Undergraduate Review

Volume 6 Article 6

2010

The Role of Body Image and Social Anxiety in

Problematic Drinking Behavior
Kira Archibald

Follow this and additional works at: http://vc.bridgew.edu/undergrad_rev

Part of the Psychology Commons

Recommended Citation
Archibald, Kira (2010). The Role of Body Image and Social Anxiety in Problematic Drinking Behavior. Undergraduate Review, 6,
15-20.
Available at: http://vc.bridgew.edu/undergrad_rev/vol6/iss1/6

This item is available as part of Virtual Commons, the open-access institutional repository of Bridgewater State University, Bridgewater, Massachusetts.
Copyright © 2010 Kira Archibald

Kira Archibald is a
senior psychology
major. This piece
was conducted with
funding with a 2009
Adrian Tinsley Program summer
research grant. Kira worked under
the mentorship of Dr. Teresa King
and was presented at the 2009 ATP
Summer Research Symposium and
at the 2010 Eastern Psychological
Association Conference in New York.
This research is being expanded and
will culminate into an honors thesis.
BRIDGEWATER STATE COLLEGE
The Role of Body Image and
Social Anxiety in Problematic
Drinking Behavior
KIRA ARCHIBALD
T
he prevalence of problematic drinking behavior in college age students
is an alarming 83% (NIAAA, 2008). Unfortunately problem alcohol
use is not the only problem college students face today. College students,
especially females, also have a high rate of body image problems
and high rates of social anxiety. With all of these problems so prevalent in this
population, it is necessary to examine how these variables interact with each other
to affect an individual’s life. Many studies have paired these variables together to
examine their connections and have found strong connections; however, no studies
have examined the relationships among all three. Could these three variables
coincide to exacerbate the effects each one has on an individual?
An individual’s expectancies about what alcohol will do for them have been
shown to relate to quantity or frequency of a person’s drinking (Morris,
Stewart, & Ham, 2005). Expectancies are a part of drinking behavior. Some
common drinking expectancies individuals hold include believing that
alcohol will make them more sociable, enhance their sexual performance,
and increase their confidence level (Morris, Stewart & Ham, 2005). Research
has suggested that alcohol expectancies act as moderators in the relationship
between alcohol use and social anxiety (Morris, Stewart & Ham, 2005,
Ruiz, Strain, & Langrod, 2007). The term moderator is used to describe a
variable that affects the direction and/or strength of the relation between an
independent or predictor variable and a dependent variable (Barron &Kenny,
1986). Thus, the relationship between social anxiety and alcohol use changes
depending on the presence of alcohol expectancies.
Many college students struggle with problematic drinking behavior, however,
their struggles do not end there. Many college age students struggle with body
image concerns as well. Body image is defined as a complex, multidimensional
construct that includes self-perceptions and attitudes (i.e., thoughts, feeling,
and behaviors) with regard to the body (Avalos et al., 2005). Although
most research has been in relation to body image and eating disorders,
some research has implicated its connection to other risky health behaviors
including problematic drinking (Striegel-Moore & Huydic, 1993). One
study found drinking to be moderately correlated with the behaviors seen in
eating disorders, especially body image concerns (Striegel-Moore & Huydic,
1993). Other studies have found that body image concerns may be a risk
factor for developing alcohol abuse problems and alcoholism (Franko et al.,
2010 • THE UNDERGRADUATE REVIEW • 15
2005; Striegel-Moore & Huydic, 1993). A connection between
frequency of drinking and an adolescent’s dissatisfaction with
his/her body when comparing themselves with media figures
was established in another study (Palmqvist & Santavirta,
2005). The result above sheds light on the connection between
social comparisons, body image concerns, and alcohol use,
which may point to the role of social anxiety in body image’s
relationship to drinking behavior.
Although some research supports the claim that body image and
drinking behavior are connected, other studies have reported
no relationship. A study conducted to measure the prevalence
of problem eating and drinking behaviors in female collegiate
athletes as compared to that of controls found no relationship
between problem eating behaviors and drinking in either
sample (Gutgesell, Moreau, & Thompson, 2003). The lack
of a relationship may have been due to the small percentage of
evident eating disorders. Another limitation of this study was
not measuring problematic eating behaviors on a continuum.
Many studies have shown a connection between body image
dissatisfaction and high social anxiety (e.g. Cash, Therriault,
& Annis, 2004; Streigel-Moore, Silberstein, & Rodin, 1993).
Social anxiety can be devastating for a college student who is
constantly surrounded by unfamiliar people. Not only are they
meeting new people within their school but in social events
outside the classroom as well. The Diagnostic Statistical Manual
(DSM-IV-TR) defines social anxiety as “a persistent fear of one
or more social or performance situations in which the person is
exposed to unfamiliar people or to possible scrutiny by others”
(APA, 2000). Continued investigation into the relationship
between body image and social anxiety is warranted to create
a more complete picture of the explanatory mechanisms
responsible for this connection.
Body image has been connected to other risky health behaviors,
such as eating disorders (Slade & Brodie, 1994), smoking
(Granner, Black, & Abood, 2002), and unhealthy exercise
patterns (Hausenblas & Fallon, 2001). It has been suggested
that the reason for this connection may be to control one’s
weight, which is often a concern for those with a negative body
image (Slade & Brodie, 1994). Behaviors such as restricting
intake of food, binging, purging, and excessive exercise are
some of the more obvious problems seen in weight control
and are the hallmark of disorders, such as Bulimia Nervosa
and Anorexia Nervosa. Smoking has also been implicated in
body image issues, weight concern, and weight control (King,
Matacin, Marcus, Bock, & Tripolone, 2000; McKee, Nhean,
Hinson, & Mase, 2006). It is suggested that people, especially
females, use cigarettes to control the urge to eat. Smoking
may also exacerbate body image problems due to the image
16 • THE UNDERGRADUATE REVIEW • 2010
and smell that smoking cigarettes brings upon the smoker
(King, et al., 2000). However, problematic drinking behavior
is different from these other behaviors in that its use is in no
way connected to weight control. In fact, alcohol, which is
high in calories, can cause weight gain thus its connection to
body image is likely due to factors other than weight control,
such as anxiety.
Alcohol has a high co-morbidity rate with psychiatric disorders
as well, especially anxiety disorders (Ruiz, Strain, & Langrod,
2007). Women are more likely than men to have both anxiety
disorders and alcohol problems (Ruiz, Strain, & Langrod, 2007).
In a study of 56 female subjects, alcohol outcome expectancies
were found to be predictive of those who drink to cope with
social anxiety (Carrigan, Ham, Thomas, & Randall, 2008).
Subjects who reported using alcohol as a coping mechanism
had higher levels of social anxiety than those who used other
styles of coping (Carrigan, Ham, Thomas, & Randall, 2008).
The relationship between alcohol use and social anxiety is not
clear-cut. A critical review of the literature did not reveal a
relationship between problem drinking and social anxiety and
further suggested that consuming a larger amount of alcohol
was correlated with a lower level of social anxiety (Morris,
Stewart & Ham, 2005). The authors suggested that one
possible explanation for this finding was that individuals with
social anxiety might find that avoiding social environments,
including those where alcohol is available, is more effective
in reducing anxiety than using alcohol. It was also suggested
that a study previously conducted by the authors might be the
key in understanding these findings (Morris, Stewart & Ham,
2005). In this study, social anxiety decreased as the number of
drinks a subject had per week increased; however, social anxiety
was positively correlated with alcohol use problems (Stewart,
Morris, Mellings, & Komar, 2006). It is suggested that, while
individuals with social anxiety may not drink more than the
general population, they tend to drink for problematic reasons
(Morris, Stewart, & Ham, 2005)
Gender differences also play an important role in this research
since men and women may drink for different reasons.
Previous research of gender differences in the relationship
between social anxiety and alcohol consumption have yielded
mixed results. In a study of 1,217 undergraduate psychology
students, males reported slightly higher levels of social anxiety
and alcohol use than females (Neighbors, 2007). Also in this
study, social anxiety was examined as a moderating variable for
the relationship between drinking and perceived social norms.
The results showed a stronger connection between perceived
norms and drinking when students had higher levels of social
anxiety.
BRIDGEWATER STATE COLLEGE
In summary, alcohol abuse has a devastating impact on the
lives of college students. Reasons for drinking are apt to vary
depending on the individual. For individuals with a negative
body image and subsequent social anxiety, drinking may be
used as a maladaptive coping strategy. There is some evidence
for a connection between negative body image and unhealthy
drinking habits, but this relationship is likely influenced by
several factors, including but not limited to gender, drinking
expectancies, and social anxiety. Social anxiety has been
connected to both body image and alcohol use; however, very
few studies have examined the three constructs together. The
purpose of this study was to examine the relationship between
social anxiety, body image concerns, and drinking behavior
and expectancies. It was predicted that participants who
reported higher social anxiety would also report more body
image concerns. Also, those participants that reported higher
social anxiety and more body image concerns would also report
higher drinking levels and a greater expectancy for alcohol to
increase their confidence and reduce their tension in social
situations, These relationships were also predicted to be more
evident in females then males.
Methods:
Participants
The participants in this study were 56 (38 females, 17 males)
students from a southeastern Massachusetts college, recruited
from introductory psychology classes. Participants were 75%
Caucasian with a mean age of 20.23. The education level of
these participants was well spread among the years of college
education.
Procedure
Each participant was given a packet of questionnaires designed
to measure body image, social anxiety, and drinking behavior
respectively. Before completing the survey each participant
read and signed and informed consent document. After
completing this survey participants were given a debriefing
sheet with contact information for questions or concerns.
Participants received credit in introductory psychology classes
for completing this survey. This study received IRB approval at
Bridgewater State College before being implemented.
Statistical analysis
Descriptive statistics were conducted on the variables of inter-
est. Independent t-tests were conducted to examine gender dif-
ferences. To examine the relationships among social anxiety,
body image, alcohol use, and drinking expectancies Pearson’s
r correlations were conducted.
BRIDGEWATER STATE COLLEGE
Measures
Several different scales were used to measure body image con-
cern. The Multidimensional Body-Self Relations Question-
naires-Appearance Subscales (MBSRQ-AS; Cash et al., 1986)
consists of the subscales Body Areas Satisfaction (BAS) and
Appearance Evaluation (AE), which measure body satisfaction.
Overweight Preoccupation (OWP) measures concern about
body weight and Self-Classified Weight (SCW) measures the
participant’s perception of his/her own weight (Cash et al.,
2000). The Physical Appearance State and Trait Anxiety Scale:
Trait Version (PASTAS; Reed, et al., 1991) was also used to
measure body image. Specifically it assesses which body parts
cause the participant concern or anxiety. The Drive For Mus-
cularity Scale (McCreary & Sasse, 2000) and the Male Body
Attitudes Scale (MBAS) were added to increase the items in
the survey measuring body image concerns that are more typi-
cal of males. The Leibowitz Social Anxiety Scale (LSAS; Lei-
bowitz, 1987) was used as a basic measure of social anxiety.
This scale can be divided into avoid and anxiety subscales or a
total score can be used. The Social Appearance Anxiety Scale
(SAAS; Hart, et al., 2008) is a 16-item survey that was used to
calculate how a participant’s social self-image is altered due to
the amount of anxiety they feel in social situations. The Alco-
hol Use Disorders Identification Test (AUDIT; WHO, 2001)
was used to measure the extent of a participant’s risky drinking
or how heavy a participant drinks. The revised Drinking Ex-
pectancy Questionnaire (DEQ-R; Lee et al., 2003)) was used
to measure the expectancies each participant has about what
drinking will do for them. The DEQ-R is composed of five
subscales: Increased Confidence, Tension Reduction, Increased
Sexual Interest, Cognitive Enhancement, and Negative Con-
sequences.
Results:
On the Physical Appearance Trait and State (PASTAS) the
female participants’ mean score was significantly higher than
that of the male participants suggesting that females have
more dissatisfaction in specific body areas than males, t(55) =
3.19, p = .002. Males scored significantly lower on the Male
Body Attitudes Scale (MBAS) than the females suggesting that
females have higher body dissatisfaction, t(31.705) = 2.11, p
= .043. Females scored significantly higher than males on the
Drive for Muscularity Scale suggesting males have a higher
drive for muscularity, t(17.902) = -3.07, p = .007. All other
mean differences between the genders were nonsignificant (see
Table 1).
As predicted, in females, significant negative correlations were
seen between the MBSRQ Appearance Evaluation and Body
Areas Satisfaction subscales and the LSAS total score, suggesting
that a female’s level of social anxiety is correlated with her body
2010 • THE UNDERGRADUATE REVIEW • 17
 Table 1. Mean Scale Scores as a Function of Gender image dissatisfaction. However, contrary to the predictions
of this study, in females there were no significant correlations
Scales Males Females emerged between social anxiety and drinking behavior as
Body Image measured by the AUDIT. Although neither the body image
MBSRQ- AE 3.52 3.15 measures nor the social anxiety scales were correlated with
the drinking measure, they were significantly correlated with
MBSRQ- BAS 3.39 3.32
drinking expectancies. The MBSRQ BAS and AE subscales
Drive for Muscularity 4.55** 5.43** were significantly negatively correlated with the DEQ Increased
MBAS 62.35* 72.8* Confidence subscale in females, suggesting that women who are
less satisfied with their appearance have a stronger expectancy
PASTAS 11.59** 21.85**
for alcohol to increase their confidence. The LSAS total score
was significantly positively correlated with the DEQ Increased
Social Anxiety
Confidence subscale suggesting that females with higher levels
SAAS 1.81 2.23 of social anxiety have stronger expectancies that alcohol will
LSAS 22.47 26.05 increase their confidence (see Table 2).

Drinking For males, body image was measured using the MBAS. The
AUDIT 6.53 5.28 MBAS was significantly positively correlated with the LSAS
total score suggesting that males with more body image
DEQ- TR 9.69 9.51
concerns also report more anxiety. However, identical to the
DEQ- IC 38.13 36.54 females, male body image did not correlate with the level of
alcohol consumed by the participant. Also, the AUDIT was
Note. The lower the score on MBSRQ subscale scores the more body image not correlated with the LSAS in males suggesting that the
concerns.
The lower the score on the Drive for Muscularity scale the higher the drive
level of social anxiety of a participant was not connected to
to change ones muscle tone. their drinking habits. The MBAS was significantly positively
T-tests significance *p<.05, **p<.01 correlated with the DEQ Increased Confidence subscale. Males
matched the pattern of females in the correlation between

Table 2 Female Correlations

Measure 1 2 3 4 5.
1. LSAS Total Score --- -.042 -.482** -.407** .393*
2. Total Score AUDIT --- .010 .013 .361*
3. Body Areas Satisfaction MBSRQ --- .807** -.492**
4. Appearance Evaluation MBSRQ --- -.350*
5. DEQ Increased Confidence ---

*p<.05, **p<.01

Table 3 Male Correlations

Measure 1 2 3 4 5.
1. LSAS Total Score --- .262 -.520* -.477 .689**
2. Total Score AUDIT --- .326 -.451 .626*
3. MBAS Total --- -.300* .336*
4. Drive for Muscularity --- -.170
5. DEQ Increased Confidence ---

*p<.05, **p<.01

18 • THE UNDERGRADUATE REVIEW • 2010 BRIDGEWATER STATE COLLEGE

level of social anxiety and expectation of alcohol to increase
their confidence level. The LSAS total score for males was
significantly positively correlated with the DEQ Increased
Confidence subscale (see Table 3).
Discussion:
The purpose of this study was to examine the relationships
among social anxiety, alcohol use, and body image. In addition,
drinking expectancies were examined to determine their role in
these relationships. Typical gender differences in body image
concerns were found with females showing more concern than
males. Females also reported higher social anxiety. Previous
research has shown a connection between social anxiety and
body image, consistent with the findings of this study (Cash,
Therriault, & Annis, 2004; Streigel-Moore, Silberstein, &
Rodin, 1993). This connection has rarely been studied in
males, however in the current study this connection was found
in both genders. This suggests that gender may not play a role
in this connection so further investigation is warranted to make
it clearer. Since females scored higher in both social anxiety
and body image concerns, it can be assumed that social anxiety
and body image concerns are more prevalent in females, even
though they are also seen in males.
Similar to previous research, social anxiety’s connection with
drinking was found to be complex (Morris, Stewart, & Ham,
2005). Contrary to the hypothesis of this study the quantity of
drinking was not found to be connected with a participant’s level
of social anxiety nor was it connected with body image concerns
in either gender. However, expectancies of drinking did seem
to be connected to social anxiety, especially the expectancy of
increased confidence. This connection was seen in both males
and females suggesting that participants with a higher level of
social anxiety may expect alcohol to increase their confidence
in social situations. Males seem to also show the same pattern
as females in that males with a more negative body image
expect alcohol to increase their confidence level more than
males who are more satisfied with their body. Even though the
frequency and quantity of drinking was not connected to social
anxiety level, this study suggests that drinking is used as a tool
to increase confidence in public situations. Also, since body
image concerns were correlated with the expectancy for alcohol
to increase the confidence of the drinker, a connection between
social anxiety, body image concerns, and drinking expectancies
may be found through further investigation. This connection
may become more evident if future studies include more
participants, especially more participants who drink. If this
is true, a negative body image may cause a person to become
more socially anxious, and possibly use alcohol to increase their
confidence in a social situation.
BRIDGEWATER STATE COLLEGE
It has been suggested that those with social anxiety avoid social
situations to lower their chance of experiencing anxiety. As a
result, frequency and quantity of drinking may be lower since
alcohol consumption, especially in college age students, usually
occurs in a social setting (Morris, Stewart, & Ham, 2005).
Previous studies have shown a connection between drinking and
body image concerns in females (Striegel-Moore, & Huydic,
1993; Franko, Dorer, Keel, Jackson, Manzo, & Herzog, 2005).
Social anxiety may therefore be a more important factor in the
connection between body image and drinking than gender.
However, males did have lower levels of social anxiety and a
more positive body image than females, which implies these
problems may be more prevalent in females.
This study did have some limitations. First the sample size was
small. A larger sample size including more males and more
drinkers would increase the statistical power and thus allow
more significant relationships to be revealed. In future studies
more complex statistical work should be done as well to more
accurately portray the connections that were revealed in this
study between drinking expectancies, social anxiety and body
image. In future work the focus should be more on expectancies
than frequency and quantity of the participants’ drinking. The
connections between social anxiety, body image, and drinking
expectancies revealed suggest that additional research in this
area is warranted to better understand why college students
drink.
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