Journal of Counseling Psychology 2009, Vol. 56, No.

3, 365375

2009 American Psychological Association 0022-0167/09/$12.00 DOI: 10.1037/a0015067

Parental Bonds, Anxious Attachment, Media Internalization, and Body Image Dissatisfaction: Exploring a Mediation Model
Hsiu-Lan Cheng
University of Michigan

Brent Mallinckrodt
University of Tennessee

The first purpose of this study was to investigate direct links between body image dissatisfaction (BID) in college women and their memories of either parent as cold and emotionally aloof. Theory, clinical case evidence, and a small (but growing) number of studies support these links. After estimating the strength of the associations between parental care and BID, the second goal of this study was to investigate a 2-stage model in which adult attachment anxiety and internalization of media images each serve as mediators of this relationship. Thus, in a sample of 224 college women, the authors tested a causal chain with 3 links and 4 sets of variables. Results suggested that both mother and father care were negatively associated with attachment anxiety; attachment anxiety was positively associated with internalization of media influence; and media influence was positively associated with BID. Most important, the authors found that the significant negative associations between mother and father care and BID were mediated by both attachment anxiety and media internalization. The data supported a 2-stage mediation model of hypothesized links of BID etiology. Keywords: media influence, body image dissatisfaction, adult attachment, parental bonds

Body image dissatisfaction (BID) involves the attitudinal and affective-evaluative facet of body image, and thus refers to how people feel about their own body (Cash & Pruzinsky, 2002; Thompson, Heinberg, Altabe, & Tantleff-Dunn, 1999). Widespread body image concerns among college women have been documented in a growing number of studies (e.g., Heatherton, Mahamedi, Striepe, Field, & Keel, 1997; Klemchuk, Hutchinson, & Frank, 1990). Mounting evidence from correlational, experimental, and longitudinal research has documented a relationship between BID in women and internalization of media images that portray an unattainable, unhealthy ideal of thinness (e.g., Cattarin, Thompson, Thomas, & Williams, 2000; Cusumano & Thompson, 1997; Hamilton, Mintz, & Kashubeck-West, 2007; Stice, Mazotti, Krebs, & Martin, 1998; Thompson, Van den Berg, Roehrig, Guarda, & Heinberg, 2004). For reasons of brevity, we used the term media internalization to refer to this construct in the remainder of the present article. Many theorists and researchers believe that an overemphasis in Western culture on thinness and the mass media

Editors Note. Karen OBrien selected Elizabeth Altmaier as Guest Editor for this manuscript.

Hsiu-Lan Cheng, Counseling and Psychological Services, University of Michigan; Brent Mallinckrodt, Department of Psychology, University of Tennessee. This manuscript was based on dissertation research conducted by HsiuLan Cheng at the University of MissouriColumbia with the supervision of Brent Mallinckrodt. We thank Tsun-Yao Ku for his assistance with the Mplus program. Correspondence concerning this article should be addressed to Hsiu-Lan Cheng, Counseling and Psychology Services, University of Michigan, 3100 Michigan Union, 530 South State Street, Ann Arbor, MI 48109. E-mail: hlcheng@umich.edu 365

portrayal of ultra-slender female figures contribute to increasing body image concerns in women (e.g., Heinberg, 1996; StriegelMoore & Franko, 2002; Tiggemann, 2002). However, despite the power of cultural messages and media portrayals, not every woman exposed to these unattainable ideals of beauty internalizes these models or develops BID. This observation has prompted researchers (e.g., Crago, Shisslak, & Ruble, 2001; Striegel-Moore & Cachelin, 1999) to speculate about factors associated with vulnerability and resistance to internalizing these media portrayals. Therefore, in the present study, we investigated factors related to internalization of media thinness ideals from the perspective of object relations, interpersonal, and attachment theories. Specifically, we posited that warm and expressive emotional bonds with parents in childhood and secure attachment in adult women could reduce the tendency to internalize media-prescribed beauty standards. Before reviewing the literature supporting this model, it is important to note that BID should not be considered as merely a subclinical level of eating disorder. Many women with BID do not present symptoms of disordered eating (Tylka, 2004), although BID has been associated with maladaptive eating (e.g., less intuitive eating, Tylka, 2006), emotional distress (Thompson et al., 1999), and depressive symptoms (Stice & Bearman, 2001; Stice, Hayward, Cameron, Killen, & Taylor, 2000). Body image is a central aspect of self-image that develops through interactions with significant others (Kearney-Cooke, 2002). A primary tenet of interpersonal and object relations theories of personality is that a childs sense of self-value and selfimage develops from the internalized opinions that parents and significant others have of the child (e.g., Fairbairn, 1952; Sullivan, 1953/1997). A substantial body of research suggests that emotional adjustment in adults is associated with memories of emotional bonds with parents. For example, adults who recalled their parents as cold and emotionally unexpressive were more likely to have high levels of depression (Parker, Hadzi-Pavlovic, Greenwald, &

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Weissman, 1995). Contemporary theorists explain these findings in terms of the damaged and incomplete sense of self that results when parents are not sufficiently emotionally responsive (for a review, see Blatt, 2004). This work has been extended to suggest that young adults who recall poor quality emotional bonds with parents have developed a negative self-concept that leads to greater BID and eating issues (Perry, Silvera, Neilands, Rosenvinge, & Hanssen, 2008). Empirical studies suggest that memories of parents as warm and emotionally responsive, versus cold and aloof, are associated with less BID (Ackard, NeumarkSztainer, Story, & Perry, 2006; Haudek, Rorty, & Henker, 1999; Panfilis, Rabbaglio, Rossi, Zita, & Maggini, 2003), whereas insecure attachment with parents is associated with increased concern about weight and risk for eating disturbance (Sharpe et al., 1998). Attachment theory offers an additional developmental model that emphasizes the importance of caregivers responsiveness for the emotional adjustment of children (Bowlby, 1973, 1980, 1988). When caregivers are reasonably responsive to a young childs emotional needs, the child develops a positive working model of others as benevolent and caring and a working model of self as valued and deserving of care and comfort. If caregivers are inconsistently responsive (or consistently unresponsive), then the child develops negative working models involving distrust of others and a sense of oneself as unworthy of protection and care. The specific configuration of negative working models of self, or others, or both self and others depends on the specifics of developmental experience (Bartholomew & Horowitz, 1991). However, once a negative working model of either type does develop, the underlying beliefs about relationships can be quite resistant to change due to the effects of selective perception (Bowlby, 1988) and a lack of social competencies needed to recruit supportive friendships (Hinderlie & Kenny, 2002; Mallinckrodt & Wei, 2005). For example, in a study of interpersonal growth groups, counseling students who recalled poor parental bonds or insecure adult attachments tended to hold negative perceptions of target others that were not shared by fellow group members (Mallinckrodt & Chen, 2004). Previous studies have also documented a positive link between memories of parents as warm and caring and secure adult romantic attachment (Levy, Blatt, & Shaver, 1998; Lopez, Melendez, & Rice, 2000; Matsuoka et al., 2006). A contemporary refinement of attachment theory suggests that adult attachment is best characterized in terms of two continuous orthogonal dimensions of anxiety and avoidance (Mikulincer, Shaver, & Pereg, 2003). Attachment avoidance corresponds to a negative working model of others and is associated with a fear of intimacy. Attachment anxiety corresponds to an underlying negative working model of self and involves low self-esteem and chronic fears of abandonment in close relationships. Women with this latter form of adult attachment insecurity may be especially vulnerable to fears of being negatively evaluated with regard to how their partners view their physical attractiveness (Thompson et al., 1999). Some research suggests that adult attachment anxiety is associated with decreased body satisfaction, whereas adult attachment avoidance is not (Cash, Theriault, & Annis, 2004; McKinley & Randa, 2005). Cash et al. (2004) used a measure of an older four-category conceptualization of attachment (Griffin & Bartholomew, 1994) and found that the category combining a negative working model of self with a positive model of others was the only one of the four categories associated with BID. Other research

reported that only this Preoccupied category was related to a drive for thinness and bulimic symptoms (Brennan & Shaver, 1995; Suldo & Sandberg, 2000). Considering these separate lines of theory and research, it appears that parents who are insufficiently emotionally responsive early in a childs development greatly increase the likelihood that the child will internalize a negative self-image and develop a negative working model of self, which, in turn, leads these children to develop attachment anxiety in romantic relationships as adults. Young women with these childhood experiences may develop an incomplete and insecure self-concept that prompts them to depend on external affirmations of self-esteem and external definitions of attractiveness and beauty (Greenwood & Pietromonaco, 2004). Thus, these women may be more susceptible to internalizing the unrealistically thin ideals portrayed in the media, thereby losing appreciation for their natural beauty and appearance. We prefer an alternative way of interpreting the same pattern of correlations that is more in keeping with the emphasis in counseling psychology on resilience and positive aspects of coping (Gelso & Fretz, 2001). This research also suggests that warm and responsive parenting leads to secure adult attachment. This alternative emphasizes that high-quality parental bonds and adult attachment security serve to help women resist the negative influence of media portrayals by not internalizing the images, thereby experiencing greater satisfaction with their body image. To date, few studies have investigated how parental bonds, adult attachment, and media factors are linked in influencing body satisfaction in young women. Some empirical research suggests that internalization of cultural appearance ideals mediates the relationship between maternal bonding and body satisfaction (Slaton, 2000). Individuals who reported better emotional bonds with their mothers were less likely to internalize sociocultural body ideals and reported more satisfaction with their body image. Other research reported that poor parental bonds predicted negative selfconcept (i.e., low self-esteem, external locus of control, and lower self-understanding), which, in turn, predicted subclinical eating disturbance in both U.S. and Norwegian college student samples (Perry et al., 2008). These preliminary empirical findings are in line with our expectation that college women who perceived emotional availability from their parents in childhood are more likely to form a positive working model of self (e.g., positive self-concept), have less attachment anxiety, and are less likely to seek external cues (e.g., media messages) to guide their selfevaluation as adults. On the basis of the theoretical underpinnings and empirical evidence reviewed above, it appears that there may be causal connections between parental bonds, adult attachment, tendency to internalize thin ideals prescribed in the media, and BID. However, no published studies could be found in which the links among all these variables together in a single model were explored. Therefore, the general purpose of this study was to investigate the model shown in Figure 1. Specifically, we were interested in two mediating variables, each one part of a three-variable system shown as overlapping triangles in Figure 1. First, we hypothesized that both mother and father care would have a direct negative association with media internalization (Path c1 and c2). We investigated parental bonds separately for mothers and fathers because some research suggests that daughters actually receive more appearancerelated messages from fathers than from mothers (Schwartz,

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b Adult Attachment Anxiety a1 Mother Care

Media Internalization Body Mass Index d c2 e

c1

a2 f1 Body Image Dissatisfaction

f2 Father Care

Figure 1.

The conceptual mediation model.

Phares, Tantleff-Dunn & Thompson, 1999). Our second hypothesis held that these direct effects would be mediated by indirect paths through adult attachment anxiety, shown as Paths a1, a2, and b in Figure 1. Whereas media internalization was the outcome (dependent) variable in the first triangular configuration, it serves as the mediating variable in the second three-variable triangle, which also involves adult attachment anxiety and BID. Specifically, our third hypothesis held that adult attachment anxiety would be positively associated with BID as a direct effectPath e in Figure 1. However, our fourth hypothesis held that this direct effect would be mediated by indirect paths through media internalization, shown as Paths b and d in Figure 1. In testing each of these hypothesizes, we controlled for the variance in BID accounted for by actual weight, assessed as body mass index (BMI). Finally, we explored whether either mother care or father care would have a significant negative relationship with BID (Path f1 and f2) after accounting for the variance through indirect paths involving both of the mediators. We were especially interested in media internalization and attachment anxiety as mediating variables because if either our second and forth hypotheses were supported, then avenues for effective intervention might be suggested. Of all the links in Figure 1, perhaps the association between media internalization and BID (Path d) has been the most widely studied and well established in previous research. However, very little is known about the precursor factors associated with a womans vulnerability to internalizing media thinness ideals. Figure 1 proposes that adult attachment anxiety may be an especially important factor in this connection or, phrased in more positive terms, that adult attachment security (low anxiety) is associated with an ability to resist internalizing media images. We were intrigued by the possibility that low attachment anxiety conveys a kind of inoculation against pervasive media images. If so, then esteem-building interventions designed to lower attachment anxiety and increase secure attachment might be effective treatments for BIDnot by addressing BID directly, but by breaking a critical link earlier in the causal chain (i.e., Path b). As shown in Figure 1, we were interested in media internalization not only as an outcome but also as a mediator. If future research suggests that it is not possible to intervene at Path b (e.g., because it turns out to be extraordinarily difficult to lower adult attachment anxiety), and if research sug-

gests that media internalization is a significant mediator, then another possibility might be interventions targeted at lowering susceptibility to media influence. We hypothesize only a partially mediated model in Figure 1 because, in addition to indirect links involving mediator variables, we posit direct links between mother or father care with media internalization and with BID.

Method Participants
At a midwest public university, female students were recruited from the following five courses: (a) Principals of Human Development, (b) Intimate Relationships and Marriage, (c) Foundations of Family Studies, (d) American Sign Language, and (e) Introduction to Educational Statistics. The courses were selected because of their appeal to a broad segment of undergraduate women and because the instructors were willing to permit data collection. A total of 605 survey packets were distributed to women in these classes, with 267 (44%) surveys returned. Four items were embedded in the survey to check for inattentive or random responding (e.g., Please code a 5 for this item.). Data from 27 (10%) of the returned surveys were excluded on the basis of answers to one or more of these items. Thus, usable surveys were received from 240 (40%) of those initially solicited. Of the remaining 240 participants, 9 had missing data for the entire scale assessing emotional bonds with their father and were therefore excluded from further analyses. In addition, procedures used to screen for univariate outliers identified four cases with scores three or more standard deviations below the mean for one or both parental bonding measures. Following the recommendations of Tabachnick and Fidell (2001), Mahalanobis distance was used to identify three additional cases that were significant multivariate outliers ( p .001). The remaining sample of 224 participants included 39 (17%) first-year students, 85 (38%) sophomores, 51 (23%) juniors, 37 (16%) seniors, and 12 (5%) graduate students. With regard to ethnic identification, 204 (91%) reported European American, 8 (3.6%) African American, 5 (2.2%) Hispanic or Latina, 4 (1.8%) Asian American, 1 (0.4%) Native American, and 2 (0.9%) other or more than one ethnicity. Their mean age was 20.54 years

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(SD 3.62, range 18 47). Self-reports of weight and height were used to calculate BMI using the formula BMI (weight in kg)/(height in meters)2. Mean BMI for this sample was 23.17 (SD 4.16, range 16.83 40.37). According to the U.S. guidelines (Expert panel, 1998), a BMI of less than 18.5 is considered underweight, between 18.5 and 24.9 is considered normal weight, from 25 to 29.9 is considered overweight, and 30 or more is considered obese. BMI was not included in screens for univariate or multivariate outliers.

Measures
Parental bonds. The Parental Bonding Instrument, Care Subscales (PBI-C; Parker, Tupling, & Brown, 1979) are two parallel 12-item subscales designed to assess adults memories of emotional warmth and expressiveness with their mother and father from the earliest age that can be recalled through age 16. Previous research suggests that only the PBI Care subscale, and not the Overprotection subscale, is consistently associated with BID (Haudek et al., 1999; Panfilis et al., 2003). A 4-point response scale is used in the PBI-C (1 very like, 2 moderately like, 3 moderately unlike, 4 very unlike), which asks participants to indicate how similar their parent was to descriptive items such as My mother/father appeared to understand my problems and worries or My mother/father was affectionate to me. Evidence of concurrent validity is provided by significant correlations of PBI-C scores with self-assessments from college students parents, significant correlations between siblings, and correlations between respondents and observers interviews with parents (Parker, 1981; Parker & Lipscombe, 1981). In the present study, coefficient alpha for the Mother Care subscale scores and the Father Care subscale scores were .93 and .94, respectively. Adult attachment. The Experiences in Close Relationship Scale (Brennan, Clark, & Shaver, 1998) contains 36 items used to measure adult romantic attachment. Brennan et al. (1998) conducted a factor analysis of more than 300 items taken from the most frequently used self-report adult attachment instruments. They identified two orthogonal factors of Anxiety and Avoidance. Each subscale contains 18 items, which respondents rate using a 7-point, partially anchored Likert-type scale (1 disagree strongly, 4 neutral/mixed, 7 agree strongly). Although the full scale was administered, only items from the Anxiety subscale (e.g., I worry a fair amount about losing my partner) were analyzed in this study because only a negative working model of self was expected to be associated with susceptibility to media influence. Previous research also indicated that only attachment anxiety but not avoidance was associated with body dissatisfaction (e.g., Cash et al., 2004; McKinley & Randa, 2005). In a sample of undergraduates, testretest reliability (3-week interval) was .70 for the Anxiety subscale scores (Brennan, Shaver, & Clark, 2000). Evidence of validity is provided by correlations in expected directions with other measures of adult attachment and with sexual feelings in a sample of college students (Brennan et al., 1998, 2000). In the present study, internal reliability (coefficient alpha) was .91 for the Anxiety subscale scores. Internalization of media portrayals of body image ideals. The Sociocultural Attitudes Towards Appearance Scale-3 (SATAQ-3; Thompson et al., 2004) was used to assess a tendency to rely on the media (i.e., TV, magazines, movies, and music videos) as a source

of influence concerning appraisals of ones body appearance. The full SATAQ-3 consists of four subscales (a) InternalizationGeneral (nine items), capturing general influence from the media regarding appearance ideals (I would like my body to look like the models who appear in magazines); (b) Pressures (seven items), assessing perceived media pressure to achieve appearance ideals (Ive felt pressure from TV and magazines to be thin); (c) Internalization-Athlete (five items), involving a tendency to internalize athletic ideals and sports figures from the media (I wish I looked as athletic as sports stars). The fourth subscale, Information, was excluded from the present study. Unlike the other subscales, Information only assesses acknowledgement of media as a source of information but not necessarily its influence (e.g., TV commercials are an important source of information about fashion and being attractive). Thompson et al. (2004) reported evidence of construct validity through strong associations between the three SATAQ-3 subscales used in this study and measures of body image concerns and eating dysfunction in a sample of college women. A 5-point, Likert-type response scale is used in the SATAQ-3 (1 definitely disagree, 2 mostly disagree, 3 neither disagree nor agree, 4 mostly agree, 5 definitely agree). In the present study, internal consistency reliability (alpha coefficients) for the Internalization-General, Pressures, and Internalization-Athlete subscale scores were .96, .94, and .86, respectively. BID. The Multidimensional Body Self-Relations Questionnaire, Appearance Evaluation subscale (MBSRQ-AE; Brown, Cash, & Mikulka, 1990; Cash, 1990) contains seven items to assess generalized satisfaction with ones body (e.g., I like my looks just the way they are). Respondents use a 5-point, fully anchored Likert-type scale (1 definitely disagree, 2 mostly disagree, 3 neither agree nor disagree, 4 mostly agree, 5 definitely agree). In contrast, the Body Area Satisfaction Subscale (BASS), also developed by Cash (1990), assesses satisfaction with specific body parts or aspects of ones appearance (e.g., How satisfied are you with your midtorso [i.e., waist, stomach]?). The BASS contains nine items that ask participants to respond on a 5-point partially anchored scale (1 very dissatisfied, 3 neither satisfied nor dissatisfied, 5 very satisfied). The two subscales are frequently used together by researchers (e.g., Foster, Wadden, & Vogt, 1997; Tager, Good, & Morrison, 2006) to assess both the emotional and evaluative experience of ones body image from a general perspective and with respect to specific body areas. The subscales are typically scored so that higher levels indicate more satisfaction, but for consistency with the model in the present study, the subscales were reverse scored so that higher scores indicated more dissatisfaction. Cash (2000) reported testretest reliability (1-month interval) in a sample of female college students of .91 for the MBSRQ-AE scores and .74 for the BASS scores. In the present study, coefficient alpha for the MBSRQ-AE subscale scores was .91 and for the BASS scores was .76.

Procedure
A member of the research team came to each class to invite students participation. Survey packets were distributed to all students. There were 605 women present in the five classes on the day of data collection. Only surveys from students who indicated their gender was female were analyzed for this study. Students were

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informed that participation was completely voluntary and that all responses would be confidential. They were asked to fill out the survey packets at home and bring them back to the next class meeting. A raffle was used as an incentive for participation; two $50 prizes and twenty $10 prizes, totaling $300, were awarded.

Results Preliminary Analyses

Table 1 shows the means, standard deviations, and zero-order correlations for the primary variables in this study. Consistent with our expectations, Mother Care was significantly correlated with Anxiety (r .26, p .001), as was Father Care (r .29, p .001). In addition, Table 1 shows that both Mother Care and Father Care were significantly associated with the two subscales that measured BID. However, contrary to expectations, neither Mother Care nor Father Care was significantly associated with any of the three subscales used to assess internalization of media influence.

Measurement Model for Testing Mediated Effects

Analysis of our proposed measurement model for latent variable structural equation modeling (SEM) was conducted with Mplus Version 5.1 (Muthe n & Muthe n, 2007). Preliminary results indicated that Mardias coefficient of multivariate kurtosis 13.09 for our data. Values greater than 2.56 are significant at the .01 level. Thus, results indicated that the data significantly departed from multivariate normality. Therefore, we decided to use Satorra and Bentlers (1988) scaled (mean-adjusted) chi-square as our primary text statistic to assess model fit because it adjusts for departures from multivariate normality. Next, we conducted a confirmatory factor analysis to examine the fit of the proposed measurement model. The three subscales of the SATAQ-3 served as indicators of media internalization. The MBSRQ-AE and BASS served as two indicators of BID. For constructs represented by only a single measured variable (e.g., mother care, father care, and attachment anxiety), we followed the recommendations of Russell, Kahn, Spoth, and Altmaier (1998) to create three parcels of items as

indicators for each of these latent variables. We conducted exploratory factor analyses with a forced one-factor solution for each variable. We then used resulting item loadings to assign items to parcels so that the loading of each parcel on its respective latent variable was as balanced as possible. The measurement model in the present study was estimated using the maximum-likelihood mean-adjusted (MLM) method in Mplus. As suggested by Hu and Bentler (1999), Martens (2005), and Quintana and Maxwell (1999), we used the following indices to assess goodness of fit for the models: the comparative fit index (CFI; a value of .95 or greater indicates adequate fit), the Tucker-Lewis index (TLI; a value of .95 or greater indicates adequate fit), the standardized root-mean-square residual (SRMR; values of .08 or less are considered an adequate fit to the data), and the root-mean-square error of approximation, (RMSEA; a value of .08 is considered an upper bound value that indicates an adequate fit). Results indicated an adequate fit of the measurement model to the data: CFI .97; TLI .96; SRMR .06; RMSEA .06, scaled 2(80, N 224) 141.08, p .001. Table 2 indicates that the factor loadings of all 14 measured variables on their correspondent latent variables were statistically significant ( p .001). Thus, it appears that all latent variables were adequately measured by their indicators. Table 3 shows correlations among the five latent variables and BMI as a single item variable used as a covariate for Body Image Dissatisfaction. Results showed that our first hypothesis was not supported. Neither mother care nor father care was significantly negatively linked with media internalization. Results pertaining to our second and fourth hypotheses are discussed in the next section in connection with mediated effects. The third hypothesis held that adult attachment anxiety would be positively associated with BID. Table 3 shows that this hypothesis was supported (r .20, p .01).

Structural Model for Testing Mediated Effects

We used the MLM method in Mplus to test the hypothesized structural model. Results indicated an adequate fit to the data: CFI .97; TLI .96; SRMR .06; RMSEA .06, scaled 2(80, N 224) 141.08, p .001. Figure 2 summarizes the results for

Table 1 Means, Standard Deviations, and Correlations

Variable Independent variable 1. Mother care 2. Father care 3. Attachment anxiety Media internalization 4. Internalization-General 5. Pressures 6. Internalization-Athlete Body image dissatisfaction and body mass 7. MBSRQ-AE 8. BASS 9. Body mass index M 2.63 2.30 3.77 3.66 3.77 3.59 3.28 3.32 23.19 SD 0.50 0.65 1.14 1.07 1.03 0.93 0.84 0.61 4.16 1 2 .34 3 .26 .29 4 .03 .03 .18 5 .09 .08 .23 .74 6 .06 .09 .07 .61 .54 7 .29 .18 .22 .25 .33 .30 8 .35 .27 .22 .31 .36 .34 .79 9 .19 .11 .13 .14 .17 .01 .46 .34

Note. N 224. MBSRQ-AE Multidimensional Body Self-Relations Questionnaire, Appearance Evaluation subscale; BASS Body Area Satisfaction subscale; the two subscale scores were reversed for the purpose of this study. p .05. p .01.

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Table 2 Factor Loadings for the Measurement Model
Measure and variable Mother Care Mother care Parcel 1 Mother care Parcel 2 Mother care Parcel 3 Father Care Father care Parcel 1 Father care Parcel 2 Father care Parcel 3 Attachment Anxiety Anxiety Parcel 1 Anxiety Parcel 2 Anxiety Parcel 3 Media Internalization Pressures Internalization-General Internalization-Athlete Body Image Dissatisfaction Appearance evaluation Body areas satisfaction Note. N 224. p .001. b 0.47 0.51 0.48 0.61 0.67 0.61 1.10 1.14 1.05 0.84 0.97 0.62 0.74 0.53 SE .03 .04 .03 .03 .04 .04 .06 .06 .06 .06 .06 .06 .05 .03 Z

CHENG AND MALLINCKRODT

.92 .90 .93 .94 .89 .91 .91 .93 .88 .81 .91 .67 .90 .87

13.77 13.62 15.75 17.93 18.62 16.57 20.45 19.96 17.42 12.68 16.24 9.81 15.29 16.22

the structural model. Path coefficients shown are standardized values. BMI was used as a covariate to control for the influence of actual body size on body dissatisfaction. Dashed lines in Figure 2 are used to show paths that were not statistically significant. Figure 2 shows that each component path linking hypothesized mediating variables was significant. Specifically, mother care and father care were negatively linked to attachment anxiety ( .20, .23, respectively). Attachment anxiety, in turn, was positively linked to media internalization ( .21), and media internalization was linked to BID ( .39), controlling for actual weight (BMI). Finally, Figure 2 shows that after accounting for this multistage indirect path and for the variance in BID due to actual weight, mother care still had a significant direct effect on BID ( .22, p .05). This was not true of father care ( .11, ns).

Bootstrap Procedure for the Significant Level of Indirect Effects

Before testing the statistical significance of mediation effects, it is important to address the issue of prerequisites for the procedure.

Baron and Kenny (1986) proposed that before an investigation of magnitude of mediation effects can be undertaken, three prerequisite conditions must be metspecifically, that each pair of variables in the three-variable system must be significantly correlated. Examination of bivariate correlations between latent variables shown in Table 3 for the triangular system that involves mother or father care, attachment anxiety, and media internalization in Figure 2 reveals that only two of the three conditions are met. The two parental bond variables are each significantly negatively associated with attachment anxiety, and attachment anxiety is positively associated with media influence. However, mother care and father care are not significantly associated with media influence (see Table 3, Column 4). However, Frazier, Tix, and Barron (2004) recently called attention to several writers who question the requirement in mediation models that the independent variable must be directly associated with the outcome (e.g., Kenny, Kashy, & Bolger, 1998). For example, unmeasured secondary mediators might have effects in addition to the mediator that is measured, thereby masking direct effects of the independent variable on the outcome. In a suggestion with particular relevance for the present study, Shrout and Bolger (2002) recommended dispensing with the requirement in circumstances in which the independent variable is fairly distal in time from the outcome. Thus, we believe there was sufficient justification to proceed with tests for mediation even though one of Baron and Kennys (1986) three assumptions was not met for one of the mediation systems shown in Figure 2. Because the product of the two path coefficients that comprise an indirect effect is not distributed normally (MacKinnon, Warsi, & Dwyer, 1995), methods of assessing the statistical significance of mediation effects on the basis of normal theory (e.g., Baron & Kenny, 1986) are no longer considered the best choice. Therefore, we used an alternative procedure based on bootstrap methods to test statistical significance of indirect effects (Mallinckrodt, Abraham, Wei, & Russell, 2006; Shrout & Bolger, 2002). We used Mplus to create 1,000 bootstrap samples from the original data in the structural model. The 1,000 bootstrap samples were run with the bias-corrected percentile method to estimate the path coefficients. Point estimates of the magnitude of the indirect effect, that is, the products of the alpha path (i.e., from the independent variable to the mediator) and beta path (i.e., from the mediator to the dependent variable), together with the associated 95% confidence interval were also estimated through the same 1,000 bootstrap samples. If the confidence interval excludes zero, then the

Table 3 Correlations Among Latent Variables for the Measurement Model

Variable 1. 2. 3. 4. 5. 6. Mother care Father care Attachment anxiety Media internalization Body image dissatisfaction BMI 1 2 .36

3 .28 .31

4 .06 .07 .21

5 .29 .22 .20 .42

.42

Note. N 224. Body mass index (BMI) was treated as a latent variable with only one indicator in the measurement model. p .01. p .001.

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Adult Attachment Anxiety -.20 -.23 Mother Care

.21 -.01

Media Internalization

Body Mass Index

.00 .39 .03 .43

.36 Father Care

-.22 Body Image Dissatisfaction -.11

Figure 2.

The structural model. Dotted lines indicate paths that were not statistically significant.

indirect effect is considered statistically significant at the .05 level (Mallinckrodt et al., 2006; Shrout & Bolger, 2002). Results from the bootstrap analyses shown in Table 4 indicate that the confidence intervals for each of the five indirect effects examined all excluded zero. Therefore, all five mediation effects can be considered statistically significant ( p .05). The first two rows of Table 4 show support for our second hypotheses regarding mediation effects of attachment anxiety. The third row of Table 4 shows support for our forth hypothesis regarding mediation effects of media internalization.

Discussion
The primary purpose of this study was to investigate the theoretical model presented in Figure 1, which posited parental bonds and adult attachment would be associated with level of media internalization and body image concerns through indirect mediation relationships and direct links. Although our first hypothesis regarding the direct relationships between mother or father care and media internalization was not supported, the third hypothesis regarding a direct connection between attachment anxiety and BID was supported. Our second and fourth hypotheses were also supported by the results of bootstrapping procedures to test mediation effects. That is, the associations of mother or father care with

media internalization were mediated by attachment anxiety, and the relationship between attachment anxiety and BID was mediated by media internalization. It is perhaps not surprising that media internalization was associated with BID in our study, given the growing body of literature supporting links between media influence and the high level of dissatisfaction that many U.S. college-age women feel about their body image (e.g., Cattarin et al., 2000; Cusumano & Thompson, 1997; Hamilton et al., 2007; Stice et al., 1998; Thompson et al., 2004). However, our primary interest was to move beyond this fundamental observation to investigate the role of adult attachment and emotional bonds with parents as precursor influences on media influence, and as direct links to BID. Consequently, we focus in the discussion that follows on our hypotheses, which emphasized the multiple mediation processes that involve the role of mother care, father care, and adult attachment anxiety as precursors of media internalization and BID. Investigating these links was the relatively unique contribution of the present study. In general, the model presented in Figure 1 received support from our findings. Before examining the mediation processes, it may be useful to first look at the nonmediated direct links between BID and three independent variables: mother care, father care, and attachment anxiety (i.e., Hypotheses f and g). Table 3 shows that

Table 4 Bootstrap Analysis of Structural Model, Magnitude, and Statistical Significance of Indirect Effects
95% confidence interval for mean indirect effecta (lower and upper) .188, .010 .169, .014 .011, .113 .072, .003 .065, .005

Independent variable Mother care Father care Anxiety Mother care Father care 3 3 3 3 3

Mediator variable(s) Anxiety Anxiety Media internalization Anxiety 3 Media internalization Anxiety 3 Media internalization 3 3 3 3 3

Dependent variable Media internalization Media internalization BID BID BID

(standardized path coefficient and product) .20 .21 .042 .23 .21 .048 .21 .39 .082 .20 .21 .39 .016 .23 .21 .39 .019

Mean indirect effect (b)a .073 .068 .055 .025 .023

SE of meana .044 .037 .026 .017 .014

Note. N 224. These values are based on unstandardized path coefficients.

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each of these independent variables had significant direct links in the expected direction with BID, but when mediating variables are considered, Figure 2 shows that only one of these three direct paths remained significant (i.e., from mother care). This pattern shifts attention to the indirect effects implied in our second and fourth hypotheses that posited mediation relationships. When considering media internalization as an outcome and attachment anxiety as a mediator, results showed that mother or father care was indirectly related to media internalization through the mediation of attachment anxiety (see Figure 2). This result is consistent with the inference that parents warmth and emotional expressiveness, through the mechanism of promoting secure adult attachment, may serve as a kind of inoculating factor against the pernicious influence of the media in U.S. culture. The significant direct connection between attachment anxiety and media influence is congruent with the one other study we were able to locate that also investigated insecure adult attachment and media influence. Greenwood and Pietromonaco (2004) found that women with preoccupied attachment style (characterized by high adult attachment anxiety and low avoidance) reported greater identification with slender and glamorous media female characters and a stronger wish to look like these models. With regard to indirect effects, Figure 2 proposes a two-stage model in which both attachment anxiety and media internalization serve as mediators. Findings supporting this model suggest that a lack of emotional caring bonds with mothers or fathers was associated with anxious adult attachment for women, which, in turn, was associated with the participants tendency to internalize media-prescribed body ideals and thereby to increased BID. These findings suggest that women who recall their parents as warm and accepting, to the extent that these parental bonds promote low attachment anxiety, appear able to resist internalizing media ideals of beauty and the pressure of messages to lose weight or achieve media-defined standards of appearance, and thus are less likely to experience dissatisfaction with their body image. These results are in line with the predictions of object relations (cf. Blatt, 2004), interpersonal theory (Sullivan, 1953/1997), and attachment theory (Bowlby, 1988). These theories predict that when parents are not sufficiently emotionally available, children may grow into adulthood with a sense of self that is incomplete or damaged, which, in turn, may prompt them to seek external validation and guidance (e.g., the mass media) regarding their sense of worth and desirability. These results are also consistent with developmental models emphasizing the specific importance of parental bonds in the etiology of body image and eating concerns (Haudek et al., 1999; Kearney-Cooke, 2002; Perry et al., 2008). A search of the literature located only one empirical study in which parental bonds and internalization of media ideals were examined. Slaton (2000) reported that poor maternal bonding (as measured by the PBI-Care subscale) was associated with media internalization. In a related vein, research has indicated that college women who received negative appearance-related feedback and teasing from mothers and other family members reported increased adherence to media thinness ideals (Van den Berg, Thompson, Obremski-Brandon, & Coovert, 2002). Thus, our findings are consistent with the small amount of previous research in this area. With regard to parental bonds, Figure 2 suggests that emotional responsiveness from fathers may be at least as important as from mothers in contributing to secure adult attachment of their daugh-

ters. Some research suggests that parental bonds with fathers may be more influential than from mothers in promoting the science self-efficacy of college women who decided to follow through on interests in a science career they had first expressed as an adolescent (Scott & Mallinckrodt, 2005). Other research suggests that for adolescent girls, the strongest influences on their body image and strategies to manage their weight were from their mothers and best female friends, with fewer influences from their fathers or the mass media (McCabe & Ricciarcelli, 2005). In the present study, Table 1 shows that mother care, but not father care, was significantly associated with actual self-reported weight (i.e., BMI); similarly, Figure 2 indicates that only mother care, but not father care, had a significant direct path to BID in the structural model, although emotional bonds with both parents were significantly associated with BIDwhen mediators were not involved (see Tables 1 and 3). Perhaps the differences in findings across studies can be explained, in part, by differences in method of assessing adults recollections of childhood bonds with parents, as well as whether key mediating variables, such as adult attachment, were included in the model. Clearly more research is needed to investigate the different roles that each parent may play in the development of their daughters self-concept and adult attachment. Overall, findings of the present study extend the literature applying concepts from object relations, interpersonal, and attachment theories to gain a better understanding of how young women might become more susceptible to the influence of media images that cause body dissatisfaction, and alternatively how these same women might develop a resistance to internalizing these images through relatively secure adult attachments and memories of each parent having been warm, emotionally expressive, and accepting. A recent study by Avalos and Tylka (2006) found that women who perceived greater unconditional regard and acceptance from the person they nominated as most influential (e.g., parent, romantic partner) reported more acceptance by others regarding their body shape and weight. Furthermore, this acceptance by others was positively associated with healthy intuitive eating patterns. Thus, the findings of the present study are congruent with those of Avalos and Tylka. Taken together, both studies further an understanding of the positive role that unconditional acceptance and secure attachment play in developing a positive sense of body image, healthy eating, and psychological well-being. Before discussing practical implications of these findings, several important methodological limitations in this study must be noted. First, participants were solicited from five specific classes in a midwestern U.S. university. Although this was a broad sampling of courses, it was not a random sample of all women on this campus. The research compliance rate of 40% usable returned surveys further limits generalizability. Women knew this study was about body image concerns and parental relationships. Those who may have been sensitive to one or both topics may have not been sufficiently represented in the sample. Second, the ethnic identification of most women (91%) was European American. Generalizability to other ethnic groups and to noncollege women of all ethnicities is limited. Some empirical studies have documented significant differences in body image among different ethnic groups (Mayville, Katz, Gipson, & Cabral, 1999; Miller et al., 2000), although other studies report no ethnic differences in body image (Gardner, Friedman, & Jackson, 1999). A further limitation is that all data were collected at one time point using

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self-report measures. A design of this type is subject to monomethod bias and inflation of correlations due to common method variance (Heppner, Kivlighan, & Wampold, 1999). Inferences about causality are not justified, and actual causal mediation cannot be inferred from this cross-sectional design. Longitudinal or experimental studies are necessary to confirm the chronological precedence of risk/protective and mediating factors to facilitate a better understanding of the processes involved in the development of body satisfaction in young women (Stice, 2001). Despite these limitations and the need to replicate the findings in future studies, the present study has several strengths. This study is among the first to examine associations between parental bonds, adult attachment, sociocultural media factors, and young womens body image concerns. As Greenwood and Pietromonaco (2004) emphasized, it is important to examine the personsituation interactions to identify the particular personal resilience (e.g., secure parental bonds) and vulnerabilities (e.g., attachment anxiety) that interact with media messages to affect human behavior and mental health. These authors pointed out that research on media and eating disorders has yet to use attachment style as a potentially useful individual risk factor . . . research on attachment and eating disorders has yet to include media consumption into the hypothesized etiological models (p. 297). The results of our study demonstrated that a mediation model is useful when conceptualizing the potential etiological relationships among parental and romantic attachment, media influence, and body image concerns. In addition, our findings may have implications for prevention and intervention. Parents hoping to shield their daughters from the harmful influence of media might accomplish this task by maintaining a warm, supportive, and emotionally expressive relationship throughout the tumultuous adolescent years because this helps youngsters develop positive models of self and secure adult attachment. Therapists working with clients whose presenting problem includes body image concerns may benefit from assessing the clients attachment history, current attachment style, and preferences about attending to media sources. A preliminary study suggests that intensive year-long psychotherapy was successful in significantly reducing attachment insecurity in clients diagnosed with borderline personality disorder (Levy et al., 2006). If future studies suggest that attachment anxiety can be reduced through psychotherapy for clients like the women who participated in the present study, concomitant decreases in media internalization and body dissatisfaction may be an additional benefit of the treatment. Counselors might be able to decrease body image concerns directly by helping women to reduce their exposure to harmful media images and to develop effective cognitive strategies that prevent internalizing the images that their clients do see. Research suggests that clients who establish a secure attachment to their therapist report more capacity to deeply explore troubling material in time-limited therapy (Mallinckrodt, Porter, & Kivlighan, 2005). Bowlby (1988) argued that this type of therapeutic secure base of attachment helps clients to revise negative working models of self and others. Perhaps this type of therapeutic relationship will facilitate a reduction in body dissatisfaction as well. Reviews of research (cf. Ward, Ramsay, & Treasure, 2000) have suggested that insecure attachment is associated with both disordered eating and body image problems. However, there remains a paucity of research examining parental and adult attachment factors in body image concerns for nonclinical populations. The present study

suggests that longitudinal and experimental research is needed to explore these potential causal links. This research should focus not only on risk and protective factors for media influence and body image issues but also on more adaptive aspects of functioning such as positive body image and intuitive eating (Tylka, 2006).

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Received November 27, 2007 Revision received December 10, 2008 Accepted December 30, 2008