Confirmatory factor analysis and psychometric properties of the Spanish version of the Multidimensional Body-Self Relations Questionnaire-Appearance Scales

Body Image 14 (2015) 47–53

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Confirmatory factor analysis and psychometric properties of the Spanish version of the Multidimensional Body-Self Relations Questionnaire-Appearance Scales ˜ b,c , Jose H. Marco d , Sergio Sánchez-Reales e María Roncero a,∗ , Conxa Perpiná a Departamento de Psicología y Sociología, Área de Personalidad, Evaluación y Tratamientos Psicológicos, Facultad de Ciencias Sociales y Humanas de Teruel, Universidad de Zaragoza, C/ Ciudad Escolar s/n, 44003 Teruel, Spain b Departamento de Personalidad, Evaluación y Tratamientos Psicológicos, Facultad de Psicología, University of Valencia, Spain c Ciber Fisiopatología Obesidad y Nutrición (CIBEROBN), Instituto de Salud Carlos III, Spain d Departmento de Personalidad, Evaluación y Tratamientos Psicológicos, Unversidad Católica de Valencia “San Vicente Martir”, Spain e Servicio de Salud Mental, Hospital General Universitario de Elche, Spain

a r t i c l e

i n f o

a b s t r a c t

Article history: Received 19 June 2014 Received in revised form 11 March 2015 Accepted 13 March 2015 Keywords: Body image Confirmatory factor analysis Multidimensional Body-Self Relations Questionnaire-Appearance Scales Spanish validation

The Multidimensional Body-Self Relations Questionnaire (MBSRQ) is the most comprehensive instrument to assess body image. The MBSRQ-Appearance Scales (MBSRQ-AS) is a reduced version that has been validated in other languages. The main aim of the present study was to confirm the factor structure of the Spanish version of the MBSRQ-AS and analyze its psychometric properties in 1041 nonclinical individuals. Confirmatory factor analysis showed excellent goodness of fit indices for the five-factor structure (Appearance Evaluation, Appearance Orientation, Body Areas Satisfaction, Overweight Preoccupation, and Self-Classified Weight). Factors possessed adequate scale score reliability indices. Some of the factors showed significant associations with the Eating Attitudes Test. Significant differences were found between boys/men and girls/women, and among age groups. The Spanish version of the MBSRQ-AS is a valid instrument for use in nonclinical population settings in people from 15 to 46 years old. © 2015 Elsevier Ltd. All rights reserved.

Introduction Body image refers to the multifaceted psychological experience of embodiment, which includes perceptions, beliefs, feelings, and behaviors related to one’s own body, particularly but not exclusively one’s physical appearance (Cash, 2004). Numerous studies have revealed that both dissatisfaction with one’s body and body image disturbance are associated with a number of problems, such as poorer social functioning, more anxiety in social situations or avoidance of anxiety-producing situations (Davison & McCabe, 2006), poorer sexual functioning (Cash, Maikkula, & Yamamiya, 2004), greater likelihood of becoming overweight (Haines, Neumark-Sztainer, Wall, & Story, 2007), chronic use of appearance and performance enhancing drugs (Hildebrandt, Alfano, & Langenbucher, 2007), and the use of cosmetic surgery (Sarwer & Crerand, 2004). Body dissatisfaction is also associated with having a lack of control over eating, adopting restrictive diets, and demonstrating bulimic symptomatology (Stice & Shaw, 2002).

∗ Corresponding author. Tel.: +34 978645343. E-mail address: [email protected] (M. Roncero). http://dx.doi.org/10.1016/j.bodyim.2015.03.005 1740-1445/© 2015 Elsevier Ltd. All rights reserved.

In fact, body image disturbance is one of the most prominent clinical characteristics of eating disorders (Garner, 2002; Nye & Cash, 2006; Schwartz & Brownell, 2004; Watson, Raykos, Street, Fursland, & Nathan, 2011), and one of the most relevant prognostic factors in bulimia nervosa (Grilo et al., 2009; Johnson & Wardle, 2005) and anorexia nervosa (Farrell, Lee, & Shafran, 2005; Hrabosky et al., 2009). Moreover, persistence of body image dissatisfaction is associated with eating disorder relapse (Cash & Deagle, 1997; Marco, ˜ & Botella, 2013a, 2013b). Perpiná, The most important limitation when evaluating body image is that the majority of the self-report measures have not been developed from a multidimensional view, and they do not capture the complexity of this construct, including only a single dimension of body image. One of the most comprehensive instruments is the Multidimensional Body-Self Relations Questionnaire (MBSRQ; Brown, Cash, & Mikulka, 1990; Cash, 2000), which was created to evaluate the self-attitudinal aspects of the body image construct. The original version of this instrument was a 294-item self-report instrument called the Body-Self Relations Questionnaire (BSRQ). Subsequently, the number of items in the original version was reduced on the basis of rational/conceptual and psychometric criteria. A 54-item version was used in a 1985 national USA survey in

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Psychology Today magazine (findings reported by Cash, Winstead, and Janda in the magazine in 1986). The conceptual framework for the instrument defined body image attitudes as reflecting two psychological dimensions, evaluation and orientation or investment, in relation to each of three somatic domains—appearance, health, and fitness. The factor analysis of the BSRQ by Brown et al. (1990) used the same national survey database and produced a structure very similar to the conceptual framework. The BSRQ factor scales are Appearance Evaluation, Appearance Orientation, Fitness Evaluation, Fitness Orientation, Health Evaluation, Health Orientation, and Illness Orientation (Cash, 2000). Subsequently, three additional appearance-related scales were included with the factor scales: the Body Areas Satisfaction Scale, the Overweight Preoccupation Scale, and the Self-Classified Weight scale. The BSRQ plus these additional scales constituted the 69-item, 10-scale assessment, renamed as the MBSRQ. The MBSRQ-Appearance Scales (MBSRQ-AS) is the 34-item version consisting of only the five appearance-related scales (described in further detail in the Measures section). This version is recommended when the objective is to evaluate appearancefocused body image, and there is no interest in fitness or health scales. Both the MBSRQ and MBSRQ-AS have been used in a large number of studies. They have shown adequate psychometric properties in nonclinical samples, students (Haugen, Johansen, & Ommundsen, 2014), people with eating disorders (Costarelli, Antonopoulou, & Mavrovounioti, 2011; Kelly et al., 2012), plastic surgery patients (Botella, Ribas, & Ruiz, 2009), and people with body dysmorphic disorder (Hrabosky et al., 2009), people with obesity, outcome studies of body image treatment, people who engage in physical exercise (Cash, 2000) or have medical conditions (Hatipoglu et al., 2014). The 69-item version of the MBSRQ has been translated into Spanish and validated in the Spanish population on two occasions with different results. Raich, Torras, and Figueras (1996) conducted an exploratory factor analysis of the instrument with 214 college students. They obtained six factors with adequate psychometric properties, which the authors labeled: (a) Interest in Sports and Physical Skills, (b) Concern about Body Image, (c) Evaluation of Body Image, (d) Hypochondriac Signs, (e) Health Evaluation, and (f) Health Concerns. More recently, Botella et al. (2009) conducted an exploratory factor analysis of the MBSRQ with 131 students and 130 patients undergoing cosmetic surgery. The authors found four factors, which they referred to as (a) Subjective Importance of Corporality, (b) Behaviors Aimed at Staying in Physical Shape, (c) Self-Rated Physical Attractiveness, and (d) Care of Physical Appearance. In the Botella et al. (2009) Spanish validation of the MBSRQ, the instrument was reduced to 45 items. Therefore, it consists of two parts, one referring to overall body image assessment, and the other assessing the degree of satisfaction with various body areas separately. However, to date, the short version of the MBSRQ, the MBSRQ-AS, has not been validated in the Spanish population. The MBSRQ-AS has been validated in French (Untas, Koleck, Rascle, & Borteyrou, 2009), Greek (Argyrides & Kkeli, 2013), and more recently German (Vossbeck-Elsebusch et al., 2014), with satisfactory results. The MBSRQ-AS is widely used in body image research. Moreover, it is able to differentiate between the evaluation of appearance-related aspects and the person’s orientation toward these aspects (i.e., the perceived importance of appearance and its influence on the person’s behavior). No Spanish validation of this instrument is available, and we think a Spanish version analyzing the original factor structure could be useful in future research in Spanish-speaking populations. The main objective of the present study was to confirm the factor structure of the Spanish version of the MBSRQ-AS and analyze its psychometric properties in a nonclinical sample. The secondary objectives were to analyze differences between sexes and among age groups and to

examine relationships with eating pathology. Based on a previous study using confirmatory factor analysis (Vossbeck-Elsebusch et al., 2014), we expected that the five original factors of the MBSRQ-AS would be confirmed. Method Participants Participants in the present study included 1041 individuals, 694 of whom were women (66.7%). The mean age was 23.11 (SD = 6.10) years, ranging from 15 to 46 years. The mean body mass index (BMI) was 22.23 (SD = 3.07; range 17–34.6). The majority of the sample was single (85.8%) and had university level studies (59.3%) and a medium socio-economic level (73.5%). Age was stratified according to the World Health Organization (WHO, 1986) study group on young people and “Health for All by the Year 2000”. Based on development in adolescence and youth, boys and girls from 15 to 17 years old would be in the “middle adolescence” stage; those from 18 to 20 years old would be in the “late adolescence” stage; and from 21 to 24 years old, they would be in the “youth” stage. Finally, in our sample, the 25- to 46-year-old group was considered the “adult” group. Given differences in BMI between men and women, F(1, 1021) = 137.17; p < .001, and among age groups, F(3, 1019) = 25.74; p < .001, ANCOVAs were calculated, controlling BMI in the MBSRQ-AS analyses of group comparisons. Measures Multidimensional Body-Self Relations QuestionnaireAppearance Scales (MBSRQ-AS 34; Brown et al., 1990; Cash, 2000). The MBSRQ-AS is composed of five scales with good psychometric properties: (a) Appearance Evaluation, composed of seven items, assesses beliefs and feelings of satisfaction or dissatisfaction with one’s appearance; (b) Appearance Orientation, made up of 12 items, assesses the extent of one’s cognitive-behavioral investment in one’s appearance; (c) Overweight Preoccupation, composed of four items, assesses fat anxiety, weight vigilance, dieting and eating restraint; (d) Self-Classified Weight, composed of two items, assesses how one perceives one’s weight status, from very underweight to very overweight; and (e) Body Areas Satisfaction, containing nine items, assesses satisfaction or dissatisfaction with specific body areas and attributes (i.e., face, hair, lower torso, mid torso, upper torso, muscle tone, weight, height, overall appearance) (Cash, 2000). Each item is scored on a 5-point scale and evaluates agreement (from 1: “Definitely disagree” to 5: “Definitely agree”), frequency (from 1: “Never” to 5: “Very often”), or satisfaction (from 1: “Very dissatisfied” to 5: “Very satisfied”). For items related to Self-Classified Weight, participants use ratings from 1: “Very underweight” to 5: “Very overweight”. Regarding the Spanish translation of the MBSRQ-AS, adjustments were made to some expressions from the existing Spanish version. After that, a native English speaker carried out a backtranslation. In cases of incongruence, the item was checked by a group of clinical psychologists with considerable expertise in the field of eating disorders and body image, and the native speaker was again consulted. The final version of the instrument is available in an online Supplementary Materials document linked to the present article. Eating Attitudes Test (EAT-26; Garner, Olmsted, Bohr, & Garfinkel, 1982). This self-report instrument assesses attitudes and behaviors related to ED across three subscales: Dieting, Bulimia and Food Preoccupation, and Oral Control. The total score measures ED symptom severity. Each item is scored on a 6-point scale from “Always” to “Never”. In the present sample, the Spanish version

M. Roncero et al. / Body Image 14 (2015) 47–53

(Castro, Toro, Salamero, & Guimerá, 1991) showed good scale score reliability (Total score: ˛ = .89, 95% confidence interval: .88 to .90; Dieting: ˛ = .84, 95% confidence interval: .83 to .86; Bulimia: ˛ = .75, 95% confidence interval: .71 to .77; and Oral Control: ˛ = .70, 95% confidence interval: .66 to .75). This questionnaire was completed by 349 participants from the total sample with comparable sociodemographic characteristics. Of these 349 participants, 234 were women (67%). The mean age was 23.39 (SD = 4.68) years, ranging from 16 to 45 years. The mean body mass index (BMI) was 22.58 (SD = 2.96; range 17.85–33.92). In addition, 86.8% of the sample were single and had university level studies (79.9%) and a medium socio-economic level (70.2%).

Procedure Cash (2000) states in the MBSRQ manual that the instrument would be suitable for people above the age of 15. Therefore, we decided to include individuals from 15 years old and up, in order to corroborate the scale’s appropriateness over a broad age range. For the 18-year-old and above sample, the recruitment procedure was carried out using the “snowball” method. Advanced psychology students, who participated voluntarily, attended a seminar in which they received training about how to present the instruments to prospective participants. Each student individually administered the assessment protocol to three friends and/or family members, who did not receive any compensation for their participation. Students received one course credit for their recruitment efforts. Participants were volunteers, and a week before completing the questionnaires, they signed an informed consent form, and their weight and height were collected. Data about their current physical and mental health status were obtained through a structured interview specifically designed for this purpose. Participants from 15 to 17 years old were recruited from five secondary schools in the city of Valencia. The students provided written agreement, and the parents gave written consent for participation in the protocol. They filled out the questionnaires during their normal school day, and their weight and height were measured by the interviewer. The order of presentation of the instruments was counterbalanced. The statistical analyses were performed with the Statistical Package for the Social Sciences, SPSS v. 20 and the EQS 6.10 (Bentler, 2006) statistical package. This study received the ethical approval of the University of Valencia Ethics Committees and the local school boards.

Results Confirmatory Factor Analysis The factor structure of the MBSRQ-AS was confirmed following the Bentler and Bonnet (1980) criteria for these fit indices: Comparative Fit Index (CFI) and Root Mean-Square Error of Approximation (RMSEA). Given the nature of the variables (ordered, categorical and non-normal), polychoric correlations and maximum likelihood Satorra–Bentler corrected standard errors and test statistics were used as the estimation method in EQS, as recommended in the literature (Finney & DiStefano, 2006). Indices for the original fivefactors, 2 (517) = 2249.062, p < .001, CFI = .955, RMSEA = .057, fits the criteria indexes of CFI > .90, and RMSEA < .08, following Hu and Bentler’s recommendations (1999). Standardized loadings are shown in Table 1. All item loadings were high, with two exceptions, Item 27 for hair satisfaction ( = .231) and Item 33 for height satisfaction ( = .308) on the Body Areas Satisfaction factor.

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Table 1 Item loadings, means, and standard deviations of the five factors. Item

Factor



M

SD

MBSRQ-AS.3 MBSRQ-AS.5 MBSRQ-AS.9 MBSRQ-AS.12 MBSRQ-AS.15 MBSRQ-AS.18 MBSRQ-AS.19 MBSRQ-AS.1 MBSRQ-AS.2 MBSRQ-AS.6 MBSRQ-AS.7 MBSRQ-AS.10 MBSRQ-AS.11 MBSRQ-AS.13 MBSRQ-AS.14 MBSRQ-AS.16 MBSRQ-AS.17 MBSRQ-AS.20 MBSRQ-AS.21 MBSRQ-AS.26 MBSRQ-AS.27 MBSRQ-AS.28 MBSRQ-AS.29 MBSRQ-AS.30 MBSRQ-AS.31 MBSRQ-AS.32 MBSRQ-AS.33 MBSRQ-AS.34 MBSRQ-AS.4 MBSRQ-AS.8 MBSRQ-AS.22 MBSRQ-AS.23 MBSRQ-AS.24 MBSRQ-AS.25

1 1 1 1 1 1 1 2 2 2 2 2 2 2 2 2 2 2 2 3 3 3 3 3 3 3 3 3 4 4 4 4 5 5

.741 .787 .540 .772 .658 −.860 −.787 .788 .753 .734 .779 .706 −.470 .486 −.643 −.411 .532 −.509 .604 .415 .231 .648 .711 .519 .539 .753 .308 .884 .792 .635 .727 .717 .982 .882

3.29 3.42 3.24 3.10 3.48 2.39 2.46 4.15 4.08 3.44 2.97 3.79 3.36 3.97 2.19 2.72 3.35 1.94 3.26 3.70 3.71 3.10 3.00 3.42 3.07 3.12 3.51 3.55 2.93 2.86 2.03 1.67 3.22 3.09

0.86 1.00 0.81 1.03 0.80 1.08 0.94 0.84 0.89 1.13 1.15 0.88 1.20 0.85 0.98 1.13 1.06 0.79 1.01 0.80 0.97 1.12 1.08 0.96 0.98 1.04 1.03 0.84 1.24 1.29 1.19 0.92 0.63 0.66

Note. Spanish version of each item is provided in the online Supplementary Materials document linked to this article. MBSRQ-AS: Multidimensional Body-Self Relations Questionnaire-Appearance Scales. : loading. M: mean; SD: standard deviation.

Association between MBSRQ-AS Factors The five MBSRQ-AS factor scales were scored as means across their constituent items, after reverse scoring items with negative factor loadings. The six reverse-scored items were identical to those in Cash’s (2000) MBSRQ-AS scoring. Pearson’s correlations among the MBSRQ-AS factors ranged from moderate to high (see Table 2). All correlations were significant except for Appearance Orientation, which was not associated with Appearance Evaluation and SelfClassified Weight. Given the high correlation between Appearance Evaluation and Body Areas Satisfaction, a new CFA was carried out with a fourfactor model (collapsing Appearance Evaluation and Body Areas Satisfaction into one factor). The Akaike Information Criterion (AIC) was used to compare the models, with a lower index indicating a better model. Indices were very similar to those of the five-factor model (2 = 2295.947; df = 517; p < .001; CFI = .954; RMSEA = .057). However, the AIC was lower for the original five-factor model (five factors’ AIC = 1215.063; four factors’ AIC = 1253.947). Thus, although more global appearance evaluation and satisfaction with specific body areas and attributes are understandably correlated, there appears to be merit in their distinction on two scales. Reliability and Validity The scale score reliability of the MBSRQ-AS factors was estimated using Cronbach’s alpha indices for the first four factors. Given that Self-Classified Weight is composed of two items, Pearson correlation was calculated. Cronbach’s alphas of the MBSRQ-AS in the present sample were adequate: Appearance Evaluation:

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Table 2 Correlations among MBSRQ-AS factors.

Appearance Evaluation Appearance Orientation Body Areas Satisfaction Overweight Preoccupation Self-Classified Weight * **

Appearance Evaluation

Appearance Orientation

Body Areas Satisfaction

Overweight Preoccupation

−.03 .77** −.39** −.46**

−.09* .41** −.00

−.45** −.41**

.48**

p < .01. p < .001.

Table 3 Correlations between MBSRQ-AS and EAT factors (n = 349).

Diet Bulimia Oral Control Total *

Appearance Evaluation

Appearance Orientation

Body Areas Satisfaction

Overweight Preoccupation

Self-Classified Weight

−.41* −.22* −.07 −.34*

.37* .24* .22* .36*

−.36* −.22* −.07 −.31*

.73* .50* .23* .66*

.38* .19* −.03 .29*

p < .001.

Table 4 Univariate comparisons by gender. Measure

Men (n = 347)

Women (n = 694)

F

df

p

2p

Appearance Evaluation Appearance Orientation Body Areas Satisfaction Overweight Preoccupation Self-Classified Weight

3.45 (0.72) 3.24 (0.63) 3.48 (0.62) 2.04 (0.79) 3.17 (0.58)

3.34 (0.69) 3.73 (0.55) 3.29 (0.57) 2.54 (0.89) 3.16 (0.61)

5.137 161.584 24.601 77.953 1.733

1, 1039 1, 1039 1, 1039 1, 1039 1, 1039

.024 <.001 <.001 <.001 .188

.005 .140 .023 .07 .002

˛ = .87 (95% confidence interval: .86 to .88); Appearance Orientation: ˛ = .85 (95% confidence interval: .84 to .87); Body Areas Satisfaction: ˛ = .78 (95% confidence interval: .76 to .80); Overweight Preoccupation: ˛ = .76 (95% confidence interval: .73 to .78); Self-Classified Weight: r = .88; p < .001. Pearson’s correlations were computed to analyze associations between the MBSRQ-AS factors and a measure that assesses attitudes and behaviors related to ED on the EAT. The MBSRQ-AS factors were associated with the three factors of the EAT, mainly with Overweight Preoccupation (see Table 3). EAT-Oral Control only correlated with Appearance Orientation and Overweight Preoccupation.

Differences among Gender and Age Groups A multivariate analysis of variance (MANOVA) was carried out to compare age and gender groups on the MBSRQ-AS factor scales. Pillai’s trace was the statistic chosen because of its power and robustness. Pillai’s trace indicated that there was a significant effect of gender on the MBSRQ-AS factors, V = 0.132, F(5, 1029) = 31.237, p < .001. Grouping variable age also had an effect on the MBSRQAS factors, V = 0.113, F(15, 3093) = 8.037, p < .001. However, there was no interaction effect between gender and age, V = 0.022, F(15, 3093) = 1.491, p = .099.

Univariate comparisons showed that there were differences between boys/men and girls/women (see Table 4). Girls/women scored higher than men on Appearance Orientation and Overweight Preoccupation, and lower on Appearance Evaluation and Body Areas Satisfaction. Then, BMI was controlled, and the differences remained statistically significant. Regarding age groups, significant differences were found in every factor except Appearance Evaluation (see Table 5). For Appearance Orientation, adults showed lower scores than the other groups. On Body Areas Satisfaction, middle adolescents scored higher than the other age groups. Regarding Overweight Preoccupation, late adolescents scored higher than the middle adolescent and adult groups. Finally, on Self-Classified Weight, middle adolescents scored lower than the other age groups. Then, BMI was controlled, and the differences remained significant.

Discussion The aim of the present study was twofold: first, to confirm the five-factor structure of the Spanish version of the MBSRQ-AS reported by Cash (2000) and analyze the psychometric properties of the Spanish MBSRQ-AS in a nonclinical sample with a broad age range; and second, to analyze differences between the sexes and among the age groups.

Table 5 Univariate comparisons for age groups. Measure

Middle adolescent (n = 173)

Late adolescent (n = 103)

Youth (n = 485)

Adult (n = 280)

F

df

p

2p

Appearance Evaluation Appearance Orientation Body Areas Satisfaction Overweight Preoccupation Self-Classified Weight

3.40 (0.66) 3.68a (0.63) 3.57a (0.63) 2.28a (0.95) 3.01a (0.54)

3.24 (0.82) 3.63a (0.70) 3.23b (0.59) 2.58b (0.87) 3.29b (0.58)

3.37 (0.71) 3.62a (0.60) 3.31b (0.58) 2.40a,b (0.90) 3.14b (0.61)

3.43 (0.68) 3.38b (0.57) 3.34b (0.56) 2.29a (0.83) 3.15b (0.61)

1.950 12.496 10.440 3.407 6.395

3, 1037 3, 1037 3, 1037 3, 1037 3, 1037

.120 <.001 <.001 .017 <.001

.006 .035 .029 .010 .018

a,b,c

Means sharing the same superscript are not significantly different from each other (Tukey).

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The CFA showed satisfactory fit indices, confirming that in the nonclinical population from 15 to 46 years old, the Spanish version of the MBSRQ-AS has the same five factors as those reported by Cash (2000): Appearance Evaluation, Appearance Orientation, Body Areas Satisfaction, Self-Classified Weight and Overweight Preoccupation. To our knowledge, data are only available for three adaptations of the MBSRQ-AS to other languages: German, French, and Greek. Similar to our results, the study of the German version, using confirmatory factor analysis, confirmed the original factor structure, with the exception of Self-Classified Weight (due to its having only two items that were highly correlated). Using exploratory factor analyses, the French and Greek studies replicated the two main scales from the study by Brown et al. (1990): Appearance Evaluation and Appearance Orientation. In the present study, item loadings were high for every item except 27 and 33, which evaluate satisfaction with hair and height, respectively. These items are included in the Body Areas Satisfaction Scale, which is one of the three “additional subscales” of the MBSRQ. The low loadings could reflect that in the Spanish population hair and height do not play a central role in the evaluation of one’s general appearance, or at least not as much as other body areas. However, in the German version these items also obtained low loadings, so that it may be a general finding across versions of the MBSRQ. The authors of the German version recommended maintaining these items because they provide information about more attractive or neutral aspects of the body, as they could be useful, for example, for therapy to include in a body exposure exercise more positive or neutral body areas than body shape or weight (Vossbeck-Elsebusch et al., 2014). Correlations among the MBSRQ-AS factors showed once again that Appearance Orientation and Appearance Evaluation represent two independent factors. This result has also been observed in previous studies where exploratory factor analysis has extracted two different factors (Argyrides & Kkeli, 2013; Brown et al., 1990; Untas et al., 2009). Moreover, in Brown et al. (1990) and VossbeckElsebusch et al. (2014), the authors found a very small correlation between these two factors. A person may pay attention to his/her appearance and spend a lot of time and resources on it, independently of his/her level of satisfaction. Another result, which was also found in the German study (Vossbeck-Elsebusch et al., 2014), is that there is a high correlation between Appearance Evaluation and Body Areas Satisfaction. This is not surprising, given that both factors evaluate appearance satisfaction, with the difference being that the first factor is about general appearance, and the second is about specific body areas. The association is not perfect, in spite of the shared variance between factors. Thus, it is relevant to maintain both factors because the items provide different information that can be analyzed independently. Moreover, a CFA collapsing these two factors into one showed worse indices than the five-factor model, corroborating the appropriateness of maintaining both factors. Our data reveal another result that has not been reported in any previous validations, the fact that Self-Classified Weight is associated with Appearance Evaluation, but not with Appearance Orientation. This means that the perception of one’s weight may be related to how satisfied one is with his/her general appearance, but it has nothing to do with the importance given to his/her appearance or the investment made in it. The reliability of the five factors is adequate, ranging from .88 to .76. Indices are similar to those reported by Cash in the users’ manual (2000), and more specifically, close to indices reported in the sample of women. This result is not surprising because almost 67% of our sample were women. Our indices are also very similar to those reported in the Greek (Argyrides & Kkeli, 2013), French (Untas et al., 2009) and German (Vossbeck-Elsebusch et al., 2014) adaptations, with the lowest reliability scores found for the Overweight Preoccupation factor.

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Regarding validity, and specifically the association with similar constructs, the most noteworthy result is that all of the MBSRQ-AS factors showed significant medium to high associations with the Diet factor from the EAT, with the highest association found with Overweight Preoccupation. This result makes sense because the Diet EAT factor evaluates not only the avoidance of fattening foods, but also the preoccupation with being thinner. The associations between the MBSRQ-AS and the Bulimia and Food Preoccupation EAT factor were small, except in the case of Overweight Preoccupation, which showed a medium association. Bulimia and Food Preoccupation includes items about thoughts related to food and bulimia, whereas the Overweight Preoccupation factor includes items about fat anxiety, weight vigilance, diet and food restriction. Regarding the Oral Control EAT factor, only small associations were found with Appearance Orientation and Overweight Preoccupation. These data are coherent with the results reported in the EAT-26 study (Garner et al., 1982), in which they found that mainly Diet and Bulimia and Food Preoccupation, but not Oral Control, were associated with body image related factors. Given the wide age range of our sample (from 15 to 46 years old), we analyzed whether the Spanish version of the MBSRQ-AS would capture differences in body image across different ages, and between the sexes. Results showed no interaction effect between the two variables. Regarding gender differences, results for Appearance Orientation showed that girls and women gave more importance to their appearance, paid more attention to it, and make more of an effort to improve it. It is noteworthy that the effect size of this difference was large (Cohen, 1973) and the highest among the MBSRQ-AS factors found in the present study. However, girls and women were more dissatisfied with their general appearance and with discrete areas of their body than boys and men were. Women and girls were also more preoccupied with being or becoming fat or overweight, in the sense that they were very concerned about their weight variations, and they engaged in eating restraint and dieting to lose weight or prevent weight gain. However, there were no gender differences in the selfclassification of weight status. Our results are in line with data across studies showing that girls/women give more importance to their appearance and are more dissatisfied with their bodies than boys/men (e.g., Cash, Melnyk, & Hrabosky, 2004; Frederick, Peplau, & Lever, 2006; Koleck, Bruchon-Schweitzer, Cousson-Gelie, Gilliard, & Quintard, 2002; Murnen, 2011). Differences between the sexes found in the present study with the Spanish version of the MBSRQ-AS are the same as those reported in the Greek MBSRQ-AS. In the French version of the MBSRQ-AS, they also found differences in the Self-Classified Weight factor in normal and overweight men and women. This result could be explained by the fact that they analyzed differences between men and women with normal weight and overweight separately, while we collapsed across BMI weight status. Regarding age differences, results indicated that satisfaction with their general appearance (Appearance Evaluation factor) was similar across the four age groups (middle adolescents, late adolescents, youths, and adults). Similarly, in a recent study no differences were found between young adult women (18–34 years old) and middle adult women (35–49 years old) in body appreciation and body satisfaction (Tiggemann & McCourt, 2013). However, regarding specific body areas (Body Areas Satisfaction), the middle adolescents (15–17 years old) were more satisfied than the other groups, and they reported the lowest Self-Classified Weight. Results from previous studies have found that body dissatisfaction increases with age; however, once established it does not seem to decrease with mere development (Wertheim & Paxton, 2011). Regarding Appearance Orientation, results showed that adults were the group with less investment in and importance placed on appearance. This result is coherent with the fact that the

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relevance of physical appearance in global self-worth decreases in adult women (Tiggemann, 2004; Tiggemann & McCourt, 2013). These results capture the stability found in body image dissatisfaction and the decrease in body image importance. Finally, regarding the Overweight Preoccupation factor, the late adolescent group scored higher than middle adolescents and adults. It is noteworthy that eating disorders commonly begin between adolescence and young adulthood (American Psychiatric Association, DSM-5, 2013). Overweight Preoccupation includes items about fat anxiety, dieting, and restraint, and so it reflects that the person is not only worried about weight, but he/she is also making an effort to control his/her weight. This factor is associated with different problems, such as eating disorder dysfunctional behaviors and attitudes, depression and academic interference, among others (Hamilton, 2008; Hrabosky et al., 2009; Klos, Esser, & Kessler, 2012; VossbeckElsebusch et al., 2014; Yanover & Thompson, 2008). The present study has some strengths. To our knowledge, this is the first study to analyze the Spanish version of the MBSRQ-Appearance Scales. The study uses a large sample (N = 1041 nonclinical individuals) composed not only of college students, but also of community sample from 15 to 46 years old, making it possible to analyze differences among age groups. The CFA in the present sample confirmed the original five-factor structure of the MBSRQ-AS. Nevertheless, the study has some limitations. The lack of a re-test measurement means we cannot corroborate the temporal stability of the Spanish version of the MBSRQ-AS. Moreover, this study did not examine the convergent validity of the MBSRQ-AS with other validated body image scales. However, the association with related constructs was tested with the Eating Attitudes Test, demonstrating that the Diet factor was highly associated with Overweight Preoccupation, one of the body image factors. Future studies should include other measures to specifically analyze the convergent and discriminant validity of the MBSRQ-AS Spanish version. Moreover, it would be interesting to analyze psychometric properties in clinical samples, especially in eating disorder patients, given the relevance of body image in this disorder. After confirming and analyzing the psychometric characteristics of this instrument in a sample of more than 1000 participants, as a practical implication we can conclude that our body image measure is sufficiently robust. The Spanish version of the MBSRQ-AS, as in adaptations to other languages, is a very complete measure (with relatively few items) of the different aspects of body image. It is quite useful for studying body image in different age groups and both sexes, in normal psychology or when a pathology related to body image is suspected, such as eating disorders, body dysmorphic disorder or the somatoform disorder. In conclusion, the five-factor structure presented by Cash (2000) has been confirmed in the Spanish MBSRQ-AS version. The psychometric properties of the Spanish version are excellent, including its scale score internal reliability and validity. Differences found between men and women, and especially across different age groups, are an additional indicator of the high sensitivity of this instrument, the most comprehensive assessment of the multidimensional body image construct.

Acknowledgements This study is supported by the Spanish Ministerio de Ciencia y Tecnología (PSI2009/10957) and by the Conselleria d’ Educació, Cultura i Esport, Generalitat Valenciana (PROMETEO/2013/066). Centro de Investigación Biomédica en Red Fisiopatología de la Obesidad y Nutrición is an initiative of ISCIII. We would like to give special thanks to Professor Cash for facilitating the use of the MBSRQ-AS material.

Appendix. Supplementary materials Supplementary materials associated with this article can be found, in the online version, at http://dx.doi.org/10.1016/ j.bodyim.2015.03.005.

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