Comparing internalization of appearance ideals and appearance-related pressures among women from the United States, Italy, England, and Australia

  • Lauren M. SchaeferEmail author
  • Natasha L. Burke
  • Lisa M. Anderson
  • J. Kevin Thompson
  • Leslie J. Heinberg
  • Anna M. Bardone-Cone
  • Mary K. Higgins Neyland
  • David A. Frederick
  • Drew A. Anderson
  • Katherine Schaumberg
  • Amanda Nerini
  • Cristina Stefanile
  • Helga Dittmar
  • Kelly L. Klump
  • Allison C. Vercellone
  • Susan J. Paxton
Brief Report


Researchers have observed variation in levels of body image disturbance and eating pathology among women from different Western countries. Examination of cross-cultural differences in the established risk factors (i.e., thin-ideal internalization, muscular-ideal internalization, and appearance pressures from family, peers, and media) for negative outcomes may help to elucidate the prominence of specific risk factors within a given Western society and guide associated interventions. Women from the United States (US), Italy, England, and Australia completed the Sociocultural Attitudes Towards Appearance Questionnaire-4 (SATAQ-4). Analysis of covariance controlling for age and BMI indicated significant cross-country differences for all SATAQ-4 subscales. Results typically indicated higher levels of appearance-ideal internalization and appearance pressures in the US and lower levels in Italy; however, associated effect sizes were generally small. A medium effect of country was observed for peer-appearance pressures, which were highest in the US compared with all other countries. Repeated-measures analysis of variance and paired samples t tests conducted within each country identified thin-ideal internalization and media appearance pressures as the predominant risk factors for all four countries. Overall, findings suggest more cross-country similarities than differences, and highlight the importance of delivering interventions to address thin-ideal internalization and media appearance pressures among women from Western backgrounds.

Level of evidence Descriptive study, Level V.



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

Compliance with ethical standards

Conflict of interest

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

Ethical approval

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

Informed consent

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


  1. 1.
    Makino M, Tsuboi K, Dennerstein L (2004) Prevalence of eating disorders: a comparison of Western and non-Western countries. MedGenMed 6:49PubMedPubMedCentralGoogle Scholar
  2. 2.
    Swami et al (2010) The attractive female body weights and body dissatisfaction in 26 countries across 10 world regions: Results from the International Body Project I. J Pers Soc Psycholl Bull 36:309–325. doi: 0.1177/0146167209359702CrossRefGoogle Scholar
  3. 3.
    Tiggemann M, Verri A, Scaravaggi S (2005) Body dissatisfaction, disordered eating, fashion magazines, and clothes: a cross-cultural comparison between Australian and Italian young women. Int J Psychol 40:293–302. CrossRefGoogle Scholar
  4. 4.
    Stice E, Nemeroff C, Shaw H (1996) A test of the dual pathway model of bulimia nervosa: evidence for restrained-eating and affect-regulation mechanisms. J Soc Clin Psychol 15:340–363. CrossRefGoogle Scholar
  5. 5.
    Thompson JK, Heinberg LJ, Altabe M, Tantleff-Dunn S (1999) Exacting beauty. American Psychological Association, Washington DCGoogle Scholar
  6. 6.
    Cafri G, Yamamiya Y, Brannick M, Thompson JK (2005) The influence of sociocultural factors on body image: a meta-analysis. Clin Psychol: Sci Pr 12:421–433. CrossRefGoogle Scholar
  7. 7.
    Stice E (2002) Risk and maintenance factors for eating pathology: a meta-analytic review. Psycholl Bull 128:825–848. CrossRefGoogle Scholar
  8. 8.
    Smolak L, Murnen SK (2008) Drive for leanness: assessment and relationship to gender, gender role and objectification. Body Image 5:251–260. CrossRefPubMedGoogle Scholar
  9. 9.
    Keery H, van den Berg P, Thompson JK (2004) An evaluation of the Tripartite Influence Model of body dissatisfaction and eating disturbance with adolescent girls. Body Image 1:237–251. CrossRefPubMedGoogle Scholar
  10. 10.
    Rodgers R, Chabrol H, Paxton SJ (2011) An exploration of the tripartite influence model of body dissatisfaction and disordered eating among Australian and French college women. Body Image 8:208–215. CrossRefPubMedGoogle Scholar
  11. 11.
    Ruggiero GM (2001) Psychological and sociocultural correlates of eating disorders in the Mediterranean area. In: Columbus F (ed) Advances in psychology research, (vol 6). Nova Science Publishers, Huntington, pp 215–227Google Scholar
  12. 12.
    Schaefer LM et al (2015) Development and validation of the Sociocultural Attitudes Towards Appearance Questionnaire-4 (SATAQ-4). Psychol Assess 27:54–67. CrossRefPubMedGoogle Scholar
  13. 13.
    Heatherton TF, Mahamedi F, Striepe M, Field AE, Keel P (1997) A 10-year longitudinal study of body weight, dieting, and eating disorder symptoms. J Abnorm Psychol 106:117–125. CrossRefPubMedGoogle Scholar
  14. 14.
    Cohen (1988) Statistical power analysis for the behavioral sciences, 2nd edn. Lawrence Erlbaum, HillsdaleGoogle Scholar
  15. 15.
    Buote VM, Wilson AE, Strahan EJ, Gazzola SB, Papps F (2011) Setting the bar: Divergent sociocultural norms for women’s and men’s ideal appearance in real-world contexts. Body Image 8:322–334. CrossRefPubMedGoogle Scholar
  16. 16.
    Holland G, Tiggemann M (2016) A systematic review of the impact of the use of social networking sites on body image and disordered eating outcomes. Body Image 17:100–110. CrossRefPubMedGoogle Scholar
  17. 17.
    Cashel ML, Cunningham D, Landeros C, Cokley KO, Muhammad G (2003) Sociocultural attitudes and symptoms of bulimia: Evaluating the SATAQ with diverse college groups. J Couns Psychol 50:287–296. CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  • Lauren M. Schaefer
    • 1
    Email author
  • Natasha L. Burke
    • 2
  • Lisa M. Anderson
    • 3
  • J. Kevin Thompson
    • 4
  • Leslie J. Heinberg
    • 5
  • Anna M. Bardone-Cone
    • 6
  • Mary K. Higgins Neyland
    • 2
  • David A. Frederick
    • 7
  • Drew A. Anderson
    • 8
  • Katherine Schaumberg
    • 9
  • Amanda Nerini
    • 10
  • Cristina Stefanile
    • 10
  • Helga Dittmar
    • 11
  • Kelly L. Klump
    • 12
  • Allison C. Vercellone
    • 13
  • Susan J. Paxton
    • 14
  1. 1.Neuropsychiatric Research InstituteFargoUSA
  2. 2.Department of Medical and Clinical PsychologyUniformed Services University of the Health Sciences (USUHS)BethesdaUSA
  3. 3.Department of PsychiatryUniversity of MinnesotaMinneapolisUSA
  4. 4.Department of PsychologyUniversity of South FloridaTampaUSA
  5. 5.Cleveland Clinic Lerner College of Medicine of Case Western Reserve UniversityClevelandUSA
  6. 6.Department of Psychology and NeuroscienceUniversity of North Carolina at Chapel HillChapel HillUSA
  7. 7.Department of PsychologyChapman UniversityOrangeUSA
  8. 8.Department of PsychologyUniversity at Albany-State University of New YorkAlbanyUSA
  9. 9.Department of PsychiatryUniversity of North Carolina at Chapel HillChapel HillUSA
  10. 10.Department of Health Sciences, Section of PsychologyUniversity of FlorenceFlorenceItaly
  11. 11.School of PsychologyUniversity of SussexSussexUK
  12. 12.Department of PsychologyMichigan State UniversityEast LansingUSA
  13. 13.Department of PsychologySaint Louis UniversitySt. LouisUSA
  14. 14.School of Psychology and Public HealthLa Trobe UniversityMelbourneAustralia

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