Sociocultural etiologies of bulimia nervosa (and studies)

Travis DixonAbnormal Psychology, Social and Cultural Psychology

The media (TV, magazines, films, music videos, internet, etc.) is one socio-cultural factor that could influence the development of eating disorders such as bulimia nervosa.

Background Information

Research has shown that body dissatisfaction is widespread amongst Western teenage girls and adult women. Furthermore, body dissatisfaction has been found to be an independent predictor of disordered eating. This makes it a significant risk factor in the development of Bulimia Nervosa (BN) and other eating disorders.

Body dissatisfaction: being unhappy with one’s body. It’s usually measured by comparing self-ratings of “ideal body shape” compared with “current body shape.”

But why is body dissatisfaction increasing? This has been the subject of numerous research studies that aim to establish a correlation, if not a causal link, between body dissatisfaction and socio-cultural factors, such as exposure to media.

The study described below attempted to use sophisticated and thorough statistical analysis to assess how strongly the association was between exposure to the media and body dissatisfaction, as well as to determine factors that could predict body dissatisfaction based on gender.  

Spanish Teenagers, The Media and Body Dissatisfaction: Methodology and Results

The research used a cross-sectional design and gathered 1,165participants from 52 high schools from across Spain. The students were aged 14-16 years old (M=14.9). The participants’ ages, weights and Body Mass Indexes (BMIs) were recorded. The data gathered was processed with statistical software in order to determine the strength of the relationships between the IVs (e.g. BMI, gender, body dissatisfaction, extent of exposure to TV/magazines, self-esteem, etc.).

The researchers gathered a range of data using questionnaires and inventories on the following areas:

Exposure to Mass Media: This questionnaire sought to find out how much TV the teenagers watched and the nature of the TV shows (e.g. sitcoms, documentaries, cartoons etc.), how many magazines they read and the nature of those magazines (e.g. fashion, fitness, hobbies etc), and how exposed the teenagers were to media (i.e. TV and magazines) related to body image (e.g. beauty, sports, health).

Disordered Eating Patterns: Data on disordered eating patterns was also gathered, using an “Eating Attitudes Test”. This involves answering questions regarding eating behaviours (e.g. avoiding eating when hungry, vomiting after eating) using a 6-point Likert scale, ranging from never to always.

Social Comparison Of Body Image: The extent to which the participants compared themselves to others (social comparison) was measured using a “Physical Appearance Comparison Scale” that was a brief questionnaire that only had five items. Another 6 point Likert scale was used as above. An example question was: “At parties or other social events, I compare my physical appearance to the physical appearance of others”.

Awareness and Idealization of Thin Ideal: Whether or not the teenagers were aware of an idealization of thinness, and if they believed in that idealization as well (i.e. it was internalized) was measured using another questionnaire of 21 statements. The participants selected a response ranging from total agreement to total disagreement. An example of a question was: “I believe that clothes look better on thin models”.

Level of Self-Esteem: Self-esteem was measured using another questionnaire consisting of 10 items that assessed the individual’s general attitude towards themselves. An example question is: “On the whole, I am satisfied with myself.”


Interestingly, the results showed that there was no correlation between the total levels of exposure to the media (TV and magazines) and body dissatisfaction. However, females who were dissatisfied with their bodies were more exposed to media related to topics such as dieting, fitness, beauty, health and music videos. This is similar to previous research studies. 

The results did show statistically significant correlations between body dissatisfaction and the following factors:

  • higher BMIs
  • disordered eating behaviours
  • awareness and internalization of the thin ideal
  • social comparison of physical appearance, and lower self-esteem.

So this might suggest that being exposed to image-related media could lead to the risk factors associated with BN. However, it is important to note that this is correlational, not causal; could the relationship work in the opposite direction? That is to say, could it be that those people already with those beliefs and behaviours may be more likely to expose themselves to image-related media.

The results showed that there was a lower percentage of males who were dissatisfied with their bodies (5.4%) than females (16.4%); this could be used to hypothesize explanations for gender differences in prevalence of disorders.

Additional Research: Natural Experiment in the Fiji Islands – The Introduction of TV

Occasionally there are developments that occur naturally in the world that make for opportune research moments. The introduction of TV to an isolated rural area of western Fiji (on the island of Viti Levu) provided researchers just such an opportunity to investigate the effects of the introduction of TV on adolescent girls’ eating attitudes and behaviours. Until this time, no such study had been conducted.

The researchers gathered before and after data using a combination of a 26-item eating attitudes test and semi-structured interviews that used open-ended questions to gather narrative data on the girls’ experiences of watching TV and their ideas about body image.

The results showed that indicators of disordered eating were more prevalent after the introduction of TV. The qualitative data gathered in the interviews also suggested that the girls were interested in modeling themselves on the characters they had seen on TV.

Critical Thinking Questions

  • How can the results of the Spanish and Fijian studies be used to explain how the media may (or may not) affect the development of body dissatisfaction? (Application)
  • How can this study be used to demonstrate the value of research methods in: (a) abnormal psychology, and (b) social and cross-cultural psychology? (Analysis and Application)
  • How can this research be used to explain etiologies of BN? (Application)
  • How may the interaction of cognitive (or biological) and sociocultural factors (e.g. exposure to media) lead to body dissatisfaction? (Synthesis)
  • What are the strengths and limitations of these studies? (Evaluation)


Calado, Maria. Lamerias, Maria. Sepulveda, Ana R. et al. The Association Between Exposure to Mass Media and Body Dissatisfaction Among Spanish Adolescents. Women’s Health Issues, 21-5 (2011). Pp 390-99 (accessed from

Becker AE1Burwell RAGilman SEHerzog DBHamburg P. Eating behaviours and attitudes following prolonged exposure to television among ethnic Fijian adolescent girls. Br J Psychiatry. 2002 Jun; 180:509-14.