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Social Comparison and Its Relation to Body Dissatisfaction in Bulimia Nervosa: Evidence From Eye Movements

From the Department of Clinical Psychology and Psychotherapy, Institute for Psychology, University of Freiburg, Freiburg, Germany.

Address correspondence and reprint requests to Jens Blechert, Department of Clinical Psychology and Psychotherapy, Institute for Psychology, University of Freiburg, Engelbergerstrasse 41, 79106 Freiburg, Germany. E-mail: Blechert{at}psychologie.uni-freiburg.de

Objective: To determine the role of social comparison for body dissatisfaction in bulimia nervosa (BN). Previous research suggested that exposure to media content idealizing thin body shape decreases body satisfaction, particularly in women with eating disorder symptoms. This might be due to the negative outcome of social comparisons with media models, and women with eating disorders might be particularly susceptible because they engage in upward social comparison more frequently than women without these symptoms. However, no study has yet explored both upward (i.e., toward more attractive others) and downward (i.e., toward less attractive others) social comparisons and their impact on body dissatisfaction in a clinical eating disorder and healthy controls.

Methods: We presented patients with BN (n = 20) and healthy controls (HC) (n = 22) with slides comprising a digitized image of their own body alongside comparison bodies with higher and lower body mass indices (BMIs) while measuring their eye movements.

Results: As hypothesized, patients with BN fixated longer on comparison bodies with lower BMIs than controls, with the reverse pattern for high BMI bodies. This gaze pattern suggests that upward comparisons were more prevalent in the BN group. Furthermore, upward comparisons were related to a drop in body satisfaction in the BN group.

Conclusions: Disadvantageous social comparison strategies might be related to body dissatisfaction and therefore to the maintenance of BN.

Key Words: bulimia nervosa • eye movements • eye tracking • social comparison • body image disturbance • body dissatisfaction

Abbreviations: BISS = Body Image State Scale; BMI = body mass index; BN = bulimia nervosa; DSM-IV = Diagnostic and Statistical Manual of Mental Disorders, 4th Edition; EDE-Q = Eating Disorder Examination Questionnaire; HC = healthy controls.