36604147

Journal of Social and Clinical Psychology, Vol. 28, No. 1, 2009, pp.
9-42
LEVINE AND MURNEN
Media, Negative Body Image and Disordered Eating
EVERYbODY KNOWS ThAT mASS mEDiA ARE/ARE NOT [pick one] A CAUSE OF EATiNG DiSORDERS: A CRiTiCAL REViEW OF EViDENCE FOR A CAUSAL LiNK bETWEEN MEDiA, NEGATiVE BODY ImAGE, AND DiSORDERED EATiNG iN FEmALES
MIchAEL P. LEvInE And SARAh K. MURnEn Kenyon College
This article reviews research pertaining to mass media as a causal risk factor for negative body image and disordered eating in females. The specific purpose is to clarify the impact of mass media by applying seven criteria that extend those of Kraemer et al. (1997) and Stice (2002). Although media effects clearly meet a majority of the criteria, this analysis indicates that, currently, engagement with mass media is probably best considered a variable risk factor that might well be later shown to be a causal risk factor. Recommendations are made for further research, with an emphasis on longitudinal investigations, studies of media literacy as a form of prevention, and clarification of psychosocial processes that moderate and mediate media effects.
Numerous professionals, parents, and adolescents nd the medias status as a cause of body dissatisfaction, drive for thinness, and eating disorders to be self-evident: Of course, mass media contribute to unhealthy beauty ideals, body dissatisfaction, and disordered eatinghavent you seen the magazine covers in the supermarket newsstands lately? No wonder so many girls have body image issues and eating disorders. On the contrary, a growing number of
Correspondence concerning this article should be addressed to Michael P. Levine, Ph.D., and Sarah K. Murnen, Ph.D., Department of Psychology, Kenyon College, Gambier, OH 43022-9623. E-mail: Levine@kenyon.edu; Murnen@kenyon.edu.
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parents, biopsychiatric researchers, clinicians (e.g., Bulik, 2004), and cynical adolescents nd proclamations about media as a cause of any disorder to be an irritating distraction. Their contention is, in effect: Of course, we know now that eating disorders, like mood disorders and schizophrenia, are severe, self-sustaining psychiatric illnesses with a genetic and biochemical basis. So, of course, no scientist seriously thinks that mass media and the escapades of actors, models, and celebrities have anything to do with causing them. This article reviews the current status of research pertaining to mass media as a causal risk factor for clinically signicant levels of negative body image and disordered eating in females. After considering the criteria for establishing a causal risk factor, we analyze the evidence for the impact of mass media (e.g., fashion magazines, television). The principal goals are to clarify (1) what is known with relative certainty about medias effects on females (2) what isnt known yet, or remains ambiguous; and (3) what methodologies and studies are needed to advance the types of risk-factor knowledge that should facilitate prevention, treatment, and support during recovery. The relationships between mass media, negative body image, and unhealthy behaviors (e.g., use and abuse of steroids and food supplements) in males are receiving increasing attention (Pope, Phillips, & Olivardia, 2000). This review, however, concentrates on females. The gender differences (conservatively, 6 to 8 females for each male) in the prevalence of anorexia nervosa, bulimia nervosa, and eating disorder not otherwise specied (EDNOS) other than Binge Eating Disorder are among the largest reported for mental disorders (Fernndez, Labrador, & Raich, 2007; Hoek & van Hoeken, 2003; but see Hudson, Hiripi, Pope, & Kessler, 2007).
MEDiA AS A CAUSE OF WhAT?WhAT iS TO BE EXpLAiNED?

A Spectrum of Phenomena Although the matter of dimensions and/or categories is complex and unresolved (Gleaves, Brown, & Warren, 2004), substantial evidence suggests that the serious and frequently chronic conditions recognized as the Eating Disorders by the DSM-IV-TR (American
MEDIA, NEGATIVE BODY IMAGE AND DISORDERED EATING
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Psychiatric Association, 2000) are composite expressions of a set of dimensions, such as negative emotionality, binge eating, and unhealthy forms of weight and shape management. The latter includes restrictive dieting, self-induced vomiting after eating, and abuse of laxatives, diuretics, diet pills, and exercise (Levine & Smolak, 2006; Stice, Killen, Hayward, & Taylor, 1998; Tylka & Subich, 1999). The adhesive drawing together and framing these intertwined continua is negative body image. In most media effects research the multidimensional construct of body image (Cash & Pruzinsky, 2002) is represented by various measures of what are essentially perceptual-emotional conclusions (e.g., I look too fat to myself and others + I am disgusted by and ashamed of this = I hate how fat I look and feel). For females body dissatisfaction results fromand feedsa schema that integrates three fundamental components: idealization of slenderness and leanness; an irrational fear of fat; and a conviction that weight and shape are central determinants of ones identity (Levine & Smolak, 2006; Smolak & Levine, 1994, 1996). Mass Media and Epidemiology The effects of media designed to reach and inuence huge masses of people are certainly a salient and thus tempting explanation for four fairly well-established ndings. First, the prevalence of discontent and problems concerning weight and shape has been so high for so long among girls and women that for 25 years it has been considered normative (Ricciardelli & McCabe, 2004; Rodin, Silberstein, & Striegel-Moore, 1985). Second, a substantial percentage, perhaps 20%, of females ages 12 through 30 have levels of negative body image and disordered eating high enough to create signicant suffering for themselves and others (Cash, 2002; Levine & Smolak, 2006). Third, weight and shape concerns, along with a dieting mentality, tend to emerge in childhood for girls of varying sizes and backgroundsand children are heavy consumers of mass media (e.g., TV, childrens books, and videos; Comstock & Sharrer, 2007) that are replete with clear messages about the positive features of thinness and the many negative aspects of being fat. Finally, while there are certainly ethnic and sociogeographic differences in risk for negative body image and disordered eating, the fact that fat talk and these
problems are found among youth and young adults of all social classes and ethnicities, and in many highly dissimilar geographic locations, is consistent with a general sociocultural model that includes a proliferating, inuential mass media (Cash & Pruzinsky, 2002; Gordon, 2000; Levine & Smolak, 2006; Nichter, 2000).
CRiTERiA FOR EVALUATiNG ThE STATUS OF A MASS MEDiA AS A CAUSE

Causes and Risk Researchers in many elds have stopped thinking about the cause of a disorder as the agent that directly brings about the undesirable outcome. Instead, there is an emphasis on variables that are reliably and usefully associated with an increase over time in the probability of a subsequent outcome. Such variables are called risk factors (Kraemer et al., 1997). Common Risk Factors and Relatively Rare Conditions Thinking in terms of risk factors has two major implications for investigating mass media as a cause of eating disorders. The rst concerns the oft-heard relative rarity argument: How could mass media be a cause when the vast majority of girls and young women are exposed to ostensibly toxic inuences, but only a small percentage develop eating disorders? This critique dissolves when one considers multiple risk factors as multiplicative probabilities. Assume, conservatively, that 35% of adolescent girls are engaged with those mass media containing various unhealthy messages. Assume also that three other risk factorssuch as peer preoccupation with weight and shape; family history of overweight/obesity; and being socialized by parents and older siblings to believe rmly that a females identity and worth are shaped primarily by appearance (Smolak & Levine, 1996)each have a probability of .35 of occurring in the population. The probability of co-occurrence for these four unweighted risk factors is .354 = .015, which is roughly the preva-
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lence of anorexia nervosa and bulimia nervosa among females in the age range at greatest risk (Hoek & van Hoeken, 2003). Behavior geneticists have long accepted that the presence of fairly common risk factors in a population can account for fairly rare and extreme conditions (Hanson, 2004). Criteria for Determining a Causal Risk Factor Second, if mass media constitute a causal risk factor (Kraemer et al., 1997; Stice, 2002) for the spectrum of negative body image and disordered eating, then the following will be the case. Cross-sectional studies will show that the extent of exposure to mass media, or to various specic forms of mass media, is a correlate of that spectrum. Longitudinal studies will demonstrate that exposure to mass media precedes and predicts development of negative body image and disordered eating. Laboratory experiments should show that well-controlled manipulation of the media risk factor (independent variable) causes the hypothesized changes in state body satisfaction and other relevant dependent variables, while controlled analog (laboratory) or eld experiments should demonstrate that prevention programs designed to combat known risk factors do indeed reduce or delay the onset of disordered eating. These criteria are demanding in and of themselves (Stice, 2002). Nevertheless, it is also important to incorporate the contributions to knowledge of two further sources: common sense and peoples "lived experience." Specically, if mass media are a causal risk factor, then content analyses should document that media provide the raw material from which children and adolescents could readily extract and construct the information, affective valences, and behavioral cues necessary to develop the components of disordered eating. Similarly, surveys and ecological analyses will reveal that engagement with mass media is frequent and intensive enough to provide multiple opportunities for this type of social-cognitive learning. Finally, surveys and qualitative studies should nd that, beginning at the age where they can think critically about themselves in relation to personal and outside inuences, children and adolescents will report that mass media are sources of inuence, and even pressure, on themselves, their peers, and others.
Thus, this review uses seven criteria to evaluate the status of mass media as a causal risk for negative body image and disordered eating. Content and exposure are foundational, so we will consider them criteria 1 and 2. The Kraemer-Stice standards are criteria 3 through 6, and the existence and impact of subjective experiences of media pressures and inuence constitute criterion 7.
CRiTERiA 1 AND 2: CONTENT AND EXpOSURE

Media EXposure and Use Mass media are a major part of the lives of many children, adolescents, and adults (Comstock & Scharrer, 2007; Harris, 2004). People of all ages select and use media for many purposes, including entertainment and distraction, but also exploration of signicant developmental issues pertaining to curiosity, education, popularity, identity, gender roles, and sexuality (Arnett, 1995; Comstock & Scharrer, 2007). Mass Marketing Appearance, status, sexuality, and buying and consuming are, for many reasons (including the power of mass media), very important aspects of life throughout many countries. Consequently, the content of mass media provides daily, multiple, overlapping, and, all too often, unhealthy messages about gender, attractiveness, ideal body sizes and shapes, self-control, desire, food, and weight management (Bordo, 1993; Currie, 1999; Spitzer, Henderson, & Zivian, 1999). These messages sometimes intentionally, sometimes incidentally indoctrinate developing girls and boys with the following easily extracted themes: (a) being sexually attractive is of paramount importance; (b) the sources of ideals about attractiveness (being hot!), style, and the best, most competitive practices for becoming and staying beautiful are obviously located outside the self; and (c) mass media are the most important and inherently enjoyable external source of the information, motivation, and products neces-
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sary to be attractive and fashionable (Ballentine & Ogle, 2005; Labre & Walsh-Childers, 2003). Mass Media and the Thinness Schema Thus, with respect to the cultural foundations of negative body image and disordered eating, even girls (and boys) as young as 4 or 5 have no trouble nding in mass media the raw materials for various maladaptive but entirely normative media-based schemata concerning gender and attractiveness (Levine & Harrison, 2004; Smolak & Levine, 1994, 1996; Smolak & Murnen, 2004, 2007). The thinness schema for females is a set of assumptions, facts, and strong feelings that are organized so as to establish a readiness to think and respond in terms of, for example, the following themes: (1) Women are naturally invested in their beauty assets and thus beauty is a womans principal project in life; (2) a slender, youthful attractive image is really something substantive, because it is pleasing to males and it demonstrates to females that one is in control of ones life; and (3) learning to perceive, monitor, and indeed experience yourself as the object of an essentially masculine gaze is an important part of being feminine and beautiful. Transnational Idol: The EXaltation of Thinness and the Vilification of Fat There is a wealth of evidence from content analyses that the ideal female body showcased on television, in movies, in magazines, and on the internet reects, indeed embodies, the proposition that thin is normative and attractive (Harrison & Hefner, 2006; Levine & Smolak, 1996; Thompson, Heinberg, Altabe, & Tantleff-Dunn, 1999). While (because?) American girls and women are becoming heavier, the current body ideal (idol) for women has become and remains unrealistically thin (Grabe & Hyde, 2006; Sypeck, Gray, & Ahrens, 2004). In fact, mass media are one of many sociocultural sources for the normative prejudice that fat is horrible and ugly, and that getting fatter is a sign of at least 4 of the classic 7 deadly sins extravagance, gluttony, greed, sloth, and, maybe, pride (see, e.g., research by Fouts & Burggraf, 2000, and Klein & Shiffman, 2006;
see reviews by Greenberg, Eastin, Hofschire, Lachlan, & Brownell, 2003, and Puhl & Latner, 2007). Conclusion Criteria 1 and 2 are fullled. Mass media are saturated with potentially unhealthy messages, and citizens of virtually all ages are motivated to use and be engaged with these media on a regular basis.
CRiTERiON 3: CROSS-SECTiONAL CORRELATES OF EXpOSURE TO MASS MEDiA

The presence of a positive correlation between level of exposure to mass media, or to certain types of mass media, and the spectrum of disordered eating is a necessary but not sufcient condition for determination of causal agency. However, absence of a positive correlation negates the argument for causality. Television Consistent with Criterion 3, cross-sectional studies show that the average amount of time adolescent girls spend viewing appearancefocused media such as soap operas and music videos is positively correlated with body dissatisfaction, drive for thinness, internalization of the thin ideal, endorsement of surgery to attain a bust size that is neither small nor too large, and bulimic symptomatology, although there is conicting evidence as to whether this relationship applies to White as well as non-White girls (Borzekowski, Robinson, & Killen, 2000; Botta, 2000; Harrison, 2003; Tiggemman, 2005; Tiggemann & Pickering, 1996). Yet, there is substantial variability in the survey-based empirical ndings (Levine & Harrison, 2004, in press; Murnen, Levine, Groesz, & Smith, 2007). To draw general conclusions, we turn to two recent meta-analytic evaluations of the relationship between exposure to television, body image, and disordered eating. Grabe, Ward, and Hyde (2008) located 12 studies yielding 21 independent effect sizes. Although these investigators did not calculate
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TABLE 1. Media Exposure (Survey-Based) and Disordered Eating in Females: Effect Sizes
Exposure to Magazines Thin Ideal Body Dissatisfaction Wt/Shape control Disordered eating Television Thin Ideal Body Dissatisfaction Wt/Shape control Disordered eating 10 30 17 21 3917 8212 5557 9345 0.02 0.09 0.05 0.06 Age < 18; non-U.S. samples age > 18 age > 18; sample is > 80% White; assessed with EDI-DT assessed with EDI-BU or EAT 16 31 17 20 4606 9398 5927 11834 0.21 0.12 0.19 0.13 Age < 18; non-US samples None of the variables coded Sample is < 80% White; U.S. samples; sample is > 80% White k n r Heterogeneity: r Larger for
Note: All rs (effect sizes) are statistically significant, p < .01. Except for the correlations between TV viewing and disordered eating (ns) and magazine reading and body dissatisfaction (p < .05), all heterogeneity statistics are significant at p < .01. ES = effect size. EDI-DT and EDI-BU = Drive for Thinness and Bulimia subscales, respectively, of the Eating Disorders Inventory. EAT = Eating Attitudes Test.
the 4 individual ds from the complete cross of magazines versus TV and correlational versus experimental design, the ds for the relationship between TV exposure and body dissatisfaction ranged from -.20 to +.61 (n = 11), while the ranges for internalization of the thin ideal and for disordered eating were -.08 to +.43 (n = 4) and +.12 to +.47 (n = 3), respectively. According to Grabe et al. (2008), their meta-analysis denitely supports a positive relationship, with small to moderate effect sizes, between TV exposure and body dissatisfaction, thin-ideal internalization, and self-reported disordered eating. We also conducted a meta-analysis (Murnen et al., 2007; see Table 1). Given that our focus was on media exposure as evaluated in survey-based correlational research, many more unpublished and published studies were identied (k = 30). We found smaller but still statistically signicant correlations (effect size rs range from between +.02 and +.09; ds = +.04 to +.18) for the relationship between TV exposure in general and sets of criterion variables categorized as thin ideal internalization, body dissatisfaction, weight and shape control, and disordered eating.
Magazines According to studies of undergraduate women and adolescent girls, the extent of exposure to magazines that feature and glamorize the thin ideal is positively correlated with disordered eating, even when controlling for the young womans level of personal interest in tness and dieting (Harrison & Cantor, 1997; Thomsen, Weber, & Brown, 2002). A path analytic study by Jones, Vigfusdottir, and Lee (2004) found that for girls 11 through 14 the extent of exposure to appearance-related magazines and to appearance conversations by peers each predicted body dissatisfaction through the mediator of internalization of the thin beauty ideal. Grabe et al.s (2008) meta-analysis identied 18 survey-based studies of the correlates of magazine exposure, yielding 33 effects. The ds for body dissatisfaction ranged from -.22 to +.63 (n = 12), while those for internalization of the thin ideal and for disordered eating were +.03 to +.81 (n = 9) and +.08 to +.63 (n = 9), respectively. Once again, Grabe et al. concluded that, in general, there is a small to moderate positive correlation between magazine exposure and the key variables. We note, however, that the relationship between magazine exposure and thin-ideal internalization may be stronger than that. Of the 9 relevant ds, only one was < +.35, and 6 were > +.55. Our meta-analysis (Murnen et al., 2007) of over 30 studies found that the effect size rs (+.12 to +.21, equivalent to ds between +.24 and +.44) were appreciably higher for magazines than for TV (see Table 1). Consistent with the ndings of Grabe et al., we also discovered that, compared to the other criterion measures, thin ideal internalization was more strongly correlated with magazine reading and TV viewing, especially for children and adolescents under age 18. Conclusion Meta-analytic studies show that there is a small to moderate positive correlation between level of exposure to mass media such as TV and magazines and each of the important triad of body dissatisfaction, thin-ideal internationalization, and disordered eating. This fullls Criterion 3.
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The two meta-analyses (Grabe et al., 2008; Murnen et al., 2007) found a lack of consistency in potential moderators within and across the two types of media. This suggests we have a lot to learn about the relationship between frequency and intensity of naturalistic media exposure and disordered eating.
CRiTERiON 4: LONGiTUDiNAL CORRELATES OF EXpOSURE TO MASS MEDiA

A causal risk factor precedes and predicts development of a problem. Consequently, longitudinal studies are critically important for identifying causal risk factors. In two quite different cultures, the Ukraine and Fiji, institution of a market-based mass media was followed by increases in internalization of the slender beauty ideal and in body dissatisfaction among adolescent girls (Becker, Burwell, Gilman, Herzog, & Hamburg, 2002; Bilunka & Utermohlen, 2002). In Fiji, 3 years after introduction of television the level of disordered eating and self-induced vomiting to control weight was signicantly greater (Becker et al., 2002). Compared to cross-sectional studies, longitudinal research linking media exposure with body image is sparse. The few published studies do suggest that early exposure to thin-ideal television predicts a subsequent increase in body-image problems. For a sample of Australian girls aged 5 to 8, viewing of appearance-focused television programs (but not magazines) predicted a decrease in appearance satisfaction 1 year later (Dohnt & Tiggemann, 2006). For European American and African American girls ages 7 through 12 greater overall television exposure predicted both a thinner ideal adult body shape and a higher level of disordered eating 1 year later (Harrison & Hefner, 2006). The results of both studies were valid regardless of whether the children were heavy, or perceived themselves to be thin or heavy, at the outset of the research. The thrust of these two studies is consistent with Sinton and Birchs (2006) nding that, among the 11-year-old American girls they studied, awareness of media messages about thinness was related to the strength of appearance schemas a year later. The importance of a longitudinal design is revealed in recent studies of older children and young adolescents conducted by
Tiggemann (2006) and by Field and colleagues (1999, 2001, 2008). In a sample of 214 Australian high school girls (mean age = 14), Tiggemann found that the only measure of television exposure, including total hours of exposure, to produce meaningful cross-sectional and longitudinal correlations was the self-reported extent of watching soap operas. Cross-lagged correlational analyses showed that Time 1 exposure to soap operas predicted, to a small but signicant degree, internalization of the slender ideal and level of appearance schema at 1-year follow up (Time 2). Time spent reading appearance-oriented magazines, but not other magazines, at Time 1 predicted, also to a small but signicant degree, Time 2 levels of internalization, appearance schema, and drive for thinness. However, none of the media exposure variables was a signicant longitudinal predictor of body dissatisfaction. Moreover, hierarchical regressions controlling for Time 1 level of each of the four criterion variables (e.g., internalization) found that none of the media exposure measures added signicantly to prediction of the Time 2 criteria. Although Field and colleagues used only single-variable measures of media exposure, their longitudinal research also casts doubt on exposure as a causal risk factor for older children and younger adolescents. Field et al. investigated a sample of over 6900 girls who were ages 9 through 15 at the 1996 baseline. Preliminary cross-sectional work did produce the expected positive linear association between frequency of reading womens fashion magazines and intensity of weight concerns (Field et al., 1999). However, subsequent longitudinal research revealed that over a 1-year period the key predictor of the development of weight concerns and frequent dieting was making a lot of effort to look like same-sex gures in the media (Field et al., 2001, p. 54). A 7-year follow-up showed that initiation of binge-eating, but not purging, in (now) adolescent and young adult females was predicted independently by frequent dieting and by Time 2 (1997) level of attempting to look like persons in the media (Field et al., 2008). The only longitudinal investigation of young adult women we could locate was Aubreys (2006) 2-year panel study of college-age women. In support of Criterion 4, the extent of exposure to sexually objectifying media at Time 1 predicted level of self-objectication at Time 2, especially in women with low self-esteem. Measures of the tendency to self-objectify are positively correlated with eating disorder symptoms such as misperceptions of weight and shape, body
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shame, drive for thinness, and restrictive dieting (see, e.g., Smolak & Murnen, 2004; Tylka & Hill, 2004). Conclusion Evidence from a very small number of longitudinal studies indicates that for children and very young adolescents, extent of media exposure does appear to predict increases in negative body image and disordered eating. Tiggemanns (2006) suggests that by early adolescence the causal risk factor is not media exposure, or even internalization of the slender beauty ideal, but rather the intensity and extent of core beliefs and assumptions about the importance, meaning, and effect of appearance in an individuals life (p. 528). Field et al.s extensive work concurs, pointing to schematic feature of paying attention to, and trying to look like, models and celebrities in the mass media. In all, there is little support for Criterion 4 as it applies to adolescence, and preliminary but inconclusive support for this criterion in regard to children and college students.
CRiTERiON 5: EXpERimENTAL MANipULATiON OF MEDiA EXpOSURE EXpERimENTAL EViDENCE: LAbORATORY RESEARCh AND ThE CONTRAST EFFECT
Laboratory experiments cannot settle the question of correlation and causal agency in a developmental sense. However, experimentation can help determine whether, as predicted by a causal risk factor model, concentrated media exposure actually makes girls and women feel immediately worse or better about their bodies and their selves. In a meta-analysis of 25 published and unpublished experiments appearing between 1979 and 2000, Groesz, Levine, and Murnen (2002) examined the effects of experimental exposure to media content on body dissatisfaction in female samples. Thirty-ve (81%) of the 43 d values were negative, and the overall d value was -0.31 (r = -.65). Compared to participants randomly assigned to control conditions, participants exposed to thin-ideal images from the media experienced a moderately large drop in body satisfaction. The aver-
age effect size was slightly greater for participants not yet in college (d = -.36), suggesting heightened sensitivity among adolescents. Grabe et al.s (2008) meta-analysis identied an additional 19 experimental studies of magazine-based images and an additional 8 studies of images from TV shows and commercials. Sixteen of 19 magazine studies and all of the TV studies were published after the Groesz et al. (2002) article went to press. Of the 24 magazine effect sizes involving body dissatisfaction, half were over -.45 and four were greater than -1.00. For the 9 TV effect sizes, the range was -.15 to -1.63, and four were greater than -.45. Grabe et al. (2008) also reported that, although there was substantial heterogeneity, the ds for experimental effects (across magazines and TV) on internalization and eating behaviors and beliefs were -.21 and -.36, respectively. Conclusion The meta-analyses by Groesz et al. (2002) and Grabe et al. (2008) provide strong support for Criterion 5. In this regard, multimethod studies by Hargreaves and Tiggemann (2002, 2003, 2004) in Australia produced compelling evidence for the contention that mass media have negative and cumulative effects on body image in girls and young women. The adolescent girls whose body image was most negatively affected by experimental exposure to 20 television commercials featuring the thin ideal tended to have greater levels of body dissatisfaction and drive for thinness 2 years later, even when initial level of body dissatisfaction was controlled statistically. The most vulnerable girls may well have a self-schema dominated by the core importance of physical appearance. In a study of girls ages 15 through 18 Hargreaves and Tiggemann (2002) found that appearance-focused TV commercials did activate an appearancerelated self-schema, as reected in several measures of cognitive set. Moreover, as predicted, appearance-focused commercials generated greater appearance dissatisfaction for those girls who began the study with a more extensive, emotionally charged, self-schema for appearance. Interestingly, the negative impact of the thin-beauty ideal in television commercials was, unlike previous ndings with magazine images, unaffected by either the girls initial level of body dissatisfaction (see Groesz et al., 2002) or whether their viewing
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style was more personal (self-focused) or more detached (imagefocused; see next section). Positive (Assimilation) Effects. Durkin and Paxton (2002) found that 32% of the 7th grade girls and 22% of the 10th grade Australian girls who were exposed to images of attractive models from magazines exhibited an increase in state body satisfaction. Similarly, two studies of Canadian college students found that restrained eaters showed moderate to large increases in body satisfaction following exposure to similar magazine images, whereas unrestrained eaters had very large decreases in body satisfaction (Joshi, Herman, & Polivy, 2004; Mills, Polivy, Herman, & Tiggemann, 2002). Two studies in the United States by Wilcox and Laird (2000) suggest that young women who focus on the slender models in magazines while defocusing attention on themselves are more likely to identify with the models and thus to feel better about their own bodies. Conversely, women who self-consciously divide their attention between the models and themselves are more likely to evaluate themselves and reach a conclusion that leaves them feeling inferior and worse. This nding is supported by research showing that selfevaluative processes, as opposed to self-improvement motives, are more likely to reect and activate upward social comparison processes, which themselves tend to generate negative feelings about ones body (Halliwell & Dittmar, 2005). Pro-Ana Web Sites. The internet offers many pro-anorexia (proana) and pro-bulimia (pro-mia) web sites. Some of the most prominent pro-ana sites deantly and zealously promote AN as a sacred lifestyle rather than a debilitating psychiatric disorder (Norris, Boydell, Pinhas, & Katzman, 2006). Their thinspirational images of emaciation and their explicit behavioral instructions for attaining and sustaining the thin ideal are intended to reinforce the identity and practices of those already entrenched in AN or BN. If concentrated exposure to typical images of slender models have negative experimental effects, then we might well expect the images and messages from pro-anorexia web sites to have even more negative effects. Two recent experiments by Bardone-Cone and Cass (2006, 2007) examined the effects of a web site that they constructed to feature the prototypical content of pro-ana sites. As predicted, exposure to this site had a large number of negative effects on young women, independent of their dispositional levels of thin ideal inter-
nalization and disordered eating. At present, we do not know what effects pro-ana and pro-mia sites have on the adolescent girls and young women who avidly seek them out because they already have a full-blown eating disorder.
CRiTERiON 6: EXpERimENTAL EViDENCE: PREVENTiON STUDiES

Media Literacy: Laboratory Investigations If media effects are a causal risk factor, then reduction or elimination of negative media inuences should reduce or prevent negative body image and other processes that eventually result in eating disorders. One way to test this proposition is to evaluate the impact of interventions designed to promote media literacy. Media literacy (ML) is a set of knowledge, attitudes, and skills that enable people to work together to understand, appreciate, and critically analyze the nature of mass media and ones relationships with them (Levine & Harrison, 2004, in press; Levine & Piran, 2004; Levine & Smolak, 2006). Systematic investigations of ML can be categorized into analog laboratory studies, brief interventions, and longer, more intensive programs. Analog Studies This research has been reviewed in detail elsewhere (Levine, Piran, & Stoddard, 1999; Levine & Smolak, 2006, chapter 13; Levine & Smolak, 2008). Several controlled experiments show that very brief written or video interventions can inoculate college-age women, including those who already have a negative body image, against the general tendency to feel worse about their bodies and themselves after viewing slides or video containing media-based images of the slender beauty ideal. The most effective ML inoculation highlights the clash between the articial, constructed nature of the slender, awless, model look versus two stark realities: (1) the actual shapes and weights of females (and males) naturally vary a great deal across a population; and (2) dieting to attain an ideal and
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glamorous weight/shape that is unnatural for a given individual has many negative effects, including risk for an eating disorder. Brief Curricular Programs Three doctoral dissertations completed in the U.S. from 1998 to 2000 taught ML to girls ages 9 through 14 (see Levine & Smolak, 2006, chapter 13). The content of these programs varied, but, consistent with the ndings of analog research, each emphasized the narrow and constructed nature of beauty ideals, as well as the futility and health costs of seeking to actualize this articial perfection. These projects demonstrated that ML lessons ranging in length from 40 to 135 minutes can have a number of positive effects lasting several months, such as improving girls body image and reducing both the glorication of thinness and social comparison tendencies. Several programs for high-school and college-age females used slide presentations or Jean Kilbournes video Slim Hopes (http:// www.mediaed.org/videos/MediaAndHealth/SlimHopes) to help participants consider the history of changing, but consistently restrictive, beauty ideals and then to answer some fundamental questions: Do real women look like the models in advertising? Will buying the product being advertised make me look like this model? These programs emphasize how fashion models, working with the production staffs of magazines and movies, use cosmetic surgery, computer graphics, and other technologies to construct idealized images. Participants are encouraged to explore how these manipulations are carefully orchestrated to stir up the desire to purchase products, many of which will supposedly reduce the discrepancy between such unreal, perfect images versus the body shapes and weights of normal, healthy females. These ML programs are brief, so positive effects are necessarily limited. Nevertheless, it is noteworthy that they tend to reduce, at least in the short run, one important risk factor for disordered eating (Thompson & Stice, 2001): internalization of the slender beauty ideal.
Intensive Programs Well-controlled studies of multi-lesson, multifaceted media literacy programs that unfold over 1 to 2 months have shown that media literacy training can help girls and boys ages 10 through 14 to reduce risk factors such as internalization of the slender or muscular ideal, while increasing the potentially protective factors of self-acceptance, self-condence in friendships, and condence in their ability to be activists and thus affect weight-related social norms (Levine & Smolak, 2006). In addition to spending considerable time working on the same components as those in the analog and brief interventions, intensive ML programs address the process and costs of social comparison. They also get participants involved in working within their ML groups, their school, and their larger community to translate their increasing literacy into peer education, consumer activism, and creating and promoting new, healthier media. Recent investigations with college students also show ML to be a promising form of prevention (Levine & Harrison, in press; Levine & Smolak, 2007, 2008). For example, Watson and Vaughn (2006) developed a 4-week, 6-hour intervention consisting of psychoeducation about the nature and sources of body dissatisfaction; group-based content analysis of beauty ideals in popular womens magazines; discussion of media ideals and beauty enhancement techniques; and a brief cognitive intervention designed to help participants dispute negative beliefs and feelings activated by media images of the thin ideal. Compared to a 1-day, 90-min version of this intervention, a one-time viewing of a 34-min media literacy lm, and a no-intervention control, the extended intervention was the most successful in reducing the following risk factors for disordered eating: unhealthy social attitudes, internalization of the slender ideal, and body dissatisfaction. Conclusion At present there have been no direct, long-term studies of whether media literacy in particular can prevent development of negative body image and the spectrum of disordered eating. At this point it seems fair to say that there is some encouraging evidence for
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Criterion 6 in that (1) brief forms of a critical social perspective can mitigate the immediate negative effects of exposure to the thin ideal; and (2) more systematic interventions over days or weeks can reduce one important risk factor: internalization of the slender ideal.
CRiTERiON 7: SUbJECTiVE INFLUENCE: MOTiVES, PRESSURES, AND IDEALS

One sensible way to add to our understanding of media effects is to ask people about their experiences with media pressures and inuences. Desiring the Medias Ideal Shape Field et al.s (1999) survey of nearly 550 working class girls ages 11 through 19 revealed that almost 70% reported that the pictures in magazines have an inuence on their conception of the perfect body shape. Over 45% indicated that those images motivated them to lose weight, and the greater the frequency of reading womens magazines, the more likely these adolescent girls were to report being inuenced to think about the perfect body, to be dissatised with their own body, to want to lose weight, and to diet. As noted previously, subsequent cross-sectional and longitudinal research by Field and colleagues revealed that wanting to look like celebrities and models in the media was a strong predictor of weight concerns, dieting behavior, and binge eating. A similar study of nearly 800 Australian adolescent girls found that 88.5% said they desired the slender media-promoted ideal body shape (Grigg, Bowman, & Redman, 1996). Further, those who denitely and enthusiastically desired this shape had signicantly higher levels of extreme dieting and disordered eating. This nding is quite consistent with the results of Levine, Smolak, and Haydens (1994) survey of nearly 400 American girls ages 10 through 14. In this study the extent to which magazine articles and advertisements were important to a young adolescent girls concept of the perfect body and how to obtain it was very strongly correlated with greater investment in thinness, use of weight management techniques, and level of disordered eating. In a survey of college women Harrison (1997) found
that interpersonal attraction (a composite variable representing liking, wanting to be like, and feeling similar) to thin media personalities predicted disordered eating beyond mere media exposure. Internalization of the Slender Ideal and Perceived Media Pressures Cross-Sectional Studies. Social-cognitive models of media inuence, including the prominent cultivation theory (see Levine & Smolak, 1996, for an application to body image and eating disorders), argue that normative beliefs about the social world, as emphasized in mass media, become beliefs and attitudes about the self. The most valid and widely used measure of both passive awareness, and active internalization, of the medias thin body ideal for females is the Sociocultural Attitudes Toward Appearance Questionnaire (SATAQ). In the original version seven of the eight items forming the internalization factor (subscale) pertained directly to the mass media (e.g., I tend to compare my body to people in magazines and on TV; Smolak, Levine, & Thompson, 2001). Two validation studies of the most recent version (SATAQ-3; Thompson, van den Berg, Roehrig, Guarda, & Heinberg, 2004) demonstrated that, for undergraduate women, self-reported levels of perceived pressure from media and of internalization of the slender beauty ideal were (1) highly correlated with each other; and (2) strong predictors of precursors of disordered eating. In addition, as hypothesized, scores on those two subscales, as well as that assessing awareness of the medias thin ideal, all signicantly differentiated eating disordered women from among nondisordered controls. Engeln-Maddox (2006) recently found that, as predicted, some young women have the clear and strong expectation that looking like a media ideal will transform their lives in multiple, positive ways. Of that group, those who have internalized the media ideal of slender beauty tended to have greater body dissatisfaction. Internalization of the thin ideal is certainly understandable and probably rational and adaptivein the current cultural context (Gordon, 2000; Smolak & Levine, 1996). However, it is far from harmless. For example, Smolak et al. (2001) found that, in 200 girls ages 11 through 14, only 7% of the variation in weight control techniques was accounted for by body mass. However, when the SATAQ awareness and internalization subscales were added to the
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regression equation, variance accounted for rose to 48%. Further, in the nal equation using all three variables, only internalization was a statistically signicant predictor of weight control behaviors. A recent study of 14 to 16-year-old Swiss girls (Knauss, Paxton, & Alsaker, 2007) also found that internalization, perceived pressure from the media, and body dissatisfaction were highly intercorrelated (all rs > .61). This nding adds to a large body of research demonstrating three key facts for girls and young women ages 8 through 22. First, perceived media pressure to be thin is correlated with increased weight- and body-dissatisfaction (Cusumano & Thompson, 2000; Van den Bulck, 2000). Second, this experience of pressure involves exposure to, and internalization of, the slender ideal, which in turn increases the probability of various eating and emotional problems (Blowers, Loxton, Grady-Flesser, Occhipinti, & Dawe, 2003; Cusumano & Thompson, 1997; Thompson & Stice, 2001; Thompson et al., 2004). Third, in support of these correlationbased ndings, level of thin-ideal internalization has consistently been identied in experimental studies as a moderator of media effects. In fact, several studies found that only high internalizers experience heightened body dissatisfaction after exposure to thin media models (Dittmar & Howard, 2004; Halliwell & Dittmar, 2004; Heinberg & Thompson, 1995). The medium to large effect sizes for the cross-sectional correlation of internalization of the media-based thin ideal and negative body image seen in the Smolak et al. (2001) and Knauss et al. (2007) studies appear to be representative of a general trend. Cafri, Yamamiya, Brannick, and Thompsons (2005) meta-analysis of 31 effect sizes from 18 studies found an r of .50 (d = 1.15) for thin ideal internalization and negative body image, which was signicantly greater than the r of .29 (d = .61, based on 25 effect sizes) for awareness of the thin ideal. Although it is based on only 7 effects from 6 studies, the composite effect size for the relationship between pressures experienced from the media and body image was nearly the size of that for internalization, r = .48 (d = 1.09). Longitudinal Studies. It is difcult to evaluate the status of evidence from longitudinal studies of internalization of the media-based thin ideal. The Cafri et al. (2005) meta-analysis included only crosssectional studies, citing a paucity of longitudinal research with the SATAQ. Stices own measure of ideal body internalization, while
reliable and valid, is not directly connected to media ideals, and its items load on the SATAQ awareness factor, not the internalization factor (Thompson et al., 2004). With those caveats in mind, Stices (2002) meta-analysis of 8 longitudinal studies (including 6 of his own) found that, over follow-up periods of 9 months to 5 years, thin-ideal internalization did predict increases in body dissatisfaction, dieting, and bulimic pathology. For example, Stice and colleagues have found that both internalization of the slender beauty ideal and perceived pressure to be thin (emanating from family, friends, dating partners, and media) predicted signicant, short-term increases in body dissatisfaction in girls ages 14 to 17. These factors were also concurrently associated with body dissatisfaction, which in turn predicted increases in dieting and negative affect (Stice, 2001; Stice & Whitenton, 2002; but see Bearman, Presnell, Martinez, & Stice, 2006). Conclusion Several other longitudinal studies by Stice and colleagues (see, also, e.g., McCabe & Ricciardelli, 2005) cast some doubt on the causal role of mass media. For example, Stice (1998) found that neither perceived pressure from media nor observational learning of unhealthy weight-shape concerns played a role in the onset of bulimic symptoms in adolescents and young adults. Nevertheless, Stices (2002) own meta-analysis of longitudinal studies and the meta-analysis of cross-sectional studies by Cafri et al. (2005) collectively provide evidence consistent with Criterion 7. More longitudinal research is needed, but it appears that, in support of media as a causal risk factor, the following are consistent predictors of negative body image and, to some extent, disordered eating: awareness of the importance of the thin ideal in society; internalization of that ideal; and perceived pressure from the media to be thin. Presumed Influences on Others In thinking about the subjective experiences of media pressures and inuences, it is worth examining more closely the construct of awareness of the thin ideal. The perception that peers and people
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in general (e.g., employers) are inuenced by thin-ideal media can itself be a form of subjective pressure that motivates young people to diet in an attempt to meet that ideal (Milkie, 1999). In fact, it appears that the mere presumption of media effects on others may exert its own effect, at least on older females. Parks (2005) path analytic study of over 400 undergraduates found that the more issues of beauty and fashion magazines a young woman reads per month, the greater the perceived prevalence of the thin ideal in those magazines. The greater this perceived prevalence, the greater the presumed inuence of that ideal on other women; and in turn the greater the perceived inuence on self, which predicted the desire to be thin. More research of this type with younger samples is needed to test this cultivation of perceived social norms hypothesis: Greater consumption of beauty and fashion magazines or of appearance-focused TV and internet content will foster stronger, more inuential beliefs that the slender ideal is ubiquitous and normative for peers. This logic will, in turn, be a source of pressure and inspiration for the persons own desire to be thin(ner).
CONCLUSiONS AND RECOmmENDATiONS

Are Mass Media a Causal Risk Factor? Based on the weight of the empirical evidence in relation to criteria 1, 2, 5, and 7, a defensible conclusion is that the content, use, and experience of mass mediain and of themselves, and in the context of synergistic messages from peers, parents, and coachesrenders them a possible causal risk factor. Further, although the strength of the relationship is relatively weak to modest, the extent of exposure to mass media in general and to thinness-depicting media (Harrison & Cantor, 1997) in particular is correlated concurrently and prospectively with negative body image and disordered eating (criteria 3 and 4). In fact, because the hypothesized paths of inuence between media exposure (engagement) and the outcomes of interest are mediated and moderated by several variables, we should probably expect effect sizes that are modest at best. Stronger evidence (criterion 5) for a causal relationship between mass media, negative body image, and disordered eating comes from the extensive experimental literature (Grabe et al., 2008; Groesz et al., 2002).
And, yet, in light of the important research by Tiggemann (2006) and by Field et al. (1999, 2001, 2008) there remains a need to demonstrate more conclusively that either (1) direct engagement with mass media or (2) media effects that are mediated by parents and/ or peers precede development of the more proximal risk factors such as negative body image (criterion 4). Similarly, despite the preliminary but encouraging evidence from media literacy interventions of varying intensities, to date no studies have tested the deceptively simple proposition (see criterion 6) that prevention programs can increase media literacy and thereby reduce or eliminate negative media inuencesand in turn reduce or delay development of proximal risk factors (e.g., internalization of the thin ideal, social comparison tendencies) and attendant outcomes such as EDNOS. In sum, of the 7 criteria, there is strong evidence for Criteria 1, 2, 5, and 7, and solid evidence for Criterion 3. However, the evidence for two of the most important criteria4 (factor precedes and predicts) and 6 (reducing the risk factor prevents the disorder)is encouraging but complicated, preliminary, and inconclusive. Consequently, engagement with mass media is probably best considered a variable risk factor that might well be later shown to be a causal risk factor (Kraemer et al., 1997; Stice, 2002). What We Need to Know But Dont Know Yet This review suggests ve principal gaps in our knowledge about mass media as a potential causal risk factor for the spectrum of disordered eating. The rst three are derived from the conclusion immediately above. First, there is a need for longitudinal research (see, e.g., Tiggemann, 2006) that examines the predictive validity of media exposure, motives for media use, and the subjective experience of media inuences. Second, as noted by an anonymous reviewer of this manuscript, there remains a dearth of information about whether it is the thinness-depicting aspects of magazine, TV, and other media content that exert negative effects. Thus, surveybased longitudinal investigations of media exposure should strive to determine as precisely as possible not only frequency and intensity of consumption, but also the nature of the images, articles, programs, and such to which participants are exposed (again, see, e.g., Tiggemann, 2006). Third, there is a need for prevention research
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that capitalizes on and extends the promising ndings of extended media literacy interventions. The fourth research direction concerns the relationship, particularly from a developmental perspective (Smolak & Levine, 1994, 1996; see also Levine et al., 1994), between engagement with mass media and other causal risk factors. We need to learn much more about the ways in which body image disturbance and disordered eating are inuenced by perceived social norms (Park, 2005), by the conuence of media, family, and peer messages about weight and shape (Levine et al., 1994; Peterson, Paulson, & Williams, 2007), and by indirect media exposure, such as acquisition of body ideals and eating behaviors via interactions with family, peers, and signicant adults (e.g., coaches) who learned them directly from television and magazines (Clark & Tiggemann, 2006; Harrison & Hefner, 2006; Krayer, Ingledew, & Iphofen, 2007). Direct media effects may be small to modest (Groesz et al., 2002; Murnen et al., 2007), but the combination of direct and indirect effects, that is, the cumulative media effect, may be substantial (Harrison & Hefner, 2006; Levine et al., 1994). Finally, the transactions between the developing child (or adolescent) and media constitute another set of important research questions to address. A cross-sectional study by Gralen, Levine, Smolak, and Murnen (1990) indicated that the correlates of negative body image and disordered eating in young adolescents tended to be more concrete and behavioral (e.g., onset of dating, pubertal development, teasing about weight and shape), whereas the predictors in middle to later adolescence were more psychological, such as the experience of a discrepancy between perception of ones own shape versus an internalized ideal shape. More recently, a longitudinal study by Harrison (2000) found that the number of hours that children ages 6 through 8 watched television per week predicted an increase in disordered eating without predicting idealization of a slender body. This raises the interesting and testable proposition that exposure to various salient media messages, including those contained in the onslaught of advertisements for diet-, tness-, and weight-related products, might have little effect on the thinness beliefs of young children, while leading them to vilify fat, glamorize dieting as a grown-up practice, and yet still think of fattening, non-nutritious foods as desirable in general and useful for as-
suaging negative feelings (Harrison, 2000; Harrison & Hefner, 2006; Levine & Harrison, in press). With respect to the transformation of relevant psychological processes over late childhood, early adolescence, and later adolescence, Thompson and colleagues have developed and validated various features of the Tripartite Model in which media, family, and peers inuence directly internalization of the slender beauty ideal and social comparison processes (Keery, van den Berg, & Thompson, 2004; Thompson et al., 1999; van den Berg et al., 2007). This valuable model reminds us that, after nearly 25 years of research on media and body image, we still know relatively little about the automatic, intentional, and motivational processes involved in the role of social comparison in media effects (Halliwell & Dittmar, 2005; Levine & Harrison, 2004; Trampe, Stapel, & Siero, 2007). Basic questions remain: What dispositional and situational factors determine when people will make upward social comparisons with highly dissimilar fashion models whose image has been constructed by cosmetic surgeons, photographers, and computer experts? And under what circumstances will such comparisons result in negative effects (contrast) or positive effects (assimilation)? Multidimensional models such as Thompsons also emphasize the need to determine when and how in the developmental process a number of important mechanisms such as appearance schematicity, thin-ideal internalization, social comparison processes, and selfobjectication begin to play key roles (see also Tiggemann, 2006). Further experimental and longitudinal studies of these mediators will be a very positive step toward understanding the emergence, particularly around puberty, of attentiveness and vulnerability to thin-ideal media images and to the many other potentially negative inuences that emanate from family, peers, and inuential adults such as coaches (Smolak & Levine, 1996; Thompson et al., 1999). How Can We Go About Learning What We Need to Know? Since the publication of our earlier reviews (see, e.g., Groesz et al., 2002; Levine & Harrison, 2004; Levine & Smolak, 1996), there has been an exciting, if daunting, upsurge in studies of the role of various media in the development of negative body image, weight and
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TABLE 2. Important Methodological Issues in the Improvement of Media Effects Research

Articulation, in text and with visual figures, of the model demonstrating how mass media influences mediators and outcomes, and how mass media is influenced by moderators such as family and peer factors Attention to validity of constructs such as media exposure and state body dissatisfaction Careful consideration of demand characteristics in regard to use of pre-post designs to investigate phenomena (e.g., impact of pictures of the slender beauty ideal) that are wellknown to participants Development of control conditions to rule out confounds, such as that between the slenderness (or muscularity) of a model in an advertisement and the models perceived attractiveness In investigations of media literacy-as-prevention, careful measurement of the chain of mediators (was literacy increased? Was internalization of the thin ideal reduced?) and arrangement for long-term follow-up to determine if onset of target problems was indeed prevented. Precise description, in the Method section, of how ethical issues were addressed, notably the risks posed by (1) experiments that present vulnerable people with images known to have negative effects; (2) the deceptions that are often necessary to address threats to internal validity; and (3) the desirability paradox recently identified in connection with media literacy training (Austin, Pinkleton, & Funabiki, 2007)
shape management, and disordered eating (see Grabe et al., 2008). This dramatic growth has brought with it a number of important improvements in attention to methodology. We encourage researchers to continue to follow the lead of research programs such as those of (in alphabetical order) Dittmar and Halliwell, Durkin and Paxton, Hargreaves and Tiggemann, Harrison, Mills, Neumark-Sztainer, Stice, and Thompson in paying careful attention to the methodological issues listed in Table 2. Stronger methodology, in connection with clearly articulated theories and well-developed, practical interventions is critically important for clarifying whether mass media are in fact a causal risk for the spectrum of disordered eating.
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Journal of Social and Clinical Psychology, Vol. 28, No. 1, 2009, pp.

LEVINE AND MURNEN

Media, Negative Body Image and Disordered Eating

10 LEVINE AND MURNEN

MEDiA AS A CAUSE OF WhAT?WhAT iS TO BE EXpLAiNED?

MEDIA, NEGATIVE BODY IMAGE AND DISORDERED EATING

12 LEVINE AND MURNEN

CRiTERiA FOR EVALUATiNG ThE STATUS OF A MASS MEDiA AS A CAUSE

MEDIA, NEGATIVE BODY IMAGE AND DISORDERED EATING

14 LEVINE AND MURNEN

CRiTERiA 1 AND 2: CONTENT AND EXpOSURE

MEDIA, NEGATIVE BODY IMAGE AND DISORDERED EATING

16 LEVINE AND MURNEN

CRiTERiON 3: CROSS-SECTiONAL CORRELATES OF EXpOSURE TO MASS MEDiA

MEDIA, NEGATIVE BODY IMAGE AND DISORDERED EATING

18 LEVINE AND MURNEN

MEDIA, NEGATIVE BODY IMAGE AND DISORDERED EATING

CRiTERiON 4: LONGiTUDiNAL CORRELATES OF EXpOSURE TO MASS MEDiA

20 LEVINE AND MURNEN

MEDIA, NEGATIVE BODY IMAGE AND DISORDERED EATING

22 LEVINE AND MURNEN

MEDIA, NEGATIVE BODY IMAGE AND DISORDERED EATING

24 LEVINE AND MURNEN

CRiTERiON 6: EXpERimENTAL EViDENCE: PREVENTiON STUDiES

MEDIA, NEGATIVE BODY IMAGE AND DISORDERED EATING

26 LEVINE AND MURNEN

MEDIA, NEGATIVE BODY IMAGE AND DISORDERED EATING

CRiTERiON 7: SUbJECTiVE INFLUENCE: MOTiVES, PRESSURES, AND IDEALS

28 LEVINE AND MURNEN

MEDIA, NEGATIVE BODY IMAGE AND DISORDERED EATING

30 LEVINE AND MURNEN

MEDIA, NEGATIVE BODY IMAGE AND DISORDERED EATING

CONCLUSiONS AND RECOmmENDATiONS

32 LEVINE AND MURNEN

MEDIA, NEGATIVE BODY IMAGE AND DISORDERED EATING

34 LEVINE AND MURNEN

MEDIA, NEGATIVE BODY IMAGE AND DISORDERED EATING

TABLE 2. Important Methodological Issues in the Improvement of Media Effects Research

36 LEVINE AND MURNEN

MEDIA, NEGATIVE BODY IMAGE AND DISORDERED EATING

38 LEVINE AND MURNEN

MEDIA, NEGATIVE BODY IMAGE AND DISORDERED EATING

40 LEVINE AND MURNEN

MEDIA, NEGATIVE BODY IMAGE AND DISORDERED EATING

42 LEVINE AND MURNEN

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