Skip to main content
SpringerLink
Log in

Thin-ideal internalization: How much is too much?

  • Brief Report
  • Published:
Eating and Weight Disorders - Studies on Anorexia, Bulimia and Obesity Aims and scope Submit manuscript

Abstract

Internalization of the thin-ideal is a risk factor for eating disorders that frequently persists into recovery and increases patient risk for relapse. Addressing thin-ideal internalization as a core element of eating disorder prevention and treatment produces significant reductions in eating pathology. However, research has not yet quantified levels of thin-ideal internalization that may signal increased versus decreased risk for disordered eating. To address this gap in the literature, receiver operating characteristic (ROC) curve analysis was used to identify a thin-ideal internalization cutoff score that signified clinically-meaningful eating disorder pathology. 787 college women (age M = 20.17, SD = 2.41; BMI M = 23.58, SD = 5.29) were classified as “healthy” (N = 717) or those with significant disordered eating (N = 70) using established clinical cutoffs for the Eating Disorder Examination-Questionnaire. ROC curve analysis was used to test the performance of the Sociocultural Attitudes Towards Appearance Questionnaire-4 (SATAQ-4) Internalization: Thin/Low Body Fat subscale in predicting disordered eating status, and to identify a cutoff score that maximized sensitivity and specificity to discriminate between healthy and disordered eating samples. Mean SATAQ-4 internalization scores were 3.29 (SD = 0.92) and 4.27 (SD = 0.62) for healthy and disordered eating participants, respectively. The SATAQ-4 internalization scores were good predictors of disordered eating status (area under the curve = 0.81, 95% CI: 0.76–0.86). The optimal cutoff of 3.78 (measured on a 1–5 Likert scale) yielded a sensitivity of 0.81 and specificity of 0.64. Overall, results provide preliminary support for the discriminant validity of SATAQ-4 thin internalization scores and suggest that even moderate levels of thin-ideal internalization may be predictive of clinically-significant eating pathology. It may be important for prevention and intervention work to actively seek to reduce internalization levels below this clinical cutoff, though future work is needed to bear this out.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Thompson JK, Stice E (2001) Thin-ideal internalization: mounting evidence for a new risk factor for body-image disturbance and eating pathology. Curr Dir Psychol Sci 10:181–183. https://doi.org/10.1111/1467-8721.00144

    Article  Google Scholar 

  2. Stice E, Nemeroff C, Shaw H (1996) A test of the dual pathway model of bulimia nervosa: evidence for restrained-eating and affect-regulation mechanisms. J Soc Clin Psychol 15:340–363. https://doi.org/10.1521/jscp.1996.15.3.3403

    Article  Google Scholar 

  3. Thompson JK, Heinberg LJ, Altabe M, Tantleff-Dunn S (1999) Exacting beauty. American Psychological Association, Washington DC

    Google Scholar 

  4. Cafri G, Yamamiya Y, Brannick M, Thompson JK (2005) The influence of sociocultural factors on body image: a meta-analysis. Clin Psychol Sci Pract 12:421–433. https://doi.org/10.1093/clipsy/bpi053

    Article  Google Scholar 

  5. Stice E, Gau JM, Rohde P, Shaw H (2017) Risk factors that predict future onset of each DMS-5 eating disorder: Predictive specificity in high-risk adolescent females. J Abnorm Psychol 126:38–51. https://doi.org/10.1037/abn0000219

    Article  PubMed  Google Scholar 

  6. Stice E (2002) Risk and maintenance factors for eating pathology: a meta-analytic review. Psycholl Bull 128:825–848. https://doi.org/10.1037/0033-2909.128.5.825

    Article  Google Scholar 

  7. Bardone-Cone AM, Harney MB, Maldonado CR, Lawson MA, Robinson DP, Smith R, Tosh A (2010) Defining recovery from an eating disorder: conceptualization, validation, and examination of psychosocial functioning and psychiatric comorbidity. Behav Res Ther 48:194–202. https://doi.org/10.1016/j.brat.2009.11.001

    Article  PubMed  Google Scholar 

  8. Heinberg LJ, Coughlin JW, Pinto AM, Haug N, Brode C, Guarda AS (2008) Validation and predictive utility of the sociocultural attitudes toward appearance questionnaire for eating disorders (SATAQ-ED): internalization of sociocultural ideals predicts weight gain. Body Image 5:279–290. https://doi.org/10.1016/j.bodyim.2008.02.001

    Article  PubMed  Google Scholar 

  9. Becker CB, Wilson C, Williams A, Kelly M, McDaniel L, Elmquist J (2010) Peer-facilitated cognitive dissonance versus healthy weight eating disorders prevention: a randomized comparison. Body Image 7:280–288. https://doi.org/10.1016/j.bodyim.2010.06.004

    Article  PubMed  Google Scholar 

  10. Bell MJ, Rodgers RF, Paxton SJ (2017) Towards successful evidence-based universal eating disorders prevention: the importance of zooming out. Eat Behav. https://doi.org/10.1016/j.eatbeh.2016.10.012

    Article  PubMed  Google Scholar 

  11. McVey G, Tweed S, Blackmore E (2007) Healthy schools-healthy kids: a controlled evaluation of a comprehensive universal eating disorder prevention program. Body Image 4:115–136. https://doi.org/10.1016/j.bodyim.2007.01.004

    Article  PubMed  Google Scholar 

  12. Becker CB, Stice E (2017) From efficacy to effectiveness to broad implementation: evolution of the body project. J Consult Clin Psych 85:767–782. https://doi.org/10.1037/ccp0000204

    Article  Google Scholar 

  13. Stice E, Rohde P, Butryn M, Menke KS, Marti CN (2015) Randomized controlled pilot trial of a novel dissonance-based group treatment for eating disorders. Behav Res Ther 65:67–75. https://doi.org/10.1016/j.brat.2014.12.012

    Article  PubMed  Google Scholar 

  14. Schaefer LM et al (2015) Development and validation of the sociocultural attitudes towards appearance questionnaire-4 (SATAQ-4). Psychol Assess 27:54–67. https://doi.org/10.1037/a0037917

    Article  PubMed  Google Scholar 

  15. Fairburn CG, Beglin SJ (2008) Eating Disorder examination questionnaire (EDE-Q 6.0). In: Fairburn CG (ed) Cognitive behavior therapy and eating disorders. Guilford Press, New York, pp 309–314

    Google Scholar 

  16. Luce KH, Crowther JH, Pole M (2008) Eating disorder examination questionnaire (EDE-Q): norms for undergraduate women. Int J Eat Disord 41:273–276. https://doi.org/10.1002/eat.20504

    Article  PubMed  Google Scholar 

  17. Swets JA (1988) Measuring the accuracy of diagnostic systems. Science 240:1285–1293

    Article  CAS  PubMed  Google Scholar 

  18. Hill LS, Reid F, Morgan JF, Lacey JH (2010) SCOFF, the development of an eating disorder screening questionnaire. Int J Eat Disord 43:344–351. https://doi.org/10.1002/eat.20679

    Article  PubMed  Google Scholar 

  19. First MB, Williams JBW, Karg RS, Spitzer RL (2015) Structured clinical interview for DSM-5 disorders, research version (SCID-5-RV). American Psychiatric Association, Arlington

    Google Scholar 

Download references

Acknowledgements

This work was supported by the the National Institute of Mental Health (Grant number T32 MH082761). The opinions and assertions expressed herein are those of the authors and are not to be construed as reflecting the views of the USUHS or the U.S. Department of Defense.

Author information

Authors and Affiliations

  1. Neuropsychiatric Research Institute, 120 Eighth Street South, Fargo, ND, 58103, USA

    Lauren M. Schaefer

  2. Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), Bethesda, MD, USA

    Natasha L. Burke

  3. Department of Psychology, University of South Florida, Tampa, FL, USA

    J. Kevin Thompson

Authors
  1. Lauren M. Schaefer
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Natasha L. Burke
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. Kevin Thompson
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lauren M. Schaefer.

Ethics declarations

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Schaefer, L.M., Burke, N.L. & Thompson, J.K. Thin-ideal internalization: How much is too much?. Eat Weight Disord 24, 933–937 (2019). https://doi.org/10.1007/s40519-018-0498-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40519-018-0498-x

Keyword

Search

Navigation