse is true. Both are plausible, as becoming highly appearance schematic at a very young age may interfere with the development of wider and more flexible relational schemata. Conversely, an insecure attachment style may lead to overreliance on appearance to establish and maintain relationships. The results of experience sampling studies essentially are correlational and are consistent with those of other correlational studies such that overall, higher appearance investment is associated with greater body image disturbance and eating pathology. In the studies that distinguished SES and MS, the latter was associated with body image dysfunction in the form of variability in body satisfaction in one study (Melnyk et al., 2004) but not in another (Rudiger et al., 2007). Further, MS actually was associated with lower BMI

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in women attempting to lose weight. In contrast, SES consistently was associated with body image and eating disturbances. These results again highlight the less dysfunctional form of appearance investment measured by the MS subscale. Although the findings issued from the experience sampling studies are consistent with the overall literature, they are limited by the fact that they mainly examined body image and eating related variables and all were conducted with women only. In cross-sectional studies, appearance investment was a significant mediator in all studies in which it was tested. In three of the studies in which the ASI-R was used as a mediator of the association of media consumption with indices of body dissatisfaction and disordered eating, the subscales were not distinguished, which precludes an assessment of the differential effect of SES and MS. In the two remaining studies in which SES and MS were distinguished, SES was a mediator whereas MS either was unrelated to the predictor and outcome variables (Łakuta et al., 2016), or was a weaker mediator than was SES (Chang et al., 2014). This pattern was seen again in the one moderation study with a female sample in which only SES moderated the association of cancer specific body image concerns to depression and stress (Sherman et al., 2017). These results are consistent with those of our analysis of other methodologies in that, for women, SES continues to emerge as a consistent predictor of dysfunction and distress, whereas MS is either unrelated or much more weakly related. In the one moderation study conducted on men only (Tod & Edwards, 2013), SES and MS equivalently moderated the association between the wish to be muscular and the engagement in actual muscle building, once again highlighting that SES and MS may be expressions of different subjective experiences of appearance in men and women. The results of experimental studies are consistent with those of the designs reviewed thus far. In studies in which the ASI was used as a moderator variable, participants with higher ASI scores were more negatively affected by ideal appearance images and messages than were those with lower scores. The results of the three studies in which the ASI-R or its subscales were significant moderators uncovered more complex findings. In one, results were as expected in that women higher in MS and SES reacted more negatively to thin ideal images than did women low on these dimensions, with high SES associated with more pronounced negative effects than high MS (Ip & Jarry, 2008). However, in two studies, women high in appearance investment responded paradoxically to the independent variable. This pattern of responding can be elucidated by a closer examination of the nature of this independent variable. In each, this independent variable can be considered a threat to participants’ appearance self-esteem either in the form of weight derogation (Boersma & Jarry, 2013) or of size enlarging photos of themselves (Mills et al., 2014). Specifically, in the Boersma and Jarry (2013) study, women high in SES reported essentially the same level of body satisfaction whether they read vignettes depicting women as targets of weight derogation or neutral vignettes describing non-appearance related aspects of these women’s lives. However, women low in SES reported lower body satisfaction after reading about weight derogation. In the Mills et al. (2014) study, women high in overall investment reported remembering themselves as being the same size, regardless of whether they saw images of themselves distorted to make them look larger or thinner. In contrast, women low in investment recalled looking thinner in the “thin” photos and larger in the “large” photos. Given the small number of experimental studies in which the ASI-R was used as a moderator and the even smaller number in which a body image threat was delivered, whether women high in appearance investment respond defensively to such threats remains an empirical question. However, there is evidence that women in general may use their appearance to respond defensively to ego threat. For example, Jarry and Kossert (2007) showed that, after seeing

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thin images, women who had received failure feedback declared themselves more satisfied with their appearance and considering it less important than did women who received success feedback. Similarly, O’Driscoll and Jarry (2015) found that after experiencing interpersonal rejection, women who consider their weight important to their self-esteem reported being more satisfied with their appearance rather than less, as had been initially hypothesized. Taken together, these results suggest that women may use their appearance to compensate for appearance and self-esteem threat and that this may particularly be the case in women highly invested in their appearance. However, given the small number of studies demonstrating this effect, more research is needed to replicate and clarify the meaning of these results. The results of the longitudinal studies underscore the importance of conducting more studies examining the evolution of appearance investment in general, non-clinical, populations over time. More research is needed to examine the factors affecting the development of appearance investment, and on how appearance investment predicts the development of associated variables in people in general. In more specific terms, the results indicate a clear advantage of distinguishing the sub-scales of the ASI-R. Although the SES subscale appears to consistently predict negative psychological outcomes, the MS subscale appears to predict some positive outcomes such as more body satisfaction, lower depression, and lower weight gain over time. However, in longitudinal studies, these positive outcomes are limited to women with breast cancer and individuals high in intuitive eating, two very specific populations. Once again, this underscores the importance of conducting more research in general, non-clinical, populations to arrive at a better understanding of the natural evolution of investment in appearance for self-definition versus behavioural investment aimed at improving esthetic presentation. Although there is a need for research examining the predictive power of SES and MS on other psychological outcomes, there also is a need for research examining factors that contribute to the development of these two variables over time. The life circumstances that may contribute to the development of adaptive versus maladaptive investment in appearance remain poorly understood. Intervention studies revealed that appearance investment is amenable to change. Indeed, all of the intervention consisting of more than a single session resulted in decreases in appearance investment. Of those, two studies distinguished the SES and MS subscales and in both, the change was observable on the SES scale. This suggests that for appearance investment to change, more advanced reflection and/or behavioural work may be necessary and that these changes occur on the less functional dimension of appearance investment measured by the SES subscale. Relatedly, only one study included a follow-up after revealing a positive intervention effect on SES and this follow-up showed that these gains were lost over time. This suggest that SES may require more advanced and sustained work to change and remain improved. Finally, the problem of demand characteristics is very real for the interventions studies reviewed here. Of the five studies that showed an intervention effect on investment, one compared the active treatment to a waitlisted condition (Bhatnagar et al., 2013). Although this represent a methodological improvement over uncontrolled studies, wait-listed groups are limited in their capacity to control for demand characteristics. Clearly, the active intervention participants know that they are getting the intervention and the waitlisted participants know that they are not. This leaves intact the confounding effect of expectation. The other two studies were comparisons of active interventions and showed no differential effect on investment (Grant & Cash, 1995; Strachan & Cash, 2002). In future studies, the use of an alternative intervention that does not explicitly target appearance investment would be helpful to control for expectancy effects.

Overall, appearance investment remains an understudied area of research, especially within experimental and longitudinal designs. At this point, we know more about how appearance investment moderates the impact of other independent/predictor variables than about the factors that contribute to its development. The consistently negative association with self-evaluative salience makes the study of this dimension particularly important. We know very little of what contributes to overinvestment in appearance for self-definition. Findings showing that higher spirituality (Goulet, Henrie, & Szymanski, 2017) and more secure attachment (Ledoux et al., 2010) are associated with lower SES suggest that specific developmental factors may protect against overinvestment in appearance but again, these findings were issued from correlational studies, leaving the question of causality unanswered. It is possible that these variables predict investment. Conversely, the early development of appearance as a centrally defining feature of the self may very well interfere with the development of other dimensions of psychological functioning. More longitudinal research is needed to understand the complex interplay of appearance investment with key developmental variables. Presently, investment in appearance is understood as a trait and with a few notable exceptions, has been studied as such by positioning it either as a moderator or a predictor variable. However, when included as a dependent variable in experimental designs and in intervention studies, it has been shown to be responsive to experimental manipulation and targeted interventions. This suggests that experimental research investigating factors that can affect appearance investment is possible. Of particular interest would be the study of factors unrelated to appearance, such as interpersonal relationships and ego threats. Further, the development of a state measure of appearance investment may be an important advancement by making appearance investment into a dimension that could be more responsive to a variety of independent variable, thus furthering our understanding of it. These considerations also have implications for interventions. A better understanding of the factor leading to overinvestment in appearance, beyond the ubiquitous effect of the media and current popular culture, could greatly influence the effectiveness of body image interventions. Presently, most body image interventions are cognitive behavioural, with a heavy emphasis on education, cognitive restructuring, and desensitisation (Alleva, Sheeran, Webb, Martijn, & Miles, 2015; Jarry & Ip, 2005). The discovery of other sources of influence on the development of investment in appearance may lead to new interventions directly addressing these influences, which may or may not include explicit discussion of appearance related messages.

4.1. Conclusion By developing the construct of appearance investment, Cash also allowed the emergence of the psychology of appearance as a field of research. Appearance investment allowed us to understand better who is more susceptible to the various forces impinging on body satisfaction. For example, the media was identified early on as a major contributor to body dissatisfaction. However, the measurement of appearance investment allowed us to understand that it is those for whom appearance is important who are the most affected. Similarly, we also now know that body dissatisfaction is associated with more negative psychological outcomes, such as depression, in those for whom appearance is important. Presently, the emerging field of positive body image (Tylka & Wood-Barcalow, 2015) is another expression of the advances that appearance investment made possible: we now are studying positive ways of being invested in one’s body. In these new conceptualisations, people’s relationship to their body includes a focus on appearance that is

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less driven by external standards and more on the expression of valued aspects of the self. Declaration of Competing Interest None. Acknowledgements The authors gratefully acknowledge the help of Jessica Barrington in the literature review and collection of articles for this manuscript. Appendix A

List of Abbreviations Used in Tables AAQ(-A) Adolescent Autonomy Questionnaire(-Appearance subscale) AASa (-A) Anxiety about Aging Scale(-Appearance subscale) AASb Affect-Arousal Scale Assessment of Body-Image Cognitive Distortions ABCD ACSS Acceptance of Cosmetic Surgery Scale ADMI-60 Auburn Differential Masculinity Inventory APT Affective Priming Task BAI Beck Anxiety Inventory BAS-2 Body Appreciation Scale-2 Body Areas Satisfaction Scale BASS BAT Body Attitudes Test Body Checking Questionnaire BCQ BDDDM Body Dysmorphic Disorder Diagnostic Module BDI(-II) Beck Depression Inventory(-II) BESa Binge Eating Scale BESb Body Esteem Scale BESAA Body Esteem Scale for Adolescents and Adults BESC Body Esteem Scale for Children BIATQ-A Body Image Automatic Thoughts Questionnaire-Positive Subscale BIATQ-P Body Image Automatic Thoughts Questionnaire-Positive Body Image Avoidance Questionnaire BIAQ BICSI Body Image Coping Strategies Inventory BICSI-A Body Image Coping Strategies Inventory-Avoidance BICSI-AF Body Image Coping Strategies Inventory-Appearance Fixing BICSI-PRA Body Image Coping Strategies Inventory-Positive Rational Acceptance BIDQ Body Image Disturbance Questionnaire BIQ Body Image Ideals Questionnaire Body Image Inventory BII BIQLI Body Image Quality of Life Inventory BISa Body Image Scale Body Image Scale for Transexuals BISb BISS Body Image States Scale BMMRS Brief Multidimensional Measure of Religiousness/Spirituality Body Image Rating Scale BIRS BIS-C Body Image Scale-Cancer BPSS Body Parts Satisfaction Scale BQSWB Bern Questionnaire on Subjective Well-Being Brief FNE(-2) Brief Fear of Negative Evaluation Scale(-2) BSAI Body Surface Area Index BSQ Body Shape Questionnaire BSQ-14 Body Shape Questionnaire-14 item version BSQ-16 Body Shape Questionnaire-16 item version Body Satisfaction Scale BSS

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BULIT-R Bulimia Test-Revised CARSAL Centre for Appearance Research Salience Scale CARVAL Centre for Appearance Research Valence Scale Contour Drawing Scale CDS CES-D Center for Epidemiologic Studies-Depressed Mood CFRS Children’s Figure Rating Scale ChEAT Children’s Eating Attitude Test CNS Connectedness to Nature CTS Current Thoughts Scale CSW Contingencies of Self-Worth Scale Distinctive Appearance Investment Scale DAIS DAS Dating Anxiety Scale; DAS-24 Derriford Appearance Scale-24 DASS-21 Depression, Anxiety, and Stress Scales DCQ Dysmorphic Concerns Questionnaire DEBQ(-Restraint) Dutch Eating Behaviour Questionnaire(Restraint subscale) DIRI-RS Depressive Interpersonal Relationships InventoryReassurance Seeking subscale DMS Drive for Muscularity Scale DMS-D Drive for Muscularity Scale-Desire DMS-B Drive for Muscularity Scale-Behaviour Visual Dot Probe Task DPT DRI Duke Religion Index Deliberate Self-Harm Inventory DSHI DQoL-Brief Diabetes Quality of Life Brief Clinical Inventory EAT-26 Eating Attitudes Test-26 ECRS Experiences in Close Relationships Scale Eating Disorder Diagnostic Scale EDDS EDE-Q Eating Disorder Examination Questionnaire Eating Disorder Inventory-2 EDI-2 EDI-2-B Eating Disorder Inventory-2-Bulimia subscale EDI-2-BD Eating Disorder Inventory-2-Body Dissatisfaction subscale EDI-2-DT Eating Disorder Inventory-2-Drive for Thinness subscale Eating Disorder Inventory-3 EDI-3 EDI-E Eating Disorder Inventory-Expanded EDS Exercise Dependence Scale Excessive Exercise Scale for Adolescents EES ESS(-BS) Experience of Shame Scale(-Body Shame subscale) ESWLS Extended Satisfaction with Life Scale EuroQoL European Quality of Life Scale Feminist Identity Development Scale FIDS FNE Fear of Negative Evaluation Scale FNAE(-B) Fear of Negative Appearance Evaluation Scale(-Brief form) Figure Rating Scale FRS FSQ Fat Stereotypes Questionnaire GAI Gender Attitude Inventory Genital Appearance Satisfaction Scale GAS GLTEQ Godin Leisure-Time Exercise Questionnaire HADS Hospital Anxiety and Depression Scale Interpersonal Competence Questionnaire ICQ IES-C Impact of Event Scale-Cancer IPIEC Inventory of Peer Influence on Eating Concerns LPS-R Revised Love Perceptions Survey Intuitive Eating Scale-2 IES-2 LOT-R Life Orientation Test-Revised MBCMS Male Body Comparison Motives Scale MBSRQ Multidimensional Body-Self Relations Questionnaire MBSRQ-AE Multidimensional Body-Self Relations QuestionnaireAppearance Evaluation subscale MBSRQ-AO Multidimensional Body-Self Relations QuestionnaireAppearance Orientation subscale MBSRQ-AS Multidimensional Body-Self Relations QuestionnaireAppearance subscale

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MBSRQ-BAS Multidimensional Body-Self Relations Questionnaire-Body Areas Satisfaction subscale MBSRQ-HE Multidimensional Body-Self Relations QuestionnaireHealth Evaluation subscale MBSRQ-OP Multidimensional Body-Self Relations QuestionnaireOverweight Preoccupation subscale Body-Self Relations MBSRQ-SCW Multidimensional Questionnaire-Self-Classified Weight MCSDS(-SF) Marlowe-Crowne Social Desirability Scale(-Short Form) Male-Female Relations Questionnaire MFRQ MHBI Multidimensional Health Behavior Inventory MIFIQ Male Internalization of the Female-Ideal Questionnaire Mini-DIPS Short form of the Diagnostic Interview of Mental Disorders MMIS Multidimensional Media Influence Scale NES Nature Exposure Scale OBCS Objectified Body Consciousness Scale OBC-Youth Objectified Body Consciousness Scale for Preadolescents and Adolescents PAAFS Physical Appearance Ambiguous Feedback Scale PAAFS-A Physical Appearance Ambiguous Feedback ScaleAppearance subscale PAAFS-G Physical Appearance Ambiguous Feedback ScaleGeneral subscale PACS Physical Appearance Comparison Scale PANAS(-X) Positive and Negative Affect Schedule(-Expanded) PARTS Physical Appearance-Related Teasing Scale PASTAS Physical Appearance State and Trait Anxiety Scale PCS Peer Conversations Scale PDQ-4 Personality Diagnostic Questionnaire-4 PDS-I Paulus Deception Scales-Impression Management PFRS Photographic Figure Rating Scale PSIQ Perceived Sociocultural Influences Questionnaire PSPSa Perfectionistic Self-Presentation Scale Perceived Sociocultural Pressure Scale PSPSb RAT Remote Associates Test RCI-10 Religious Commitment Inventory-10 Regulation of Eating Behaviour Scale REBS RQ Relationship Questionnaire Restraint Scale RS RSCR Rochester Social Comparison Record Rating Scale of Romantic Relationships RSRR RSES Rosenberg Self-Esteem Scale SAAS Social Appearance Anxiety Scale SACS State Appearance Comparison Scale Self-Assessment Manikin SAM SAQ Social Anxiety Questionnaire SATAQ(-3/-4) Sociocultural Attitudes Towards Appearance Questionnaire(-3/-4) SCL-90 Symptom Checklist-90 SCS-R Self-Consciousness Scale-Revised Self-Consciousness Scale SCSb SCSc (-14) Self-Compassion Scale(-14 item version) SHI Self-Harm Inventory SIAS Social Interaction Anxiety Scale SIBID(-S) Situational Inventory of Body-Image Dysphoria(-Short form) SPAS Social Physique Anxiety Scale SPS Social Phobia Scale SS Stigmatization Scale SSAS Social Support Appraisals Scale SSES State Self-Esteem Scale Stigmatizing Situations Questionnaire-Extended SSQ-E SVS Schwartz Value Survey SWBQ Subjective Well-Being Questionnaire

TAPES Trinity Amputation and Prosthesis Experiences Scale TFEQ Three Factor Eating Questionnaire TSBI Texas Social Behaviour Inventory Unimportance of Male Body Image Scale UMBI US Uniqueness Scale YBOSCS Yale-Brown Obsessive-Compulsive Scale YSQ-SF Young Schema Questionnaire-Short Form WHOQOL-BRIEF World Health Organization Quality of Life-Brief form.

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