Elsevier

Computers in Human Behavior

Volume 65, December 2016, Pages 142-150
Computers in Human Behavior

Full length article
A revised examination of the dual pathway model for bulimic symptoms: The importance of social comparisons made on Facebook and sociotropy

https://doi.org/10.1016/j.chb.2016.08.018Get rights and content

Highlights

  • Limited support found for the dual-mechanism model proposed by the DPM.

  • Sociotropy found to be a risk factor for BN symptoms.

  • Appropriate Facebook use should be considered for bulimia prevention.

Abstract

Objective

To replicate the Dual Pathway Model (DPM) of bulimia nervosa (BN) symptoms prospectively, and to assess whether a revised version of the DPM that included the variables social comparisons made on Facebook and sociotropy influenced the DPM.

Method

Participants were 245 females who completed baseline measures (T1) that assessed the DPM, as well as the constructs social comparisons made on Facebook, and sociotropy, and a follow-up questionnaire, which assessed symptoms of depression, bulimia, and dietary restraint, one month later (T2).

Results

Path analysis revealed that the original and the revised DPMs had excellent fit once modifications to the respective models were made. In both DPMs, T1 pressures to be thin and T1 thin ideal internalization were related to T1 body dissatisfaction. T1 body dissatisfaction prospectively predicted T2 depressive symptoms and T2 bulimic symptoms, but not T2 dietary restraint. Furthermore, T2 dietary restraint, but not T2 depressive symptoms, predicted T2 BN symptoms. Results also showed that T2 dietary restraint was associated with T2 depressive symptoms. In the revised DPM, T1 social comparisons made on Facebook were associated with T1 body dissatisfaction, T1 pressures to be thin, and T2 bulimic symptoms. T1 sociotropy was related to T1 social comparisons on Facebook, T1 pressures to be thin, T1 body dissatisfaction, and T2 bulimic symptoms.

Conclusions

Findings suggest the BN preventative efforts might benefit from addressing appropriate forms of social comparisons, especially those made on Facebook, and the personality trait sociotropy.

Introduction

The dual pathway model (DPM) proposes to account for the etiology of bulimia nervosa (BN) symptomology (Stice, Nemeroff, & Shaw, 1996). To date, only one longitudinal study (Stice, Shaw, & Nemeroff, 1998), and two cross-sectional studies (Duemm et al., 2003, Stice et al., 1996) have tested the model in its entirety, and hence, the predictive utility of the model remains unclear. In addition, research has identified other important social factors associated with BN symptoms that have yet to be tested in the context of the DPM. For example, despite the social media site Facebook being a ubiquitous feature of many women's everyday social interactions (Duggan et al., 2015, Lenhart et al., 2010), no study has assessed the influence of social comparisons made on Facebook on the DPM. Further, it remains unclear why some individuals who are exposed to sociocultural risk factors of BN (e.g., pressures to be thin) may be more susceptible to developing BN symptoms. To this end, research has examined whether the personality trait sociotropy [defined as the need for dependence on and/or approval from others (Clark & Beck, 1991)] is associated with BN symptoms. To date, only one cross-sectional study (Duemm et al., 2003) has examined the influence of sociotropy on the DPM. Thus, the present study is the first to use a large female sample to i) replicate the original DPM as proposed by Stice et al. (1996) prospectively, and ii) assess a revised conceptualization of the DPM that includes social comparisons made on Facebook and sociotropy.

According to the DPM, pressures to be thin from one's social environment (e.g., the media, family, and peers) leads to thin ideal internalization (the belief that the thin ideal is a desirable end state; Stice, 2002). Both of these constructs are thought to lead directly to body dissatisfaction as individuals are largely unable to achieve and/or maintain unrealistic thin-ideal standards, and thus, comparison between one's perceived body shape/size with this unrealistic ideal causes body dissatisfaction (Duemm et al., 2003). Body dissatisfaction is theorized to lead to BN symptoms through dual-pathways. The first pathway is via dietary restraint: binge-eating is thought to be a compensatory mechanism for caloric deprivation associated with dietary restraint (Polivy, Coleman, & Herman, 2005). The second pathway is via negative affect: increased body dissatisfaction leads to negative internal states, and binge-eating/purging behaviors are thought to be mechanisms that distract attention away from these negative mood states (Heatherton & Baumeister, 1991). Dietary restraint is also proposed to lead to negative affect.

In addition to the original Stice et al. (1996) publication, eight further cross-sectional studies (Duemm et al., 2003, Evans et al., 2013, Hutchinson et al., 2010, Mason and Lewis, 2015, Ouwens et al., 2009, Ruisoto et al., 2015, Van Strien et al., 2005, Womble et al., 2001) have tested modifications of the model in female and male samples, and shown support for various pathways of the DPM. For example, in the earliest assessment of the DPM, Stice et al. (1996) found all hypothesized pathways to be significant and that the model accounted for 71% of the variance in BN symptoms. Support for the DPM was also found by Duemm et al., 2003, Mason and Lewis, 2015, and Womble et al. (2001). These three studies found the DPM accounted for 59–70% of the variance in BN symptoms. The study by Evans et al. (2013) excluded the variable pressures to be thin, and found that the DPM accounted for 50% of the variance in disordered eating symptoms. Ouwens et al. (2009) and van Strien et al. (2005) did not examine the constructs pressures to be thin and thin ideal internalization, and failed to find support for the dietary restraint to disordered eating pathway. These two studies found that the DPM accounted for 7–12% of the variance in respective eating pathology symptoms.

Longitudinal studies (Allen et al., 2012, Dakanalis et al., 2014, Salafia and Gondoli, 2011, Stice et al., 1998) have also shown support for the DPM. In a nine-month (Stice et al., 1998) and a four-year longitudinal study (Salafia & Gondoli, 2011), the predictive utility of the DPM was supported, as these two studies explained 33.3% and 49% of the variance in BN symptoms, respectively. While Stice et al. (1998) operationalized pressures to be thin as a composite of pressures stemming from the media, peers, and family members, Salafia and Gondoli (2011) assessed the separate influence of pressures from peers, fathers, and mothers on body dissatisfaction. When assessed in this way, Salafia and Gondoli (2011) found that relative to pressures from fathers and mothers, pressures from peers was the strongest predictor of body dissatisfaction, suggesting that different types of pressures might confer different risk to the development of BN symptoms. However, as Salafia and Gondoli (2011) did not assess thin ideal internalization, the unique effect of different types of pressures on thin ideal internalization remains unknown.

Similarly, two subsequent longitudinal studies (Allen et al., 2012, Dakanalis et al., 2014) that also excluded thin ideal internalization found that the respective models accounted for 54–59% of the variance in binge-eating symptoms. Finally, the DPM has also been validated at a state-based level in a female community sample (Holmes, Fuller-Tyszkiewicz, Skouteris, & Broadbent, 2014).

While the above-mentioned evidence demonstrates support for the links between different types of pressures (e.g., family) on body dissatisfaction and BN symptoms, it should be noted that meta-analyses by Ferguson (2013) and Holmstrom (2004) have found little evidence to support the influence of thin-ideal media effects on these same constructs. Further, other researchers (e.g., Roberts & Good, 2010) have suggested that the potentially negative influence of thin-ideal media effects on body dissatisfaction (and therefore on disordered eating symptoms) might be moderated by personality traits, such a neuroticism. Hence, it is important for future research to consider the influence of different types of social pressures, and other personality factors in the etiology of body dissatisfaction and BN symptoms.

Past research into the DPM is limited by not assessing contemporary pressures that women are exposed to, such as the influence of the social media site Facebook. Current research suggests that many Western women use Facebook on a regular basis (Duggan et al., 2015). Given the apparent popularity of Facebook, as well as the influence of Facebook use on negative mood (Kross et al., 2013; Sagioglou & Greitemeyer, 2014), it is important to examine whether this factor is etiological to BN symptomology by examining it in the context of the DPM.

Studies that have examined how individuals present themselves on Facebook indicate that females often digitally enhance images in accordance with stereotyped representations of the thin ideal (Haferkamp and Krämer, 2011, Rodgers et al., 2013). Researchers have argued that exposure to such images on Facebook might lead to body dissatisfaction as individuals likely compare their bodies to the “enhanced” bodies of others (Perloff, 2014, Williams and Ricciardelli, 2014). This process of evaluating one's self via comparison to an “other” is known as a social comparison (Festinger, 1954). It is thought that if an individual makes a comparison to an individual that, relatively speaking, is perceived to be closer to the thin ideal (i.e., an ‘upward comparison’) the resulting discrepancy might generate increased body dissatisfaction (Dittmar & Howard, 2004).

Indeed, extant research has provided initial evidence linking those who make social comparisons to others on Facebook with body dissatisfaction (see Holland & Tiggemann, 2016 for a review). Other studies have shown that women who display a greater tendency to make social comparisons were more likely to report higher levels of thin ideal internalization (Papp et al., 2013, Rodgers et al., 2011). While some studies have found social media usage is associated with thin ideal internalization in females (Tiggemann & Slater, 2013), other research (Ferguson, Munoz, Garza, & Galindo, 2014) has shown a null relationship of social media use on body dissatisfaction and disordered eating symptoms. No study to our knowledge has examined whether social comparisons made on Facebook are linked to pressures to be thin.

It has been suggested that the personality trait sociotropy is etiological to the development of BN symptoms (Friedman & Whisman, 1998). Researchers have proposed that individuals with higher levels of sociotropy may be more likely to experience BN symptoms, pressures to be thin, thin ideal internalization, and body dissatisfaction, potentially due to increased levels of sensitivity to rejection, need for approval, and/or social dependency (Duemm et al., 2003, Hayaki et al., 2003, Jackson et al., 2005, Narduzzi and Jackson, 2002, Oates-Johnson and Clark, 2004, Pedlow and Niemeier, 2013). The only study to date to assess the influence of sociotropy on the DPM (Duemm et al., 2003) found that sociotropy was associated with thin ideal internalization and negative-affect suggesting that the variable conferred an indirect effect on bulimic behaviors.

Researchers have also argued that individuals with higher levels of sociotropy may be more susceptible to seeking validation from others, and hence more likely to make social comparisons (Giordano et al., 2000, Krause et al., 2015). To date, no research has examined the relationship between sociotropy and social comparisons on Facebook. While preliminary in nature, the above evidence suggests that the inclusion of sociotropy in the DPM is indicated, and hence, further research is needed to examine the degree to which sociotropy influences the DPM.

While there is evidence confirming specific pathways of the DPM, only two cross sectional studies (Duemm et al., 2003, Stice et al., 1996) and one longitudinal study (Stice et al., 1998) have examined the DPM in its entirety. Indeed, the majority of studies in this area have omitted one or more variables from the model. Thus, these omissions, as well as a lack of longitudinal research in this area, have made it difficult to draw firm conclusions regarding the predictive utility of the DPM as a whole. Further, while the DPM was originally proposed to be a model that accounts for the development and maintenance of bulimic symptoms, a large number of studies have only assessed binge-eating (e.g., Dakanalis et al., 2014, Mason and Lewis, 2015) or overeating symptoms (e.g., van Strein et al., 2005). While these studies have contributed important findings regarding the factors that influence the etiology of eating pathology as assessed via the DPM, further research is required to test the original proposition that the DPM is a model that accounts for the etiology of bulimic symptoms. Hence, further studies that utilize bulimic symptoms as the outcome measure for the DPM are required. Finally, only one study (Duemm et al., 2003) has examined the influence of sociotrpy on the DPM, and no study has assessed the contribution of social comparisons made on Facebook. Understanding how these two factors influence the DPM longitudinally has the potential to provide further insight into how BN risk factors and subsequent BN symptoms develop.

The present study had two aims: i) to assess the DPM prospectively by assessing all variables in the model at T1, and symptoms of dietary restraint, depression, and BN one month later at T2, and ii) to test a revised DPM to determine whether social comparisons made on Facebook and sociotropy assessed at T1 influenced the model.

For the original prospective DPM, it was hypothesized that T1 pressures to be thin would be related to T1 thin ideal internalization and T1 body dissatisfaction, and that T1 thin ideal internalization would be related to T1 body dissatisfaction. It was also hypothesized that T2 dietary restraint and T2 depressive symptoms would mediate the relationship between T1 body dissatisfaction and T2 BN symptoms, and T2 dietary restraint would be associated with T2 depressive symptoms.

For the revised prospective DPM, in addition to the existing DPM hypotheses, it was hypothesized that a) T1 social comparisons made on Facebook would be associated with T1 body dissatisfaction, T1 pressures to be thin, T1 thin ideal internalization, and T2 bulimic symptoms and b) T1 sociotropy would be related to T1 pressures to be thin, T1 thin ideal internalization, T1 body dissatisfaction, and T2 bulimic symptoms. Given there is no literature on the relationship between sociotropy and social comparisons made on Facebook, no hypothesis was made for this relationship.

Section snippets

Participants

Of the 498 participants who enrolled at T1, a total of 245 females (M = 23.77, SD = 7.10) participated in the baseline (T1) and one-month follow up (T2) assessments. Of these participants, 127 (M = 19.37, SD = 2.49) were undergraduate students from a Melbourne university, 58 (M = 27.78, SD = 0.80) were recruited from the community in Australia, and 60 (M = 29.13, SD = 5.75) were from the United States of America (USA) enlisted via the online labour system Clickworker. The university students

Results

Partial correlations controlling for BMI, age and sample characteristic differences between all variables are presented in Table 2. All variables showed significant positive correlations in the expected direction, with the magnitude of effects ranging from weak to strong.

Discussion

The current study addressed an important gap in the literature by exploring the potential role of social comparisons made on Facebook and sociotropy on the development of BN symptoms. Regarding the original DPM, the hypothesis that T1 pressures to be thin would be associated with T1 thin ideal internalization was supported. Similarly, results showed that T1 pressures to be thin and T1 thin ideal internalization were associated with T1 body dissatisfaction. Consistent with predictions, T1 body

Conclusion

In conclusion, the present findings provide limited longitudinal support for the original conceptualization of the DPM as proposed by Stice et al. (1996). In terms of the revised DPM, these preliminary results suggest that future research would benefit from examining the influence of social comparisons made on Facebook and sociotropy on the development of BN symptoms, as both variables appear instrumental in conferring risk to BN symptoms.

References (57)

  • A. Roberts et al.

    Media images and female body dissatisfaction: The moderating effects of the Five-Factor traits

    Eating Behaviors

    (2010)
  • R. Rodgers et al.

    An exploration of the tripartite influence model of body dissatisfaction and disordered eating among Australian and French college women

    Body Image

    (2011)
  • C. Sagioglou et al.

    Facebook's emotional consequences: Why Facebook causes a decrease in mood and why people still use it

    Computers in Human Behavior

    (2014)
  • K.L. Allen et al.

    The dual-pathway and cognitive-behavioural models of binge eating: Prospective evaluation and comparison

    European Child and Adolescent Psychiatry

    (2012)
  • D.A. Clark et al.

    Personality factors in dysphoria: A psychometric refinement of beck's sociotropy-autonomy scale

    Journal of Psychopathology and Behavioral Assessment

    (1991)
  • R. Cohen et al.

    Comparative effects of Facebook and conventional media on body image dissatisfaction

    Journal of Eating Disorders

    (2015)
  • H. Dittmar et al.

    Thin-ideal internalization and social comparison tendency as moderators of media models' impact on Women's body-focused anxiety

    Journal of Social and Clinical Psychology

    (2004)
  • I. Duemm et al.

    The addition of sociotropy to the dual pathway model of bulimia

    Canadian Journal of Behavioural Science

    (2003)
  • M. Duggan et al.

    Social media update 2014

    (2015)
  • C.J. Ferguson et al.

    Concurrent and prospective analyses of peer, television and social media influences on body dissatisfaction, eating disorder symptoms and life satisfaction in adolescent girls

    Journal of Youth and Adolescence

    (2014)
  • L. Festinger

    A theory of social comparison processes

    Human relations

    (1954)
  • M.A. Friedman et al.

    Sociotropy, autonomy, and bulimic symptomatology

    International Journal of Eating Disorders

    (1998)
  • D.M. Garner et al.

    The eating attitudes test: Psychometric features and clinical correlates

    Psychological Medicine

    (1982)
  • C. Giordano et al.

    Depressive personality styles, dysphoria, and social comparisons in everyday life

    Journal of Personality and Social Psychology

    (2000)
  • N. Haferkamp et al.

    Social comparison 2.0: Examining the effects of online profiles on social-networking sites

    Cyberpsychology, Behavior, and Social Networking

    (2011)
  • J. Hayaki et al.

    Sociotropy and bulimic symptoms in clinical and nonclinical samples

    International Journal of Eating Disorders

    (2003)
  • T.F. Heatherton et al.

    Binge eating as escape from self-awareness

    Psychological Bulletin

    (1991)
  • A.J. Holmstrom

    The effects of the media on body image: A meta-analysis

    Journal of Broadcasting & Electronic Media

    (2004)
  • Cited by (0)

    View full text