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Adolescent Body Image Dissatisfaction:

Relationships with Self-esteem, Anxiety, and
Depression Controlling...

Article in Journal of Child Psychology and Psychiatry March 1998

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 J. Child Psychol. Psychiat. Vol. 39, No. 2, pp. 255262, 1998
Cambridge University Press
' 1998 Association for Child Psychology and Psychiatry
Printed in Great Britain. All rights reserved
00219630}98 $15.000.00

Adolescent Body Image Dissatisfaction : Relationships with Self-esteem,

Anxiety, and Depression Controlling for Body Mass
Marion Kostanski
Victoria University of Technology, St Albans, Australia

Eleonora Gullone
Monash University, Clayton, Australia

The current study examined the relationships of anxiety, depression, and self-esteem with
Perceived Body Image Dissatisfaction (PBID) in a nonclinical population of 516 adolescents,
aged 12 to 18. The prevalence of PBID was comparative with previous findings. Interestingly,
actual body mass and psychological well-being variables were found to be significantly
related with PBID, whilst being independent of each other. Findings support proposals that
PBID arises from a complex interplay of factors, including gender, self-esteem, and actual
body mass. In particular, our findings highlight the need for future research of a prospective
nature incorporating psychological, sociocultural, and maturational factors.

Keywords : Depression, anxiety, adolescence, self-esteem, body image.

Abbreviations : BMI : Body Mass Index ; EAT-26 : Eating Attitudes Test ; EDI-2 : Eating Dis-
order Inventory ; FRS : Figure Rating Scale ; PBID : Perceived Body Image Dissatisfaction ;
RADS : Reynolds Adolescent Depression Scale ; RCMAS : Revised Childrens Manifest
Anxiety Scale ; RSES : Rosenberg Self-Esteem Scale.

Introduction been linked with popular and socially accepted restrictive

Pathological eating disorders have been identified as
one of the most common and serious forms of adolescent
illness in developed societies (Slade, 1995). Over the past
20 years much research has been directed towards
evaluating the nature and correlates of eating disorders.
One factor that appears to be common to adolescents
diagnosed as suffering from clinical levels of eating
pathology is a high level of perceived body image
dissatisfaction (PBID) (Gross & Rosen, 1988 ; Post &
Crowther, 1985). Indeed, a longitudinal study of eating
behaviours in a group of pre- and post-menarcheal
adolescent girls by Attie and Brooks-Gunn (1989) indi-
cated that PBID was the single significant factor among
others, including pubertal status, family relationships,
reported eating problems, psychopathology, emotional
tone, and impulse control, which predicted the devel-
opment of future eating problems.
Of significance, PBID has also been reported to be
highly prevalent within non-eating disordered popula-
tions of adolescents, particularly females (Gralen, Levine,
Smolak, & Murnen, 1990 ; Maude, Wertheim, Paxton,
Gibbons, & Szmukler, 1993). Furthermore, it has also
Requests for reprints to : Marion Kostanski, Department of
Psychology, Victoria University of Technology, PO Box 14428,
MCMC, Melbourne, 8001 Australia.
(E-mail : MarionKostanski!vut.edu.au)
dietary behaviours (C. Davis, Shapiro, Elliott, & Dionne,
1993 ; Hill, 1993 ; Wertheim et al., 1992). This finding has
led researchers to propose that there may be an incre-
mental process or line of continuum in the development
of eating pathology, with normative levels of PBID
and preliminary dietary behaviours at one end, extending
into clinical eating disorders at the other (Attie & Brooks-
Gunn, 1989 ; Killen et al., 1994 ; Wertheim et al., 1992).
The notion of PBID being a normative component
of female life in Western society was first introduced into
the literature by Rodin, Silberstein, and Striegel-Moore
(1984). These researchers proposed that cultural values of
attractiveness being equal to thinness and social pressures
to conform have led women, in particular, to be
preoccupied with the pursuit of a thin ideal. Consistent
with this line of thinking, much of the research into PBID
has been directed toward examination of the physio-
logical and sociocultural correlates of PBID. Studies have
included evaluation and exploration of factors such as
gender (Maude et al., 1993), actual body weight (Paxton
et al., 1991), pubertal development, and age (Fabian &
Thompson, 1989 ; Shore & Porter, 1990). Also, issues
such as the psychological consequences of being perceived
as fat (McCarthy, 1990 ; Tiggemann & Rothblum, 1988),
the promotion of attractiveness as being equated with
thinness (Desmond, Price, Gray & OConnell, 1986), and
the high level of media attention toward promotion of
dieting and sexual attractiveness (Eisele, Hertsgaard, &

255
256 M. KOSTANSKI and E. GULLONE
Light, 1986 ; Freedman, 1984) have received a good deal
of attention.
In contrast, research into the relationships between
PBID and psychological well-being variables, such as
depression and self-esteem, has been limited. Those
studies that have investigated the psychological profile of
adolescents who report high levels of PBID indicate a
rather complex pattern of relationships between these
two constructs.
For example, Kaplan, Busner, and Pollack (1988)
reported a strong relationship between PBID and de-
pression, such that adolescents who perceived themselves
to be of normal weight were less depressed than those
who thought they were underweight or overweight. A
study of depressive symptomatology and body image by
Rierdan, Koff, and Stubbs, (1989) suggested that negative
cognitions served to undermine adolescents perception
of their body, leading both male and female adolescents
who were experiencing depression to develop high levels
of body dissatisfaction. However, it is noteworthy that, in
a study of sex differences and depression in adolescent
girls and boys, Allgood-Merten, Lewinsohn, and Hops
(1990) found that the strong relationship they showed
between PBID and depression was eliminated when they
controlled for self-esteem. These authors concluded that
body image is not a separate construct, but an important
aspect of self-esteem.
In support of this proposal, Koff, Rierdan, and Stubbs
(1990) provided a detailed analysis of body image and
self-concept in adolescents and revealed that a higher
level of body satisfaction was associated with a higher
level of self-esteem, in both males and females. Similarly,
Thompson and Altabe (1991) reported that body dis-
satisfaction was negatively correlated with self-esteem,
particularly for females.
However, contrary to the above findings, Silberstein,
Streigel-Moore, Timko, and Rodin (1988) found no
significant differences between the self-esteem scores of
college women who wanted to be thinner and college
women who reported satisfaction with their present
figures. Fabian and Thompson (1989) also found that
self-esteem was not a correlate of body-esteem, size
overestimation, or eating disturbance.
Thus, research examining the relationships between
psychological well-being variables and perceptions of
body image has not resulted in any conclusive under-
standing of the nature or extent of relationship between
these constructs. The purpose of the present study was to
examine this issue further. Given recent proposals about
the implications of negative affectivity (incorporating
both anxiety and depression) for psychological well-
being (e.g. Finch, Lipovsky, & Casat, 1989 ; King,
Ollendick, & Gullone, 1991), we included a measure of
anxiety in addition to depression and self-esteem, thereby
resulting in a more comprehensive assessment of psycho-
logical well-being compared to previous research. Specifi-
cally, we report a cross-sectional investigation of the
relationships among self-esteem, depression, anxiety, and
PBID in a nonclinical sample of adolescents. Our major
aim in carrying out this investigation was to determine
the relative importance of psychological well-being mea-
sures compared with actual body size for understanding
variations in levels of PBID.
Method
Participants
The sample included 516 subjects (268 females, 248 males)
drawn from 6 secondary schools across Melbourne, Australia.
The schools (four co-educational, one girls, and one boys
school) were randomly selected from government listings of
state and private secondary schools in the Melbourne metro-
politan region, hence increasing the representativeness of the
sample with regard to demographic variables including socio-
economic status (i.e. annual income of household), birthplace,
language spoken at home, and geographic location (i.e. Di-
rectorate of School Education Regions).
The average age of respondents was 147 years (males : M
148, SD 17 ; females : M 145, SD 14). The sample was
divided into two age groups (1 : 1214 years ; 2 : 1518 years) for
analysis. Chi-square analysis indicated there was no significant
difference in gender distribution by age-group [#(1,516)
299, P "05]. In general, males were found to weigh 78 kg
more than females (males : M 625 kg, SD 152 ; females :
M 547 kg, SD 105) and to be 9 cm taller (males : M
171 cm, SD 10 ; females : M 162 cm, SD 10).
Instruments
Figure Rating Scale (FRS ; Stunkard, Sorenson, & Schlusinger,
1983). The Figure Rating Scale consists of a series of nine
figure drawings, ordered from extremely thin to very obese in
appearance. For this study participants are provided with a set
of three scales depicting either the male or female form (female
if the subject was female, male if the subject was male). On the
first scale, participants are required to rate what they perceive
their ideal figure to be. For the second scale they rate what they
perceive their current figure to be. On the third scale, partici-
pants rate how they feel they look (Thompson & Altabe,
1991). The figures are graded on a scale from 1 (thinnest) to 17
(heaviest). The discrepancy between cognitive and ideal figures
(current figure rating minus ideal figure rating), and affective
and ideal figures (how I feel figure rating minus ideal figure
rating) represents two different expressions of body dissatis-
faction (cognitive-rational}affective, respectively).
Psychometric evaluation by Thompson and Altabe (1991)
has indicated the Figure Rating Scale has good testretest
reliability over a 2-week period (83 for affective ratings, 71 for
ideal size). Validity of the scale for adolescents has also been
established. For example, correlations with actual weight (for
boys r 61 and girls r 71) and with bodymass (for boys
r 75, and for girls r 67) have been reported (Cohn et al.,
1987).
Eating Disorder Inventory (EDI-2 ; Garner, 1991). The EDI-
2 is a self-report inventory designed to measure symptoms
commonly associated with anorexia and bulimia. It consists of
64 items, each of which is scored on a 6-point Likert scale,
ranging from always , usually , often , sometimes ,
rarely , to never . Responses for each item are weighted
from 3 to 0, with a score of 3 being assigned to the response
that reflects highest symptomatology, a score of 2 for the next
highest level of indicated symptomatology, a score of 1 for the
next, and a score of 0 being assigned to the remaining three
responses. Garner (1991) suggests that the rationale for this
scoring process is based on a theoretical premise that non-
symptomatic responses should not contribute to a total score
reflecting psychopathology.
Three subscales of the EDI-2 (each consisting of eight items)
were selected for use in this study. These were : Body Dis-
satisfaction, which was designed to measure dissatisfaction with
overall shape and size ; Bulimia, which was designed to elicit
information regarding individuals tendency to consider and
engage in bouts of uncontrollable overeating, and Drive for
 ADOLESCENT BODY IMAGE
Thinness, which was designed to assess excessive concerns with
dieting, preoccupation with weight, and fear of gaining weight.
The EDI-2 has been found to have sound psychometric
properties. Garner (1991) reports that the EDI-2 subscales have
strong convergent validity, with reported correlation between
the Body Dissatisfaction, Bulimia, and Drive for Thinness
subscales and the Eating Attitudes Test (EAT-26 ; Garner,
Olmstead, Bohr, & Garfinkel, 1982) of r 44, 26, and 61,
respectively. Content validity has also been established with
reported item-total correlations within each of the subscales for
both eating disordered (r 54 to 75) and nonclinical female
(r 40 to 78) groups (Garner, 1991).
Revised Childrens Manifest Anxiety Scale (RCMAS ; C. R.
Reynolds & Richmond, 1985). The RCMAS is one of the most
frequently used self-report anxiety scales providing a general
measure of chronic anxiety in children and adolescents. It
comprises 28 anxiety items and 9 lie items. Respondent are
required to answer yes or no to each item depending on what is
most true for him or her. Representative items include : I am
nervous and My hands feel sweaty. schools was selected to participate in the study. This allocation
The scale has been psychometrically evaluated on samples
ranging in age from 6 to 19 years. The KuderRichardson
coefficient has been reported to range between 80 (Pela &
Reynolds, 1982) and 85 (C. R. Reynolds & Richmond, 1978).
Good testretest reliability has also been reported and ranges
between 97 and 68 for 3-week and 9-month retest, respectively
(W. M. Reynolds, 1981 ; Pela & Reynolds, 1982). Published
data on validity of the RCMAS have provided evidence for
concurrent (C. R. Reynolds, 1981), construct (C. R. Reynolds
& Richmond, 1978), and predictive validity (C. R. Reynolds,
1981). Factor analyses of the scale have been reported to
yield three anxiety factors : Physiological Anxiety, Worry}
Oversensitivity, Social Concerns}Concentration, and a lie
factor.
Reynolds Adolescent Depression Scale (RADS ; W. M. Rey-
nolds, 1987). The RADS is self-report measure designed for
use as a clinical tool or as a screening instrument for the
identification of depression in adolescents. It consists of 30
items. Each item is rated on a four-point Likert scale (i.e. almost
never, hardly ever, sometimes, or most of the time). Seven items
are inconsistent with depression in order to allow for checking
response sets and to ensure that each respondent is attending to
each item on an individual basis. The psychometric properties
reported for the scale have included concurrent validity (r 84
with the Hamilton Rating Scale), convergent validity (r 73
with the Childrens Depression Inventory) and testretest
reliability coefficients of 79 and 63 over 3 months and 1 year,
respectively (Davis, 1990 ; W. M. Reynolds, 1987).
Rosenberg Self-Esteem Scale (RSES ; Rosenberg, 1965).
This scale, developed by Rosenberg (1965), is designed to
provide a unidimensional measure of global self-esteem. It is a
self-report instrument consisting of 10 statements, which the
respondent is required to rate on a four-point Likert scale
ranging from 1 strongly disagree to 4 strongly agree. The
scale has been designed specifically for brevity and ease of
administration and has been reported to have high reliability (2-
week testretest 85) and acceptable convergent validity, with
correlations ranging from r 56 to r 83 between the RSES
and similar measures (e.g. Coppersmith Self-Esteem Inventory :
r 59). Discriminant validity is also considered substantial,
with correlations of between r 21 and 53 with various self-
stability measures and ratings of others (Silber & Tippett, 1965).
Body Mass Indexrationale and calculation. Body Mass
Index (BMI) is the term used to define the ratio of body weight
to height in normal build people [BMI weight (kg)}height#
(m) ; Keys, Fidanza, Karronen, Kimura, & Taylor, 1972].
Originally defined by Quetlet in 1869, BMI has become accepted
as a highly convenient, valid, and reliable indicator of obesity.
Garrow and Webster (1985) found that BMI provided a
257
measure of fatness that corresponds highly with specialised
laboratory methods, and provides an estimate of size that is
more useful than percentage of fat. Normative ranges for
Quetlets Indices}BMI are defined as : (1) ! 15emaciated ;
(2) 1519underweight ; (3) 2024normal ; (4) 2529over-
weight ; and (5) " 29obese.
In consideration of the normal changes in body proportions
that accompany age, in the present study, BMI was adjusted for
adolescents by dividing the actual body mass by expected body
mass (based upon calculation of expected weight for age) then
multiplied by 100 to derive a Body Mass Percentile (Coates,
Boyce, Muller, Mearns, & Godfrey, 1980). Body mass percentile
ranks, for the purpose of this paper, have been defined as : (1)
Below 90 % Underweight ; (2) 90 %110 % Normal ; (3)
111 %120 % Overweight ; (4) above 120 % Obese.
Procedure
A class of students from each year level within each of the six
was based upon classes who would have a double period
timetabled on the day}s of testing. Students were informed, and
parental consent forms distributed, 1 week prior to their
expected participation. Of all adolescents approached only two
students declined to participate.
Administration of the questionnaires was supervised by the
first author within regular class periods. Questionnaires were
distributed in counterbalanced order so as to eliminate any
possible order effects. All respondents completed the ques-
tionnaires on an anonymous and voluntary basis.
Weight was measured with a set of bathroom scales that were
calibrated prior to each testing to ensure comparison with
standardised measures. The scales were placed in a secluded
area of the room, and each student was ensured complete
privacy. Height was measured by the attending teacher, with a
standard metal retracting tape. Shoes and blazers were removed
prior to weighing and measuring.
Results
The results of this study are presented in four sections.
The first section consists of an evaluation of the actual
body mass distribution of the sample. The second section
provides information relating to the prevalence and
distribution of PBID for the sample. The third section
reports findings relating to psychological well-being. In
this section we report Pearsons correlations for anxiety,
depression, and self-esteem with body image and actual
body mass. The final section reports stepwise multiple
regression analyses with gender (recorded as 0 male
and 1 female), body mass, self-esteem, depression, and
anxiety entered as independent variables and PBID as the
dependent variable.
It is noteworthy that, in the interest of brevity, we only
report analyses for the age-group variable rather than for
age as a continuous variable. Preliminary analyses using
age as a continuous variable indicated no differences on
any of the body image variables, nor was age found to be
a significant correlate in these analyses.
The data were analysed using the third edition of SPSS-
X (SPSS-X, 1988).
Actual Body Mass Distribution
Means and standard deviations for body mass for
Quetlets five categories are presented in Table 1. Dis-
tribution of the sample by adjusted Body Mass Percentiles
258 M. KOSTANSKI and E. GULLONE

Table 1
Means and Standard Deviations for Quetlets Five Categories of Body Mass Index by Gender
Males Females Total

Category N Mean (SD) N Mean (SD) N Mean (SD)

Emaciated 3 138 (09) 4 141 (03) 7 140 (06)
Underweight 90 182 (12) 118 182 (11) 208 182 (11)
Normal 125 219 (13) 108 218 (13) 233 218 (13)
Overweight 23 261 (11) 20 262 (09) 43 262 (10)
Obese 7 315 (26) 14 310 (106) 21 312 (86)

Total 248 211 (33) 264 209 (43) 512 210 (39)

Table 2
Means and Standard Deviations for Adjusted Body Mass Percentiles by Gender
Males Females Total

Category N Mean (SD) N Mean (SD) N Mean (SD)

! 90 % 47 846 (51) 58 842 (43) 105 843 (46)
90 %110 % 130 1011 (49) 142 992 (54) 272 1001 (52)
111 %120 % 37 1145 (28) 32 1148 (30) 69 1145 (29)
" 120 % 34 1371 (145) 32 1416 (367) 66 1378 (276)

Total 248 1045 (162) 264 1029 (215) 512 1037 (191)

Table 3
Means and Standard Deviations for Body Dissatisfaction as Measured with the Figure Rating Scale by Gender and
Body Mass
Body mass

Under Normal Over Obese

Scale M (SD) M (SD) M (SD) M (SD)
Figure rating N N 105 N 272 N 69 N 66
Cognitive
Females 265 20 (24) 28 (21) 32 (14) 40 (24)
Males 247 14 (15) 11 (17) 14 (14) 16 (17)
Affective
Females 265 26 (27) 40 (27) 46 (24) 51 (28)
Males 247 20 (21) 15 (21) 19 (18) 26 (22)

(see Table 2) indicated that the majority of adolescents
fell within prescribed normal weight for height ranges
(males : M 1045, SD 162 ; females : M 1029,
SD 215). Analysis of variance indicated there were no
significant differences in actual body mass between
females and males, nor by age-group.
Body Dissatisfaction as measured by the FRS. The
cognitive and affective measures of PBID were found to
differ for males and females. Females predominantly
rated their perceived self as being two or more sizes larger
than their ideal figure [cognitive : N 181 (675 %) ;
affective : N 207 (781 %)]. A small proportion rated
their bodies as being within two sizes of their ideal figure
[cognitive : N 55 (206 %) ; affective : N 36 (136 %)]
and a further small proportion described themselves as
being two or more sizes smaller than their ideal figure
[cognitive : N 32 (119 %) ; affective : N 22 (83 %)].
In contrast, for males the highest proportion of cognitive
and affective scores fell within two sizes of their idealised
norm, with a small proportion rating themselves to be
two sizes or more smaller than their ideal figure [cog-
nitive : N 46 (185 %) ; affective : N 47 (19 %)]. A
similar proportion rated themselves as being two sizes or
more larger than their ideal figure [cognitive : N 56
(226 %) ; affective : N 72 (29 %)]. A paired t-test
indicated that the affective figure ratings were signifi-
cantly greater than the cognitive ratings (t 928 ; df
515 ; p !001), indicating that a greater discrepancy
between ideal and real was perceived on the affective than
on the cognitive ratings.
A 2 (gender)2 (age-group)4 (body mass) ANOVA
was carried out for each of the cognitive and affective
ratings. A main effect for gender was found for each
ANOVA [cognitive : F(1,496) 8997, p !0001 ; affec-
tive : F(1,496) 10594, p !001]. Each ANOVA also
yielded a main effect for body mass (cognitive : F(3,496)
572, p !001 ; affective : F(3,496) 4248, p !001].
As shown in Table 3, for each of the cognitive and
 ADOLESCENT BODY IMAGE 259

Table 4
Means and Standard Deviations for Body Dissatisfaction, Drive for Thinness, Bulimia, Self-esteem, Anxiety, and
Depression by Gender and Body Mass
Body Mass

Total
Under Normal Over Obese sample
Variable N M (SD) M (SD) M (SD) M (SD) M (SD)
Body Dissatisfaction
Female 258 85 (75) 133 (68) 194 (67) 186 (70) 136 (78)
Male 235 48 (40) 41 (43) 62 (41) 101 (68) 54 (50)
Bulimia
Female 258 18 (31) 23 (30) 32 (48) 24 (27) 23 (32)
Male 242 22 (35) 19 (30) 21 (28) 15 (27) 19 (30)
Drive for Thinness
Female 251 33 (55) 60 (51) 96 (56) 83 (61) 61 (57)
Male 240 09 (21) 12 (22) 21 (24) 34 (35) 16 (26)
Self-esteem
Female 259 278 (53) 282 (42) 274 (41) 274 (53) 279 (46)
Male 243 292 (63) 307 (49) 298 (50) 307 (60) 303 (54)
Depression
Female 247 666 (160) 648 (137) 658 (135) 680 (117) 657 (140)
Male 235 596 (107) 565 (118) 606 (129) 578 (141) 579 (121)
Anxiety
Female 251 123 (64) 128 (56) 129 (51) 138 (56) 129 (57)
Male 236 106 (46) 91 (57) 100 (55) 89 (49) 95 (54)

affective ratings, females scored higher than males. Also,
particularly for females, the discrepancy between per-
ceived body image and ideal body image increased as
body mass increased. No significant interaction effects
were found nor were any main effects found for age-
group.
PBID as measured by the EDI-2. PBID, as measured
on the EDI-2 subscale, indicated that females reported a
mean PBID level 8 points greater than males (females :
M 136 ; males : M 54). Females also reported a
Drive for Thinness rating over 4 points greater than did
males (females : M 61 ; males : M 16). Ratings of
Bulimic behaviour were only marginally different for
males and females (females : M 23 ; males : M 19)
(see Table 4 for means by gender and body mass).
Three 2 (gender)2 (age-group)4 (body mass)
ANOVAs were carried out in order to investigate whether
there were any significant differences for ratings of body
dissatisfaction, drive for thinness, and bulimia, by gender,
body mass, and age-group. A main effect for gender was
found on the body dissatisfaction [F(3,489) 942 ; p !
001] and drive for thinness [F(3, 488) 487 ; p !01] vari-
ables. A significant main effect was also found for body
mass on the variables of body dissatisfaction [F(3, 489)
019 ; p !01] and drive for thinness [F(3, 488) 1239 ;
p !001]. As shown in Table 4, females scored signifi-
cantly higher on each of these. A significant inter-
action effect was found between gender and actual body
mass on the variables body dissatisfaction [F(3,489)
942 ; p !001], and drive for thinness [F(3,488) 487 ;
p !01], indicating that females falling into a higher
body mass percentile were more likely to report a greater
level of body dissatisfaction and a greater drive for
thinness. No main effect for gender was found on the
Bulimia scale and no significant main effects were found
for age-group.
Psychological well-being. A 2 (gender)2 (age-
group)4 (body mass) ANOVA was carried out, in turn,
for each of the psychological well-being measures. A
main effect for gender was yielded by each ANOVA.
These main effects resulted from females reporting
significantly higher levels of anxiety [F(1,486) 3145 ;
p !001] and depression [F(1,481) 2815 ; p !001] than
males. Conversely, males reported a significantly greater
level of self-esteem than females [F(1,501) 1967 ;
p !001] (refer to Table 4 for means by gender by body
mass). No significant main effects were found for body
mass nor for age-group however, a significant interaction
effect was found between body mass and age-group for
depression [F(3,481) 351 ; p !05] with younger, over-
weight adolescents (BMI 110 %120 %) and older
underweight adolescents (BMI ! 90 %) reporting the
highest levels of depression.
Pearsons correlation coefficients between body dissat-
isfaction, body mass, and the psychological well-being
variables. All psychological well-being measures were
found to be significantly correlated with all measures of
PBID. As shown in Table 5, anxiety and depression were
found to be positively correlated, whereas self-esteem was
found to be negatively correlated with body dissatis-
faction. Measures of body dissatisfaction and drive for
thinness were positively correlated with actual body
mass ; however, neither bulimia nor any measure of
psychological well-being was correlated with actual body
mass.
Multiple step-wise regression analyses. Two regression
analyses were carried out. The first was carried out with
the whole sample and included all measures of psycho-
logical well-being (self-esteem, depression, and anxiety),
gender, and body mass as independent variables, and
body dissatisfaction (as measured with the EDI-2) as the
dependent variable. The second included the above
260 M. KOSTANSKI and E. GULLONE
Table 5
Pearsons Correlation Coefficients between PBID, Drive for Thinness, Bulimia,
Psychological Well-being, and Body Mass for Total Sample
Variable RCMAS
PBID 36**
Thinness 36**
Bulimia 28**
Affective 22**
Cognitive 19**
Body Mass 01
* p !05 ; ** p ! 01.
variables but was carried out including only those
adolescents who were categorised as being within
normal weight range (90 %110 % ; N 272).
The first regression analysis indicated that gender
(Beta 045, t 1198, p !001), body mass (Beta
032, t 907, p !001), self-esteem (Beta 021,
t 487, p !001) and anxiety (Beta 010, t 239, esteem in addition to anxiety were found to be signifi-
p !05) were all significant predictors of PBID [Adjusted
R# 045, F(4,434) 8967 ; p !001].
The second analysis indicated that gender (Beta
059, t 1127, p !001), self-esteem (Beta 020,
t 375, p !001), and body mass (Beta 011, t
222, p !05) were significant predictors of PBID in
adolescents of normal weight [Adjusted R# 044,
F(3, 227) 6035, p !001].
Discussion
In our sample of adolescents, which was demonstrated
to be normally distributed with regard to weight, the
prevalence of PBID was found to be comparative with
previous studies (e.g. Maude et al., 1993). Also consistent
with past research, over 80 % of females and 40 % of
males reported a high level of incongruency and dis-
satisfaction with their body image (Paxton et al., 1991 ;
Rierdan et al., 1989 ; Wertheim et al., 1992). The majority
of females rated their dissatisfaction at being too large. In
contrast, males tended to report dissatisfaction that
correlated closely with their actual body mass distribution
such that males who were overweight rated themselves as
being too large and those who were underweight were
dissatisfied at being too small. Furthermore, this gender
difference was constant across the age range sampled in
our study. Indeed, this consistency suggests that PBID
may be well established by the time the individual reaches
adolescence.
Consistent with past research (e.g. Allgood-Merten et
al., 1990 ; Kaplan et al., 1988 ; W. M. Reynolds, 1987), we
found that males reported a higher level of self-esteem
and lower levels of depression and anxiety than females.
With regard to the relationship between psychological
well-being and PBID, we found anxiety and depression to
be positively related and self-esteem to be inversely
related. In fact, anxiety and depression were almost
equally related to PBID providing support for the overlap
between anxiety and depression (cf. negative affectivity)
in an adolescent sample.
Similarly, body mass index was found to be signifi-
cantly related with PBID. When comparing the relative
importance of psychological well-being and body mass
RADS RSES Body Mass
34** 41** 31**
28** 29** 21**
13** 13** 20
21** 24** 32**
16** 17** 36**
02 02
for explaining variance in PBID, body mass explained
more than double the variance that self-esteem did.
Nevertheless, it was gender that explained most of the
variance (approximately 20 %). Given that the male and
female samples in the study were equally normally
distributed with regard to body mass and given that self-
cantly related with PBID, it is clear that actual body size
interacts with a variety of other variables in predicting
body image dissatisfaction. Interestingly, depression was
not found to be a significant predictor. This may have
been due to the regression method used whereby variables
are entered in order of variance explained. Given the
overlap between anxiety and depression, once variance
explained by anxiety was accounted for the remaining
variance for depression alone was no longer significant.
In contrast, body mass index was not related with any
of the psychological well-being variables. Thus, adol-
escents who were categorised as either overweight or
underweight were not necessarily found to report lower
levels of self-esteem or higher levels of depression and
anxiety. This is particularly interesting in light of research
that has indicated that perceptions of fatness in other
individuals is a pertinent issue in defining their status
(Tiggeman & Rothblum, 1988).
In order to shed some light on this complexity, we
conducted a subsequent analysis with only those adol-
escents classified as being within the normal weight
range, thereby eliminating any variance in PBID asso-
ciated with being underweight or overweight. In this
analysis the importance of gender was demonstrated to
be even greater, with gender now accounting for approxi-
mately 35 % of the variance compared to 20 % for
the entire sample. Furthermore, for normal weight adol-
escents, self-esteem was found to be more strongly
associated with PBID than actual body mass, and
anxiety was no longer a significant predictor.
As the results have indicated, although actual body
mass and psychological well-being are totally indepen-
dent of each other, they are significant correlates of
PBID. Thus, being underweight or overweight appears to
have no association with psychological well or ill-being.
On the other hand, levels of self-esteem, anxiety, and
depression are related with PBID such that high levels of
dissatisfaction are associated with lower levels of self-
esteem and high levels of negative affectivity, particularly
for females.
These findings were further supported by reports of
PBID as measured by the Figure Rating Scale. This
measure indicated that body dissatisfaction was not only
 ADOLESCENT BODY IMAGE
moderated by cognitive-rational evaluations of ones
body size, but also included a significant affective com-
ponent. Thus, adolescents not only perceived a strong
cognitive-rational discrepancy in their actual}ideal body
image, they also experienced a strong affective dissonance
in their perceptions of body size. Indeed, the affective
rating discrepancy (how I feel) was found to be signifi-
cantly greater than that for the cognitive-rational rating
(how I look).
In considering the present findings, it should be noted
that the assignment of variables to the positions of
dependent versus independent for analysis and interpret-
ation purposes was, to some degree, arbitrary. Fur-
thermore, the study design was cross-sectional. There-
fore, any discussion of causality can only be tentative.
There is an obvious need in the literature for more studies
using a prospective or longitudinal design in order to
explore whether, for example, self-esteem variations
coincide with variations in PBID or whether one precedes
the other.
To date longitudinal studies in this area have been
limited, including only three that have been concerned
with the adolescent population (Attie & Brooks-Gunn,
1989 ; Cattarin & Thompson, 1994 ; Rosen, Tacy, &
Howell, 1990). Although these studies have highlighted
the importance of variables such as PBID and teasing
history as being predictive of future eating problems,
unfortunately these studies in themselves have been
limited due to small sample size (e.g. N 87 for Cattarin
& Thompson, 1994), restricted socioeconomic status (e.g.
white upper-middle-class girls for Attie & Brooks-Gunn,
1989), or short follow-up periods (e.g. 4-month testretest
for Rosen et al. 1990).
Conclusions and Future Directions
Notwithstanding the noted limitations of the present
investigation, the findings raise doubt about the validity
of proposals that PBID is simply the outcome of
sociocultural pressure to conform which causes young
adolescents, especially females, to be disparaging of their
bodies. In fact, the present findings highlight the complex
interaction among individual differences in personality,
actual body size, and socialisation processes.
A further implication of the present study relates to the
consistency of our findings across the age range from 12
to 18 years. Such a finding suggests that body dis-
satisfaction may be well established by the age of 12
years. The constancy of body image dissatisfaction from
the beginning of the adolescent period to 18 years of age
points to the need for future research throughout earlier
developmental periods. Such research may shed light on
some of the nuances inherent in the subsequent manifest-
ation of extreme PBID and dysfunctional dietary
behaviours in adolescence.
To date, research prior to the adolescent years has been
limited (e.g. Collins, 1991 ; Folk, Pedersen, & Cullari,
1993 ; Kolody & Sallis, 1995). The research that has been
conducted in the childhood years indicates the need for
further investigation during this developmental period,
given that by 7 or 8 years of age children have already
developed images of an ideal body type. Furthermore,
children as young as 9 years report engaging in restrictive
261
dietary behaviours (Hill, 1993). Future research with
children should investigate body image perceptions in the
pre-adolescent period. Given the findings of the present
investigation and similar previous work, it is clear that
such research needs to be of a prospective nature if it is to
further our understanding of factors that are central to
the development of PBID.
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Accepted manuscript received 6 December 1996