Open Journal of Medical Psychology, 2013, 2, 17-24
doi:10.4236/ojmp.2013.24B004 Published Online October 2013 (http://www.scirp.org/journal/ojmp)
Body-focused Anxiety in Women: Associations with
Internalization of the Thin-ideal, Dieting Frequency, Body
Mass Index and Media Effects
Aileen Pidgeon, Rachel A. Harker
Bond University, Australia
Received July, 2013
Exposure to media that portrays thin women as ideal and attractive can lead to women internalizing the thin ideal,
which results in incorporating societal standards of thinness into belief systems. Internalization of the thin-ideal is asso-
ciated with numerous detrimental effects on women, including decreased levels of self-esteem and increased levels of
body-focused anxiety, negative emotions and disordered eating. The present study utilized a sample of women (N = 208)
aged between 18 and 67 years (M = 29.44, SD = 13.08) to examine the relationship between internalization of the thin-
ideal, body-focused anxiety, body mass index (BMI), and dieting frequency. Correlational, regression and mediation
analyses conducted on the data showed that internalization of the thin-ideal, BMI and dieting frequency significantly
contributed to body-focused anxiety in women. In addition, body-focused anxiety fully mediated the relationship be-
tween internalization of the thin-ideal and dieting frequency among women. BMI did not moderate the relationship be-
tween internalization of the thin-ideal and body-focused, indicating that women who internalize the thin-ideal are less
vulnerable to dieting unless experiencing body-focused anxiety. The results of the current study enhance our under-
standing of the relationship between internalization of the thin-ideal, body-focused anxiety, BMI, and dieting frequency
among women. Clinical implications will be discussed.
Keywords: Body-focused Anxiety; Internalization of the Thin-ideal; BMI; Dieting
The thin-ideal relates to current societal standards of fe-
male beauty, in particular the female body, portrayed by
the media as a level of thinness that is impossible for
most women to achieve .The standards of appearance
and beauty portrayed by the media, which includes the
consistent portrayal of women of an unattainable stature
and portraying underweight female models as ‘normal’,
contributes to poor body image amongst women. Inter-
nalization of societal standards includes both the accep-
tance and endorsement of the messages sent by the media
that thin women are attractive . The term internaliza-
tion of the thin-ideal is the degree that women cogni-
tively adopt socially defined beliefs of attractiveness,
which results in women engaging in behaviors, such as
chronic dieting, to achieve a body in line with the
thin-ideal [3,4]. Some women incorporate the values of
the thin-ideal such as, ‘women must be thin to be consid-
ered attractive’, which become the guiding principles in
their lives . Reinforcement and perpetuation of the
thin-ideal is achieved through socialization agents such
as the mass media encouraging women to diet and lose
weight exemplified in the glorification of ultra-thin mod-
els . Furthermore, the mass media targets women by
promoting new diets, exercise regimens, and beauty
treatments to rectify and conceal flaws in their bodies to
achieve attractiveness and the thin-ideal .
The factors examined in this paper are defined as fol-
lows. Body-focused anxiety, which is analogous to body
dissatisfaction, refers to the extent in which a woman
feels at unease about her body and physical appearance
[7, 8]. Dieting frequency is the frequency women diet to
lose weight to ease the anxiety and dissatisfaction felt
about their bodies. Positive expectancies associated with
being thin refers to women adopting the belief that the
associated benefits of being thin are increased success,
happiness and popularity [9,10].
Women who perceive the thin-ideal as the norm and
believe it is attainable with effort and sacrifice tend to
selectively expose themselves to media content that is
congruent with this belief system [11, 12]. Exposure to
media that portray thin women as ideal women can result
in women internalizing the thin-ideal, developing body
dissatisfaction and chronic dieting [13, 14]. Over the past
Copyright © 2013 SciRes. OJMP
A. PIDGEON, R. A. HARKER
decades, the average weight of women has increased ,
while women portrayed in the media, particularly models,
have become increasingly thinner . The gap between
the typical thin ideal body of women portrayed by the
media and the size of the average woman’s body haswi-
dened  promoting the notion that thin models are
more attractive than the realistically sized women. Re-
cent research indicates that it is the thinness of the mod-
els, rather than their attractiveness, that leads to increased
body-image concerns [18, 19]. These studies controlled
for attractiveness and found that exposure to thin size 8
models, but not to size 14 models, resulted in increased
The thin-ideal internalization directly cultivates body-
focused anxiety and dissatisfaction because the thin-ideal
portrayed by the media is unattainable for most women
. Body dissatisfaction is identified as women having
negative thoughts and feelings about their body [7, 8],
such as believing parts of their body are not thin enough.
Body dissatisfaction is proposed to arise from socio cul-
tural pressures from the media to conform to the
thin-ideal and physical deviation from the ideal espoused
for women . Body dissatisfaction can result from
heightened internalization of the thin-ideal and the belief
that attaining the thin-ideal will result in a multitude of
benefits [7, 22, 23]. Additionally, dieting is a behavioral
indicator of body-focused anxiety and dissatisfaction .
How the thin-ideal standard of appearance and beauty
for women portrayed in the media influences the preva-
lent phenomenon of body dissatisfaction among women
is explained by sociocultural theory and self-discrepancy
theory. Sociocultural theory postulates there is a link
between pressures from social sources, such as the media,
and body dissatisfaction. This theory attains there is per-
vasive societal pressure, from the media, on women to
conform to the thin-ideal and that this pressure has re-
sulted in a culture of thinness in Western society .
The mass media is identified as the most pervasive and
powerful social influence . The sociocultural pres-
sures by the media on women to be thin are associated
with body dissatisfaction among women .
Self-discrepancy theory refers to the beliefs held by
women about who they are (actual self), who they would
like to be (ideal self) and who they ought to be (ought
self). When a discrepancy exists between the actual
and ideal self, this is called an ideal discrepancy .
Women who report experiencing an ideal discrepancy
between their actual body size and body mass index
(BMI), and their ideal body size report low body satis-
faction, self-criticism, emotional distress and engage in
self-regulatory behaviors, such as dieting, to mitigate the
distress and moderate the incongruity [28-30]. The media
is a key player in propagating the thin-ideal, resulting in
women feeling dissatisfied with their bodies . In par-
ticular, the media communicates expectations pertaining
to the benefits of conforming to the thin-ideal (“thin is
good”), from which women develop positive expectan-
cies and belief relative to thinness and dieting (e.g., in-
creased success, confidence, respect and attractiveness)
[10,32]. These expectations play a key role in the propa-
gation of the thin-ideal, with advertisements (ranging
from beer to make-up commercials) consistently using
“successful” and attractive women who look like the
significantly underweight models also seen in the fashion
magazines . As a result, society is inundated with the
message that thin women are successful and attractive,
and women begin to internalize expectancies associated
with conforming to the thin-ideal. Whilst the media em-
phasizes and glorifies thinness, there is a powerful socie-
tal stigma against obesity; to the extent society associates
obese individuals with personality traits such as laziness,
gluttony and lack of self-control [11, 33].
A meta-analytic review revealed the negative effect on
women being exposed to the thin-ideal as portrayed in
the mass media . Results found that for body dissatis-
faction there was a small to moderate mean effect size (d)
of -0.28 across 90 independent effect sizes, indicating a
relationship between exposure to the ultra-thin images by
the mass media, analogous to the exemplar models in the
media and body dissatisfaction in women . In addition,
results found a relationship between the media and inter-
nalization of the thin-ideal, with over 23 independent
effect sizes for internalization of the thin-ideal having a
small to moderate mean effect size (d) of -0.39 . These
results support the socio cultural perspective that the me-
dia propagates a thin-ideal for women which contributes
to body dissatisfaction among women .In addition,
internalization of the thin-ideal has been shown to sig-
nificantly influence the relationship between body dis-
satisfaction and perceived media pressure in young
women aged between 10-13 years .
BMI is a significant moderator of internalization of the
thin-ideal. Research indicates that women with high lev-
els of internalization of the thin-ideal and high BMI’s,
also report significantly greater levels of body dissatis-
faction . Previous research suggests that being over-
weight does not result in body-focuses anxiety and dis-
satisfaction unless the thin-ideal has been internalized
1.1. The Current Study
The current study seeks to further our understanding of
the effect of the media on women by examining the di-
rectional links between internalization of the thin-ideal,
body-focused anxiety and dieting frequency within a
testable mediation model shown in Figure 1. Figure 1
shows the hypothesized pathway between internalization
of the thin-ideal and body-focused anxiety (pathway a).
Copyright © 2013 SciRes. OJMP
A. PIDGEON, R. A. HARKER
Copyright © 2013 SciRes. OJMP
mediate the relationship between internalisation of the
thin-ideal and dieting frequency.
Previous research has demonstrated internalization of the
thin-ideal directly fosters body-focused anxiety because
it is unattainable for most women . The predictive
pathway between body-focused anxiety and dieting fre-
quency (pathway b) was formulated on the proposition
that individuals who experience body-focused anxiety
are likely to diet as it is a common belief dieting is an
effective weight control technique . Based on previous
research that shows there is an association between body
dissatisfaction and increased dieting frequency, and due
to the fact that body-focused anxiety is positively related
to internalization of the thin-ideal, it was predicted that
internalization would indirectly predict dieting frequency
via body-focused anxiety (pathway a and b). The direct
effect between internalization and dieting frequency (c’)
must be significantly reduced from the total effect (c),
before it can be reliably suggested that mediation exists
Hypothesis 4 statedBMI would moderate the relation-
ship between internalization of the thin-ideal and body-
The sample consisted of208women aged between 18 and
67 years (Mage= 29.44, SD = 13.08).
Body mass was measured with BMI collected via the
demographics. BMI = Weight (kg) / Height2 (m2), based
on self-report data. Self-reported dieting frequency was
collected via the demographics.
Sociocultural Attitudes towards Appearance Scale-3
(SATAQ-3) is a 30-item self-report questionnaire that
provides a reliable measure of the sociocultural influence
of multiple dimensions of media on female body image
. Items were summed to produce a total score, and
higher scores indicated increased internalization of so-
cially presented views regarding the importance of at-
tractiveness in society . The current study used the
internalization-general subscale, which assesses inter-
nalization and acceptance of societal standards of the
The current study builds on previous research by ex-
amining the relationship between body-focused anxieties,
internalization of the thin-ideal, BMI, dieting frequency,
desirability and positive expectances. In addition, the
current study will examine the moderating effect of BMI
between internalization and body-focused anxiety among
1.2. Hypotheses Physical Appearance Trait and State Anxiety Scale
(PASTAS [Trait Subscale]) was used to measure body-
focused anxiety for eight weight-related (e.g., thighs and
buttocks) body sites . Scores were summed to reveal
a weight-related anxiety total, with higher scores indi-
cating higher levels of body-related, appearance anxiety.
The following hypotheses were formulated from past
research and literature reviewed above.
Hypothesis 1 stated internalization of the thin-ideal,
body-focused anxiety, BMI, dieting frequency, desirabil-
ity and positive expectancies associated with being thin
would be significantly positively related. Media Attitudes Questionnaire (MAQ) is a 22-item
measure used to assess media skepticism . Higher
scores indicate lower levels of media skepticism and
greater endorsement of the statements. The current study
used the desirability and positive expectancies associated
with being thin subscales.
Hypothesis 2 stated BMI, dieting frequency, internali-
zation of the thin-ideal, desirability and positive expec-
tancies associated with being thin would significantly
predict body-focused anxiety.
Hypothesis 3 stated body-focused anxiety would fully
Internalization Dieting Frequency
Figure 1. Hypothesized mediation model of the relations between body-focused anxiety, internalization of the thin-ideal and
A. PIDGEON, R. A. HARKER
A cross-sectional, correlational design using bivariate
correlation, standard multiple regression, mediated re-
gression and moderated regression analyses was used.
The standard multiple regressions were performed using
the predictor variable body-focused anxiety and criterion
variables BMI, dieting frequency, internalization of the
thin-ideal, desirability, and positive expectances. The
mediated regression was performed using body-focused
anxiety as the mediator, internalization of the thin-ideal
as the predictor and dieting frequency as the criterion
variable. A moderated regression was conducted using
BMI as the moderator, internalization of the thin-ideal as
the predictor and body-focused anxiety as the criterion
3.1. Correlational Analysis
Table 1 show that BMI was significantly positively cor-
related with dieting frequency and body-focused anxiety.
Dieting frequency was significantly positively correlated
with internalisation, body-focused anxiety and positive
expectancies and contrary to predictions did not signifi-
cantly correlate with desirability. Internalisation was sig-
nificantly positively correlated with body-focused anxi-
ety, desirability and positive expectancies. Body- focused
anxiety was significantly positively correlated with de-
sirability and positive expectancies. In addition, desir-
ability and positive expectancies were significantly posi-
3.2. Main Analyses
Standard Multiple Regression Analysis. Body-focused
anxiety was regressed onto BMI, dieting frequency, in-
ternalization of the thin-ideal, desirability, and positive
expectances. As predicted, the model accounted for a
significant amount of variance in body-focused anxiety,
R2 = 0.50, adjusted R2 = 49, F (5, 202) = 40.18, p < 0.001.
As indicated by the R2 value of .50, 50% of the variance
in body-focused anxiety is predicted by BMI, dieting
frequency, internalization of the thin-ideal, desirability,
and positive expectances. The regression coefficients for
BMI, dieting frequency and internalization of the thin-
ideal differed significantly from zero. However, in con-
trast to prediction, the regression coefficients for desir-
ability and positive expectancies did not differ signifi-
cantly from zero. Therefore, desirability and positive
expectancies were excluded from all further analyses.
BMI contributed 11.16% unique variance to body-focused
anxiety, whilst dieting frequency contributed 6.55%, and
internalization of the thin-ideal contributed 6.81% unique
variance. Thus, 24.12% of the variance in body-focused
anxiety can be attributed to shared variability amongst
the predictor variables; dieting frequency, BMI, inter-
nalization of the thin-ideal, desirability and positive ex-
Mediated Analysis.Linear and hierarchical multiple
regression procedures and a Sobel test  were per-
formed to test the third hypothesis. In the simple regres-
sion analysis internalisation accounted for a significant
amount of variance in body-focused anxiety, R2 = 0.25,
Adjusted R2 = .25, F(1, 206) = 68.17, p < .001. Moreover,
the coefficient for internalisation was significant β = .50,
p < 0.001. A hierarchical multiple regression analysis
was conducted predicting dieting frequency. Internaliza-
tion was entered on Step 1 and body-focused anxiety on
Step 2 of the regression equation. The results of the hier-
archical multiple regression equation are summarized in
As shown in Table 2, internalization accounted for
10.9% of the variance in dieting frequency at Step 1,
R2change = 0.11, Fchange = (1, 206) = 25.18, p < 0.001, addi-
tionally the coefficient for internalization was significant,
β = .33, p < 0.001. Table 2 shows that at Step 2, body-fo-
cused anxiety explained a significant increment in the
variance accounted for in dieting frequency, R2change =
0.15, Fchange = (1, 205) = 40.87, p < 0.001. The coeffi-
cient for body-focused anxiety was significant at Step 2,
β = 0.44, p< 0.001. When body-focused anxiety was en-
tered on Step 2, the coefficient for internalization mark-
edly decreased to β = 0.11 and was not significant (p =
0.119), these findings are in support of hypothesis three.
A Sobel test  was conducted to establish if the de-
crease in the coefficient for internalization was significant.
Table 1. Means, standard deviations and Pear son correlation coefficients among the variables.
Measure 1 2 3 4 5 6 M SD
1. Body Mass Index .18** -.09 .36*** -.03 -.01 23.53 4.55
2. Dieting Frequency .33*** .50*** .13 .29*** 2.61 1.25
3. Internalization .50*** .47*** .68*** 27.47 9.52
4. Body-Focused Anxiety .20*** .44*** 16.74 7.31
5. Desirability .48*** 12.52 2.72
6. Positive Expectancies 12.71 5.87
*p< 0.05. **p< 0.01. ***p< 0.001.
Copyright © 2013 SciRes. OJMP
A. PIDGEON, R. A. HARKER 21
Table 2. Hierarchical multiple regression analysis predicting dieting frequency from internalization of the thin-ideal and
body-focused anxiety (N = 208).
Predictor ∆R2 β B SE B 95% CI for B
Step 1 .11***
Constant 2.61 0.08 [2.45, 2.77]
Internalization .33*** 0.04 0.01 [.03, .06]
Step 2 .15***
Constant 2.61 0.08 [2.46, 2.76]
Internalization .11 0.01 0.01 [-.00, .03]
Body-Focused Anxiety .44*** 0.08 0.01 [.05, .10]
Total R2 = .26***
Note:. CI = Confidence Interval; *p< 0.05. **p< 0.01. ***p< 0.001.
Sobel’s test indicated perfect mediation, as the decrease
in the coefficient was significant (z = 5.04, p < 0.001).
Moderated Analysis. A moderated regression analy-
sis was performed to examine the fourth hypothesis. A
hierarchical multiple regression analysis was performed
to examine the variance accounted for by internalization
of the thin-ideal, BMI and the interaction term (Inter-
nalization X BMI) when predicting body-focused anxiety.
Internalization and BMI were entered at Step 1, and the
interaction term (Internalization X BMI) was entered at
Step 2. However, entering the interaction term (Inter-
nalization X BMI) did not add significantly to the ex-
plained variance after controlling for the main effects of
internalization of the thin-ideal and BMI on
body-focused anxiety. BMI did not moderate the rela-
tionship between internalization and dieting frequency
and did not support the fourth hypothesis.
The current study examined the relationships between
body-focused anxiety, internalization of the thin-ideal,
BMI, dieting frequency, desirability and positive expec-
tancies among women. Results provided partial support
for hypothesis one, with all variables significantly posi-
tively correlated with the exception of the correlations
between BMI and internalization of the thin-ideal, BMI
and desirability and, BMI and positive expectancies.
These results were contrary to the prediction that BMI-
would have a significant relationship with all three vari-
ables. In addition, converse to expectations the results
indicated there was a non-significant correlation between
dieting frequency and desirability.
Post hoc interpretation suggests the negative correla-
tion between BMI and internalization of the thin-ideal
could be explained by the fact that those women with a
high BMI may reject societal norms and not have the
desire to conform to the thin-ideal. This result supports
Harrison’s  argument that women selectively expose
themselves to media content that conforms to their exist-
ing worldview. Women who have a greater BMI and
have rejected the thin-ideal might selectively expose
themselves to media content that conforms to their per-
sonal worldview (e.g., average to overweight models).
The result that dieting frequency was not significantly
correlated with desirability was unexpected as it was
anticipated women who desire to look like the thin mod-
els portrayed in the media would have elevated dieting
frequencies in order to achieve the thin-ideal. It is possi-
ble that the women in the current study who desire to
look like the thin exemplar model portrayed by the me-
diamay use healthy means to lose or maintain weight,
such as exercise and balanced diets.
Hypothesis two was partially supported. Whilst BMI,
dieting frequency and internalization significantly con-
tributed to body-focused anxiety, desirability and posi-
tive expectancies did not. Despite desirability and posi-
tive expectancies having moderate to strong bivariate
correlations with body-focused anxiety, they did not play
a significant unique role in the extent to which women
experience body-focused anxiety. The finding that BMI
played a significant unique role in body-focused anxiety
was consistent with previous research that found that
being overweight is a major determinant of body dissat-
The result that dieting frequency significantly contrib-
utes to unique variance to body-focused anxiety was ex-
pected. This finding supports previous research that in-
dicates body-focused anxiety promotes dieting . The
results of Stice’s  study, in conjunction with the re-
sults from the current study demonstrate the relationship
between dieting frequency and body-focused anxiety
may be cyclical. Specifically, body-focused anxiety
promotes dieting, but despite dieting, many women fail
to achieve the thin-ideal as it is unattainable for most
women, which leads to dieting promoting body-focused
In addition, the strong positive correlation between di-
eting and body-focused anxiety provides support for
self-discrepancy theory. Women who experience a dis-
crepancy between their actual and ideal self tend to en-
gage in behaviors to try and “fix” the discrepancy .
Copyright © 2013 SciRes. OJMP
A. PIDGEON, R. A. HARKER
As such, the relationship between dieting and
body-focused anxiety can be explained in terms of dis-
satisfaction, which can results from a discrepancy be-
tween the actual and ideal self, and attempts to amend the
discrepancy involve dieting.
In support of hypothesis three, the results indicated
body-focused anxiety fully mediated the relationship
between internalization of the thin-ideal and dieting fre-
quency. Women who internalize the thin-ideal do not
necessarily diet unless they experience body-focused
anxiety. These findings highlight the importance of de-
veloping interventions aimed at preventing and decreas-
ing body-focused anxiety in women of all ages. Body-
focused anxiety can lead to dieting, and can be a precur-
sor to disordered eating.
Although BMI was significantly correlated with
body-focused anxiety and contributed unique variance to
body-focused anxiety, the final hypothesis was not sup-
ported by the results. These findings are consistent with
past research .Internalization of the thin-ideal and
BMI significantly predicted body-focused anxiety indi-
vidually, but the interaction between the two variables
did not predict body-focused anxiety. The strong associa-
tion between BMI and body-focused anxiety in the cur-
rent study demonstrates that women with a high BMI can
also experience body-focused anxiety and not internalize
the thin-ideal. The result may be explained in terms of
the stigma society places on overweight women and obe-
sity . Being thin is associated with a number of bene-
fits  and being overweight is not [11,33].The results
are contrary to arguments that theoretically having a
greater BMI would only produce body-focused anxiety if
the thin-ideal had been internalized.
The results of the current study demonstrate that in-
ternalization of the thin-ideal; BMI and dieting are con-
tributing factors to body-focused anxiety. Adapted from
Blowers et al. , Figure 2 proposes an updated model
on the relationship between these variables that includes
both psychological (e.g., internalization) and physical
features (e.g., BMI). The potential cyclical relationship
between dieting and body-focused anxiety is shown in
Some limitations of the current study warrant consid-
eration, including the cross-sectional, correlational de-
sign of the current study limits the interpretation from the
results, as no causal inferences can be made. Therefore, it
is recommended that future research investigate causal
priority by experimentally manipulating variables of in-
The relationship between internalization of the thin-ideal
and body-focused anxiety was demonstrated in the current
study among women across a broad range ages (18-67
Figure 2. Modified model of the relationships between
body-focused anxiety, internalization of the thin-ideal, diet-
ing frequency and BM I.
years). These further our understanding of the relation-
ships between body-focused anxiety, internalization of
the thin-ideal, BMI and dieting. These results provide
evidence of a need for change, as it seems that women
across a broad age range may be manipulating their bod-
ies through dieting to achieve the thin-ideal and body-
focused anxiety. In conclusion, the current study high-
lights the importance of addressing body-focused anxiety
in women across the adult life span by developing multi-
focus interventions aimed at preventing and decreasing
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