Social Comparison in Eating Disorder Recovery: A Mixed-Methodological Approach

This dissertation examines social comparison tendencies in young women during eating disorder (ED) recovery. Study one drew on a photo-elicitation method (“PhotoVoice”) and semi-structured interviews to examine this relation. Thirty U.S. women, ages 18-35, in self-defined recovery from disordered eating, used photography to capture personally-meaningful social and cultural influences on their recovery. Participants then shared these photographs with the research team and described them in detail. Photographs and interviews were examined for social comparisons using thematic analysis, and two broad categories emerged: recovery-promoting and recovery-hindering comparisons. The presence of both “upward” and “downward” comparisons that both support and hinder recovery suggests that social comparisons during the recovery process are more nuanced than previously known. Study two drew from this qualitative data to revise and validate an existing measure of food and body comparisons for women in ED recovery. Women from across the U.S. (n = 183) completed measures of body, eating, and exercise social comparison general comparison orientation, and body dissatisfaction and disordered eating in one online session. After removing four items based on prior research and theory, the revised model fit the data well. Results suggest that body, eating, and exercise social comparisons continue to correlate with body dissatisfaction and disordered eating during recovery, but there are nuances in the content of the comparisons. Study three used this revised measure of social comparison to examine how the interrelations among thin ideal internalization, social comparison, and disordered eating outcomes vary throughout the disorder and recovery processes. An additional 78 women with an active ED, and 178 healthy-control women completed the above-mentioned measures, along with a measure of thin-ideal internalization. Multi-group path analysis showed that the relations among these constructs change between disordered eating and recovery. Study four drew from the same interviews explored in study one, returning to the interviews and photographs to highlight the key areas of potential change for clinicians and policymakers. Participant responses clustered into six themes: healthcare practice and access, health insurance reform, education, objectification of the female body, and mental health stigma. Direct suggestions and implications are discussed.