Social comparison, a pervasive aspect of daily life, consists in comparing oneself to others in order to evaluate or enhance some aspect of the self. The first systematic theory of social comparison was proposed by Leon Festinger, who was interested in the effects of social comparisons on self-appraisals of abilities and opinions. Since the 1980s, there has been the recognition that comparisons also influence the thoughts, feelings, and behaviors that affect physical health and illness. For example, if a teenager who surreptitiously smokes marijuana learns that most of his or her peers also smoke marijuana, he or she is more likely to think it is appropriate and continue to smoke. A surgery patient recovering in the hospital may feel better after comparing with patient in the next bed who is experiencing more pain and adversity after experiencing the same surgery. Researchers have devoted considerable effort to understanding what motivations prompt social comparison and its effects in health domains.
Festinger proposed that people make social comparisons when they need to know when their opinions are correct and what their abilities allow them to do. When persons are trying to make accurate assessments about their abilities and opinions, their comparisons are motivated by self-evaluation. In some circumstances, certain opinions or abilities cannot be directly tested in the environment because of the costs involved or because objective standards are unavailable. To reduce uncertainty, people compare themselves with others. The general reasoning is that observing similar others, that is, people with similar personal attributes, allows them to learn about their own possibilities for action and performance. For opinions, finding agreement with others should make one hold the view more confidently.
Stanley Schachter subsequently showed that social comparison also is important for the interpretation of ambiguous emotional states. When people anticipate a novel situation involving a noxious stimulus, such as a potentially painful medical procedure, they may be uncertain about the level of fear that is appropriate. Comparing with another patient also awaiting the same procedure provides a helpful index. In this regard, the recent introduction of Internet chatlines for specific patient groups may be popular because they provide users with the opportunity to compare opinions regarding the appropriateness and interpretation of symptoms, feelings, and expectations about the course of recovery.
Social comparison also may be involved in the interpretation of physical symptoms and decision to seek medical treatment. Access and awareness of internal symptoms are indirect and often ambiguous, leading to uncertainty. For example, whether people label diffuse symptoms such as body aches and feverishness as illness and consequently refer themselves for medical attention may depend on whether their friends are experiencing or have experienced the same symptoms. Extreme cases of symptom labeling via comparison occurs in mass psychogenic illness. These situations involve widespread symptom perception and feelings of being ill among groups of individuals in places like factories, schools, and military bases, even though there is no objective evidence of physical illness. Typically, such episodes occur when people who work closely together or know each other personally are already fatigued or anxious and experiencing ambiguous symptoms, which may only be due to stress. If someone in the group, however, thinks he or she contracted a flu or was bitten by a bug, this becomes a plausible illness label for the ambiguous symptoms, and soon, via social comparison, large numbers of people think they are ill, stay home from work, and seek medical care.
Social comparison also is integrally involved in people’s evaluations of the appropriateness of health-relevant attitudes and beliefs. For matters of personal preference, such as deciding whether to select a family physician with a particular bedside manner, people compare views with others who share their personal tastes. In matters of fact, a person seeks someone with more knowledge and expertise, although even in matters of fact, the expert should share the person’s basic values to be seen as credible.
Self-Enhancement and Self-Improvement
In some situations, people are more motivated to generate positive evaluations of themselves than to obtain an accurate assessment. Thomas Wills was interested in the kinds of comparisons people make when they feel threats to their subjective well-being. Such cases may arise when people experience a medical threat of some kind, such as learning to adjust to a chronic illness (e.g., cancer or kidney disease). According to Wills s downward comparison theory, people tend to selectively compare with other persons who are worse off than themselves to boost their sense of well-being. For example, in an early study that provided support for this idea, breast cancer patients seemed to benefit from strategic downward comparisons; nearly 80% of those interviewed, even though by available evidence they were not doing well, reported adjusting somewhat better or much better than other cancer patients. Positive contrastive effects are emphasized by downward comparison theory (e.g., “I only had a lumpectomy, but those other women lost a breast”). Because many medical patients experience threatening feelings as a result of their symptoms, pain, and uncertainty associated with their illnesses, downward comparisons might serve as a coping strategy to protect their self-esteem and improve psychological recovery. Much research has been done on the use of social comparison as a coping strategy in persons diagnosed with cancer, infertility, cardiac disease, arthritis, and other diseases.
All evidence gathered in the last two decades, however, does not show that downward comparisons are consistently beneficial for medical patients. Although victims of serious illness may think about or imagine there are others whose medical predicament are even worse, rarely do they prefer to affiliate with more debilitated patients, and such exposure does not necessarily produce positive reactions. Conversely, comparing with someone better off does not necessarily lead to negative feelings. This is because people also may experience a self-improvement motive, which directs comparison in the interest of improving the self. In particular, upward targets (superior role models) may provide hope and inspiration. For example, one experimental study found that exposing breast cancer patients to an audiotape of an interview with a very well-adjusted patient made them feel better about their own prognosis and treatment.
The affective effects of comparison apparently are not determined merely by whether the comparison is with a better versus a worse-off person because, as just noted, upward comparisons can produce positive feelings and downward comparisons can produce negative feelings in some instances. This is because exposure to a better-adjusted person can suggest to the patient that he or she is relatively disadvantaged or alternatively that he or she might be able to improve. Similarly, exposure to a worse-adjusted person can imply that the patient is relatively advantaged, or alternatively he or she might decline to a lower level in the future. The patients reaction depends on which implication of the comparison is salient. As a result, social comparison sometimes produces assimilation (i.e., when the patient feels he or she is more like the comparison target) rather than contrast (i.e., when the patient feels that he or she is less like the target).
Assimilation and Contrast
Researchers have identified several factors that determine whether assimilation or contrast with a target occurs after comparison. If patients believe that they can obtain the same status as the comparison target or perceive an identification or connection to the target person, then assimilation is more likely. Contrast is maximized when the target is very distinctive or little connection to the target is perceived. More generally, factors that suggest the patient and the comparison target are similar in some way should facilitate seeing even more similarities with the target. On the other hand, factors that imply the patient and the target are different should increase perceived dissimilarity and consequently produce contrast. In addition, the degree to which the patient’s self-concept is unclear and there is room for inclusion of additional information, then assimilation is encouraged, assuming there is some psychological connection perceived with the target.
People who differ in personality also respond differently to upward and downward comparisons in terms of assimilation and contrast. For example, cancer patients who are highly neurotic tend to react more negatively to both upward and downward comparison than do more emotionally stable patients. One explanation is that the neurotic individuals can more easily identify (and assimilate themselves) with patients who are worse off and feel less connection (and therefore contrast themselves) with those who are coping better.
Theory and research has shown how social comparisons provide information to reduce uncertainty regarding health-relevant opinions, behaviors, and symptoms. Comparisons also make people who are adjusting to serious health threats feel better about themselves, although whether their spirits will be lifted or lowered by being exposed to a better or worse-off comparison is determined by several factors. Health psychologists are actively researching the effects of social comparisons to develop interventions that promote the adoption of positive health behaviors and adjustment to serious medical threats.
- Festinger, L. (1954). A theory of social comparison processes. Human Relations, 7, 117-140.
- Mechanic, D. (1972). Social psychological factors affecting the presentation of bodily complaints. New England Journal of Medicine, 286, 1132-1139.
- Stanton, A., Danoff-Burg, S., Cameron, C, Snider, P., & Kirk, S. (1999). Social comparison and adjustment to breast cancer: An experimental examination of upward affiliation and downward evaluation. Health Psychology, 18, 151-158.
- Suls, J., Martin, R., & Wheeler, L. (2000). Three kinds of opinion comparison: The Triadic Model. Personality and Social Psychology Review, 4, 219237.
- Van der Zee, K., Buunk, B., & Sandersman, R. (1998). Neuroticism and reactions to social comparison information among cancer patients. Journal of Personality, 66, 17’5-194.
- Wills, T. A. (1981). Downward comparison principles in social psychology. Psychological Bulletin, 90, 245-271.
- Wood, J. V, Taylor, S. E., & Lichtman, R. (1985). Social comparison in adjustment to breast cancer. Journal of Personality and Social Psychology, 49, 1169-1183.
Back to Health Psychology.