Peer Interactions and Relationships
Synonyms
Definitions
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Risk factor – a variable that predicts the development of a given outcome.
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Body dissatisfaction – negative emotions associated with one’s physical appearance or body in general.
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Diet – a usually short term change in eating patterns and caloric intake for the purpose of weight loss
Background
Although only a relatively small amount of theory and research has examined ways in which peer interactions and peer relationships contribute to risk for clinical eating disorders, a substantial literature has explored relationships between peer interactions and the known risk factors for eating disorders, in particular bulimia nervosa, of body dissatisfaction and dieting. Consequently, in this chapter, the role of peer interactions and relationships in the development of body dissatisfaction and dieting as well as eating disorder symptoms will be explored.
Peer interactions and relationships that have been examined in regard to eating disorder risk factors can broadly be considered in two categories. The first category includes peer interactions related to appearance and eating behaviors such as appearance conversations; peer appearance-related teasing, criticism, or exclusion; peer pressure to be thin, diet, or conform to appearance ideals; and peer body dissatisfaction, dieting, disordered eating, or importance placed on appearance. The second category relates to peer and friendship quality, in which the focus has been on lack of social support and negative friendship qualities such as conflict with friends.
A number of theories have been proposed to explain how peer interactions related to appearance and eating behaviors might have their influence on the development of disordered eating and its risk factors. Drawing on social identity theory that suggests that attitudes and self-perceptions are the result of shared group norms, group pressure for uniformity, and involvement in group activities that emphasize shared values, it has been proposed that exposure to peer groups that are highly focused on appearance and express the importance of attaining the ideal appearance through their own behaviors or criticism of others will increase the likelihood of an individual adopting these same norms and internalizing these appearance ideals (Webb and Zimmer-Gembeck 2013). Drawing on social learning theory, it is also proposed that an individual may learn attitudes and behaviors such as body dissatisfaction, dieting, purging, and binge eating from observation and imitation of peers along with encouragement or reinforcement from peers for these attitudes and behaviors (Webb and Zimmer-Gembeck 2013). Thus, a modeling process is involved.
The predominant sociocultural model for the development of body dissatisfaction, dieting, and bulimic symptoms, the Tripartite Influence Model, identifies mechanisms whereby peer appearance norms can result in body dissatisfaction, dieting, and disordered eating symptoms. It postulates that peers are one of the three major sources of sociocultural influences on the development of body dissatisfaction (along with parents and media). Sociocultural influences may lead to internalization of the ideal appearance, and greater endorsement of this usually unattainable ideal highlights the gap between the ideal and one’s own physical appearance, leading to body dissatisfaction and dieting. In addition, sociocultural influences are proposed to enhance social appearance comparison, the tendency to compare one’s appearance with those of one’s peers. Such comparison again highlights the discrepancy between internalized ideals and one’s own appearance resulting in body dissatisfaction. Recent longitudinal research in adolescent girls supports these processes, suggesting that internalized body ideals predict greater social body comparison which in turn leads to greater body dissatisfaction.
A theory to explain how poor friendship quality may contribute to body dissatisfaction has also been proposed (Schutz and Paxton 2007). Especially in adolescence, positive peer relationships fulfill a number of vital functions, including enhancing self-esteem and providing emotional support, security, and validation of self-worth. Therefore, it has been proposed that positive friendship qualities that contribute to self-esteem such as friend trust, communication, and acceptance might also provide validation about the acceptability of a girl’s appearance and value as a person regardless of appearance, and thus be related to positive body image and low symptoms of disordered eating, and the opposite may also be true. Although positive friendship quality may be protective, Webb and Zimmer-Gembeck (2013) suggest that it is likely that even when friendship quality is high, friendships may provide an appearance-conscious environment that transmits messages that have a negative impact on body image.
Current Knowledge
A growing research literature has examined the role of peer interactions on body dissatisfaction, dieting, and disordered eating symptoms. Below, research exploring the impact of peer interactions related to appearance and eating behaviors and friendship quality are reviewed. Where available, specific attention has been placed on longitudinal rather than cross-sectional studies as these are more likely to provide information about the role of peer variables as risk factors.
Peer Interactions Related to Appearance and Eating Behaviors
Peer Appearance Conversations
A wide range of qualitative and quantitative research indicates that talk about appearance especially among girls is very common. In girls and women, these conversations include discussions of weight and shape, dieting, fashion, clothes, and makeup. They may also take the form of “fat talk,” an expression used to describe ritualized self-derogatory talk about weight and fat which often takes the form of “I’m so fat!”, “No you’re not – I’m the one who’s fat!”. Appearance conversations are less frequently observed in boys, and when they do occur, they are more likely to relate to working out and becoming fit or muscular.
Measures of appearance conversations have quite consistently been found to be cross-sectional, prospective, and experimental predictors of body dissatisfaction in a wide range of age-groups. For example, recent research with 5-year-old girls has also found child appearance conversations to be a cross-sectional predictor of dietary restraint Damiano et al. (2015). In addition, in a 4-year longitudinal study, peer discussions about dieting in grade 5 were found to be predictors of body dissatisfaction in grade 6, which predicted the later development of dieting and binge eating symptoms (Blodgett Salafia and Gondoli 2011). Further, in an experimental study in which young women were exposed to an ultrathin confederate who either complained about being fat and talked about intentions to lose weight or raised a neutral topic, women exposed to the appearance conversation had significantly increased body dissatisfaction (Stice et al. 2003). It is likely that appearance conversations, including fat talk, work to establish group norms about the importance of appearance as well as model negative ways of thinking about one’s body and unhealthy dieting behaviors.
Peer Appearance-Related Teasing, Criticism, Exclusion, and Perceived Peer Pressure
Peer appearance teasing (and related criticism and exclusion) has been the peer variable most frequently explored in relation to body dissatisfaction, dieting, and disordered eating symptoms (Webb and Zimmer-Gembeck 2013), and cross-sectional research typically reveal findings of moderate-sized relationships between weight and appearance teasing and body dissatisfaction, and weight teasing and dietary restraint and bulimic behaviors. These relationships are not merely the result of self-perceptions of teasing as the negative relationship observed between self-reported teasing and body esteem was also observed between classmate reported teasing and body dissatisfaction. Longitudinal studies have produced somewhat less consistent findings, but this inconsistency may relate to the age of teasing and the timing of assessments. Overall, it is feasible that appearance teasing, criticism, or exclusion highlights nonconformity with appearance ideal norms and consequently leads to self-criticism and body dissatisfaction.
The relationship between perceived peer pressure to attain a body ideal or to diet and risk factors for eating disorders has been widely examined. Perceived peer pressure can be communicated subtly and isn’t typically as negative an experience as teasing or criticism. In addition, although frequently described as “peer pressure” the variable examined has invariably been “perceived peer pressure,” and it is not necessarily the case that such pressure really exists or whether the perceived pressure stems from the individual’s own body image or eating concerns. Strong associations between perceived peer pressure and body dissatisfaction and dieting have been observed. Prospective relationships have also been found (e.g., Blodgett et al. 2011). However, these have not consistently been observed and Webb and Zimmer-Gembeck (2013) have suggested that prospective relationships between these variables may be accounted for by relationships with body mass index or negative affect.
Peer Body Dissatisfaction, Dieting, and Importance of Appearance
Early peer research in this field in adolescent girls identified similarities among friends in friendship groups on levels of body dissatisfaction, dietary restraint, use of extreme weight loss behaviors, and binge eating (Paxton et al. 1999). Although this finding of similarity among friends, known as homophily, raised the possibility of girls becoming more like their friends (e.g., through modeling), it also raised the possibility that girls selected friends who shared the same body image and weight concerns as themselves. A longitudinal study of adolescents supported the likelihood that selection was the dominant factor in homophily, but a study of college women indicated that both processes may operate. Zalta and Keel (2006) conducted a longitudinal study of a college sample and concluded that young women selected their friends according to shared personality variables, but once selected, they became more like their friends on bulimic symptoms suggesting a role for peer influence through peer norms or modeling.
Findings from cross-sectional and longitudinal research support the likelihood that perceptions of the body image attitudes and dieting behaviors of friends are risk factors for greater body dissatisfaction, dieting, and disordered eating in children and early and late adolescents. For example, in a prospective study of 5–8-year-old children, Dohnt and Tiggemann (2006) found perceived peer desire for thinness predicted later appearance satisfaction. In addition, in a large sample of adolescents, friends’ dieting at baseline has been shown to be positively associated with chronic dieting, unhealthy weight control behaviors, extreme weight control behaviors, and binge eating 5 years later among females and with extreme weight control behaviors 5 years later among males (Eisenberg and Neumark-Sztainer 2010).
Friendship Quality
Relationships between body dissatisfaction, dieting, and disordered eating and a number of indicators of friendship quality have been examined. In relation to social support findings are inconclusive suggesting it is not likely to be a key risk or protective factor, and in particular, high social support does not appear to be protective. However, indicators of negative friendship quality such as friend conflict, bullying, and peer victimization have been linked with body dissatisfaction (e.g., Schutz and Paxton 2007). Notably, in a cross-sectional study, this effect was eliminated when controlling for depressive symptoms (Schutz and Paxton 2007), and prospective studies have not controlled for depression, so the nature of this relationship remains unclear. The mechanisms operating behind these relationships require further research.
Peer Interactions and Relationships as Targets for Prevention
The predominant model in preventive research is an etiological approach in which it is proposed that reducing critical causal risk factors for a problem will reduce the problem’s frequency and intensity by interrupting the developmental sequence. Due to growing evidence that peer interactions and relationships described above increase risk for the development of body dissatisfaction, dieting, and disordered eating symptoms, these interactions have frequently been recommended as appropriate targets for prevention interventions.
A number of school-based prevention interventions for pre- and early adolescents have included components that address peer interactions, either as a primary or secondary focus (e.g., Richardson and Paxton 2010). Discussion and role-play activities aim to change peer group norms by assisting students to understand the negative impact of appearance teasing and criticism, ways to reduce appearance conversations and fat talk, and ways to create peer environments that emphasize the value of non-appearance-related qualities in friends. Notably, in addition to peer-based activities, these interventions have also included non-peer-based components such as media literacy, dissonance, and self-esteem activities.
The school-based prevention intervention studies mentioned above have supported the promise of this approach, with observations of reductions in body dissatisfaction, dietary restraint, and internalization of the thin ideal in different studies. However, because of the blend of peer and other activities it is not clear which components are having the major effect. While not assessed in all studies, a number of studies have found reductions compared to a control condition in appearance conversations (e.g., Richardson and Paxton 2010), but reductions in peer teasing have not been observed (although baseline levels are typically low). Further, although these interventions aim to change peer norms, assessments have only been made at the individual level. Thus, although prevention interventions that address peer interactions show promise, it is not clear whether this is because of the peer-related material or some other aspect of the intervention. Further, the positive outcomes against no-intervention control group are not consistently observed, indicating the need for further research to increase their impact.
Another approach to prevention of body dissatisfaction and disordered eating has drawn on the theory that high friendship quality will result in more positive body image and eating behaviors. With this in mind, programs have aimed to increase peer support for adolescent girls. To date, uncontrolled studies suggest the possibility that peer support programs may reduce body dissatisfaction. However, research in this field is at a very preliminary phase.
Current Controversies
As indicated in the section above, support is building for the role of peer interactions and relationships as risk factors for the development of body dissatisfaction, dieting, and disordered eating behaviors, especially peer interactions that highlight unachievable appearance norms such as high levels of peer appearance conversations and peer environments in which high levels of body dissatisfaction, dieting, and disordered eating are present. However, in most areas there is a paucity of longitudinal and experimental research to confirm these relationships. In addition, there is little research that clearly identifies at what age and what kinds of peer interactions are most likely to be detrimental. Further, although a growing number of studies have examined the role of peer interactions in male participants, the measures used do not always adequately capture the appearance concerns of boys and young men. Further research which addresses these issues will extend our understanding of this field.
Future Directions
Up until recent years, the peer interactions that were most intense and meaningful to young people occurred in face-to-face settings. With the advent of social media, this is no longer necessarily the case. Peer appearance comparisons, conversations, comments, teasing and criticism, and peer social support may be expressed on social media and indeed, given the very visual nature of many social media sites and the focus on posting of self-photographs, there may be an intensification of appearance focus and the importance of meeting appearance ideals. In addition, social media typically provides an opportunity for the peer network to be greatly expanded beyond the size typically encountered in one’s face-to-face network, thus expanding opportunities for exposure to appearance comments as well as opportunities to compare with peers. In light of these developments, it is not surprising that a new area of research is the relationship between social media use and risk factors for eating disorders, and recent research supports a positive association between social media use and body dissatisfaction, drive for thinness, and disordered eating. To date, little is known, however, about ways in which online peer interactions and relationships are involved in the development of these problems. Future research will be needed to explore these relationships.
Cross-References
References and Further Reading
- Blodgett Salafia, E. H., & Gondoli, D. M. (2011). A 4-year longitudinal investigation of the processes by which parents and peers influence the development of early adolescent girls’ bulimic symptoms. Journal of Early Adolescence, 31, 390–414. doi:10.1177/0272431610366248.CrossRefGoogle Scholar
- Damiano, S. R., Paxton, S. J., Wertheim, E. H., McLean, S. A., & Gregg, K. J. (2015). Dietary restraint of 5-year old girls: Associations with internalization of the thin ideal, maternal, media and peer influences. International Journal of Eating Disorders, 8, 1166–1169.Google Scholar
- Dohnt, H., & Tiggemann, M. (2006). The contribution of peer and media influences to the development of body satisfaction and self-esteem in young girls: A prospective study. Developmental Psychology, 42, 929–936. doi:10.1037/0012-1649.42.5.929.PubMedCrossRefGoogle Scholar
- Eisenberg, M. E., & Neumark-Sztainer, D. (2010). Friends’ dieting and disordered eating behaviors among adolescents five years later: Findings from Project EAT. Journal of Adolescent Health, 47, 67–73.PubMedCrossRefGoogle Scholar
- Paxton, S. J., Schutz, H. K., Wertheim, E. H., & Muir, S. L. (1999). Friendship clique and peer influences on body image concerns, dietary restraint, extreme weight-loss behaviors, and binge eating in adolescent girls. Journal of Abnormal Psychology, 108, 255–266. doi:10.1037/0021-843X.108.2.255.PubMedCrossRefGoogle Scholar
- Richardson, S. M., & Paxton, S. J. (2010). An evaluation of a body image intervention based on risk factors for body dissatisfaction: A controlled study with adolescent girls. International Journal of Eating Disorders, 43(2), 112–122. doi:10.1016/j.bodyim.2008.11.001.PubMedGoogle Scholar
- Schutz, H. K., & Paxton, S. J. (2007). Friendship quality, body dissatisfaction, dieting and disordered eating in adolescent girls. British Journal of Clinical Psychology, 46, 67–83. doi:10.1348/014466506X115993.PubMedCrossRefGoogle Scholar
- Stice, E., Maxfield, J., & Wells, T. (2003). Adverse effects of social pressure to be thin on young women: An experimental investigation of the effects of “fat talk”. International Journal of Eating Disorders, 34, 108–117. doi:10.1002/eat.10171.PubMedCrossRefGoogle Scholar
- Webb, H. J., & Zimmer-Gembeck, M. J. (2013). The role of friends and peers in adolescent body dissatisfaction: A review and critique of 15 years of research. Journal of Research on Adolescence, 24, 564–590. doi:10.1111/jora.12084.CrossRefGoogle Scholar
- Zalta, A. K., & Keel, P. K. (2006). Peer influence on bulimic symptoms in college students. Journal of Abnormal Psychology, 115, 185–189.PubMedCrossRefGoogle Scholar