Physical appearance comparisons and symptoms of disordered eating: The mediating role of social physique anxiety in Spanish adolescents

Body Image 32 (2020) 145–149

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Body Image journal homepage: www.elsevier.com/locate/bodyimage

Brief research report

Physical appearance comparisons and symptoms of disordered eating: The mediating role of social physique anxiety in Spanish adolescents ˜ ∗ , Álvaro Sicilia, David M. Díez-Fernández, Adrian Paterna Manuel Alcaraz-Ibánez Department of Education and Health Research Centre, University of Almería, Spain

a r t i c l e

i n f o

Article history: Received 18 January 2019 Received in revised form 21 December 2019 Accepted 21 December 2019 Keywords: Physical appearance Psychopathology Adolescence Eating pathology Social comparison

a b s t r a c t Physical appearance comparisons (PAC) and social physique anxiety (SPA) have been independently related to disordered eating (DE). However, the extent to which these variables may be concurrently associated with DE in the adolescent population remains largely unknown. This study was aimed at addressing a twofold objective: firstly, to examine whether SPA may moderate or mediate the relationship between PAC and DE in a sample of Spanish adolescents of both sexes; secondly, to examine whether these mechanisms may differ according to sex. A total of 738 adolescents (50 % girls) ranging from 12 to 17 years of age (M = 14.45, SD = 1.50) were recruited from nine secondary schools. Participants completed a self-reported questionnaire covering the variables of interest. After controlling for the effects of sex, age, standardized body mass index (z-BMI), and depressive symptoms, the results from bootstrapping crosssectional regression analyses supported the mediating effect of SPA on the relationship between PAC and DE, but not the moderating one. Sex was not found to moderate either the mediated or moderated relationships. Prevention/intervention efforts targeted towards decreasing DE among adolescents may benefit from minimizing the social relevance of the body inherent in the cognitive and affective processes underlying both SPA and PAC. © 2019 Published by Elsevier Ltd.

1. Introduction Eating disorders are a serious mental health problem that, despite their low prevalence, exert a substantial socioeconomic burden (Crow, 2014; Smink, Van Hoeken, & Hoek, 2012). In contrast, less severe forms of eating disorders (i.e., disordered eating, DE) are fairly common amongst adolescents (Herpertz-Dahlmann, Dempfle, Konrad, Klasen, & Ravens-Sieberer, 2015). This is especially worrisome considering that DE is defined according to a continuum (i.e., from normal eating to full syndrome), so those exhibiting more symptoms (e.g., skipping meals, following extreme diets or losing control over food intake) would be at greater risk of developing a clinical disorder (Franko & Omori, 1999). Consequently, examining the mechanisms leading to increased DE symptoms is important from a prevention point-of-view. Cognitive-behavioural models of body image conceptualize DE as a maladaptive coping strategy in response to two groups of proximal influencing factors: (a) the cognitive processes acti-

∗ Corresponding author at: Universidad de Almería, Facultad de Ciencias de la ˜ Educación, Carretera de Sacramento s/n, 04120 La Canada de San Urbano Almería, Spain. ˜ E-mail address: [email protected] (M. Alcaraz-Ibánez). https://doi.org/10.1016/j.bodyim.2019.12.005 1740-1445/© 2019 Published by Elsevier Ltd.

vated by daily body–related experiences and (b) the emotional reactions emerging from those cognitive processes (Cash, 2012). Consistent with these theoretical tenets, both a body-related cognitive process such as physical appearance comparisons (PAC) and a body-related emotion such as social physique anxiety (SPA; defined as the uneasy feelings derived from anticipating possible unfavourable social evaluations of the body; Hart, Leary, & Rejeski, ˜ 1989) have been consistently associated with DE (Alcaraz-Ibánez, 2017; Fitzsimmons-Craft, Harney, Brownstone, Higgins, & BardoneCone, 2012; Lanfranchi, Maïano, Morin, & Therme, 2015; Walker et al., 2015). At least two possibilities may be considered for explaining how PAC and SPA would lead to the emergence of DE. On the one hand, PAC and SPA may exert a synergistic effect on DE (FitzsimmonsCraft et al., 2012). Thus, the positive relationship between one of these variables (i.e., PAC or SPA) and DE may be strengthened in the presence of high levels of the other. This possibility has received preliminary empirical support in a sample of female university students (Fitzsimmons-Craft et al., 2012). Conversely, PAC may be associated with DE via SPA. Specifically, because engaging in PAC may increase anxiety and discomfort related to worries about unfavourable body evaluations by others, which may increase DE. This possibility seems plausible according to the tenets of cognitive-

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behavioural models of body image, concretely, since these models posit that body image-related emotions may play a more proximal causal role relative to body image-related cognitive processes to DE (Cash, 2012). In this vein, empirical evidence points to SPA both as a consequence of PAC (McCreary & Saucier, 2009; ThøgersenNtoumani, Dodos, Chatzisarantis, & Ntoumanis, 2017) and as an antecedent of DE (Fitzsimmons-Craft et al., 2012; Lanfranchi et al., 2015). However, the potential mediating effect of SPA on the relationship between PAC and DE remains unexplored. An empirical examination of these two possibilities (moderation/mediation) in the context of a single study could contribute to unravelling some of the body-image related psychological processes leading to DE. Evidence emerging from such research may inform preventive actions aimed at reducing DE and, by extension, the incidence of eating disorders. In the present study, we sought to examine whether the relationship between PAC and symptoms of DE may be moderated or mediated by SPA in a sample of Spanish adolescents of both sexes. Some reasons may be adduced in favour of considering this population. Firstly, despite adolescence being an important developmental stage in terms of the emergence of body image concerns and DE (Cash, 2012), previous research addressing the relationships between PAC/SPA/DE has almost exclusively considered female university students (Fitzsimmons-Craft et al., 2012; Thøgersen-Ntoumani et al., 2017; Walker et al., 2015). Secondly, even though girls tend to display higher levels of DE than boys, the fact remains that the latter are not free from experiencing this ˜ health issue (Alcaraz-Ibánez, 2017; Ferreiro, Seoane, & Senra, 2012). Given the sex-specific nature of some of the body-related cogni˜ tions and emotions that may lead to DE (Alcaraz-Ibánez & Sicilia, 2018; Ferreiro et al., 2012; Schaefer & Thompson, 2018a), a second objective of the present study is to examine in an exploratory way whether the tested models are moderated by sex. According to the theoretical and empirical research presented, it is expected that PAC and SPA will be positively related to symptoms of DE. Given the plausibility of the two tested possibilities (moderation/mediation), no specific hypothesis has been formulated which supports one rather than the other. These relationships are examined accounting for several covariates that have previously been considered as particularly relevant when examining mechanisms leading to DE (i.e., sex, age, body mass index [BMI], and depres˜ sive symptoms; Alcaraz-Ibánez, 2017; Ferreiro et al., 2012; Puccio, Fuller-Tyszkiewicz, Ong, & Krug, 2016; Walker et al., 2015). 2. Method 2.1. Participants A total of 738 participants (50 % girls) were recruited from nine secondary schools in the Spanish provinces of Almeria and Granada. The participants’ age ranged from 12 to 17 years (M = 14.45, SD = 1.50) and their self-reported BMIs ranged from 14.13–38.95 kg/m2 (M = 20.96, SD = 3.39). The participants identified themselves as White/Caucasian (90 %), Maghrebi (4 %), Latin (2 %), Black (1 %), Asian (1 %) and Gypsy (2 %). 2.2. Measures 2.2.1. Physical appearance comparison We used our Spanish translation of the Physical Appearance Comparison Scale-Revised (PACS-R; Schaefer & Thompson, 2014). Since the PACS-R has not been validated in Spanish samples, the instrument was firstly adapted into Spanish (see Supplementary Material). The 11 items comprising the instrument are scored on a 5-point scale from 0 (never) to 4 (always).

2.2.2. Social physique anxiety We used the Spanish version of the Social Physique Anxiety Scale (SPAS; Motl & Conroy, 2000), validated in the adolescent population (Sáenz-Alvarez, Sicilia, González-Cutre, & Ferriz, 2013). The 7 items comprising this instrument (e.g. “In the presence of others, I feel apprehensive about my physique/figure”) are scored on a 5-point scale from 1 (never) to 5 (always). 2.2.3. Depressive symptoms We used the Spanish version of the depression sub-scale from the Brief Symptom Inventory-18 (BSI-18; Derogatis, 2000). Scored on a 5-point scale from 0 (not at all) to 4 (extremely), the 6 items comprising this instrument assess distress experienced over the previous 7 days as a result of depressive symptoms such as apathy, sadness, self-deprecation, anhedonia, loss of hope, and suicidal ideation. Evidence supporting the validity and reliability of this instrument’s scores has been found in Spanish adolescents (Pereda, Forns, & Peró, 2007). 2.2.4. Symptoms of disordered eating We used the Spanish version of the SCOFF questionnaire ˜ (Morgan, Reid, & Lacey, 1999), validated in adolescents (Caamano, Aguiar, López-Otero, & Takkouche, 2002). Scored dichotomously (No = 0, Yes = 1), the 5 items comprising this instrument reflect some of the key characteristics of anorexia and bulimia nervosa (e.g., loss of eating control or food intrusive thoughts). 2.2.5. Demographics Participants reported their sex, ethnicity, age, height (in cm), and weight (kg), the latter two being employed to calculate BMI (kg/m2 ). BMI was standardized (z-BMI) adjusting for age and sex according to data obtained for the Spanish adolescent population (Fernández et al., 2011). 2.3. Procedure Participants were recruited in classroom settings by one of the authors of the present study. Prior parental consent to participate in the research was required for minors. After being briefly informed about the study’s contents (body/eating attitudes) and the anonymous nature of their participation, those who provided their informed consent (97 %) completed a paper-and-pencil questionnaire. The measures included in the questionnaire were counterbalanced using two different arrangements. Participants were asked to refrain from discussing/sharing their answers and they did not receive any form of inducement for their participation. After completing the task, the participants were debriefed and thanked. Data were collected from the beginning of 2018 until mid2019. The study was approved by the Research Ethics Committee at the first author’s institution. 2.4. Statistical analyses 2.4.1. Preliminary analyses Firstly, the factor structure of the PACS-R and the invariant nature of its scores across sex were examined (see Supplementary Material S1). Secondly, values of composite reliability (; see Table 1) for the psychometric instruments used were obtained using a confirmatory factorial analysis (CFA) technique and the weighted least squares mean- and variance-adjusted (WLSMV) estimation method in Mplus 7 (Muthén & Muthén, 1998-2015Muthén & Muthén, 1998-2015). This method provides standard errors that are robust to the absence of normality when dealing with polytomous ordinal data (Li, 2015). Thirdly, plausible composite scores for the involved constructs were obtained (Asparouhov & Muthén, 2010) using Mplus 7, these being employed

d (95% CI)

.75 Range 6

.02 .26*** .56*** .44*** .68*** –

5 4 3

.10 .11* – .50*** .60*** .59***

1

2

1. Age 2. z-BMI 3. Depressive symptoms 4. PAC 5. SPA 6. Symptoms of DE

– −.03 .14** .15** .09 .12*

−.04*** – .07** .20*** .20*** .29***

.15** .00 .30*** – .72*** .68***

.00 .15** .53*** .57*** – .81***

12-17 −1.44-1.45 0-4 0-4 1-5 0-5

a

Table 1 Descriptive Statistics, Correlational Analysis and Sex Differences.

Note. zBMI = Standardized body mass index;  = Composite reliability index; d = Cohen’s d effect size of difference. To facilitate interpretation, means and standard deviations for depressive symptoms, physical appearance comparisons (PAC), social physique anxiety (SPA) and symptoms of disordered eating (DE) correspond to instruments’ mean scores. Correlations were derived from plausible composite latent scores. Correlation values below (above) the diagonal correspond to girls (boys). a Referring to the observed range in the case of age/z-BMI and the possible range for the remaining variables. * p < .05; **p < .01; ***p < .001.

1.52 0.04 0.86 0.75 0.95 −0.41 (-0.55, -0.26) 14.43 0.29 0.73 0.81 1.97 0.98

SD  Range

12-17 −1.46-1.45 0-4 0-4 1-5 .64

M

SD

– – .91 .95 .92 1.23

Girls (n = 369) 

14.47 0.14 1.17 1.18 2.51 1.29

1.47 0.04 1.00 1.03 1.12 0-5

– – .92 .92 .92 0.80

Boys (n = 369) M

−0.03 (-0.17, 0.12) 3.75 (3.51. 3.99) −0.47 (-0.62, -0.33) −0.41 (-0.56, -0.27) −0.52 (-0.67, -0.37)

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in subsequent analyses. Missing data (less than 1 %) were handled using WLSMV (in the CFA) and Bayesian (when estimating the plausible composite scores) estimation methods implemented in Mplus 7. Fourthly, descriptive statistics and bivariate correlations were obtained. Lastly, sex differences across study variables were obtained and interpreted in terms of effect size (d, Cohen, 1988). 2.4.2. Main analyses The relationships of interest were examined using the following PROCESS macro for SPSS models (Hayes, 2013): Model-1 (for examining the effect of the interaction between PAC × SPA on DE), Model-3 (for examining the interaction between PAC × SPA × Sex on DE), Model-4 (for examining the mediating sequence PAC→SPA→DE), and Model-59 (for examining the moderating effect of sex on this latter mediated relationship). A graphical representation of the tested models is provided in Supplementary Material S2. The examined associations are considered statistically significant when the 95 % confidence interval (CI) obtained from applying a bias-corrected and accelerated bootstrapping technique does not contain zero. The bootstrapping technique does not require meeting assumptions such as homoscedasticity or residual normality (Hayes, 2013). All continuous variables were standardized; thus, regression coefficients (␤) are shown in their standardized form. In these regression analyses, age, sex, z-BMI, and depressive symptoms were introduced as covariates. 3. Results 3.1. Preliminary analyses Preliminary evidence was obtained supporting the onedimensional and partially invariant nature of the Spanish PACS-R scores across sex (see Supplementary Material). Descriptive statistics, bivariate correlations, composite reliability, and sex differences across study variables are shown in Table 1. As previously reported (Sáenz-Alvarez et al., 2013), a weak factor loading was found (i.e., .03 for girls and -.03 for boys) for the reverse-worded item included in the SPAS (number 5); thus, it was dropped from further analyses. The scores for depressive symptoms, PAC, SPA, and symptoms of DE were below the mid-point of the scales. The analysed variables were positively correlated with DE both in boys and girls. Weak to medium-sized sex differences favouring girls were found for all study variables except for the z-BMI; the latter being a variable in which boys showed higher scores. 3.2. Main analyses The results from the first tested model revealed that the interaction between PAC and SPA did not significantly contribute to explaining DE (ˇ = .027, SE = .020, 95% CI = -.011, .066). Additionally, the results from the second tested model revealed that a triple interaction (i.e., PAC × SPA × Sex) was not plausible (ˇ = .030, SE = .045, 95% CI = -.060, .119). The results from the third tested model (see Table 2) revealed that the relationship between PAC and DE was positively mediated by SPA. The results from the fourth and last tested model revealed that the relationships under investigation were not moderated by sex. The latter was true for the relationships between PAC and SPA (ˇ = -.012, SE = .052, 95% CI = .114, .091), SPA and DE (␤ = -.107, SE = .059, 95% CI = -.223, .010), and PAC and DE (␤ = -.067, SE = .060, 95% CI = -.185 to .052). Additionally, the CI of the moderated mediation index (i.e., the difference between the indirect effects of PAC on DE through SPA for girls and boys) included zero (ˇ = -.060, SE = .041, 95% CI = -.114, .019), thus suggesting that no moderation by sex of the indirect effect was plausible.

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Table 2 Summary of Direct and Indirect Effects of Physical Appearance Comparison on Symptoms of Disordered Eating. Outcomes

SPA F(5, 732) = 201.881, p < .001, R2 = .580

Symptoms of DE

F(6, 731) = 237.470, p < .001, R2 = .661

Predictors

ˇ

SE

95 % BCA-CI Lower

Upper

Age Sex z-BMI Depressive symptoms PAC

−.064 −.116 .102 .351 .511

.024 .050 .030 .027 .027

−.112 −.214 .044 .297 .458

−.017 −.017 .160 .404 .565

Age Sex z-BMI Depressive symptoms PAC SPA PAC (indirect effect through SPA) PAC (total effect)

.008 −.093 .173 .206 .152 .514 .263 .415

.022 .045 .027 .027 .030 .033 .023 .028

−.035 −.182 .121 .152 .094 .449 .221 .356

.051 −.004 .226 .259 .211 .579 .310 .471

Note. ˇ = Standardized estimates, referring to direct effect (unless otherwise stated); SE = Standard error; BCA-CI = Bias corrected and accelerated confidence interval; z-BMI = Standardized body mass index. PAC = Physical appearance comparisons; SPA = Social physique anxiety; DE = Disordered eating. Results are derived from a 10,000 resample bootstrapping analysis. Except for the effect of age on symptoms of DE, all the presented effects were significantly different from zero at the p < .05 level.

4. Discussion This study sought to build on previous research by simultaneously considering the potential moderation/mediation role of SPA in the relationship between PAC and DE in a sample of Spanish adolescents. Once the effects of age, sex, z-BMI, and depressive symptoms were controlled for, data supported the mediated but not the moderated nature of the explored relationship, without this being moderated by sex. Consistent with both the cognitive-behavioural model of body image (Cash, 2012) and previous empirical findings (Alcaraz˜ Ibánez, 2017; Fitzsimmons-Craft et al., 2012; Halliwell & Harvey, 2006; Jackson, Zheng, & Chen, 2015), the results supported the expected positive relationship between PAC/SPA and DE. Conversely, the absence of evidence in support of the interactive effect of PAC and SPA when explaining DE differs from findings reported in previous research (Fitzsimmons-Craft et al., 2012). This results disparity may be due to a number of reasons. Firstly, the different assessment tools employed, with the main differences between the two instruments being (a) the wider number of contexts covered in the PACS version used in the present study and (b) that the latter included body features relevant to both sexes (e.g., body weight and shape; Schaefer & Thompson, 2014). Secondly, the omission in the study by Fitzsimmons-Craft et al. (2012) of relevant confounding variables included in the present study (e.g.; ˜ BMI or depressive symptoms; Alcaraz-Ibánez, 2017; Puccio et al., 2016; Walker et al., 2015). Conversely, the data supported the second possibility advanced (i.e., that a body-related emotion such as SPA may mediate the relationship between PAC and DE). These findings offer preliminary cross-sectional support for a potential causal sequence whereby engaging in PAC may lead to experiencing anxiety derived from anticipating unfavourable social evaluations of one’s own body and, in turn, lead to the emergence of DE. The fact that neither of the tested possibilities were moderated by sex is consistent with previous findings revealing associations of a similar magnitude between the variables under consideration ˜ across boys and girls (Alcaraz-Ibánez, 2017; Halliwell & Harvey, 2006). In spite of the sex-specific nature of some of the factors leading to DE (Ferreiro et al., 2012; Schaefer & Thompson, 2018a), our findings suggest that this would not be the case for PAC and SPA. This is relevant from a practical point-of-view because it suggests that, despite the recipient’s sex, public health and educational actions that target these two body-related variables may contribute to preventing disordered eating among Spanish adolescents.

This study had a number of limitations that should be noted. Firstly, relying on cross-sectional data means that causality cannot be inferred. Accordingly, other possibilities (e.g., that the relationship between PAC and SPA may be bidirectional) cannot be discarded. Secondly, despite western standards of attractiveness being oriented towards either a thin or a muscular body (Cash, 2012), the attributes included in the instrument employed to assess PAC were mainly restricted to the former (e.g. body fat, shape or size). Moreover, it has been suggested that targets of PAC may be of a proximal (e.g., similar others) and a distal nature (e.g., media images; Schaefer & Thompson, 2018b). Consequently, future research on this topic should consider employing muscularityrelated comparisons and distal targets of comparison. Thirdly, DE was assessed using a reduced instrument focused on symptoms of anorexia and bulimia nervosa (Morgan et al., 1999). Hence, further research employing more comprehensive assessment approaches is warranted. Finally, this study was conducted with a non-clinical sample of Spanish adolescents; therefore, it is unclear whether these results would be generalizable to other cultures or age groups (e.g., adults), or to the clinical population. The findings from the present study suggest that prevention and intervention efforts targeted at decreasing DE among adolescents may benefit from minimizing the social relevance of the body inherent in the cognitive and affective processes underlying both SPA and PAC. Even though speculatively proposed, examples of the latter may be promoting body diversity and the adoption of one’s own, realistic (instead of socially prescribed and hardly attainable) body ideals. Role of the funding source ˜ Manuel Alcaraz-Ibánez (FPU17/01158) and Adrian Paterna (FPU18/01055) were supported by the Spanish Ministry of Education through FPU grants. Acknowledgements None to declare. Appendix A. Supplementary data Supplementary material related to this article can be found, in the online version, at doi:https://doi.org/10.1016/j.bodyim.2019. 12.005.

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References ˜ Alcaraz-Ibánez, M. (2017). Comparación social de la apariencia en contextos de ejercicio físico como variable predictora de los trastornos de la conducta alimentaria en adolescentes de ambos sexos [Social appearance comparison in exercise contexts as a predictor of eating disorder symptoms in male and female adolescents]. Espiral. Cuadernos del Profesorado, 10, 80–89. ˜ Alcaraz-Ibánez, M., & Sicilia, A. (2018). Psychometric evaluation and sex invariance of the Spanish version of the Body and Appearance Self-Conscious Emotions Scale. Body Image, 25, 78–84. http://dx.doi.org/10.1016/j.bodyim.2018.02.006 Asparouhov, T., & Muthén, B. O. (2010). Plausible values for latent variables using Mplus Mplus Technical Report. Retrieved from. http://www.statmodel.com/ download/Plausible.pdf ˜ F., Aguiar, M., López-Otero, M. J., & Takkouche, B. (2002). Validation of Caamano, SCOFF questionnaire among preteenagers. British Medical Journal,. Retrieved from. https://www.bmj.com/rapid-response/2011/10/29/validation-scoffquestionnaire-among-pre-teenagers Cash, T. F. (2012). Cognitive-behavioral perspectives on body image. In T. F. Cash (Ed.), Encyclopedia of body image and human appearance (pp. 334–342). San Diego, CA: Academic Press (Elsevier). http://dx.doi.org/10.1016/B978-0-12384925-0.00054-7 Crow, S. (2014). The economics of eating disorder treatment. Current Psychiatry Reports, 16, 14–16. http://dx.doi.org/10.1007/s11920-014-0454-z Derogatis, L. R. (2000). Brief Symptom Inventory 18. Minneapolis, MN: NCS Pearson, Inc. C. Fernández, H. Lorenzo, K. Vrotsou, U. Aresti, I. Rica, E. Sánchez. Curvas y tablas de crecimiento (Estudios Longitudinal y Transversal) [Growth charts (Longitudinal and cross-sectional studies)], Fundación Faustino Orbegozo Eizaguirre; Bilbao, Spain. Retrieved from: https://www.aepap.org/sites/default/files/documento/archivosadjuntos/f orbegozo 04.pdf 2011;. Ferreiro, F., Seoane, G., & Senra, C. (2012). Gender-related risk and protective factors for depressive symptoms and disordered eating in adolescence: A 4-year longitudinal study. Journal of Youth and Adolescence, 41, 607–622. http://dx.doi.org/10.1007/s10964-011-9718-7 Fitzsimmons-Craft, E. E., Harney, M. B., Brownstone, L. M., Higgins, M. K., & Bardone-Cone, A. M. (2012). Examining social physique anxiety and disordered eating in college women. The roles of social comparison and body surveillance. Appetite, 59, 796–805. http://dx.doi.org/10.1016/j.appet.2012.08.019 Franko, D. L., & Omori, M. (1999). Subclinical eating disorders in adolescent women: A test of the continuity hypothesis and its psychological correlates. Journal of Adolescence, 22, 389–396. http://dx.doi.org/10.1006/jado.1999.0230 Halliwell, E., & Harvey, M. (2006). Examination of a sociocultural model of disordered eating among male and female adolescents. British Journal of Health, 11, 235–248. http://dx.doi.org/10.1348/135910705X39214 Hart, E. A., Leary, M. R., & Rejeski, W. J. (1989). The measurement of social physique anxiety. Journal of Sport & Exercise Psychology, 11, 94–104. Hayes, A. F. (2013). Introduction to mediation, moderation, and conditional process analysis: A regression-based approach. New York, NY: Guilford Press. Herpertz-Dahlmann, B., Dempfle, A., Konrad, K., Klasen, F., & Ravens-Sieberer, U. (2015). Eating disorder symptoms do not just disappear: the implications of adolescent eating-disordered behaviour for body weight and mental health in young adulthood. European Child & Adolescent Psychiatry, 24, 675–684. http:// dx.doi.org/10.1007/s00787-014-0610-3

149

Jackson, T., Zheng, P., & Chen, H. (2015). Features of objectified body consciousness and sociocultural perspectives as risk factors for disordered eating among late-adolescent women and men. Journal of Counseling Psychology, 62, 741–752. http://dx.doi.org/10.1037/cou0000096 Lanfranchi, M.-C., Maïano, C., Morin, A. J. S., & Therme, P. (2015). Social physique anxiety and disturbed eating attitudes and behaviors in adolescents: Moderating effects of sport, sport-related characteristics, and gender. International Journal of Behavioral Medicine, 22, 149–160. http://dx.doi.org/10. 1007/s12529-014-9406-6 Li, C.-H. (2015). Confirmatory factor analysis with ordinal data: Comparing robust maximum likelihood and diagonally weighted least squares. Behavior Research Methods, 48, 936–949. http://dx.doi.org/10.3758/s13428-015-0619-7 McCreary, D. R., & Saucier, D. M. (2009). Drive for muscularity, body comparison, and social physique anxiety in men and women. Body Image, 6, 24–30. http:// dx.doi.org/10.1016/j.bodyim.2008.09.002 Morgan, J. F., Reid, F., & Lacey, J. H. (1999). The SCOFF questionnaire: Assessment of a new screening tool for eating disorders. BMJ, 319, 1467–1468. http://dx.doi. org/10.1136/bmj.319.7223.1467 Motl, R. W., & Conroy, D. E. (2000). Validity and factorial invariance of the Social Physique Anxiety Scale. Medicine and Science in Sports and Exercise, 32, 1007–1017. http://dx.doi.org/10.1097/00005768-200005000-00020 Muthén, L. K., & Muthén, B. O. (2015). Mplus version 7: User’s guide (7th ed.). Los Angeles, CA: Muthén & Muthén. Pereda, N., Forns, M., & Peró, M. (2007). Dimensional structure of the Brief Symptom Inventory with Spanish college students. Psicothema, 19, 634–639. Puccio, F., Fuller-Tyszkiewicz, M., Ong, D., & Krug, I. (2016). A systematic review and meta-analysis on the longitudinal relationship between eating pathology and depression. The International Journal of Eating Disorders, 49, 439–454. http://dx.doi.org/10.1002/eat.22506 Sáenz-Alvarez, P., Sicilia, A., González-Cutre, D., & Ferriz, R. (2013). Psychometric Properties of the Social Physique Anxiety Scale (SPAS-7) in Spanish adolescents. The Spanish Journal of Psychology, 16, 1–9. http://dx.doi.org/10. 1017/sjp.2013.86 Schaefer, L. M., & Thompson, J. K. (2014). The development and validation of the Physical Appearance Comparison Scale-Revised (PACS-R). Eating Behaviors, 15, 209–217. http://dx.doi.org/10.1016/j.eatbeh.2014.01.001 Schaefer, L. M., & Thompson, J. K. (2018a). Self-objectification and disordered eating: A meta-analysis. The International Journal of Eating Disorders, 51, 483–502. http://dx.doi.org/10.1002/eat.22854 Schaefer, L. M., & Thompson, J. K. (2018b). The development and validation of the Physical Appearance Comparison Scale-3 (PACS-3). Psychological Assessment, 30, 1330–1341. http://dx.doi.org/10.1037/pas0000576 Smink, F. R. E., Van Hoeken, D., & Hoek, H. W. (2012). Epidemiology of eating disorders: Incidence, prevalence and mortality rates. Current Psychiatry Reports, 14, 406–414. http://dx.doi.org/10.1007/s11920-012-0282-y Thøgersen-Ntoumani, C., Dodos, L., Chatzisarantis, N., & Ntoumanis, N. (2017). A diary study of self-compassion, upward social comparisons, and body image-related outcomes. Applied Psychology: Health and Well-Being, 9, 242–258. http://dx.doi.org/10.1111/aphw.12089 Walker, M., Thornton, L., De Choudhury, M., Teevan, J., Bulik, C. M., & Levinson, C. A., et al. (2015). Facebook use and disordered eating in college-aged women. Journal of Adolescent Health, 57, 157–163. http://dx.doi.org/10.1016/j. jadohealth.2015.04.026