Moral incongruence, self-perceived addiction and problematic pornography use

Lewczuk, K., Glica, A., Nowakowska, I., et al. Evaluating Pornography Problems Due to Moral Incongruence Model. J Sex Med 2020;17:300–311. https://www.sciencedirect.com/science/article/pii/S1743609519317837

Abstract
Introduction  To date, multiple models of problematic pornography use have been proposed, but attempts to validate them have been scarce.

Aim  In our study, we aimed to evaluate the Pornography Problems due to Moral Incongruence model proposing that self-appraisals of pornography addiction stem from (i) general dysregulation, (ii) habits of use, and (iii) moral incongruence between internalized norms and behavior. We investigated whether the model can be used to adequately explain the self-perceptions of addiction to pornography (model 1) and a broader phenomenon of problematic pornography use (model 2).

Methods  An online, nationally representative study was conducted on a sample of 1036 Polish adult participants, of whom, 880 declared a lifetime history of viewing pornography.

Main Outcome Measure  The outcomes were self-perceived pornography addiction, problematic pornography use, avoidant coping, frequency of pornography use, religiosity, moral disapproval of pornography, and related variables.

Results  Our results indicated that avoidant coping (an indicator of general dysregulation), frequency of pornography use (indicator of habits of use), and the distress connected with incongruence between own sexual behavior and internalized norms, attitudes and beliefs positively contributed to self-perceived addiction (model 1) as well as problematic pornography use (model 2). This broadly confirms the basic shape of the PPMI model. There were, however, notable differences between the models. Moral incongruence related distress was only weakly related to self-perceived addiction (β = 0.15, P < .001), with a stronger relation for problematic pornography use (β = 0.31, P < .001). When controlling for other factors, religiosity weakly predicted problematic pornography use (β = 0.13, P < .001), but not self-perceived addiction to pornography (β = 0.03, P = .368). Frequency of pornography use was the strongest predictor of both self-perceived addiction (β = 0.52, P < .001) and problematic pornography use (β = 0.43, P < .001).

Clinical Implications  Factors proposed within the PPMI model are distinctly relevant intervention targets, and they should be considered in the process of diagnosis and treatment.

Strengths & Limitations  The presented study is the first to evaluate PPMI model. Its main limitation is that it has a cross-sectional design.

Conclusion  The PPMI model is a promising framework for investigating the factors related to self-perceived addiction and problematic pornography use. Despite the differences between the models and in the strength of specific predictors, (i) dysregulation, (ii) habits of use, and (iii) moral incongruence all uniquely contribute to self-perceived addiction and problematic pornography use.

Discussion

The presented work is one of only a few attempting a nonfragmentary assessment of the validity of any model of pornography addiction, problematic pornography use or problematic sexual behavior, and the first to do so for the PPMI model. On a general level, our results confirmed the appropriateness of the basic shape of the model to depict the structure of predictors of both self-perceived addiction to pornography (model 1, Figure 1) and problematic pornography use (model 2, Figure 2). However in some places, our results diverge from the predictions stemming from the model, and there are at least several specific but important issues that require consideration as well as have potential implications for the shape of the model and future research.

As described previously, the analysis reported in the present study was based on 3 paths proposed within the PPMI model: dysregulation path (as indicated by avoidant coping), habits of use path (indicated by frequency of pornography use) and moral incongruence path (operationalized by religiosity, moral disapproval of pornography use, and moral incongruence–related distress). Overall, the results showed that all 3 paths uniquely and significantly contribute to explaining both self-perceived addiction and a broader set of symptoms that fall under the label of problematic pornography use. Moreover, our results confirmed that problematic pornography use symptoms are distinct from simple declarations of being an addict. The correlation between these 2 constructs was r = 0.55. Based on our results, none of the 3 paths postulated within the model can be reduced to the other or eliminated without deterioration in the quality and predictive value of the model. This confirms the basic prediction stemming from the PPMI model.³ Estimated models explained a significant portion of variance in self-perceived addiction (33.9%, model 1) and problematic pornography use (35.9%, model 2).

Conclusions regarding each of the 3 paths of the model are delineated in the following section.

Moral Incongruence Path

People experiencing moral incongruence–related distress reported higher levels of self-perceived addiction and problematic pornography use. This confirms the prediction of the authors of the PPMI model^3,31 regarding the role that moral incongruence plays in shaping the self-appraisals of self-perceived addiction²⁴ and extends it to more general problematic pornography use symptoms. However, the prediction of the model is that moral incongruence should be the stronger predictor of self-perceived addiction to pornography than frequency of use and dysregulation,^3,31 which is not confirmed by our findings. Our results are more in line with recent work showing that frequency of pornography use is a stronger predictor of self-perceived addiction to pornography than moral incongruence²⁶ (refer also to the study by Lewczuk et al²⁷ for an analysis conducted on the same sample as the present study). It is also possible that the lower impact of moral incongruence–related distress on self-perceived addiction is at least partially caused by a slightly lower level of moral disapproval of pornography use in the current Polish sample, compared with, for example, a representative sample of U.S. adults.²⁵ In our study, 20.5% of participants who used pornography in their lifetime agreed that pornography use is morally wrong (answer options ranged from “somewhat agree” to “strongly agree”), while the same answer was given by 24% of Americans. Moreover, based on the same measure, U.S. participants declared to be slightly more religious on average (M = 4.10, SD = 1.95²⁵) than Polish participants in the current sample (M = 3.81, SD = 1.84), which may also explain the weaker impact of the moral incongruence path on self-perceived pornography addiction than the PPMI model based mostly on research performed on the U.S. predicts.

In addition, moral incongruence–related distress was more strongly connected to problematic pornography use than to self-perception of addiction. A possible explanation for this pattern is that, compared with self-perceived addiction, problematic pornography use encompasses a broader group of cognitive and affective consequences and determinants of pornography use. One of them is increased levels of guilt regarding pornography use, which can be a consequence of moral incongruence.²⁰ One of the 5 statements in the BPS,³⁴ which was an indicator of problematic pornography use in our study, reads “You continue to use pornography even though you feel guilty about it.” The relation between self-labeling as an addict and moral incongruence–related distress is theoretically not as close as in other studies, which is reflected by our findings.

Next, our results generally confirmed the specifics of the chain of influence between morality-related variables, although not without a caveat. More religious people were more inclined to see pornography use as morally reprehensible and were more prone to experiencing feelings of incongruence between own sexual behavior and adopted beliefs, attitudes, and norms. The impact of religion was not strong in these cases, as our method of measuring it does not directly invoke a religious context (see the Introduction section for more information on this issue). As expected, distress connected to behavior-attitudes misalignment was determined by 2 additional factors: frequency of the behavior (frequency of pornography use) and restrictiveness of the attitudes (moral disapproval of pornography; refer to the study by Grubbs et al³). However, although religiosity and moral disapproval significantly predicted moral incongruence–related distress, their contribution was somewhat limited. Other possible predictors should be investigated, both connected to other sources of norms that can determine disapproval of pornography, for example, sociopolitical views, religious fundamentalism^53,54 or certain branches of feminism,⁵⁵ as well as variables related to the awareness and sensitivity to own behaviors being incongruent with own beliefs, attitudes, and internalized norms (eg, self, awareness, concern over mistakes, perfectionism, the centrality of the norms that motivate attitudes toward pornography and sexuality). Here, we echo the suggestions that were voiced by other authors in their commentaries for the model.^19,22

In addition, our results showed that, controlling for other variables, more religious people declared higher levels of problematic pornography use. The influence of religiosity on problematic pornography use was weak, but present—which is in agreement with at least a significant portion of previous studies showing a weak, positive relationship between religiosity and problematic pornography use symptoms^25,26 (refer also to the study by Lewczuk et al²⁷). A corresponding relation was not found for self-perceptions of addiction.

Habits of Use Path

Frequency of pornography use was the strongest predictor of self-perceived addiction in model 1 and of problematic pornography use in model 2. This indicates that the self-appraisal of pornography-related problems does not merely rely on perceiving this behavior as transgressing one's personal norms, that is, it is not a function of mere convictions (refer to the discussion in the study by Humphreys⁵⁶). A significant portion of the variance is better explained by the frequency of use, which validates the disorder model of problematic pornography use and is similar to the symptomology of at least some cases of substance use disorders and other behavioral addictions, for which excessive use during at least some part of the course of the disorder is a definitional criterion (refer to the study by Kraus et al¹ and Potenza et al⁵⁷). Frequency of pornography use was also a significant predictor of problematic pornography use, although its influence was slightly weaker than for self-perception of addiction (β = 0.43 vs β = 0.52). This is understandable, given that problematic use has a broader scope than self-perception of addiction, encompassing not only excessive pornography use but also loss of control, using pornography as a coping mechanism and guilt connected to pornography use.³⁴

Dysregulation Path

Avoidant coping style was an indicator of dysregulation in our model. People using an avoidant coping style more frequently were also more inclined to see themselves as pornography addicts and had a higher severity of symptoms of problematic pornography use. This is in line with previous research, which showed the specific importance of an avoidant coping style for problematic sexual behavior.39, 40, 41 This result is also in agreement with studies showing that engagement in sexual behaviors itself can constitute an avoidance strategy (eg, avoiding negative emotions associated with other areas of one's life). However, the impact on avoidant coping for both dependent variables was weak (β = 0.15, P < .001) and was not stronger for problematic pornography use than for self-appraisals of addiction. This can be considered surprising, as problematic pornography use has a pornography-as-coping component (“You find yourself using pornography to cope with strong emotions, eg, sadness, anger, loneliness, etc.” is one of BPS items that operationalized problematic pornography use in our study).

Implications for the Shape of the Model and Future Research

Our findings indicate that the PPMI model can serve as a general model of factors contributing to self-perception of pornography addiction and problematic pornography use. However, the dysregulation path is underdeveloped in the current version of the model. This has also been pointed out by other researchers.¹⁶ This path should be delineated with more detail and extended. In their initial proposition of the model, Grubbs et al³ focused on moral incongruence–related factors describing the dysregulation path with less detail. This approach is understandable as moral incongruence is a central focus of the model. However, as a consequence, the current conceptualization of the PPMI model places all dysregulation-related factors (such as emotion dysregulation, impulsivity, coping, compulsivity) into one general and unspecified category and abstains from depicting mechanisms of influence between these variables, ascribing them differential degrees of importance or depicting relations between dysregulation-related variables and moral incongruence–related variables. Such relations have been proposed by others^16,22 and are also visible in our analysis, as avoidant coping was connected to moral incongruence–related distress (r = 0.21, P < .001) possibly indicating that avoidant coping strategies can serve as a way of dealing with moral incongruence.

As the PPMI model was initially validated in the present study, we postulate that it should be extended and possibly reshaped into an even more ambitious, general model in which dysregulation-related variables will be treated with the same degree of carefulness as morality-related ones. To achieve this, specific models—such as the current version of the PPMI model—should be merged with broader models (eg, I-PACE model^12,58) that go into more detail regarding behavior dysregulation–related factors, but, as of now, neglect the role of morality-related variables. It seems that only this approach would allow for the full picture of factors influencing both lay self-perceptions of addiction and problematic pornography use to be accounted for. These 2 branches of research should not and cannot develop separately because of their possible mutual influence.^16,22 Because of this interdependence, the shape of the moral incongruence path cannot be definitively established when the dysregulation-related side of the model is underdeveloped.

In future studies, other indicators of general dysregulation (eg, impulsivity, maladaptive emotion regulation, perfectionism) should be tested within the PPMI model to extend and provide further support for the discussed framework. Such an extension seems to have been predicted and welcomed by the authors of the model,³¹ which we fully agree with.

Another issue worth pointing out is that our analysis is based on a populational sample. One of the important future directions for further research is to also verify the model based on clinical samples, experiencing a clinical level of symptoms of problematic pornography. This is crucially important because the significance of factors predicting problematic pornography use can change the clinical level, compared with populational investigations. Future studies should also apply the PPMI model to CSBD recognized in the ICD-11^13,14 when screening measures for this disorder become available for use. We agree with other researchers who suggested studying behavior-norms misalignment for sexual behaviors other than problematic pornography use,²⁰ which may lead to an extension of the model to explain general problematic sexual behavior symptoms.

Additional concerns about the issue of operationalizing moral incongruence vs moral disapproval of pornography use (see Material and Methods section) and self-perceived addiction vs disordered pornography use based on formal clinical definitions (such as problematic pornography use, see the Introduction section) were noted in the earlier parts of the manuscript.

The current research extends research on the PPMI model to another cultural context, namely, Polish participants. However, Poland shares cultural similarities with the United States as it is a predominantly Christian country (77.3% of participants in the current analysis declared being Catholic). Future research should further validate the model, based on different religious and cultural circles.

Limitations

Some of the limitations of the present study were already noted (single dysregulation-related factor). We also note that the present work is based on cross-sectional research design, which precludes analyses of directionality or causality. That is, although the present work is consistent with the PPMI, without longitudinal observations that examine trajectories of these variables over time, it is impossible to conclusively evaluate any model of problematic pornography use. Finally, we did not include a definition of pornography for the participants in the online survey.

Users with nonproblematic low-frequency pornography use are around 68–73% of all users, nonproblematic high-frequency pornography users are approx 19–29% & problematic high-frequency users are around 3–8% of the total

Bőthe B, Tóth-Király I, Potenza MN, et al. High-Frequency Pornography Use May Not Always Be Problematic. J Sex Med 2020;XX:XXX–XXX. https://doi.org/10.1016/j.jsxm.2020.01.007

Abstract
Background  Previously, variable-centered analytic approaches showed positive, weak-to-moderate associations between frequency of pornography use (FPU) and problematic pornography use (PPU). However, person-centered studies are sparse in the literature, and these could provide insight into whether there are individuals who use pornography frequently and do not experience problems or whether there are individuals with comparable high-frequency use who differ on reported experiencing of negative consequences.

Aim  The aims of the present study were (i) to identify profiles of pornography use based on FPU and PPU by applying a person-centered analytic approach and (ii) to examine whether the identified profiles could be distinguished based on theoretically relevant demographic and psychological constructs.

Methods  Latent profile analyses were conducted on 3 nonclinical samples recruited from general websites and a pornography site (study 1: N = 14,006; study 2: N = 483; study 3: N = 672).

Results  Results were consistent across all studies. 3 distinct pornography-use profiles emerged: nonproblematic low-frequency pornography use (68–73% of individuals), nonproblematic high-frequency pornography use (19–29% of individuals), and problematic high-frequency use (3–8% of individuals). Nonproblematic and problematic high-frequency-use groups showed differences in several constructs (ie, hypersexuality, depressive symptoms, boredom susceptibility, self-esteem, uncomfortable feelings regarding pornography, and basic psychological needs).

Clinical Translation  FPU should not be considered as a sufficient or reliable indicator of PPU because the number of people with nonproblematic high-frequency use was 3–6 times higher than that with problematic high-frequency use. These results suggest that individuals with PPU use pornography frequently; however, FPU may not always be problematic.

Strengths & Limitations  Self-report cross-sectional methods have possible biases that should be considered when interpreting findings (eg, underreporting or overreporting). However, the present research included 3 studies and involved large community samples and visitors of a pornography website. The present study is the first that empirically investigated pornography-use profiles with a wide range of correlates using both severity of PPU and FPU as profile indicators on specific and general samples.

Conclusion  The present study is a first step in the differentiated examination of pornography-use profiles, taking into consideration both PPU and FPU, and it provides a foundation for further clinical and large-scale studies. Different psychological mechanisms may underlie the development and maintenance of FPU with or without PPU, suggesting different treatment approaches. Therefore, the present results may guide clinical work when considering reasons for seeking treatment for PPU.

Check also Lewczuk, K., Glica, A., Nowakowska, I., et al. Evaluating Pornography Problems Due to Moral Incongruence Model. J Sex Med 2020;17:300–311. https://www.bipartisanalliance.com/2020/02/moral-incongruence-self-perceived.html

The War on Porn Is Back: Conservatives hope to renew their old alliance with radical feminists

The War on Porn Is Back: Conservatives hope to renew their old alliance with radical feminists. Katherine Mangu-Ward. Mar 2020 issue. https://reason.com/2020/02/06/the-war-on-porn-is-back/

"If you want better men by any standard, there is every reason to regard ubiquitous pornography as an obstacle," declared New York Times columnist Ross Douthat in a 2018 column bluntly headlined "Let's Ban Porn."

In this, as in many things, Douthat was ahead of the conservative intellectual curve by a year or two. And in this, as in many things, he was dangerously wrong.

In due course, Douthat has been joined by the folks at the Christian journal First Things, who have taken up the anti-pornography banner as part of their peculiar subvariant of a resurgent interest in nationalism among traditionalist conservatives. In last year's manifesto, "Against the Dead Consensus," a clutch of First Things friends and familiars reject "economic libertarianism" and "the soulless society of individual affluence" and add that they "respectfully decline to join with those who would resurrect warmed-over Reaganism." Which makes it all the more disconcerting when they turn around and immediately kneel before the scolding ghost of Ed Meese.

As attorney general, Meese sought to deliver on Reagan's 1987 threat to "purveyors" of obscene material that the "industry's days are numbered." It was Meese who pulled together the first National Obscenity Enforcement Unit. (One surprising and familiar name also crops up in the tale: then–assistant attorney general and recent Libertarian Party vice presidential pick William F. Weld, who was given the task of bringing together various agencies for the task force.)

Meese's bill of grievances against the relatively constrained pornography of his day—which he credited in a speech to a report from a federal Commission on Pornography convened the previous year—will sound alarmingly familiar to readers of Douthat and First Things. He asserts "that violence, far from being an altogether separate category of pornography, is involved with almost all of it; that there are empirically verifiable connections between pornography and violent sex-related crimes; that the pornography industry is a brutal one that exploits and often ruins the lives of its 'performers' as well as its consumers, and that the 'performers' often include abused children and people plied with hard drugs; that whether or not it is directly imitated by those who consume it, pornography has a deleterious effect on what its consumers view as normal and healthy."

The effort was, in some sense, successful. By 1990, the Department of Justice had managed to use obscenity statutes to force seven national porn distributors out of business. But the decades that followed were boom times for porn as the industry moved into new forms of distribution, so the success was far from permanent.

In a rare moment of sanity in 2011, the Justice Department shuttered what had come to be known as the Obscenity Prosecution Task Force, resulting in the delightful Politico headline "Holder accused of neglecting porn" and a harrumph from peeved conservatives, who vowed to reverse the Obama administration's decision as soon as they could.

In December, four Republican congressmen wrote a letter to Attorney General William Barr asking his Justice Department to do just that by prioritizing obscenity prosecutions.

"The Internet and other evolving technologies are fueling the explosion of obscene pornography by making it more accessible and visceral," they wrote. "This explosion in pornography coincides with an increase in violence towards women and an increase in the volume of human trafficking as well as child pornography. Victims are not limited to those directly exploited, however, and include society writ large."

Like herpes, the war on porn flares up when the body politic is compromised or stressed. Both in the 1980s and today, cherry-picked social science write-ups purposely conflate "addicts" and users, assert connections between porn and violence at a time of increasing porn consumption and decreasing violence, and offer terrifying but unsubstantiated stories about brain damage and erectile dysfunction in the nation's young men. Such coverage fuels the porn panic even as the predicted hairy-palmed decline of the U.S. fails to materialize.

The proposed crackdown fits nicely with the nationalist agenda, which is focused—as nationalists tend to be—on purity. As has too often been the case historically, a campaign for moral purity can slide awfully smoothly into efforts to preserve ethnic purity, as Reason's Elizabeth Nolan Brown documents in her cover story on the current panic over Asian-run massage parlors.

In his 1987 speech, Meese was careful to limn the distinction between pornography and obscenity, acknowledging that only the latter is subject to prosecution per the Supreme Court's clear instruction.

By contrast, at the end of 2019, Reason's Damon Root was compelled to publish a basic explainer about the First Amendment protections afforded to material that fails the three-pronged Miller test of obscenity. Too many would-be porn banners have simply ignored the legal guardrails the Court provided.

The porn-banning conservatives, though newly impatient with their former allies on the libertarian side of the spectrum, are often the same folks who were quite recently willing to fight bans on smoking, extra-large sodas, and trans fats to the death, and who would never entertain a return to alcohol prohibition.

There are people on the left, of course, who would forbid porn along with the rest of that list and much more as well, and Catholic writer Sohrab Ahmari would happily make common cause with them: "Conservatives must partner with anti-porn feminists. We won't agree on everything, but imagine how powerful such an alliance could be," he tweeted in December.

The utterly unfunny joke, of course, is that we don't need to imagine such an alliance. It was indeed a powerful force in 1980s politics, with rhetoric crafted by feminists Andrea Dworkin and Catharine MacKinnon furnishing talking points for Reagan and Meese. In 1984, legislation defining pornography as a violation of women's civil rights was passed with the support of conservatives on the Indianapolis city council and signed into law by a Republican mayor. (It was later struck down in the courts.)

Conservative firebrand Phyllis Schlafly borrowed from Dworkin in her 1987 book Pornography's Victims: "Those who become addicted crave more and more bizarre and more perverted pornography, and become more callous toward their victims. Pornography changes the perceptions and attitudes of men toward women, individually and collectively, and desensitizes men so that what was once repulsive and unthinkable eventually becomes not only acceptable but desirable. What was once fantasy becomes reality. Thus conditioned and stimulated by pornography, the user seeks a victim."

Douthat has noted that porn is "a product," which he helpfully defines as "something made and distributed and sold, and therefore subject to regulation and restriction if we so desire."

"We are rightfully skeptical of government overreach, but I think we take that skepticism so far that we're skeptical of even using political power when we have it for ends that we think are valuable," Hillbilly Elegy author and conservative golden boy J.D. Vance explained in a podcast episode taped following a July conference on national conservatism that brought together the new movement's leading lights. "And I do think that we have to get over that, and we have to recognize that when people entrust us with political power to solve problems we should at least try to solve them." Suffice it to say that in political rhetoric, as in pornography, everything before the but should be ignored.

To do as Ahmari wishes and "fight the culture war with the aim of defeating the enemy and enjoying the spoils in the form of a public square re-ordered to the common good and ultimately the Highest Good" will not eliminate vice, nor will it eliminate the production and consumption of porn. As with all prohibitions, a ban would discourage generally law-abiding and nonproblematic users while driving more committed or addicted users to darker places to find what they want. Meanwhile, more committed producers, taking on more risk, would likely produce more outré content. The new war on porn is a dangerous symptom of a recurring delusion on both the left and the right that men can be reshaped by the state into better versions of themselves.

Check also Pornography Use: What Do Cross-Cultural Patterns Tell Us? David L. Rowland, Dudbeth Uribe. In: Cultural Differences and the Practice of Sexual Medicine pp 317-334. January 28 2020. https://www.bipartisanalliance.com/2020/02/all-religious-etchnic-and-racial-groups.html

And Behind Closed Doors: Individual and Joint Pornography Use Among Romantic Couples. Brian J. Willoughby & Nathan D. Leonhardt. The Journal of Sex Research, Volume 57, 2020 - Issue 1, Pages 77-91. https://www.bipartisanalliance.com/2020/01/individual-joint-pornography-use-among.html

The Prevalence of Paraphilic Interests in the Czech Population: Preference, Arousal, the Use of Pornography, Fantasy, and Behavior. Klára Bártová et al. The Journal of Sex Research, Jan 9 2020. https://www.bipartisanalliance.com/2020/01/the-prevalence-of-paraphilic-interests.html

Life: Seen as more satisfying, more meaningful, & characterized to a greater extent by more intense positive & negative emotions when reflecting on life in general than when reflecting on daily life in real time

Global reports of well-being overestimate aggregated daily states of well-being. David B. Newman,Norbert Schwarz &Arthur A. Stone. The Journal of Positive Psychology , Feb 5 2020. https://doi.org/10.1080/17439760.2020.1725608

ABSTRACT: Researchers can characterize people’s well-being by asking them to provide global evaluations of large parts of their life at one time or by obtaining repeated assessments during their daily lives. Global evaluations are reconstructions that are influenced by peak, recent, and frequently occurring states, whereas daily reports reflect naturally occurring variations in daily life. The present research compared the averages of individual global evaluations and corresponding aggregated daily states from an ordinary two-week period and used a range of well-being measures (life satisfaction, meaning in life, and affect) and related constructs (searching for meaning in life and nostalgia). Across all measures, global reports were significantly higher than aggregated daily states. That is, life is considered more satisfying, more meaningful, and is characterized to a greater extent by more intense positive and negative emotions when reflecting on life in general than when reflecting on daily life in real time.

KEYWORDS: Well-being, daily diary, ecological validity, global evaluations, emotion

Watching eyes do not stop dogs stealing food: evidence against a general risk-aversion hypothesis for the watching-eye effect

Watching eyes do not stop dogs stealing food: evidence against a general risk-aversion hypothesis for the watching-eye effect. Patrick Neilands, Rebecca Hassall, Frederique Derks, Amalia P. M. Bastos & Alex H. Taylor. Scientific Reports volume 10, Article number: 1153. January 24 2020. https://www.nature.com/articles/s41598-020-58210-4

Abstract: The presence of pictures of eyes reduces antisocial behaviour in humans. It has been suggested that this ‘watching-eye’ effect is the result of a uniquely human sensitivity to reputation-management cues. However, an alternative explanation is that humans are less likely to carry out risky behaviour in general when they feel like they are being watched. This risk-aversion hypothesis predicts that other animals should also show the watching-eye effect because many animals behave more cautiously when being observed. Dogs are an ideal species to test between these hypotheses because they behave in a risk-averse manner when being watched and attend specifically to eyes when assessing humans’ attentional states. Here, we examined if dogs were slower to steal food in the presence of pictures of eyes compared to flowers. Dogs showed no difference in the latency to steal food between the two conditions. This finding shows that dogs are not sensitive to watching-eyes and is not consistent with a risk-aversion hypothesis for the watching-eye effect.

Analysis

The latency to approach the food was recorded in both the ‘Go’ and ‘Leave’ trials. Latency was timed from the point that the owner gave the command until the dog had eaten the food. An additional coder, blind to condition, coded the approach latency for 40% of the sample. The high intra-class correlation (ICC = 0.99) indicates excellent levels of agreement between coders. To analyse the data, we constructed several mixed-effects Bayesian ANOVA models. The factors included in these models were Trial Type (Leave vs Go), Condition (Eye vs Flower), and a Trial Type*Condition interaction. Due to the repeated-measures aspect of the design (all dogs took part in both a ‘Go’ and ‘Leave’ trial), participant was included as a random effect in all models. Each model was compared to a null model, which only contained participant as a random effect. Additionally, an analysis of effects was carried out to determine the inclusion BF for each individual factor. Inclusion BFs are calculated by comparing the fit of models containing the factor against the fit of models not containing that factor. BF_incl > 3 indicate that including a factor substantially increases model fit while BF_incl < 0.333 indicates a factor substantially decreases model fit. Each model was constructed with objective priors of prior width (r) = 1 for fixed effects and r = 0.5 for random effects.
As the extent to which humans attended to images of eyes appeared to affect their likelihood of showing the watching-eye effect²¹, we re-ran this analysis but included the proportion of time that the dogs looked at the picture as a covariate for each model. Each model was compared to a null model which contained participant as a random effect and proportion of time looking at the picture as a covariate. Again, models were constructed with objective priors of r = 1 for fixed effects and r = 0.5 for random effects.
Additionally, in order to specifically get at our comparison of interest, we compared the ‘Leave’ latency in both conditions after adjusting for differences in individual dogs’ approach speed. This adjustment was made by subtracting the ‘Go’ latency from the ‘Leave’. If the dogs display the watching-eye effect, we would predict that the adjusted latency would be higher in the eyes condition than in the flowers condition. Comparisons between the adjusted ‘Leave’ latencies were analysed using a Bayesian independent-samples t-test. The prior distribution for the alternative hypothesis was a Cauchy half-distribution, centred on an effect size of 0, with r = 0.707. All analyses were carried out using JASP 0.10.0.0 (JASP team, 2019.) This study design was pre-registered (http://aspredicted.org/blind.php?x=j6er8v). It should be noted using the Go trial as a baseline to adjust the dogs’ Leave latencies meant it was necessary to have the owners give the ‘Go’ command on the same trial. Whilst this means that it is impossible to fully disentangle the effect of the command on the dogs’ latency to approach food from order effect, we concluded that the extreme implausibility that dogs would approach food slower on a 2^nd trial after being able to take it without punishment in the previous trials made this a worthwhile trade-off.

Preparation hypothesis: Women’s indiscriminate genital responses do not indicate or necessarily promote sexual interest & motivation, but rather prepare the vaginal lumen for possible sexual activity & therefore prevent injuries

The Empirical Status of the Preparation Hypothesis: Explicating Women’s Genital Responses to Sexual Stimuli in the Laboratory. Martin L. Lalumière, Megan L. Sawatsky, Samantha J. Dawson & Kelly D. Suschinsky. Archives of Sexual Behavior, February 5 2020. https://link.springer.com/article/10.1007/s10508-019-01599-5

Abstract: Research conducted in our laboratory and in other laboratories has revealed that (1) women’s genital responses to visual and auditory stimuli are strongly affected by the presence of sexual cues, but that (2) specific sexual cues (e.g., gender of actors, the presence of sexual violence) often have little impact on the magnitude of the responses—that is, similar genital responses are observed to very different sexual stimuli. In addition, (3) women’s genital responses do not strongly correspond with self-reported sexual partner and activity preferences, or (4) with self-reported sexual arousal during the presentation of sexual stimuli. Taken together, these facts represent a puzzle, especially considering that men’s genital responses are highly affected by specific sexual cues and strongly correspond to stated preferences and self-reported sexual arousal. One hypothesis to explain female low cue-specificity and low concordance (relative to men) is the preparation hypothesis: Women’s indiscriminate genital responses serve a protective function. That is, they do not indicate or necessarily promote sexual interest and motivation, but rather prepare the vaginal lumen for possible sexual activity and therefore prevent injuries that may occur as a result of penetration. We review evidence for and against this hypothesis. We conclude that the evidence is favorable but not entirely convincing, and more work is required to reach a firm conclusion. We offer directions for future research.

Sexual Chemosignals: Evidence that Men Process Olfactory Signals of Women’s Sexual Arousal

Sexual Chemosignals: Evidence that Men Process Olfactory Signals of Women’s Sexual Arousal. Arnaud Wisman & Ilan Shrira. Archives of Sexual Behavior, February 5 2020. https://link.springer.com/article/10.1007/s10508-019-01588-8

Abstract: Research suggests that humans can communicate emotional states (e.g., fear, sadness) via chemosignals. However, thus far little is known about whether sexual arousal can also be conveyed through chemosignals and how these signals might influence the receiver. In three experiments, and a subsequent mini meta-analysis, support was found for the hypothesis that men can process the scent of sexually aroused women and that exposure to these sexual chemosignals affect the subsequent perceptions and sexual motivation of men. Specifically, Experiment 1 revealed that men evaluate the axillary sweat of sexually aroused women as more attractive, compared to the scent of the same women when not sexually aroused. In addition, Experiment 2 showed that exposure to sexual chemosignals increased the men’s sexual arousal. Experiment 3 found support for the thesis that exposure to sexual chemosignals would increase sexual motivation. As predicted, men devoted greater attention to and showed greater interest in mating with women who displayed sexual cues (e.g., scantily dressed, in seductive poses). By contrast, exposure to the sexual chemosignals did not alter males’ attention and mating interest toward women who displayed no sexual cues. It is discussed how sexual chemosignals may function as an additional channel in the communication of sexual interest and how contextual factors can influence the dynamics of human sexual communication.

General Discussion

The present studies provide support for the hypothesis that men are sensitive to olfactory signals of sexual arousal released by women. Overall, Experiments 1–3 and a subsequent mini meta-analysis found that men evaluated the scent of sexually aroused women as relatively more attractive. Experiment 2 showed that these sexual chemosignals increased men’s self-reported sexual arousal. Finally, Experiment 3 found support for the hypothesis that the sexual chemosignals increased men’s attention to and interest in women who displayed sexual cues. Specifically, men spent relatively more time looking at women who displayed sexual cues, and were more motivated to mate with them. Taken together, the current findings are among the first to show that that women’s sexual arousal led to the release of a distinctive scent that increases men’s sexual motivation.
These findings are consistent with numerous studies, showing that emotional states (e.g., fear, disgust, sadness) produce olfactory signals that orient nearby recipients to the immediate environment and sensitize them to emotionally consistent cues (de Groot et al., 2012; Gelstein et al., 2011; Pause, 2012; Zhou & Chen, 2008). Sexual arousal in particular is both socially and fitness-relevant states, and there are clear interpersonal benefits to its communication for both the sender and the recipient, such as the signaling and detection of mating opportunities, as well as synchronizing mating behavior between partners (Schaller, Park, & Kenrick, 2007). The current research expands on the existing literature by showing that olfactory messages may serve as an additional channel of communication between humans, and in relevant mating contexts, sexual chemosignals may be released along with corresponding visual and auditory expressions of sexual interest to produce a stronger overall signal.
Interestingly, recent research by Hoffmann (2019) also found support for the thesis that men can process the scent of sexually aroused women. Specifically, men were exposed to axillary sweat (collected from women who were sexually aroused vs. not aroused) while the men listened to erotic stories, and the findings showed that the sexual scents elicited greater genital arousal in the men. However, this effect was only detected in response to female scents collected during the luteal phase of their cycle, but not their follicular phase. In contrast to the current studies, Hoffmann (2019) did not find an effect of female scent on men’s self-reported sexual arousal and sexual interest. Those results may have diverged from the findings reported here because of several procedural differences between the two research paradigms. Notably, in our experiments, the scent samples were collected and presented to recipients under different conditions. For instance, the female scent donors in our studies briefly exercised at the start of the experiment to create a similar base rate of physiological arousal in both conditions, in order to control for physiological arousal that is also elevated during sexual arousal. Additionally, in Experiments 2 and 3, men’s sexual arousal was assessed after exposing them to a block of multiple scent samples from either scent condition, rather than each time after exposure to one scent sample. Finally, the current experiments did not present male recipients with any additional sexual stimuli (i.e., an erotic story) in conjunction with the chemosensory primes (Hoffmann, 2019). Whether or not any of these factors contributed to the different findings is an important empirical question that deserves future investigation.
Most studies have examined emotional chemosignals secreted by the axillary regions because they are dense with apocrine glands that produce sweat in response to activation of the sympathetic nervous system (de Groot, Semin, & Smeets, 2014). However, apart from perspiration, there are other volatile body fluids (e.g., urine, sperm, lacrimal fluid) that likely play roles in olfactory signaling (Pause, 2012). For instance, research has shown that exposure to scents from the vulvar area (collected during the periovulatory phase) can increase testosterone secretion and sexual interest in men (Cerda-Molina et al., 2013). In light of the current findings, it would therefore be worth testing whether women’s sexual arousal level moderates men’s responses to scents from the vulvar area.
Additionally, it would be interesting to examine the influence of the context in which men are exposed to female scents. For example, as mentioned earlier, some research paradigms have primed a sexual context when exposing recipients to the scent stimuli (Alves-Oliveira et al., 2018; Hoffmann, 2019). That is, male scent recipients listened to an erotic story or watched audiovisual stimuli (Alves-Oliveira et al., 2018) during exposure to the scents, before measuring the men’s sexual arousal. Thus, men’s reactions to the sexual scents in these studies were always a product of both the olfactory and audiovisual stimuli. In contrast, our experiments showed that the olfactory stimuli alone can elicit a sexual response in recipients, in the absence of a conceptually similar prime in a different sensory modality. Although our findings highlight that sexual chemosignals alone can prime male sexual motivation, it is unclear whether additional sexual priming via different sensory modalities can elicit stronger sexual responses in men. Thus, future research may wish to further investigate the role of priming multiple sensory modalities on how recipients are influenced by sexual chemosignals.
The current research is not without limitations. Although the indices of sexual arousal and sexual motivation used in Experiments 2 and 3 established that men respond to female chemosignals, future work would do well to examine a wider range of measurements of subjective and physiological sexual arousal (e.g., Ciardha, Attard-Johnson, & Bindemann, 2018; Janssen, Prause, & Geer, 2007; Kukkonen, Binik, Amsel, & Carrier, 2007; Laws, 2009; McPhail et al., 2019). In addition, while our studies did not take the donors’ menstrual cycle into account, the recent findings of Hoffmann (2019) highlight that there is scope to further investigate the interaction between menstrual cycle phase and women’s axillary chemosignals, and the influence of these signals on male sexual arousal (see Hoffmann, 2019, for a full discussion of the results). Additionally, future research in chemosignal research would benefit from considering procedural differences in order to understand which factors tend to enhance and mitigate the effects of sexual chemosignals on recipients (Pause, 2012). Moreover, it is perhaps worth considering how sexual arousal chemosignals interact with individual factors we did not specifically examine, such as testosterone levels (Gangestad, Thornhill, & Garver-Apgar, 2010; Thornhill & Gangestad, 1999), or individual differences in disgust sensitivity (Haidt, McCauley, & Rozin, 1994; Stevenson, Case, & Oaten, 2011). Finally, future work could include a wider range of measures to monitor the emotions of the scent donors and the scent recipients during the experiment (de Groot et al., 2015b; Mitchell, DiBartolo, Brown, & Barlow, 1998).
Consistent with the growing evidence that emotional states can be communicated through scent, our findings provide evidence that humans can signal and process olfactory signals of sexual arousal. Importantly, the results showed that perceiving these sexual chemosignals alters the scent receiver’s sexual arousal and their interest and preference for potential mates. Informed by the present findings, we can envision a dynamic exchange of olfactory signals that, combined with corresponding visual and auditory expressions, are communicated between men and women during mating encounters. These encounters may thus entail more than meets the eye and we hope that the current findings encourage further research to examine the role of sexual olfactory signals in human communication.

Investigating Google's suicide-prevention efforts in celebrity suicides: Celebrities who die by suicide can elicit relatively strong copycat effects, but Google never displayed preventive information in celebrity-suicide-related searches

Investigating Google's suicide-prevention efforts in celebrity suicides using agent-based testing: A cross-national study in four European countries. Florian Arendt, Mario Haim, Sebastian Scherr. Social Science & Medicine, February 5 2020, 112692. https://doi.org/10.1016/j.socscimed.2019.112692

Highlights
•    Celebrities who die by suicide can elicit relatively strong copycat effects.
•    Internet search engines may play an increasingly important role for suicide prevention.
•    Google's suicide-prevention result (SPR) presents preventive information.
•    Yet Google never displayed SPRs in celebrity-suicide-related searches.
•    Higher SPR display rates may contribute to saving the lives of vulnerable users.

Abstract
Rationale Google can act as a “gatekeeper” for individuals who seek suicide-related information online (e.g., “how to kill oneself”). The search engine displays a “suicide-prevention result” (SPR) at the very top of some suicide-related search results. This SPR comes as an info box and contains supposedly helpful crisis help information such as references to a telephone counseling service.

Objective It remains unknown, however, how Google has implemented the SPR in the especially dangerous context of celebrity suicide for which imitational copycat suicides in vulnerable individuals are most likely.

Method Relying on agent-based testing, a computational social science method, we emulated a total of 137,937 Google searches in April 2019, using both general suicide-related and specific celebrity suicide-related search terms. Given the recently discovered language-based differences in SPR display rates, we held the language constant and focused on German-speaking populations in four European countries.

Results The SPR was never shown in searches for celebrities who died by suicide in all four countries. Furthermore, analyses indicated a digital divide in access to suicide-prevention information with moderately high SPR display rates in Germany and Switzerland, yet with no display in Austria and Belgium.

Conclusion Higher SPR display rates could support global suicide-prevention efforts at virtually no cost by providing preventive information to vulnerable users precisely at the moment when it is apparently needed.

Dissatisfaction with breast size affects 70.7 % of women sampled: linked to greater Neuroticism, lower Conscientiousness, lower Western media exposure, greater local media exposure, lower financial security, & younger age

The Breast Size Satisfaction Survey (BSSS): Breast size dissatisfaction and its antecedents and outcomes in women from 40 nations. Viren Swami et al. Body Image, Volume 32, March 2020, Pages 199-217. https://doi.org/10.1016/j.bodyim.2020.01.006

Highlights
•    Majority of women sampled (70.7 %) were dissatisfied with their breast size.
•    A number of significant antecedents and outcomes of breast size dissatisfaction were identified.
•    Relationships with antecedents and outcomes were stable across 40 nations.

Abstract: The Breast Size Satisfaction Survey (BSSS) was established to assess women’s breast size dissatisfaction and breasted experiences from a cross-national perspective. A total of 18,541 women were recruited from 61 research sites across 40 nations and completed measures of current-ideal breast size discrepancy, as well as measures of theorised antecedents (personality, Western and local media exposure, and proxies of socioeconomic status) and outcomes (weight and appearance dissatisfaction, breast awareness, and psychological well-being). In the total dataset, 47.5 % of women wanted larger breasts than they currently had, 23.2 % wanted smaller breasts, and 29.3 % were satisfied with their current breast size. There were significant cross-national differences in mean ideal breast size and absolute breast size dissatisfaction, but effect sizes were small (η2 = .02–.03). The results of multilevel modelling showed that greater Neuroticism, lower Conscientiousness, lower Western media exposure, greater local media exposure, lower financial security, and younger age were associated with greater breast size dissatisfaction across nations. In addition, greater absolute breast size dissatisfaction was associated with greater weight and appearance dissatisfaction, poorer breast awareness, and poorer psychological well-being across nations. These results indicate that breast size dissatisfaction is a global public health concern linked to women’s psychological and physical well-being.

4. Discussion

Women’s breasts – particularly breast size – play an important role in shaping body and appearance anxieties (e.g., Lee, 1997; Millsted & Frith, 2003; Swami, Cavelti et al., 2015), yet comparatively little research has considered these issues from a cross-national perspective. Even less research has examined antecedents and outcomes of breast size dissatisfaction across nations, which is important because it is unclear to what extent women’s breasted experiences in WEIRD nations can be generalised to women in other cultural and national contexts. The BSSS was set up to address these gaps in the literature: through analyses of our data from 18,541 women in 40 nations, we are able to draw a number of important conclusions about cross-national differences and similarities in breast size ideals and dissatisfaction, as well as antecedents and outcomes of breast size dissatisfaction in diverse national contexts. Below, we provide a summary of the main findings of the BSSS before considering implications of our work.

4.1. Breast size ideals and dissatisfaction across nations

The BSSS dataset suggests that breast size ideals were relatively homogeneous across nations. Although there was a significant cross-national difference in ideal breast size, the effect size of the difference was small and suggestive of only minor cross-national variation. In fact, ideal breast size ratings were relatively homogeneous, with mean values falling between figures 6 through 8 in the BSRS. This is consistent with the suggestion that, despite historical differences across nations, breast size ideals have become largely homogenous in nations sampled in the BSSS. Just as there now appears to be a near-global idealisation of thinness in sites of high socioeconomic status (Swami, 2015; Swami, Frederick et al., 2010), the BSSS data indicate a similar homogenisation of breast size ideals in women. This finding is important because it suggests that the objectification of medium-to-large breasts is now a global phenomenon, including in parts of the world that may have historically de-emphasised breast aesthetics (Miller, 2003, 2006). It should also be noted that, partially consistent with our hypothesis, greater rurality (but not financial security) was associated with the idealisation of larger breasts, although effect sizes were weak and likely a reflection of sampling issues – a concern we return to below.

Importantly, mean ideal breast size ratings were higher than mean current breast size ratings in the vast majority that we sampled, although the magnitude of the difference varied. In the total dataset, just under a majority of women (i.e., 47.5 %) that were sampled indicated a preference for larger breasts than they currently had, while just under a quarter (i.e., 23.2 %) desired smaller breasts and under a third (i.e., 29.3 %) reported no discrepancy between their ideal and current breast sizes. This is consistent with existing research in WEIRD nations suggesting that a majority (Swami, Cavelti et al., 2015) or close to a majority of women (Lombardo et al., 2019; Swami & Furnham, 2018) wanted larger breasts than they currently had. Nevertheless, it should be noted that there was some cross-national variation in (absolute) breast size dissatisfaction ratings, with a small effect size. Of note, larger breast size dissatisfaction in some nations (particularly the United Kingdom, Egypt, China, Japan, and Brazil) appeared to be primarily driven by smaller current breast size; that is, while ideal breast size was largely homogeneous across nations, greater breast size dissatisfaction was found in nations where women reported smaller mean current breast sizes.

4.2. Antecedents of breast size dissatisfaction

4.2.1. Socioeconomic status

In the BSSS, we also examined a number of potential antecedents of breast size dissatisfaction, but our results were inconsistent with our hypotheses. That is, we hypothesised that greater financial security and urbanicity (i.e., proxies for higher socioeconomic status), respectively, would be associated with greater breast size dissatisfaction. However, our results suggested that urbanicity was not significantly associated with breast size dissatisfaction (except in women who desired larger breasts than they currently had), whereas lower rather than higher financial security was associated with greater breast size dissatisfaction. One possibility here is that, unlike body dissatisfaction (Swami, Frederick et al., 2010), increasing financial security affords women greater opportunities to negotiate breasted experiences by, for instance, de-emphasising the importance of breast size, de-coupling the breasts from an aesthetic gaze, or (re-)defining breast size ideals in a manner that is healthier in terms of one’s body image. Conversely, the pressure to view the breasts in purely aesthetic terms or to internalise a male gaze of breasts as providers of gratification for men may be heightened for women who are less financially secure, precisely because their financial insecurity affords fewer opportunities to negotiate breasted experiences. That is, among financially insecure women, there may be greater pressure to treat the breasts as assets that play performative roles, such as in terms of attracting potential partners or to attain material benefits (see Edmonds, 2010).

Of course, it should be noted that the weak relationships between proxies of socioeconomic status and breast size dissatisfaction likely reflect the fact that participants in the BSSS were all recruited from largely urbanised sites. That is, we did not include samples from explicitly rural research sites, which means there was limited within-nation variation in actual socioeconomic status to warrant a fuller test of our hypotheses. It may also reflect the fact that both urbanicity and perceived financial security are imprecise indices of socioeconomic status (Braveman et al., 2005). The most direct way of examining this issue in further research would be to sample participants from the same nation but from sites varying in socioeconomic status (e.g., Swami & Tovée, 2005b, 2005b). Although such studies have previously examined breast size ideals within a single nation (Swami & Tovée, 2013a), it is noteworthy that no previous study has extended this to include examinations of breast size dissatisfaction. Doing so would provide a fuller understanding of the relationships between socioeconomic status and breast size dissatisfaction and also help clarify some of our explanations above.

4.2.2. Personality

Consistent with our hypothesis, we found that higher Neuroticism was significantly associated with greater breast size dissatisfaction. This corroborates previous work indicating that Neuroticism is associated with more negative body image generally (for a review, see Allen & Walter, 2016) and may reflect the fact that individuals who score highly on this trait are more likely to experience negative emotional states and become dissatisfied more easily. In addition, individuals who score highly on Neuroticism may also be more sensitive to appearance evaluation and rejection, which heightens breast size dissatisfaction. There is also some evidence that women scoring higher on Neuroticism are more likely to misperceive their body size as larger than they actually are (Hartmann & Siegrist, 2015; Sutin & Terracciano, 2016), and it might be suggested that these individuals are also more likely to misperceive their current breast size.

Beyond Neuroticism, our results also indicated that lower Conscientiousness was significantly associated with greater breast size dissatisfaction. Although this result was unexpected, one recent review concluded that there was a negative relationship between Conscientiousness and negative body image, but only in studies classified as having low risk of bias (Allen & Walter, 2016; see also Allen, Vella, Swann, & Laborde, 2018). Examining associations between facets of Conscientiousness and breast size dissatisfaction may help scholars to better understand this relationship. For example, there is evidence that lower scores on some Conscientiousness facets – primarily low self-control (i.e., greater impulsivity, spontaneity, and carelessness) – are associated with greater body preoccupation (Ellickson-Larew, Naragon-Larew, & Watson, 2013). Facet-level analyses may also be useful in terms of other personality dimensions (Roberts & Good, 2010), as it may help to more accurately determine personality traits that shape breast size dissatisfaction.

4.2.3. Media exposure

In contrast to our hypothesis, we found that exposure to Western media was negatively, rather than positively, associated with greater breast size dissatisfaction. This finding stands in marked contrast to the extant literature indicating that exposure to Western media is associated with more negative body image (e.g., Swami, Frederick et al., 2010; Swami, Mada, & Tovée, 2012). Interpreting the present finding is complicated by the fact that we were working with the total BSSS dataset, which may obscure the meaning, importance, and impact of Western media in specific national and cultural contexts (Anderson-Fye, 2004; Becker, 2004; Swami, 2020). It should also be noted that these analyses are limited by the focus on media exposure per se, rather than perceived pressure from, and the internalisation of, breast size ideals that are communicated through Western media. In addition, there were likely ceiling effects in mean Western media exposure across nations (a reflection of the fact that all research sites were largely urbanised), as well as limited variation in breast size dissatisfaction scores that any predictor could account for.

In contrast to the effects of exposure to Western media, our results indicated that greater exposure to local media was significantly and positively associated with breast size dissatisfaction. Indeed, the strength of the relationship between local media exposure and breast size dissatisfaction was stronger than that of Western media exposure. Thus, it would seem that local media play an important role in engendering breast size dissatisfaction, possibly through the communication of breast size narratives that are “tailored” for local populations (Swami, 2020). A good example of such local transmission is Latin American telenovelas, which idealise larger breast sizes though in ways that are often specific to local socio-political and gendered narratives (Edmonds, 2010; Smith, 2017). More generally, it has been reported that local (Asian) media play a more important role than Western media in predicting appearance concerns in Chinese women (Jackson, Jiang, & Chen, 2016). The BSSS results fit this broader perspective and suggests that local media may play a crucial role in communicating narratives about ideal breast size, which in turn pressure women to attain culturally-sanctioned ideals.

4.2.4. Age

The results of our analyses also indicated that age was inversely related to breast size dissatisfaction. Previous studies have neglected to explore associations between breast size dissatisfaction and participant age, whereas the broader literature examining associations between negative body and age have returned equivocal results, with large-sample studies indicating a positive relationship (Frederick et al., 2008; Swami, Frederick et al., 2010; Swami, Tran, Stieger, Voracek, & The YouBeauty.com Team, 2015), a negative relationship (Frederick et al., 2016), or no significant association (Runfola et al., 2013). In terms of breast size dissatisfaction specifically, it is possible that breast objectification pressures decline with age (see Tiggemann & Lynch, 2001), such that older women experience less pressure to attain breast size ideals or develop embodiment practices that challenge constraining appearance ideals (Piran, 2016). Older age may also be associated with lifespan experiences, such as the transition to motherhood and breastfeeding, that help focus women’s attention on breast functionality (e.g., a maternal view of breasts that emphasises nurturing; Chang, Chao, & Kenney, 2006; Earle, 2003) and reduces preoccupation with the sexual uses of breasts (Bojorquez-Chapela, Unikel, Mendoza, & de Lachica, 2013; Harrison, Obeid, Haslett, McLean, & Clarkin, 2019; Lombardo et al., 2019), though it should also be noted that midlife breast changes may also impact sexual satisfaction (Thomas, Hamm, Borrero, Hess, & Thurston, 2019).

4.3. Outcomes of breast size dissatisfaction

4.3.1. Body image and psychological well-being

As hypothesised, greater breast size dissatisfaction was significantly and positively associated with both weight and appearance dissatisfaction. This is consistent with previous work showing that greater breast size dissatisfaction is significantly associated with higher scores on a range of indices of negative body image (Forbes & Frederick, 2008; Frederick et al., 2008; Junqueira et al., 2019; Swami & Furnham, 2018). The most straightforward interpretation of the present finding is that breast size dissatisfaction is an important facet of global negative body image (Swami, Tran et al., 2015). Importantly, the BSSS data also indicated that greater breast size dissatisfaction was significantly associated with lower self-esteem and subjective happiness. The former finding corroborates previous research showing that breast size dissatisfaction is associated with lower self-esteem (Koff & Benavage, 1998; Swami, Tran et al., 2015). Taken together, the present results suggest that breast size dissatisfaction may have substantive and detrimental links to both global body image and psychological well-being.

4.3.2. Breast awareness

Partially consistent with our hypothesis and previous research with British women (Swami & Furnham, 2018), analysis of the BSSS dataset indicated that greater breast size dissatisfaction was associated with poorer breast awareness, as indexed through lower breast self-examination frequency and lower confidence in detecting breast change, though not greater estimated delay in seeking professional help upon discovering breast change. These effects appeared to be primarily driven by participants who desired larger breasts than they currently had, whereas associations in participants who desired smaller breasts were not significant. These findings nevertheless remain important: breast cancer is the leading cause of cancer-related mortality in women worldwide (Torre, Siegel, Ward, & Jemal, 2016) and poor survival rates are reliably associated with poorer breast awareness (for a review, see Richards, Westcombe, Love, Littlejohns, & Ramirez, 1999). Conversely, more positive breast awareness is associated with improved efficacy in breast cancer detection (Harmer, 2011; Mant, 1991; World Health Organization, 2017) and early diagnosis (Gadgil et al., 2017), but our results suggest that breast size dissatisfaction may act as a barrier to optimal breast awareness. As discussed by Swami and Furnham (2018), breast size dissatisfaction may result in avoidance behaviours and cognitions (i.e., avoiding or distrusting one’s breasts) that reduce breast awareness, particularly if one’s breasts trigger feelings of anxiety, shame, and embarrassment. Importantly, our results indicated that the negative association between breast size dissatisfaction and self-examination frequency and confidence in detecting breast change, respectively, was stable across nations sampled in the BSSS, which requires urgent public health intervention.

4.4. Implications

The results of the BSSS suggest a relatively homogenised idealisation of medium-to-large breasts, in tandem with similar levels of breast size dissatisfaction across all sites that were sampled. Indeed, over two-thirds of women sampled in the BSSS reported some form of breast size dissatisfaction, with most of these women indicating that they wanted larger breasts than they currently had. Just as a thin ideal for women’s bodily attractiveness is now dominant across many nations (Swami, 2015; Swami, Frederick et al., 2010), our results point to the homogenisation of breast size ideals, which in turn may shape women’s breasted experiences. Perhaps most importantly, greater breast size dissatisfaction was robustly associated with poorer psychological well-being and lower breast awareness. Based on these results, one conclusion we might draw is that breast size dissatisfaction represents a global public health, with important consequences for the psychological and physical well-being of women in many places.

Most immediately, we urge greater scholarly attention to issues related to breast size dissatisfaction and, concomitantly, the development of targeted interventions aimed at reducing breast size dissatisfaction. Various techniques – such as cognitive restructuring, changing negative body language, and size-estimate exercises – have been shown to successfully promote healthier body image (for a meta-analysis, see Alleva, Sheeran, Webb, Martijn, & Miles, 2015), but it will be important to determine the extent to which such methods are efficacious at reducing breast size dissatisfaction specifically. Of course, it is possible that reducing breast size dissatisfaction will require more tailored interventions. Such a tailored approach might involve interventionist and therapeutic techniques designed to reduce self-objectification of one’s breasts and effective negotiations of sociocultural contexts that value idealised feminine embodiment (see Roberts & Waters, 2004; Tylka & Augustus-Horvath, 2011). In addition, interventions that promote greater appreciation of the functional value of women’s breasts (e.g., their role in nurturing and sustenance) may be vital to shift attention away from unrealistic and unattainable beauty ideals, though this should not come at the expense of women’s own needs (Piran, 2016; Schmied & Lupton, 2001). Such interventions may be particularly valuable if they also promote better breast awareness, which could empower women to take a more active role in breast cancer practices (Anastasi & Lusher, 2019). Importantly, whatever intervention methods are developed will need to be sensitive to national contexts and meet the informational, healthcare, and corporeal needs of women.