Does body dissatisfaction have the same meaning for males and females? A measurement invariance study

A baseline comparison of three diagnostic groups using the Progress Monitoring Tool for Eating Disorders

Utilisation of intensive inpatient treatment for eating disorders (EDs) has climbed in the last decade, illuminating a need for better consensus on what constitutes effective treatment and context-appropriate progress/outcome monitoring during residential stays. The novel Progress Monitoring Tool for Eating Disorders (PMED) measure is specifically designed for inpatient settings. Previous research supports the factorial validity and internal consistency of the PMED; however, additional work is needed to determine its appropriateness for complex patient populations. This study used measurement invariance (MI) testing to determine if the PMED administered at programme admission measures the same items in similar ways across patients with anorexia nervosa restricting- and binge-purge subtypes (AN-R; AN-BP) and bulimia nervosa (BN, N = 1121; M_age  = 24.33 years, SD = 10.20; 100% female). Progressively constrained models were used to determine the level of invariance upheld between the three groups. Results indicated that, while the PMED meets configural and metric MI, it does not display scalar invariance. Said otherwise, the PMED similarly assesses constructs and items across AN-R, AN-BP, and BN, however the same score overall may reflect different levels of psychopathology for patients in one diagnostic category versus another. Comparisons of severity between different EDs should be made with caution, however the PMED appears to be a sound tool for understanding the baseline functioning of patients with EDs in an inpatient setting.

Psychometric properties of the Italian body shape questionnaire: an investigation of its reliability, factorial, concurrent, and criterion validity

PURPOSE

This study was set up to investigate the reliability, factorial, concurrent, and criterion validity of the Italian version of the 34-item Body Shape Questionnaire (BSQ) and its shorter versions.

METHODS

The study included 231 patients diagnosed with an eating disorder and 58 putatively healthy people (comparison sample). The Italian BSQ-34 was administered to participants together with the Hamilton Depression Rating Scale and the Hamilton Anxiety Rating Scale. Information on body mass index, caloric intake at baseline, and the number of episodes of self-vomiting per week was also acquired.

RESULTS

Cronbach's alpha of BSQ-34 was 0.971 (95% confidence interval [CI] 0.965-0.976) in patients and 0.960 (0.944-0.974) in controls. Test-retest stability in patients (n = 69), measured with intraclass correlation coefficient, was 0.987 (0.983-0.991). Confirmatory factor analysis of the single-factor model yielded acceptable fit for all versions of the BSQ. On all BSQ versions, patients scored higher than controls with a large effect size when calculated as Cliff's delta. BMI and mean caloric intake at baseline had a stronger association with BSQ-34 than levels of anxiety and depression. The analysis with the receiver operating characteristics (ROC) curve showed that the BSQ-34 distinguished patients with an eating disorder from controls with good accuracy (Area Under the Curve = 86.5; 95% CI 82.2-90.7).

CONCLUSION

The Italian version of the BSQ possesses good psychometric properties, in both the long and the shortened versions, and it can be applied to measure body dissatisfaction for both clinical and research purposes.

LEVEL OF EVIDENCE

Level III, Evidence obtained from well-designed cohort or case-control analytic studies.

Relationships between body image and mental health in white, cisgender college students

PURPOSE

Previous studies have suggested that drive for leanness (DL) may be less maladaptive than drive for thinness (DT) or drive for muscularity (DM). However, no studies have examined whether there might be gender differences in the relationships between these three drives and mental health variables. The purpose of this study was twofold. First, we wanted to examine DL in the context of mental health and to see if it is less maladaptive than DT and DM. Second, we wanted to examine gender differences in the relationships between body dissatisfaction (DT, DM, DL) and mental health in a sample of college students.

METHODS

A sample of 988 White, heterosexual, cisgender college students (76.8% female) completed an omnibus survey measuring body image (DL, DT, DM) and mental health (generalized anxiety, social physique anxiety, self-esteem) variables. Regression analyses evaluated associations between these drives and mental health variables.

RESULTS

DT predicted all three mental health outcomes in both men and women. DM predicted generalized and social physique anxiety in women but only generalized anxiety in men. DL predicted social physique anxiety only in women.

CONCLUSION

Because we found gender differences in body image and relationships between body image and mental health, future studies should take gender into account when exploring body image and related variables.

LEVEL OF EVIDENCE

V Cross-sectional descriptive study.

Body image as a multidimensional concept: A systematic review of body image facets in eating disorders and muscle dysmorphia

Body image disturbance is core to the psychopathology of eating disorders (EDs), and related disorders such as muscle dysmorphia (MD). Global measures of body image fail to quantify specific aspects of body image disturbance that characterizes EDs, and may be differentially associated to outcomes. The aim of this systematic review was to provide an overview of specific body image facets and synthesize findings from controlled studies that compared clinical ED/MD and control-comparison groups in body image disturbance. One-hundred sixty-seven studies met inclusion criteria, and reported on comparisons among 30,584 individuals in 28 body image facets, which were more broadly grouped into evaluative, perceptual, cognitive-affective and motivational categories for the purpose of the present review. Effect sizes were calculated as Cohen's d for every comparison between ED and control groups. Body dissatisfaction (evaluative category) was the most prevalent facet assessed across studies (62 %), and differences between clinical and control groups were the largest in this category, especially for bulimia nervosa (d = 1.37). Scarcity of studies with male and MD clinical samples, and use of single-item and non-validated measures, should encourage development of instruments for body image facets pertinent to EDs and MD that can be validly applied across gender.

Difficulties in Emotion Regulation, Alexithymia, and Social Phobia Are Associated With Disordered Eating in Male and Female Undergraduate Athletes

Investigations of disordered eating in the athlete population tend to focus on females and the influence of sport level. This leaves unanswered whether, and how, team interdependence (i.e., whether the competition is engaged with one person or as a team) may differentially impact male athletes. In the present study, we recruited a sample of non-athletes, individual athletes, and team athletes and examined the interaction of gender and teammate interdependence on established psychosocial risk factors for disordered eating, including social phobia, alexithymia, and emotion regulation. Although we identified a significant main effect of gender, there was no main effect of team type, nor was there a significant interaction of gender and team type. Using descriptive discriminant analysis, these variables significantly discriminated between genders. Women were defined by higher scores than men on drive for thinness, body dissatisfaction, and emotion recognition and men were defined by relatively higher scores on emotion dysregulation and binge eating. When we combined all athletes and compared them with non-athletes, a significant interaction of gender and athlete status emerged such that female athletes, compared to male athletes and women non-athletes, were defined by higher scores on drive for thinness, emotion dysregulation, and binge eating. Conversely, male athletes, compared to female athletes, were defined by greater difficulty identifying feelings and body dissatisfaction. Non-athletes were not well defined by the discriminant function. These results highlight that emotional processes convey risk of eating disorders in men and women, particularly in athletes, and these risk factors are not uniform.

Psychometric Analysis of the Body Shape Questionnaire in Mexican University Students

OBJECTIVE

To analyse the psychometric properties, internal structure, and relationship with anthropometric indicators of the Body Shape Questionnaire (BSQ) among Mexican university students according to the measurement invariance approach.

METHODS

An instrumental study was carried out to assess the psychometric properties, validity, and reliability of the BSQ. The analysis of the measurement invariance was performed using the Least Squares Estimation, and weighted by adjusted variance and polychoric correlations after assessing different measurement models for BSQ in each group. The scores of the final version were correlated with anthropometric indicators by the Pearson correlation coefficient.

RESULTS

As regards the dimensional analysis, all of the previous models for BSQ have favourable adjustment rates, although those with a single factor show more robust evidence. The configural invariance was accepted; suggesting that the one-dimensional structure is common for both men and women. However, 16-item factorial loadings were statistically different between the groups. Hence, they were discarded and an 18-item version (BSQ-18) was obtained, which is considered invariant as regards gender. In addition, there is a direct relationship between the scores of the BSQ-18 version and the body mass index, waist circumference, and fat percentage. Satisfactory indicators were found as regards stability.

CONCLUSIONS

The BSQ-18 can be used with men and women, and has high reliability indicators to be conducted in clinical settings to assess eating disorders and obesity among university students.

Systematic review of body image measures

This systematic review synthesizes and critically appraises measurement properties of influential body image measures. Eight measures that met the definition of an assessment of body image (i.e., an individual's cognitive or affective evaluation of their body or appearance with a positive or negative valence), and scored high on systematic expert priority ranking, were included. These measures were: the Body Appreciation Scale (original BAS and BAS-2), the Body Esteem Scale for Adolescents and Adults, the Body Shape Questionnaire, the Centre for Appearance Research Valence Scale, the Drive for Muscularity Scale, two subscales of the Eating Disorders Examination Questionnaire, one subscale of the Eating Disorder Inventory 3, and two subscales of the Multidimensional Body Relations Questionnaire. Articles assessing these scales' psychometric properties (N = 136) were evaluated for their methodological quality using the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) checklist, and a best evidence synthesis was performed. The results supported the majority of measures in terms of reliability and validity; however, suitability varied across populations, and some measurement properties were insufficiently evaluated. The measures are discussed in detail, including recommendations for their future use in research and clinical practice.

Cross-Cultural Invariance of Emotional Skills and Competence Questionnaire between Portugal and Croatia

Emotional intelligence (EI) and its measures have been widespread across several countries and cultures and the need for valid and robust measures that could expand research on international settings is on the current agenda. This study aimed to assess the measurement invariance of a widely used self-report EI measure, Emotional Skills and Competence Questionnaire (ESCQ), in two cultural contexts (Portugal vs. Croatia). The ESCQ, a 42-item self-report EI scale which comprises three dimensions – Perceive and Understand Emotion, Express and Label Emotion and Manage and Regulate Emotion - was administered to 1,188 Portuguese and Croatian secondary students. The results showed that the ESCQ had satisfactory reliability and the three-factor structure was replicated on both country samples. Configural (χ2 = 308.71, df = 220, p < .01; RMSEA = .030, CFI = .956, TLI = .948) and partial metric (Δχ2 = 9.102, Δdf = 10, p = .522; ΔCFI = −.01, ΔRMSEA = .002) and scalar (Δχ2 = 15.290, Δdf = 21, p = .083; ΔCFI = .001, ΔRMSEA = .006) invariances were supported across groups. This EI measure invariance cross-cultural study highlighted cultural particularities related to emotional competence in Portugal and Croatia contexts and contributed to bring awareness to the validity of cross-cultural studies in the emotional abilities field.

Assessing the factor structure of the Body Uneasiness Test (BUT) in an overweight and obese Croatian non-clinical sample

PURPOSE

The study objectives are to investigate the psychometric properties of the Body Uneasiness Test (BUT-A) in a general sample of overweight and obese persons in Croatia, to evaluate structure differences between men and women and to examine the relationship with other measures of body dissatisfaction as well as with objective body mass measure.

METHODS

This study included 320 adults (156 women and 164 men; aged between 20 and 71) with BMIs ranging from 24 to 48.83 kg/m(2).

RESULTS

The analysis confirmed a structural one-factor model for BUT-A. The one-factor model fits the data equally as well as the more complex five-factor model did and should be considered a more robust, parsimonious and adequate model. Female participants showed higher results (higher body uneasiness), but the importance of items is roughly comparable between genders. The BUT-A score significantly contributes to the prediction of general body dissatisfaction, even after gender and BMI are controlled. The multifaceted nature of the BUT-A might explain the relatively low measure of general body dissatisfaction in this sample. Congruent with previous studies, obese subjects expressed dissatisfaction with their body on the figure rating scale by selecting the ideal figure two units thinner than their current body figure. In overweight and obese men, body dissatisfaction is lower than in women.

CONCLUSION

The BUT-A can be a reliable one-dimensional tool for the assessment of body uneasiness in a wide range of samples, including obese individuals.