Social Comparison Processes
in the Physical Health Domain
University of Iowa
The famous 19th-century medical pathologist Rudolf Virchow argued that medicine is a social science. Virchow was thinking mainly of the role of socioeconomic factors and social conventions in the etiology of disease, but this chapter argues that even more fundamental interpersonal processes play an essential role in understanding why people become ill, how people decide they are ill, whether they seek formal medical attention, and how they cope with illness. This chapter focuses on how people's health-related thoughts, feelings, and behaviors are influenced by comparisons with other people. It begins with a brief survey of classic social comparison theory and recent extensions and then considers four areas of health psychology, researched over the past 25 years, in which social comparison has been strongly implicated.
Festinger (1954) provided the first systematic theory of comparison processes. He noted that people have the need to evaluate the correctness of their opinions and gauge their capabilities for action In the absence of physical objective standards, people engage in comparisons with others to establish their standing. Festinger proposed that people prefer similar others for gauging the correctness of their opinions and adequacy of their abilities.
Since the initial presentation of the theory, it has undergone several extensions and reinterpretations (Latane, 1966; Olson, Herman, & Zanna, 1986; Singer, 1966; Suls & R. L. Miller, 1977; Suls & Wills, 1991; Wheeler, Martin, & Suls, 1997). Schachter and Singer (1962) showed how social comparison extends to the interpretation of emotional states, a domain of clear relevance to the physical health domain where physical symptoms and trauma covary with affect. Mechanic (1972) emphasized how social comparisons with others play an important role in the interpretation of physical symptoms and health care seeking behavior.
Besides these extensions of the theory to domains beyond ability and opinion evaluation, the basic elements of the theory have also undergone refinement. From the inception of Festinger's theory, questions have been raised about how similarity of a comparison other should be best conceptualized. Goethals and Darley (1977) argued that comparisons are preferred with others who are similar by virtue of sharing attributes thought to be related to performance on the ability or opinion under evaluation. For example, for individuals to gauge their swimming performance (“How good am I”), they should prefer to compare themselves with someone who is similar in body build, swimming experience, and level of motivation (Gastorf & Suls, 1978; Zanna, Goethals, & Hill, 1975). For individuals to predict whether they will be able to achieve a given performance (“Can I do X?”), they should want to learn the outcome of someone else who has already attempted the same goal and who has performed comparably to themselves in the past on a similar or related task (Wheeler et al., 1997).