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


  • 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.


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

publication date

  • 2018