Contact information for corresponding author:

Thomas F. Cash, Ph.D., Department of Psychology, Old Dominion University, Norfolk, Virginia 23529 USA; Telephone: (757) 683-4439; Fax: (757) 683-5087; E-mail: TCash@odu.edu.

1 Department of Psychology, Old Dominion University, Norfolk, VA USA
2 Department of Psychology, University of South Florida, Tampa, FL USA
 
 

A growing literature points to the role of body-image attitudes in human sexual functioning. Specifically, body dissatisfaction and excessive psychological investment in one’s physical appearance may lead to physical self-consciousness and body exposure avoidance during sexual relations, which in turn may impair sexual desire, enjoyment, and performance. The present research with 145 college women and 118 college men evaluated a contextual body-image measure, the Body Exposure during Sexual Activities Questionnaire (BESAQ), which assesses anxious/avoidant body focus during sex. Findings supported the BESAQ’s reliability and validity. Associations with sexual functioning were stronger for the BESAQ than for trait body-image measures. For both sexes, better sexual functioning was related to less anxious/avoidant body focus and stronger sexual self-schemas. Physical self-consciousness during sexual relations focused substantially on weight and gender-relevant attributes. Clinical and research implications of the findings are considered.
 
 

Body image refers to human experiences of embodiment and is a multi-faceted construct incorporating persons’ perceptions and attitudes about their own body, especially their physical appearance (Cash & Pruzinsky, 2002). Body-image attitudes include one’s appearance-related cognitions (or schemas), emotions, and behaviors (Cash, 2002b). Most body-image research has focused on eating disturbances among women (Cash & Pruzinsky, 2002; Thompson, Heinberg, Altabe, & Tantleff-Dunn, 1999). Clearly, body image has implications for other facets of psychosocial functioning in both sexes (Cash & Fleming, 2002; Cash & Pruzinsky, 2002).  Body-image evaluations can influence one’s interest in and experiences during sexual activities. Masters and Johnson’s (1970) classic perspective on “spectatoring” and Barlow’s (1986) emphasis on anxious self-focus have concentrated more on self-scrutiny of sexual performance than on concerns about bodily appearance. However, scientists have recently found that body dissatisfaction may inhibit sexual behavior and interfere with the quality of sexual experiences (Wiederman, 2002).

 Much research on body image and sexual functioning assesses body image as a global trait dimension—especially overall satisfaction-dissatisfaction with one’s appearance. A promising complementary approach examines body-image experiences in particular situational contexts (Cash, 2002a). Reflecting the need for an assessment of body image within sexual contexts, Hangen and Cash (1991) developed the Body Exposure during Sexual Activities Questionnaire (BESAQ) to measure anxious attentional focus on and avoidance of body exposure during sexual relations. Their preliminary evidence and that from another study (Faith & Schare, 1993) offered initial support of the BESAQ’s reliability and its convergent and discriminant validity.

The central purpose of the present research was to investigate further the validity of this 28-item measure with both male and female college students. We examined the BESAQ’s relationship to several dispositional or trait body-image measures—global body satisfaction, overweight preoccupation, and psychological investment in one’s own appearance. Because obesity is associated with a poorer body image (Cash & Roy, 1999; Schwartz & Brownell, 2004), we also examined the relationship of the BESAQ to body mass index. Recent research attests to the utility of the sexual self-schema construct in understanding the quantity and quality of sexual experiences (Andersen & Cyranowski, 1994; Andersen, Cyranowski, & Espindle, 1999). Sexual self-schemas are defined as “cognitive generalizations about sexual aspects of oneself that are derived from past experience, manifest in current experience, influential in the processing of sexually relevant social information, and guide sexual behavior” (Andersen & Cyranowski, 1994, p. 1079). We measured this construct in the current study to ascertain its relationship to the BESAQ. Perhaps most importantly, we sought to discern how the BESAQ and other study variables predicted participants’ sexual functioning. Accordingly, the research had eight specific objectives or hypotheses:

1. The BESAQ was expected to be associated with poorer trait body satisfaction, more overweight preoccupation, and more dysfunctional appearance investment.
2. We hypothesized a modest positive correlation of the BESAQ and body mass, with heavier persons reporting more anxious self-focus and exposure avoidance during sexual relations.
3. Weaker sexual self-schemas were expected to be associated with greater self-consciousness and exposure avoidance during sex.
4. BESAQ scores were expected to be predictable from both trait body-image measures and sexual self-schemas.
5. We hypothesized that the BESAQ would predict aspects of sexual functioning—experiences of desire, arousal, orgasm, and overall sexual satisfaction.
6. We expected that the context-specific BESAQ’s predictive efficacy of sexual functioning would exceed that found for trait body-image variables.
7. A multivariate analysis examined whether the BESAQ, along with other variables in the study, uniquely explained variance in sexual functioning.
8. The literature on body image and sexuality lacks specificity regarding the physical self-foci of body image in this context. Therefore, a final, exploratory objective of this study was to provide descriptive information to answer the questions: What physical characteristics do men and women feel self-conscious about during sexual relations, and how do the sexes differ?

Measures and Procedure
In a research laboratory, following informed consent, participants individually and anonymously completed a demographic information form and these assessments:

Body Exposure during Sexual Activities Questionnaire (BESAQ; Cash, 2004a; Hangen & Cash, 1991): The BESAQ is a 28-item measure of anxious attentional focus on and avoidance of body exposure during sex. Exemplary items are: “I don’t like my partner to see me completely naked during sexual activity.” “During sexual activity I try to hide certain areas of my body.” “I am self-conscious about my body during sexual activity.”  Respondents rate each item on a 5-point frequency scale (0 = “Never” to 4 = “Almost Always”). Higher scores reflect more self-conscious focus and avoidance. In the present study, the BESAQ’s internal consistency (Cronbach’s alpha) was .95 for men and .96 for women.

Multidimensional Body-Self Relations Questionnaire (MBSRQ; Brown, Cash, & Mikulka, 1990; Cash, 2004a): Two subscales of the well-validated MBSRQ were used.  Higher scores on the 9-item Body Areas Satisfaction Scale (BASS) indicate greater satisfaction, on average, with specific physical areas or attributes (e.g., face, weight, lower torso, height, etc.) on a 5-point response scale. The 4-item Overweight Preoccupation Scale (OPS) consists of 5-point ratings of fat anxiety, weight vigilance, eating restraint, and dieting, with higher scores indicating greater preoccupation. In this sample, internal consistencies of the BASS and OPS, respectively, were .80 and .74 among men and .82 and .80 among women.

Appearance Schemas Inventory (ASI; Cash & Labarge, 1996): This is a 14-item assessment of dysfunctional investment in one’s appearance. Using a 5-point disagree-agree response format, exemplary items include: “I should do whatever I can to always look my best.” “My appearance is responsible for much of what has happened to me in my life.” Higher scores reflect more psychological investment in one’s appearance. The ASI’s internal consistency in this study was .84 for men and .85 for women.

Sexual Self-Schema Scale (SSSS; Andersen & Cyranowski, 1994; Andersen et al., 1999): The SSSS is an adjectival inventory that measures one’s self-concept as a “sexual person,” consisting of a 50-item form for women and a 45-item form for men.  Items do not explicitly refer to sexuality. Each adjective is rated from 0 (“not at all descriptive”) to 6 (“very descriptive”). The SSSS is composed of three factor dimensions for each sex. Among women, this self-view is one of passionate-romantic, open-direct, and (not) embarrassed-conservative. Among men, this is a self-view of passionate-loving, powerful-aggressive, and open-minded or liberal. In each case, higher scores indicate greater sexual self-schematicity. In this sample, the internal consistency of the SSSS was .79 for men and .85 for women.

 Changes in Sexual Functioning Questionnaire (CSFQ; Clayton, McGarvey, & Clavet, 1996, 1997): The CSFQ is a validated 14-item self-report measure of sexual functioning vis-à-vis experiences of pleasure, desire, arousal, and orgasm. There are different forms for men and women that reflect some variation in wording of items, with 5-point response options for each item. The CSFQ has subscales for sexual pleasure (1 item), desire/frequency (2 items), desire/interest (3 items), arousal (3 items), and orgasm (3 items). In addition, a 14-item total score may be calculated. Higher scores are indicative of more favorable sexual functioning. In this study, the internal consistency of the CSFQ total score was .77 for men and .80 for women.

  Physical Self-Consciousness during Sex Questionnaire (PSCSQ): Developed for this study, the inventory asks participants how often and how intensely they experience self-consciousness about 14 body areas/attributes during sexual relations (e.g., chest/breasts, hips, buttocks, thighs, scalp hair, etc.). Ratings were made on 5-point (0 to 4) scales for each dimension and characteristic. A frequency X intensity cross-product gauged respondents’ extent of self-consciousness about each attribute.

Relationships of Trait Body Image and Body Mass with the BESAQ
 In relation to the first objective of the study, Pearson correlations evaluated the BESAQ’s associations with trait body-image satisfaction, overweight preoccupation, and appearance investment. As hypothesized, Table 1 confirms moderate relationships for both sexes. Greater anxious self-focus and exposure avoidance during sex was associated with less overall body satisfaction, more overweight preoccupation, and more dysfunctional investment in one’s physical appearance.

 The study’s second objective entailed an examination of the relationship of the BESAQ and body mass. As hypothesized, significant modest relationships indicated that heavier persons reported somewhat more anxious/avoidant body focus during sex.

Relationships of Sexual Self-Schemas with the BESAQ
The study’s third objective was to examine the relationships of sexual self-schemas with BESAQ scores. Table 1 shows that women, but not men, with a more sexual self-view reported less anxious/avoidant body focus during sex. Analyses of SSSS factor scales revealed that all three schema subscales were significantly (p < .01) related to women’s BESAQ scores (i.e., romantic-passionate, r = -.24; open-direct, r = -.23; and embarrassed-conservative, r = .26). For men, only a powerful-aggressive self-view was significantly negatively correlated with the BESAQ (r = -.23, p < .05); passionate-loving and open-minded liberal self-views were unrelated to self-consciousness and exposure avoidance during sex.

Multivariate Prediction of BESAQ Scores
Regarding the study’s fourth objective, standard multiple linear regressions examined the prediction of BESAQ scores from the trait body-image dimensions and sexual self-schemas. For men, each of the three trait body-image variables significantly predicted BESAQ scores (R² = .44, p < .001)—body dissatisfaction (ß = -.42, p < .001), appearance investment (ß = .28, p < .001), and overweight preoccupation (ß = .19, p < .02).  For women, body dissatisfaction (ß = -.41, p < .001) and appearance investment (ß = .38, p < .001) predicted the BESAQ (R² = .44, p < .001). Sexual self-schemas did not account for variance unexplained by these trait body-image measures.

Correlates and Prediction of Sexual Functioning
 Sexual functioning was measured by the CSFQ. Consistent with hypotheses from the study’s fifth objective, Table 1 shows that for both sexes, persons experiencing more anxious/avoidant body focus during sex had significantly poorer sexual functioning in their current relationship. This was true for reported sexual pleasure, frequency of sexual desire, and arousal and orgasmic experiences. It is noteworthy that correlations were generally higher for women than men.

Table 2 summarizes the relationships of study variables with the composite CSFQ index of sexual functioning. As hypothesized in the study’s sixth objective, for both sexes, the context-specific BESAQ correlated with sexual functioning more strongly than did the trait body-image measures. Body mass was unrelated to sexual functioning. Sexual self-schemas were significantly positively associated with sexual functioning for both women and men.

 Pertinent to the seventh research objective, multiple regression analyses examined the prediction of sexual functioning from variables that were significantly correlated with the CSFQ (from Table 2). For women and men alike, two predictors accounted for significant variance in sexual functioning—sexual self-schemas and the BESAQ (R² = .20 for women and .16 for men, p < .001). More favorable functioning was related to less anxious/avoidant body focus (ß = -.21 for men, p < .02, and -.25 for women, p < .002) and a more sexually schematic self-view (ß = .32 and .31, respectively, p < .001). Among women, this self-view reflected the composite of all three dimensions; for men, it reflected the powerful-aggressive sexual self-view.

During Sex, Who are Physically Self-Conscious about What?
 In the study’s final objective, we examined the physical foci of self-consciousness during sexual activities, using the PSCSQ. Table 3 summarizes these data. Higher values reflect more frequent and intense self-consciousness about a specific physical characteristic. It is empirically noteworthy that the mean composite PSCSQ scores were significantly correlated with the BESAQ (r = .61 for women and r = .69 for men, p < .001). Among women, the top five foci were: (1) weight in general, (2) thighs, (3) waist, (4) buttocks, and (5) hips. Among men, these foci were: (1) weight in general, (2) muscularity, (3) waist, (4) chest, and (5) genitals. As Table 3 shows, F tests indicated that, compared to women, men reported significantly more self-consciousness during sex about their scalp hair, lower arms/hands, and upper arms/shoulders. Women were more self-conscious than men about their weight in general, thighs, hips, and buttocks.

A growing literature highlights the importance of the body-image construct to various aspects of sexual functioning (Wiederman, 2002). The principal purpose of this investigation was to evaluate further the reliability and validity of a measure of body-image experiences occurring specifically in sexual contexts. This 28-item Body Exposure during Sexual Activities Questionnaire assesses anxious self-focus on and avoidance of exposing aspects of one’s physical appearance in sexual contexts. The ideas and observations of Masters and Johnson (1970) and Barlow (1986) about the role of spectatoring or cognitive interference in sexual dysfunction have focused more on performance-based distraction. However, some evidence suggests that the distinction between performance-oriented and appearance-focused attention may be less clear for women (Dove & Wiederman, 2000).

The present research confirms and extends preliminary research evidence of the reliability and validity of the BESAQ (Faith & Schare, 1993; Hangen & Cash, 1991). In our sample of sexually active, heterosexual college women and men, we found that the highly internally consistent BESAQ converged appropriately (i.e., moderately) with three trait measures of body image for both sexes. Bivariate correlations indicated that more anxious/avoidant body focus was associated with more trait body dissatisfaction, overweight preoccupation, and dysfunctional investment in one’s appearance. A heavier body mass was also modestly related to more anxious/avoidant body focus during sex, consistent with evidence of a more negative body image among overweight or obese persons (Cash & Roy, 1999; Schwartz & Brownell, 2004). However, the findings indicated that such self-conscious and avoidant experiences were more clearly related to being weight-preoccupied than to actual weight.

For men, each of the three body-image traits explained incrementally unique variance in their BESAQ scores. For women, anxious/avoidant self-focus on appearance was also predictable from body dissatisfaction and appearance investment, which accounted for their overweight preoccupation. Thus, such self-conscious body-image experiences during sex reflect both discontent with one’s body in general and greater psychological investment in one’s looks as a source of self-evaluation. The latter dimension increases the likelihood of attending to and processing appearance-related information in specific situational contexts (Cash, 2002b; Cash, Fleming, Alindogan, Steadman, & Whitehead, 2002; Cash, Melnyk, & Hrabosky, 2004; Labarge, Cash, & Brown, 1998; Williamson, Stewart, White, & York-Crowe, 2002).

Results confirmed our hypothesis that higher BESAQ scores would be associated with poorer levels of sexual functioning. Both women and men with more anxious/avoidant appearance self-focus during sex indicated less positive experiences vis-à-vis most aspects of their current sexual functioning. They reported less enjoyment of their sex life, less frequent desire for sex, as well as less consistency and quality in their experiences of sexual arousal and orgasm. The only aspect of sexual functioning that was unrelated to the BESAQ pertained to sexual desire as reflected by fantasized rather than actual experience. These findings collectively support the validity of the BESAQ. The fact that only minimal or nonsignificant associations were observed between trait body-image measures and sexual functioning affirms the importance of contextual body-image assessment. Thus, the BESAQ is a much better predictor of sexual functioning than are measures of body image as general trait dispositions. What matters most are the body-image experiences in the experiential sexual context.

With respect to sexual self-schemas, our results expand those from Wiederman and Hurst (1997), who found that women with more positive sexual self-schemas rated themselves as more physically attractive and reported less social avoidance due to body-image anxiety. We also found that sexually self-schematic women (Andersen & Cyranowski, 1994), who viewed themselves as romantic-passionate, open-direct, and not embarrassed-conservative persons, reported less anxious self-consciousness and body-exposure avoidance during sex. Perhaps their consistent self-identity as a “sexual person” leads them to focus more on the self-congruent experience of sexual behaviors and sensate pleasures than on a partner’s potential evaluations of their appearance.  Among men, one facet of sexual self-schemas (Andersen et al., 1999) was associated with BESAQ scores. Specifically, men with a powerful-aggressive self-view (but not necessarily passionate-loving or open-minded liberal self-views) reported less anxious/avoidant physical self-focus during sex. Perhaps this identity entails a more active or assertive behavioral orientation to sex rather than a reflective or relational orientation. Men lacking this self-view are somewhat more self-conscious about their body during sex. Notwithstanding these modest associations between the BESAQ and sexual self-schemas, regression analyses confirmed that both variables independently contributed to the prediction of sexual functioning for women and men.

Although our findings confirm the salience of body-image experiences in sexual relations, they offer no insight into the specific foci of concerns for women and men. An assessment of the frequency and intensity of self-consciousness about various physical characteristics was elucidating. Women’s most self-conscious foci were their weight and gender-relevant shape attributes—weight in general, thighs, waist, buttocks, and hips. Men’s foci were their weight in general, muscularity, waist, chest, and genitals. Relative to women, men were more self-conscious about their scalp hair, lower arms/hands, and upper arms/shoulders, whereas women were more self-conscious about weight, thighs, hips, and buttocks. In sum, both women and men report physical self-consciousness during sex, but they focus on different, gender-relevant physical characteristics.

Directions for future research are myriad. As body-image researchers often exclusively study women (Cash, 2004b), our inclusion of men in the study was an important direction. Recent research points to body-image issues that many boys and men face, particularly concerns about conforming to societal ideals of muscularity (Cohane & Pope, 2001; Corson & Andersen, 2002; Olivardia, 2002). Our findings derive from a sample of individuals in their current sexual relationship for an average of nearly 2 years, and 60% of our sample had only one sexual partner in the past year. As Wiederman (2002) notes, research is lacking on the role of body-image experiences in persons’ first sexual encounter with a new partner. In one study of such experiences, Yamamiya and Cash (2002) found that women with higher BESAQ scores reported more ambivalence/acquiescence in their decision to have sex with the partner, greater emotional detachment during sex, and more subsequent regret and concerns about acceptance. Further research on body image in sexual contexts should expand the diversity of samples to study older adults, gay and lesbian individuals, persons with physical disabilities, and clinical populations (e.g., those with sexual dysfunctions).

 Body-image experiences are integral to the quality of life of women and men, including the quality of sexual life (Cash & Fleming, 2002; Cash, Jakatdar, & Williams, in press). An anxious, self-conscious focus on one’s appearance and avoidance of bodily exposure during sex may undermine one’s sexual functioning. These and other data (Wiederman, 2002) suggest the value of incorporating body-image interventions into the treatment of sexual dysfunctions. For example, cognitive-behavioral body-image therapy (Cash, 1997; Cash & Hrabosky, 2004; Cash & Strachan, 2002) is an efficacious treatment of body-image difficulties and disorders, with outcomes empirically shown to ameliorate physical self-consciousness during sex (Grant & Cash, 1995).

Andersen, B.L., & Cyranowski, J.M. (1994). Women’s sexual self-schema. Journal of Personality and Social Psychology, 67, 1079-1100.

Andersen, B.L., Cyranowski, J.M., & Espindle, D. (1999). Men’s sexual self-schema. Journal of Personality and Social Psychology, 76, 645-661.

Barlow, D.H.  (1986). Causes of sexual dysfunction: The role of anxiety and cognitive interference. Journal of Consulting and Clinical Psychology, 54, 140-148.

Brown, T.A., Cash, T.F., & Mikulka, P.J.  (1990). Attitudinal body-image assessment: Factor analysis of the Body-Self Relations Questionnaire. Journal of Personality Assessment, 55, 135-144.

Cash, T.F. (1997). The body image workbook: An 8-step program for learning to like your looks. Oakland, CA: New Harbinger Publications.

Cash, T.F.  (2002a). Beyond traits: Assessing body image states. In T.F. Cash & T. Pruzinsky (Eds.), Body image: A handbook of theory, research, and clinical practice (pp. 163-170). NY: Guilford Press.

Cash, T.F. (2002b). Cognitive behavioral perspectives on body image. In T.F. Cash & T. Pruzinsky (Eds.), Body image: A handbook of theory, research, and clinical practice (pp. 38-46). NY: Guilford Press.

Cash, T.F. (2004a). Body-image assessments: Manuals and questionnaires. Available  from the author’s web site at http://www.body-images.com.

Cash, T.F. (2004b). Body image: Past, present, and future. Body Image: An  International Journal of Research, 1, 1-5.

Cash, T.F., & Fleming, E.C.  (2002). The impact of body-image experiences: Development of the Body Image Quality of Life Inventory. International Journal of Eating Disorders, 31, 455-460.

Cash, T.F., Fleming, E.C., Alindogan, J., Steadman, L., & Whitehead, A. (2002). Beyond body image as a trait: The development and validation of the Body Image States Scale. Eating Disorders: The Journal of Treatment and Prevention, 10, 103-113.

Cash, T.F., & Hrabosky, J.I. (2004). The treatment of body-image disturbances. In J.K.  Thompson, (Ed.) Handbook of eating disorders and obesity (pp. 515-541). New  York: Wiley.

Cash, T.F., Jakatdar, T.A., & Williams, E.F. (in press). The Body Image Quality of Life  Inventory: Further validation with college men and women. Body Image: An  International Journal of Research.

Cash, T.F., & Labarge, A.S. (1996). Development of the Appearance Schemas Inventory: A new cognitive body-image assessment. Cognitive Therapy and Research, 20, 37-50.

Cash, T.F., Melnyk, S.E., & Hrabosky, J.I. (2004). The assessment of body image investment: An extensive revision of the Appearance Schemas Inventory. International Journal of Eating Disorders, 35, 305-316.

Cash, T.F., & Pruzinsky, T. (Eds.) (2002). Body image: A handbook of theory, research, and clinical practice. New York: Guilford Press.

Cash, T.F., & Roy, R.E. (1999). Pounds of flesh: Weight, gender, and body images. In J. Sobal & D. Maurer (Eds.), Interpreting weight: The social management of fatness and thinness (pp. 209-228). New York: Aldine de Gruyter.

Cash, T.F., & Strachan, M.D.  (2002). Cognitive behavioral approaches to changing body image. In T.F. Cash & T. Pruzinsky (Eds.), Body image: A handbook of theory, research, and clinical practice (pp. 478-486). New York: Guilford Press.

Clayton, A.H., McGarvey, E L., & Clavet, G.J. (1996). Changes in Sexual Functioning Questionnaire (CSFQ)—Validation study. Psychopharmacology Bulletin, 32, 423.

Clayton, A.H., McGarvey, E.L., & Clavet, G.J. (1997). Changes in Sexual Functioning Questionnaire (CSFQ)—Development, reliability, and validity. Psychopharmacology Bulletin, 33, 731-745.

Cohane, G.H., & Pope, H.G., Jr. (2001). Body image in boys: A review of the literature. International Journal of Eating Disorders, 29, 373-379.

Corson, P.W., & Andersen, A.E. (2002). Body image issues among boys and men.  In T.F. Cash & T. Pruzinsky (Eds.), Body image: A handbook of theory, research,  and clinical practice (pp. 192-199). New York: Guilford Press.

Dove, N.L., & Wiederman, M.W. (2000). Cognitive distraction and women’s sexual functioning. Journal of Sex & Marital Therapy, 26, 67-78.

Faith, M. S., & Schare, M. L. (1993). The role of body image in sexually avoidant behavior.  Archives of Sexual Behavior, 22, 345-356.

Grant, J.R., & Cash, T.F.  (1995). Cognitive-behavioral body image therapy: Comparative efficacy of group and modest-contact treatments. Behavior Therapy, 26, 69-84.

Hangen, J.D., & Cash, T.F. (1991). The relationships of body-image attitudes to sexual functioning and experiences in a normal college population. Paper presented at the annual meeting of the Association for Advancement of Behavior Therapy, NY, NY.

Labarge, A.S., Cash, T.F., & Brown, T.A. (1998). Use of a modified Stroop task to examine appearance schematic information processing in college women. Cognitive Therapy and Research, 22, 177-188.

Masters, W., & Johnson, V.  (1970). Human sexual inadequacy. Boston, MA: Little, Brown.

Olivardia, R. (2002). Body image and muscularity. In T.F. Cash & T. Pruzinsky (Eds.), Body image: A handbook of theory, research, and clinical practice (pp. 210-218). New York: Guilford Press.

Schwartz, M.B., & Brownell, K.D. (2004). Obesity and body image. Body Image: An  International Journal of Research, 1, 43-56.

Thompson, J.K., Heinberg, L.J., Altabe, M., & Tantleff-Dunn, S. (1999). Exacting beauty: Theory, assessment, and treatment of body image disturbance.  Washington, D.C.: American Psychological Association.

Wiederman, M.W. (2002). Body image and sexual functioning. In T.F. Cash & T. Pruzinsky (Eds.), Body image: A handbook of theory, research, and clinical practice (pp. 287-294). New York: Guilford Press.

Wiederman, M.W., & Hurst, S.R. (1997). Physical attractiveness, body image, and women’s sexual self-schema. Psychology of Women Quarterly, 21, 567-580.

Williamson, D.A., Stewart, T.M., White, M.A., & York-Crowe, E. (2002). An information-processing perspective on body image. In T.F. Cash & T. Pruzinsky (Eds.), Body image: A handbook of theory, research, and clinical practice (pp. 47-54). New York: Guilford Press.

Yamamiya, Y., & Cash, T.F. (2002).  Body image and sexual decision-making. Unpublished manuscript, Old Dominion University, Norfolk, VA.

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